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  • China - A Hospitalized Pediatric Case of H7N9 Bird Flu in Beijing - 650 km from other H7N9 Cases- Confirmed

    A Pediatric Case of H7N9 in Beijing, April 13th, 2013

    Today the Beijing CDC announced the first suspected case of H7N9 in Beijing in a 7-year-old child. This case is significant, not only because it is only the second pediatric case, but also because this case is more than 650 km from any of the other nearest confirmed cases in the Anhui, Jiangsu, Shanghai, or Zhejiang provinces. This case is hospitalized pending confirming tests.

    This suggests that the infection source of H7N9 is widespread in China.

    link: http://www.flutrackers.com/forum/sho...7&postcount=12 hat tip Shiloh.
    -----
    It is also worth reconsidering recent ILI outbreaks and pediatric reports from China over the past month.

    March 15, 2013
    Lu’an City hospitals, Anhui Province
    Many children with “cough, nasal congestion, runny nose and other symptoms of respiratory tract infection, children under 1 year old or even more severe bronchiolitis infections.”


    April 1st, 2013
    Sino-Japanese Friendship Hospital, Beijing
    Increasing number of patients with of ILI symptoms.



    April 10, 2013
    Yantai Yuhuangding Hospital, Shandong
    Patients exhibiting ILI symptoms (Hospital also conducted an H7N9 bird flu drill on April10).



    April 12, 2013
    Weifang City, Shandong Province
    Peadiatric division filled with 80+ pediatric cases suffering with ILI symptoms. “fever, runny nose, sneezing, loss of appetite, stuffy nose”

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    Last edited by sharon sanders; April 12, 2013, 03:46 PM. Reason: added a couple of clarifications
    http://novel-infectious-diseases.blogspot.com/

  • #2
    Re: China - A Confirmed Pediatric Case of H7N9 Bird Flu in Beijing - 650 km from other H7N9 Cases

    Something else to consider is that yesterday, there were articles reporting that the Beijing Health Bureau announced that the possibility of H7N9 appearing in the city could not be ruled out.

    Machine translation:

    "Beijing Municipal Health Bureau: do not rule out the Huadong H7N9 avian influenza into Beijing

    Apr. 12, 2013 08:49

    In view of the high incidence of Respiratory Diseases in Spring, staff mobility, is in North normalized during migratory birds can not be ruled out in east China cases the possibility of entering Beijing, and there is the risk of transmission of the virus among poultry flocks. - Beijing Municipal Health Bureau"



    xhttp://info.pharmacy.hc360.com/2013/04/120849454715.shtml



    "What information consumes is rather obvious: it consumes the attention of its recipients. Hence a wealth of information creates a poverty of attention, and a need to allocate that attention efficiently among the overabundance of information sources that might consume it." - Herbert Simon

    "The benefits of education and of useful knowledge, generally diffused through a community, are essential to the preservation of a free government." - Sam Houston

    Comment


    • #3
      Re: China - A Confirmed Pediatric Case of H7N9 Bird Flu in Beijing - 650 km from other H7N9 Cases

      Since the beginning of this crisis, Beijing said that human cases would likely have been detected there, for several reason, included the high travel & trade movements between the Capital and the SE provinces.

      So far it remains totally unclear the possible animal reservoir of the virus and its dispersion in the Mainland China territory.

      Comment


      • #4
        Re: China - A Hospitalized Suspected Pediatric Case of H7N9 Bird Flu in Beijing - 650 km from other H7N9 Cases

        So lets say all these different ILI's are H7N9, then the CFR would be very low and not as high as everyone has been saying?

        Comment


        • #5
          Re: China - A Hospitalized Suspected Pediatric Case of H7N9 Bird Flu in Beijing - 650 km from other H7N9 Cases

          Originally posted by jeffrey View Post
          So lets say all these different ILI's are H7N9, then the CFR would be very low and not as high as everyone has been saying?
          I am not sure it would be "very low" -
          Right now it is close to a 90% CFR - and the 1918 flu was 2%.

          If we have more cases then that would support the theory that the illness is already widespread - which would not be good news, either - although it would be best to have a lower CFR rate.

          Comment


          • #6
            Re: China - A Hospitalized Suspected Pediatric Case of H7N9 Bird Flu in Beijing - 650 km from other H7N9 Cases

            Originally posted by mb59747 View Post
            I am not sure it would be "very low" -
            Right now it is close to a 90% CFR -
            Not quite - the apparent cfr is running at 26%, 11 deaths from 43 cases up to now. That being said, the situation is very unclear at this time. Until a larger population size is sampled, we will not know if there is a significant number of asymptomatic or mild cases out there.
            Twitter: @RonanKelly13
            The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

            Comment


            • #7
              Re: China - A Hospitalized Suspected Pediatric Case of H7N9 Bird Flu in Beijing - 650 km from other H7N9 Cases

              there are two things here: CFR - Case Fatality Rate (ratio) and CAR - Case Attack Rate (ratio)

              Until all patients in this particular outbreak have gotten over their disease or died we can only surmise a case attack rate, not the fatality rate.

              CFR - "case fatality rate, case fatality ratio or just fatality rate — is the proportion of deaths within a designated population of "cases" (people with a medical condition), over the course of the disease. A CFR is conventionally expressed as a percentage and represents a measure of risk. CFRs are most often used for diseases with discrete, limited time courses, such as outbreaks of acute infections. .... CFRs are actually risks (or "incidence proportions") and take values between 0 and 1. They are not rates, incidence rates, or ratios (none of which are limited to the range 0-1). If one wants to be very precise, the term "case fatality rate" is incorrect, because the time from disease onset to death is not taken into account." SOURCE

              CAR - "attack rate is the cumulative incidence of infection in a group of people observed over a period of time during an epidemic, usually in relation to foodborne illness. Quantitatively, it is the number of exposed people infected with the disease divided by the total number of exposed people. It is measured from the beginning of an outbreak to the end of the outbreak. The term should probably not be described as a rate because its time dimension is uncertain. For this reason, it is often referred to as an attack ratio." SOURCE

              Once the N has grown and analysis has been done on a sufficiently large population impacted by the outbreak then one can assign a CFR but it wouldnt be a good idea to assume future similar outbreaks would have the same CFR due to drift and reassortments, etc.
              Nika

              Comment


              • #8
                Re: China - A Hospitalized Suspected Pediatric Case of H7N9 Bird Flu in Beijing - 650 km from other H7N9 Cases

                Originally posted by Ronan Kelly View Post
                Not quite - the apparent cfr is running at 26%, 11 deaths from 43 cases up to now. That being said, the situation is very unclear at this time. Until a larger population size is sampled, we will not know if there is a significant number of asymptomatic or mild cases out there.
                That makes sense!

                Thanks so much for the clarification.

                I guess we just have to wait and see. So far I don't like what I am seeing, though.

                Comment


                • #9
                  Re: China - A Hospitalized Suspected Pediatric Case of H7N9 Bird Flu in Beijing - 650 km from other H7N9 Cases

                  Originally posted by mb59747 View Post
                  I am not sure it would be "very low" -
                  Right now it is close to a 90% CFR - and the 1918 flu was 2%.

                  If we have more cases then that would support the theory that the illness is already widespread - which would not be good news, either - although it would be best to have a lower CFR rate.
                  Despite some internet personalities claiming the current CFR for H7N9 is 90%, this is not true.

                  Nika has posted the definition of case fatality rate above and Ronan Kelly's rate of .26 is correct as of April 12, 2013 for confirmed cases (11/43).

                  If there are many mild or asymptomatic cases that have not been identified, then the CFR will go down, not up to 90%.

                  A 90% CFR based on the currently available data is just internet hype.
                  <object style="position:absolute;z-index:1000" type="application/x-dgnria" id="plugin0" height="0" width="0">

                  </object>
                  http://novel-infectious-diseases.blogspot.com/

                  Comment


                  • #10
                    Re: China - A Hospitalized Pediatric Case of H7N9 Bird Flu in Beijing - 650 km from other H7N9 Cases- Confirmed

                    I saw the 90% value and the only thing I can think would have prompted it is if the calculation was arrived at by excluding unresolved cases i.e. only those who either died or have completely recovered were used in the calculation. Regardless of how either the 90% or 25% figure are reached they are both fairly meaningless at this stage of the game as we have nothing like enough data to make a useful calculation and what we do have is heavily skewed towards severe cases. As Al said - just internet hype.

                    Comment


                    • #11
                      Re: China - A Hospitalized Pediatric Case of H7N9 Bird Flu in Beijing - 650 km from other H7N9 Cases- Confirmed

                      JJackson - that is exactly how the individual concerned arrived at these numbers.

                      Hype indeed - and most certainly not what is needed right now.

                      Comment


                      • #12
                        Re: China - A Hospitalized Pediatric Case of H7N9 Bird Flu in Beijing - 650 km from other H7N9 Cases- Confirmed

                        Originally posted by Vibrant62 View Post
                        JJackson - that is exactly how the individual concerned arrived at these numbers.

                        Hype indeed - and most certainly not what is needed right now.
                        Thanks I had not seen how it was reached but it is the correct way to calculate as unresolved case should not be included. It remains a meaningless value however.<object style="position:absolute;z-index:1000" type="application/x-dgnria" id="plugin0" height="0" width="0">

                        </object>
                        Last edited by Laidback Al; April 13, 2013, 08:03 AM. Reason: typo

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                        • #13
                          Re: China - A Hospitalized Pediatric Case of H7N9 Bird Flu in Beijing - 650 km from other H7N9 Cases- Confirmed

                          Thank you all for explaining and as I thought the CFR would be lower dependent on factors.

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                          • #14
                            Re: China - A Hospitalized Pediatric Case of H7N9 Bird Flu in Beijing - 650 km from other H7N9 Cases- Confirmed

                            I see the CFR as something arrived at in hindsight. For example, even though H5N1 has been infecting humans for years, we still don't know its CFR, primarily because only severe cases or deaths are tested and reported, and we have no idea as to the number of asymptomatic or mild cases. Trying to calculate the CFR for H7N9 at this stage is impractical and, given the small number of cases and the bias in testing toward severe cases, would be exaggerated by an order of magnitude or more.

                            I would be very surprised if the CFR for either H5N1 or H7N9 truly exceeds 5%. And, as long as the attack rate is low, this shouldn't cause a full-blown Pandemic. However, if either virus develops into a Pandemic with an attack rate exceeding 25%, then it would be catastrophic globally, with on the order of 50 to 75 million deaths worldwide.
                            "I know God will not give me anything I can't handle. I just wish that He didn't trust me so much." - Mother Teresa of Calcutta

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