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

Laidback Al · Apr 12, 2013

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/showpost.php?p=492457&postcount=12 hat tip Shiloh.
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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.”
http://www.flutrackers.com/forum/showthread.php?t=202046

April 1st, 2013
Sino-Japanese Friendship Hospital, Beijing
Increasing number of patients with of ILI symptoms.
http://www.flutrackers.com/forum/showthread.php?t=202724

April 10, 2013
Yantai Yuhuangding Hospital, Shandong
Patients exhibiting ILI symptoms (Hospital also conducted an H7N9 bird flu drill on April10).
http://www.flutrackers.com/forum/showthread.php?t=203373

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”
http://www.flutrackers.com/forum/showthread.php?t=203475
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Catbird · Apr 12, 2013

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

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

Giuseppe · Apr 12, 2013

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

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.

jeffrey · Apr 12, 2013

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

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?

mb59747 · Apr 12, 2013

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

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

jeffrey said:
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.

Ronan Kelly · Apr 12, 2013

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

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

mb59747 said:
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.

Nika · Apr 12, 2013

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

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.

mb59747 · Apr 12, 2013

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

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

Ronan Kelly said:
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.

Laidback Al · Apr 13, 2013

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

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

mb59747 said:
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.
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JJackson · Apr 13, 2013

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.

Vibrant62 · Apr 13, 2013

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.

JJackson · Apr 13, 2013

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

Vibrant62 said:
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">

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jeffrey · Apr 13, 2013

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. :tiphat:

JimO · Apr 13, 2013

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.

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

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