Is H7N9 Spreading from Human to Human in China?

jflorida · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

I dont know if anything has been ruled out as it is a evolving situation and I imagine "all the above to some extent" will probably be the correct answer as it usually is eventually. But for now I dont see the need for too much suspicion even if there turns out to be some playing down of H2H infection, which I would expect some degree of in any situation with almost every illness. Especially between family members.

I would think before widespread H2H transmission we would see a large scale infection first however in concentrations of domesticated animals, especially pigs, considering their social behavior. Ive been looking and dont see that as of yet.

I still think there are possibly other clusters of this yet to be revealed.

I am still thinking about the dead floating pigs - albeit a bit less and indeed there is something of a restriction placed on discussing that issue that also could have implications in the revealing other information:

On March 19 a Chinese government agency issued the following statement, which ended up on the social media site, Weibo: “The Shanghai Huangpu River dead pig incident is already being dealt with effectively. Related follow-up coverage should follow Xinhua wire copy and information issued by authoritative local departments. The media are not to send journalists to Jiaxing or similar locations to investigate, nor to sensationalize or comment on the issue.” - CNN

10,000+ dead pigs bobbing lazily by in your drinking water supply being not a issue to concern yourself with.

Some suspicion is probably healthy here.

gsgs · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

we don't know if pigs are susceptible, and if, whether it would kill
them in masses. This didn't even happen with H5N1.
I assume you would see it by examing the lungs of the dead pigs

Laidback Al · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

Why is H7N9 different from other recent novel infections?

Since the onset of the first reported H7N9 cases in mid-February (barely six weeks ago), China has reported at least 20 human cases of the infection. In contrast, although not an influenza virus, NCoV has only infected a total of 17 cases since April 2012. Notably, among the 17 cases of NCoV, four separate clusters were reported. According to WHO, a cluster is defined as two or more cases of confirmed, probable, or suspected infections with onset of illness occurring within the same two-week period and who are in the same geographical area and/or are epidemiologically linked.

H5N1, a comparable influenza virus, was first recognized in a cluster of cases in Hong Kong in 1997. Since 1997, among the 600+ human H5N1 cases there are at least 60 separate clusters of cases. Why are there no clusters of H7N9 infections?

The initial outbreak of H3N2v was easily identifiable because of the correlation of infected cases with county fairs in the United States. Quickly, infected pigs were identified as the natural reservoir. How can H7N9 infect individuals with such widely different lifestyles, and in such widely separate geographic areas, without China even speculating on an identifiable source of infection.

So far in China for H7N9, we have an acceleration of cases, no clearly identifiable reservoir or source of infection, and no clear clusters of cases.

What is different about H7N9?
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Giuseppe · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

I would answer with ''a lot of subclinical cases''...

As happened in the Netherlands where only few symptomatic cases and one Death happened during the HP H7N7.

The vast majority had only minor or no signs on illness and only serology detected their exposures.

Curiously, some of the larger cluster of human H7N7 subclinical cases were in household with more than one toilet, suggesting some contamination via oro-fecal route...

It is also possible that a number of Chinese patients were involved in some recreational or local ethnic activities that increased their exposure to a (unknown) animal / human source.

gsgs · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

in Netherlands many people were symptomatic, thow low,
mainly conjunctivitis. But you could detect the cases.

I read conjunctivitis were also common with other H7,
not in China with H7N7 ?

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didn't we have at least one cluster with H7N7 ?
S1, father sons

-------------------------------

could it be H7 infects by eating, as H5 ?
But they should have detected that and told us

sharon sanders · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

So really we know nothing. That is the consensus on this thread.

Too bad. But that is reality I think.

Anyway, this is what I did this week because when there is an outbreak of a novel flu virus among humans anywhere in the world we all need to take a long look at that. At the very least we can say there is a novel flu virus outbreak in the Shanghai-Eastern China area that is infecting some people and has killed a few:

1) I renewed a 90 day prescription of a maintenance drug that I must take everyday,

2) My husband had an eye procedure that he has put off for a year,

3) I stocked up on large chocolate bars since they were on sale - by one and then get one for free (I ate one already - lol),

4) I bought a 25 pound bag of rice.

5) I am still in Florida. I go to Canada in the summers, leaving Florida in mid-May, and this is still the schedule for this year.

So that is where my mind is. It wasn't much but I feel better. I think that people who are in the public eye should disclose what they are doing, or not doing, about disease outbreaks. Action speaks louder than words.

Vibrant62 · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

Sharon, thanks for leading the way!

Until we have some hard research data on this virus it is all guesswork and will remain that way.

What concerns me is that as of now, the leading researchers in the world do not yet have viral samples to test and examine, let alone commence making a seed strain for a future vaccine.

Exerpt from an article in the Wall St Journal

Still, the new H7N9 is more worrying than H5N1 in some ways. Genetic changes in the avian virus suggest it may be adapting to infect mammals, said Nancy Cox, a virologist who is the CDC's Atlanta-based flu chief.

"The markers are there indicating the virus has moved toward more readily binding the type of receptors that are in the human airway," she said. In addition, "there have been a larger number of H7N9 cases in a relatively short period of time than we saw with H5N1," Dr. Cox said.

But she cautioned that little is still known about the new virus. The CDC hopes to receive a virus isolate or isolates from China within the next week or so, she said, and will study the genetic changes further to try to determine how transmissible the virus may be among humans.

Why such a long delay for dissemination of samples, at the very least for further research which is clearly urgent?

Nika · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

CDC said in their call last week that they were synthesizing seed virons from the seq data. Likely that means they (and contracted companies and other labs) will make a panel of candidate seed virus for testing.

curiosity · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

A few thoughts and questions -

"The virus has mostly been found in live poultry trading markets, but not in farms raising poultry. The virus has not been found in pigs so far, he said." from Xinhau's article: Migratory birds may have carried H7N9 into China

Is it possible the human is the mixing vessel for this strain? Consider the possibility an individual was exposed to an avian influenza virus while sick with another non-seasonal flu virus, created the virus and started the event. Then, as cases developed (more mild than severe) and the illness became more prevalent in a given geographical location (and the majority undetected) in the human population, the birds began to get sick - hence the reason poultry markets are showing signs of disease and not farms (yet) - I don't even know if this is possible, but it's worth considering

Laidback Al's got a really good point here: "H5N1, a comparable influenza virus, was first recognized in a cluster of cases in Hong Kong in 1997. Since 1997, among the 600+ human H5N1 cases there are at least 60 separate clusters of cases. Why are there no clusters of H7N9 infections?

The initial outbreak of H3N2v was easily identifiable because of the correlation of infected cases with county fairs in the United States. Quickly, infected pigs were identified as the natural reservoir. How can H7N9 infect individuals with such widely different lifestyles, and in such widely separate geographic areas, without China even speculating on an identifiable source of infection."

Aside from knowing we are not getting the whole picture from China, the reality is this outbreak is unlike we have any seen before and doesn't make sense. In consideration of a food borne source (particularly if oral/fecal route is possible) there are many similarities to this outbreak and the food distribution events we have seen before.

However, I can't help but wonder if there ARE many many cases that just are not being detected because the testing is not accurate or capable. This season, there were reports of some 50% false negatives in rapid flu screening tests in one product (sorry I can not remember the product's name). Also, China is likely not going to divulge positive rapid tests to the public and would rather do confirmatory testing - that can take upwards of a week to obtain because it is a new virus assuming the lab system is as capable as US. This would explain why there have not been any positive tests with onset dates after March 31.

As quoted in post: China H7N9 Human Isolates on Deposit

"... the recent influenza detection data in previous years, was essentially flat over the same period..."
That is worrisome. I know translation is difficult through machine - but it sounds like they are seeing influenza activity above baseline and not detecting H7N9, but H1N1 instead.

Cases #15 and #16 - Both are "in retirement home" in Jiangsu and died similar time. More information regarding cases like these may help us understand more. What is the definition for "retirement home" there? Does this mean they were invalid? In a closed nursing facility? What would be there exposure outdoor to birds? Or did a caretaker bring something to them?

Finally, I cringe to even mention the possibility because I think the thought induces far more fear than the realistic probabilities do - and I consider this scenario to be excessively not likely - what about intentional/accidental release? They argued for so long publicly that releasing data about gene sequence would make it too easy to manipulate the influenza virus into a weapon - and precedence was set in 1976/77(?) when an old influenza virus was released back into the population accidentally - only to become a seasonal strain once again.

Threads like
China - Reports of many persons attacked on Wenzhou City buses with needles - tests pending, Zhejiang province
can really make you wonder about the other crazy ideas.

sharon sanders · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

NS1 told me that he thinks the evolution of this virus, genetically speaking, looks "natural" to him. i.e. not a lab experiment.

AlaskaDenise · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

sharon sanders said:
NS1 told me that he thinks the evolution of this virus, genetically speaking, looks "natural" to him. i.e. not a lab experiment.

Did he include an escaped vaccine in that opinion?, e.g., if the vaccine wasn't completely killed - unintentionally.

.

sharon sanders · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

I didn't ask that. He just said from what he sees the genetic components of H7N9 are all in nature and therefore he thinks it naturally evolved from what is available in the wild.

AlaskaDenise · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

curiosity said:
.....what about intentional/accidental release? They argued for so long publicly that releasing data about gene sequence would make it too easy to manipulate the influenza virus into a weapon - and precedence was set in 1976/77(?) when an old influenza virus was released back into the population accidentally - only to become a seasonal strain once again.......

I believe nature has clearly outdone humans on this issue. The historical major influenza pandemics demonstrate that a highly intelligent virus like influenza, will always mutate to accomplish their life's purpose - to keep nature in balance. Back in 2006 I was surprised when I looked at over 100 years of H1N1 sequences and found a striking increase in mutation frequency - when we started vaccinating people. Those vaccinations were obviously done with the best of intentions. Just looking at the sequences from North American H9N2 avians, we can see quite a few differences - based on different species, locations, whether domestic or wild, etc.

jflorida · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

With most influenza infections I think the immune response plays a role in accelerating the course of the infection. Im kinda concerned that in such a new virus the incubation period could be longer than we are perhaps used to and indeed the cases so far reported seem to progress rather slowly. That and the means of transmission and other mechanics may be a bit different as well.

I dont understand how a new virus could appear out of nowhere with so many cases spread out over such a wide area. A lot seems to have been assumed. We will see where it goes.

I think official organizations are a bit too concerned with generic "panic" and markets as well and probably should have moved a bit quicker and with more aggressiveness in investigating this. Probably this will be nothing but if its not its off to a really bad start in the wrong place.

Taiwan:

CDC rules out 3 of 5 suspected local H7N9 cases [ http://insidechina.onehotspots.com/...twitter&utm_medium=twitter&utm_source=twitter ]

The CDC said Sunday afternoon that it had ruled out the virus in tourists from Shanghai, Wenzhou and Jiangsu province, but it did not provide details on the other two people still undergoing tests.

Eight suspected cases were previously reported to local authorities between April 3 and Saturday noon, but none of the cases tested positive for the H7N9 virus

JimO · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

I believe that it is worth revisiting some of the suspected H5N1 cases from the past few months. This boy was gravely ill and tested negative for H5N1:

http://www.flutrackers.com/forum/showthread.php?t=202268

There was no report of confirmed diagnosis, nor his outcome. The second post in the thread quotes a source that states, "Some 2,319 Influenza A cases were reported in January in the mainland, leaving nine people dead."

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This report posted by Sharon describes unsanitary conditions in live poultry markets and warns against H5N1. First, the practices described sound very unhealthy. Second, what prompted this warning specifically? I'm sure the markets were always like this. Why publish a warning at that particular time? Could there have been influenza A cases that were unsubtypeable and assumed to be H5N1?

http://www.flutrackers.com/forum/showthread.php?t=201808

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This report indicates that a couple thousand ducks died and a total of 30,000 were culled. It was blamed on E. coli. I'm pretty sure that fecal samples from ducks would test positive for E. coli. I wonder if they tested for H7N9.

http://www.flutrackers.com/forum/showthread.php?t=200407

Shannon Bennett · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

Sharon I will pick up your challenge. All in all, I think we are in pretty good shape but, there were a few things that will make me feel more confidant.

I looked at my regular food storage and decided I really needed to cull some things and replace them.
Replaced some nitrile gloves.
For those of you who know me this will come as no surprise. I think I need to make some more elderberry and mullein extracts. Most of my elderberry has been consumed. The mullein was always in short supply since it is flu specific.
I am planting a fairly large garden this year. Good exercise, good vitamin D and, fewer visits to the market.

Laidback Al · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

Alternative Medicine

For those of you who do not know Shannon, she has participated here at FluTrackers since 2006 and is highly knowledgeable in what is today called Complementary and Alternative Medicine (CAM).

Defining CAM

 Defining CAM is difficult, because the field is very broad and constantly changing. NCCAM defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Conventional medicine (also called Western or allopathic medicine) is medicine as practiced by holders of M.D. (medical doctor) and D.O. (doctor of osteopathic medicine) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses. The boundaries between CAM and conventional medicine are not absolute, and specific CAM practices may, over time, become widely accepted.

"Complementary medicine" refers to use of CAM together with conventional medicine, such as using acupuncture in addition to usual care to help lessen pain. Most use of CAM by Americans is complementary. "Alternative medicine" refers to use of CAM in place of conventional medicine. "Integrative medicine" combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness. It is also called integrated medicine.

http://nccam.nih.gov/health/whatiscam

Many of her posts and threads can be found in this subforum: Traditional & Alternative Treatments. Home care and alternative medicines may be the only option in the event of a severe pandemic. Everyone need to remember that during the 1918 pandemic, hospitals were overwhelmed with flu cases.

If a virulent pandemic strikes in the 21<sup>st</sup> century, hospital treatment will not be available to everyone. People will most likely have to take care of sick relatives and friends in their own homes. Everyone should be prepared for this possibility.

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gsgs · Apr 7, 2013

Re: Is H7N9 Spreading from Human to Human in China?

Alasks Denise wrote:

> I looked at over 100 years of H1N1 sequences and found a striking
> increase in mutation frequency - when we started vaccinating people.

is this reported somewhere ? Some paper ? I never heard it and
would be surprised.

AlaskaDenise · Apr 8, 2013

Re: Is H7N9 Spreading from Human to Human in China?

Actually, I originally did the 100 year lookback after you introduced the term "evolutionary bottleneck".

I suppose the review of "patterns" in changes might be somewhat subjective.

THere is a 2009 paper written on the subject:

Paradox of Vaccination: Is Vaccination Really Effective against Avian Flu Epidemics?

Abstract

Background

Although vaccination can be a useful tool for control of avian influenza epidemics, it might engender emergence of a vaccine-resistant strain. Field and experimental studies show that some avian influenza strains acquire resistance ability against vaccination. We investigated, in the context of the emergence of a vaccine-resistant strain, whether a vaccination program can prevent the spread of infectious disease. We also investigated how losses from immunization by vaccination imposed by the resistant strain affect the spread of the disease.

Methods and Findings

We designed and analyzed a deterministic compartment model illustrating transmission of vaccine-sensitive and vaccine-resistant strains during a vaccination program. We investigated how the loss of protection effectiveness impacts the program. Results show that a vaccination to prevent the spread of disease can instead spread the disease when the resistant strain is less virulent than the sensitive strain. If the loss is high, the program does not prevent the spread of the resistant strain despite a large prevalence rate of the program. The epidemic's final size can be larger than that before the vaccination program. We propose how to use poor vaccines, which have a large loss, to maximize program effects and describe various program risks, which can be estimated using available epidemiological data.

Conclusions

We presented clear and simple concepts to elucidate vaccination program guidelines to avoid negative program effects. Using our theory, monitoring the virulence of the resistant strain and investigating the loss caused by the resistant strain better development of vaccination strategies is possible.

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(snipped)

.....
Furthermore, vaccines might provide immunological pressure on the circulating strains, which might engender the emergence of drifted or shifted variants with enhanced potential for pathogenicity in humans.....

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It's an interesting article and I'm sure you'll understand the mathematics far better than I can.

.

AlaskaDenise · Apr 8, 2013

Re: Is H7N9 Spreading from Human to Human in China?

While the above quoted paper is referencing influenza and different strains, some of the principles can apply to different pathogens affecting a person in a similar fashion. Where I live we had a treatable respiratory illness affecting children in smaller remote villages, so they developed a vaccine and its use effectively eliminated this illness. However, there is another respiratory pathogen that was constantly being over-ruled by the first illness. So now, #2 pathogen is #1 - with devastating results - because #2 is far less treatable!

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