This completes the provinces surrounding the highly active Zhejiang provin...
New insight into testing and epidemiology of infection.
In an excellent new article in the Lancet, Chen and colleagues explain testing (sensitive real-time RT-PCR for M, H7 and H9 targets; culture on MDCK (canine) cells to grow virus) describing result from throat and sputum samples from 4 patients.They associate human cases directly to epidemiologically linked chickens (also tested quail, pigeons and ducks) samples from "wet" market (traditional live...
Infectious and Cerebrovascular Diseases in Peru
Shibani MukerjiPGY-3, Partner's NeurologyAs in many South American countries, Peru has a wealth of patients with neuroinfectious diseases. In Lima, there appears to be a disproportionate number of neurologists available to help with their diagnosis in comparison to the rest of...
H7N9 cases in China to be reported weekly instead of daily.
Well that will let the guys at FluTrackers get some more sleep. Mike at Avian Flu Diary(who could probably do with some sleep too) notes it might not have a real impact on provincial reports but time will tell. The info is nestled at the bottom of this report. This is a real shame for the public who have been getting access to some great real-time data break-downs, assemblies and interpretations from...
Three hospital workers test negative.
Despite contact, and some confusion over whether they were or were not wearing personal protective equipment, they are H7N9 negative. So the upper respiratory tract infections (UTRIs; acute signs and symptoms including headache, perhaps a temperature, runny nose, sneezing, cough etc) they manifested after being in contact are due to another virus. Might be interesting to know which one(s). Presumably...
Shanghai looks for antibodies to H7N9 in healthy people!
..and I say WOO-HOO! This is an important step forward. Looking among the currently healthy for past exposure to H7N9 will tell us a lot.These results will start to unravel how long this virus has been circulating in Shanghai (it takes a couple of weeks to "seroconvert"; show a jump in specific antibody levels in the blood; looking in any older paired sera repositories would be great too) and also...
Aaron BerkowitzPGY-3, NeurologyTravel Grant: Neurology Education in MalawiAfter two weeks on the wards of Queen Elizabeth Central Hospital in Blantyre, described in my blog entry below, the last two weeks have taken me to two very different contexts in Malawi. I spent one week in the capital city...
Jiangxi tests positive for H7N9.
Given its proximity to Zhejiang its not too surprising that a case has been reported here-still to be confirmed by central testing. However, I don't know of a provincial/municipal announcement that didn't get confirmed so the odds are good that a confirmation is forthcoming After a quiet yesterday, Zhejiang also has a couple more H7N9 cases to repo...
Returning to the issue of H7N9 and its skewed presentations in the sexes.
I wrote about this on the 22.04.13 but forgot to mention that there are no accompanying descriptions of the societal roles of males and females in these areas, or in general. The skewing may reflect a bias towards the males simply because they could be more involved in activities that increase their risk of exposure to the influenza A(H7N9) virus host or its environmental sour...
A note on case fatality risk, rate or ratio (CFR)
..used in a couple of charts on the H7N9 page. This uses numbers based on very limited testing, publicly available data, recovered case numbers or understanding of the acquisition, transmission and clinical presentations associated with avian influenza A(H7N9) virus. It is very early days yet however I think this number gives you an idea of our understanding at the moment. It will undoubtedly...
One of the most lethal influenza viruses.
Well of course that was going to be the quote picked up by the world's press from comments made by WHO Assistant-Director-General, Health Security and Environment, Dr Keiji Fuku...
H7N9 is not the only game in town.
Three HCWs who looked after the first H7N9 exported case have developed upper respiratory tract(URTs) infections somewhere during the 15-days between illness onset and lab confirmation. It is well worth noting that H7N9 is not the only virus that can cause URTs. There are over 200 endemic human "respiratory viruses" that have been associated with URTs including the rhinoviruses (160 of them alone),...
H7N9 transported outside mainland China.
The first case of H7N9, has been reported reported in Taiwan marking its first known departure from the borders of mainland China. It seems that the 53-year old businessman imported it from somewhere on the mainland - he visited Suchou city in Jiangsu province, traveling out via Shanghai. He reportedly did not have any live birds or poultry. There is now a risk of new cases emerging from close/regular/healthcare...
Hepatitis B rears its tiny ugly head in the Taiwan case.
Apparently the 53M was also hepatitis B (HepB) positive as were 2/3 cases described in detail in the recent NEJM manuscript (see H7N9 page). Is there an association between HepB virus/viral disease and H7N9 or are these co-detections just coincidence due to high prevalence of HepB infection in China (suggested her...
Market closure the key?
Is the closure of Shanghai's wet animal markets to thank for the precipitous drop in H7N9 cases from Shanghai from around mid-April? Back in 13.04.13 I mentioned we still had a few days to see if there was any impact based on the diagnostic testing lag of 10-12 days. Dr Kelso of the WHO influenza-A team thinks the drop and the market closures could be link...
WHO panel wraps up visit.
"The primary focus of the investigation is to determine whether this is in fact spreading at a lower level among humans. But there is no evidence for that so far except in these very rare instances," said the WHO panel. So presumably there are no signs or symptoms of disease spreading within these clusters. It is remains unclear from this visit whether the spread of the virus can be ruled out among...
Two deaths and 5 new confirmations tip the numbers above 100
..avian influenza A(H7N9) cases. Nothing has changed since yesterday, apart from Zhejiang province now surpassing Shanghai municipality in the total number of cases reported and accelerating (see chart below) in case numbers at a very rapid rate. Still, but a 3-digit number tends to sound more scary to some - so expect the media to carry big banner headlines akin to "100 cases of killer virus in three...
FluTrackers notes a new province has been added.
The H7N9 outbreak welcomes Shandong, about 870km north-west of Shanghai and 420km south of Beijing; population >95,000,000, of whom 1 (37M) is now confirmed as being H7N9-positive.Given the rate of case reports from Zhejiang, I'm surprised we haven't heard from provinces further south such as Jiangxi or Fuji...
H7N9 and the tendency for males to predominate in case and fatality numbers.
The H7N9 graphs highlight that cases and deaths are occurring in males more than females. We often see more males than females in hospital presentations for acute respiratory illnesses. Why this is so is not known for certain.Published research from Prof John Upham in Queensland, Australia shows a difference in the immune response to rhinovirus, the virus responsible for triggering most asthma attacks,...
H7N9 and the skewed age issue.
We are reading much about the older than expected ages of those infected by H7N9 (current average case age of 58 years). Why? One school of thought is that the elderly have weaker, or perhaps "less experienced" immune defences. But there are many other risk factors for severe complications arising after influenzavirus infection including heart and other organ disease, things which may accumulate...
Absence of evidence is not evidence of absence. Welcome to the end of the third week.
Three weeks since the WHO was notified of the newly emerged avian influenza A(H7N9) virus. Today the case tally sits at 97 confirmation including 18 deaths, an asymptomatic case, three family clusters, no proven or sustained human-to-human transmission, no clear host in poultry or wild birds or pigs (all things that history or H7N9 genetic sequences indicate should be hosting infectio...
