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 Fukuda.
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), coronaviruses, adenoviruses, enteroviruses, parainfluenzaviruses, influenza viruses, metapneumovirus, respiratory syncytial virus and bocavirus. Working out what causes a patient's URT is a challenging task, especially when more than one of these viruses can be detected by PCR in a patients airway sample at the same time.
Differential diagnoses (testing for all the things that may cause the same clinical appearance) is interesting in times of an outbreak. Keep an eye on these HCWs - they could be an important canary in the dark H7N9 mine we've been stumbling about in so far.
There are over 200 endemic human "respiratory viruses" that have been associated with URTs including the rhinoviruses (160 of them alone), coronaviruses, adenoviruses, enteroviruses, parainfluenzaviruses, influenza viruses, metapneumovirus, respiratory syncytial virus and bocavirus. Working out what causes a patient's URT is a challenging task, especially when more than one of these viruses can be detected by PCR in a patients airway sample at the same time.
Differential diagnoses (testing for all the things that may cause the same clinical appearance) is interesting in times of an outbreak. Keep an eye on these HCWs - they could be an important canary in the dark H7N9 mine we've been stumbling about in so far.
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 worker (HCW) contacts (n=138) he had (also also those during travel although he was pre-symptomatic and possibly not shedding), in the 3 three days he spent in Taiwan before showing signs of illness and at the medical facilities where he visited and was eventually admitted. If human-to-human transmission can happen, this will be the first chance to see it spread under the auspices of a different government. Four HCWs have cleared the suspected 7-day incubation period without symptoms while 3 HCWs have "developed" upper respiratory infections.
The patient did not seem to respond to Tamiflu but his infection was well advanced and beyond the recommended 48-hour commencement time (Tamiflu was started 16.04.13, about a week after first symptoms). His condition on 20.04.13 required intubation to manage respiratory failure.
The only upside to this "release" is that we may see and hear about some prospective testing which is sorely needed. Thanks to ClaireW and Jason Gale for the heads up.
There is now a risk of new cases emerging from close/regular/healthcare worker (HCW) contacts (n=138) he had (also also those during travel although he was pre-symptomatic and possibly not shedding), in the 3 three days he spent in Taiwan before showing signs of illness and at the medical facilities where he visited and was eventually admitted. If human-to-human transmission can happen, this will be the first chance to see it spread under the auspices of a different government. Four HCWs have cleared the suspected 7-day incubation period without symptoms while 3 HCWs have "developed" upper respiratory infections.
The patient did not seem to respond to Tamiflu but his infection was well advanced and beyond the recommended 48-hour commencement time (Tamiflu was started 16.04.13, about a week after first symptoms). His condition on 20.04.13 required intubation to manage respiratory failure.
The only upside to this "release" is that we may see and hear about some prospective testing which is sorely needed. Thanks to ClaireW and Jason Gale for the heads up.
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 here)?
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 linked.
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 these cases. Realistically (and pedantically), its very likely that the virus entered the airways and eyes of close contacts during sneezing, coughing etc. It just didn't cause obvious signs or self-reported symptoms of disease as a result of that challenge.
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 these cases. Realistically (and pedantically), its very likely that the virus entered the airways and eyes of close contacts during sneezing, coughing etc. It just didn't cause obvious signs or self-reported symptoms of disease as a result of that challenge.
Presumably the virus lacks something when replicating in humans that it has when coming from the suspected animal source, which allows it to cause disease in humans. Or that other theory - it can infect humans and cause mild and subclinical disease.
The quickest way to resolve this question, a very important one for short-term and future containment of the virus, is to use PCR-based lab testing of contacts; look for virus in eye and upper airway swabs and, for a little bit, forget about being led by symptomatic illness alone.
The quickest way to resolve this question, a very important one for short-term and future containment of the virus, is to use PCR-based lab testing of contacts; look for virus in eye and upper airway swabs and, for a little bit, forget about being led by symptomatic illness alone.
