Entries in Shanghai (2)
The Chinese are reacting to both the introduction of H7N9 into humans, and the fact that birds are not showing symptoms as they usually do.
The Chinese have ordered the culling of poultry in the city of Shanghai. A live bird market has been ordered culled of anything with feathers. Specifically, according to the Chinese news service Xinhua, it was the Huhuai wholesale agricultural products market in the Songjiang district of Shanghai.
In the meantime, it appears a contact of one of the H7N9 confirmed fatalities has gotten sick. The entire world press corps will be camped at that hospital while we openly wonder if H2H has begun.
The world woke up Easter Sunday to some pretty unsettling news. No, it was not about that twit in North Korea. The news came out of China, and it hit hard enough for me to start blogging again.
China is the source of a novel H7N9 influenza virus. And the virus is infecting, and killing, humans.
In the past three years, I have written a small handful of infectious disease blogs. I just felt that I had nothing to contribute; people such as my buddies Mike Coston, Crof and Maryn McKenna were filling that space quite nicely, and I could not offer anything of value.
Then, a few months ago, I began to formulate a concept in my mind. Things were just too dang quiet, I thought. H1N1 was still infecting and killing overseas, but H3N2 was the principal culprit in North America. Odd, I thought: Flu always plays King of the Mountain. Why should a seasonal strain be more prevalent -- and also more deadly -- than the recent pandemic strain?
I looked at this novel coronavirus situation in the Middle East. What the heck was going on with that? As I began the research into this novel coronavirus, I thought what everyone else was thinking: Is this the Next Big Pandemic?
And, as always, Mother Nature shows us who is boss. She shows us that you simply cannot predict when something is going to pop up and take all us arrogant humans by the scruff of the neck and shake us and berate us for ever, ever thinking we know what is coming.
Here, in a capsule of a capsule, is what we know, as of 1PM EDT on the second of April, 2013.
Sometime in mid-February, a family of three Chinese men in Shanghai -- an 87-year-old father, and two sons, aged 55 and 69 -- contracted something very, very virulent. Two of the men died. The lone survivor was hospitalized with pneumonia (alarm bell #1). The dead father was discovered to have had H7N9 influenza. H7N9 was not found in the two sons. The younger son also died. H7N9 was not found in him. The inescapable fact is that all three men suffered from terrible pneumonia, and two died. As we all know, pneumonia is the most prevalent byproduct of influenza. No one is going on the record as stating, flatly, that the other two cases were not H7N9. They are saying they did not detect any. There is a difference.
In early March, about two hundred miles away, a 35-year-old woman contracted something very, very virulent. She, too, was diagnosed with H7N9 influenza (alarm bell #2).
It took the Chinese authorites until March 31st -- March 31st -- to disclose that, indeed, there was the presence of a novel influenza, never before seen in humans. I suppose we should celebrate the fact the Chinese disclosed anything at all. And the Chinese are, apparently, doing their due diligence. Some 88 contacts of the three men have been monitored, and to date, none have shown symptoms of respiratory distress. That would seem to downplay the possibility of human-to-human transmission.
This would be all fine, well and good, except for one small fact: We are getting reports of more cases. Just as I was fact-checking this blog, news arrived of four more cases, again disclosed by the Chinese government. All the new cases come from a third province. Quoting from the proMED dispatch:
The number of confirmed human cases of avian A(H7N9) influenza virus infection has now risen to 7; the number of fatalities remains at 2.
The condition of the 4 new cases is critical, and all remain in hospital. None of the 4 new cases are related to the previous 3 cases or to each other. Only one of the new cases has had daily contact with birds, a 45-year-old woman who is described as a poultry butcher. The pattern remains the same, presumptive direct infection from poultry and no evidence of person-to-person transmission. The overall situation is becoming more serious, suggesting that many people may be directly susceptible to a strain of avian A(H7N9) influenza virus that may be widespread in the avian population (wild or farmed) in China.
The consequences of infection by this virus appear to be severe. - Mod.CP
The number of human cases of infection via H7 influenzas is considerable. Mike Coston has constructed a nifty history of those infections in his recent blog post, so I will not attempt to replicate his fine post. Suffice it to say that H7 is known to scientists and researchers, but (up to now) its ability to cause serious illness in humans, save for one hapless vet in the Netherlands a few years ago, is small.
Crawford Killian, the noted author and flu blogger, has an excellent post today. The spource is an AP story on the outbreak. It quotes a researcher from the Bill and Melinda Gates Foundation.
"When you don't look, you don't find them, but when you look, you'll find," said Dr. Ray Yip, a public health expert who heads the Bill and Melinda Gates Foundation in China.
"A lot of people get severe respiratory conditions, pneumonias, so you usually don't test them. Now all of a sudden you get this new reported strain of flu and so people are going to submit more samples to test, [so] you're more likely to see more cases," Yip said.