Could the deadly H7N9 Bird Flu influenza A virus identified in China lead to a pandemic? How does it differ from other Bird Flu viruses like H5N1? Should I travel to China and what precautions can I take?


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Wendy takes one last look into the sunset on the last day of 2009

Influenza A (H7N9) could be carried by a bird without any obvious symptoms

Regular visitors to will be aware of my more than passing interest in current topics related to virology and bacteriology. This originated from the early days of my career when I studied both of these subjects at the Manchester University Medical School and then moved onto perform some mutant research into bacteria in the Biochemicals laboratory of ICI Billingham (UK).

Today my work is more focused on risk management, where I help the oil industry identify and manage threats and opportunities to its business, employees and other stakeholders across the globe. One of the risk areas we consider is the level of preparedness in our operations for quickly and effectively responding to pandemics. You can find an article I recently prepared to raise awareness of what should be considered in a pandemic response plan using the link below:

Pandemic Risk Management Article by Chris Duggleby (February 2012) (or ‘How to Prepare for the Consequences of Microbial Sex!’)

I lived through the SARS crisis when I was the president of a petrochemicals Joint Venture in Asia and am therefore painfully aware of the fears, concerns and dangers which accompany an emerging pandemic. In such scenarios it is important to ensure that everyone concerned has quick, up to date access to quality information. In this article I will share with you the information that I have obtained about the current outbreak of H7N9 Bird Flu influenza in and around Shanghai in China.

By Friday (5th April 2013) according to the Chinese state media (Xinhua) there have been six deaths from H7N9 in China. They identified 14 people in eastern China infected with the relatively poorly researched H7N9 influenza strain: six in Shanghai, four in Jiangsu, three in Zhejiang and one in Anhui. You can find a link to the Xinhua report here.

On Friday Xinhua also reported that following the discovery of an infected pigeon in the major Huhuai poultry market in Shanghai the authorities had ordered the slaughter of 20,000 chickens, ducks, geese and pigeons to try to control the spread of the virus. They also suspended the sale of poultry at another two Shanghai markets until further notice. On Saturday (6th April 2013) Xinhua confirmed that the H7N9 virus had now been identified in birds in two other markets selling agricultural products in the district of Minhang. These markets were both close to the Huhuai market involved in the culling of 20,000 birds.

Pretty bird getting ready to jump onto my balcony

Many different kinds of bird can carry Influenza A (H7N9)

Learning from past experience the Chinese authorities are trying to move swiftly to control the situation. The have now banned the import of poultry into Shanghai and all poultry markets there have been closed. In the Eastern Chinese province of Nanjing the sale of all poultry has also been banned.

The latest news over the weekend was that 4 people have died from the disease in Shanghai. Apparently the latest victim was a 64-year-old man from the province of Zhejiang who had a serious lung infection, fever, coughing and breathing difficulties.

Initial research reported by the World Health Organisation (WHO) indicated the virus may by susceptible to antiviral agents Tamiflu and Relenza, but it is still early days and little research has previously been carried out on this strain. The information about antiviral agent susceptibility is mainly based on experience with other strains of bird flu  influenza. Tests are urgently being carried out with H7N9 and attempts are being made to develop a vaccine. At the moment there is no evidence that H7N9 (as with the earlier bird flu virus H5N1) can be easily transmitted from person to person. Despite this there had been 350 deaths from H5N1 by March 2013.

On a cold Winter's morning there is nothing the ducks like more than a good gossip on the locks

In China places where birds congregate in large numbers are likely to present a higher risk of Influenza A (H7N9) infection in humans

The Who has provided a useful set of answers to frequently asked questions about the  outbreak of H7N9 Bird Flu. For convenience these are included below. The WHO’s own website with the latest information can be found using the link here.

Frequently Asked Questions on human infection with influenza A(H7N9) virus, China

World Health Organisation Update as of 5 April 2013

(Updates will be posted on the WHO website as new information becomes available).

1. What is the influenza A(H7N9) virus?

Influenza A H7 viruses are a group of influenza viruses that normally circulate among birds. The influenza A(H7N9) virus is one subgroup among the larger group of H7 viruses. Although some H7 viruses (H7N2, H7N3 and H7N7) have occasionally been found to infect humans, no human infections with H7N9 viruses have been reported until recent reports from China.

2. What are the main symptoms of human infection with influenza A(H7N9) virus?

Thus far, most patients with this infection have had severe pneumonia. Symptoms include fever, cough and shortness of breath. However, information is still limited about the full spectrum of disease that infection with influenza A(H7N9) virus might cause.

3. How many human cases of influenza A(H7N9) virus have been reported in China to date?

New cases that are reported are now being compiled and posted daily. The most current information on cases can be found in Disease Outbreak News.

4. Why is this virus infecting humans now?

We do not know the answer to this question yet, because we do not know the source of exposure for these human infections. However, analysis of the genes of these viruses suggests that although they have evolved from avian (bird) viruses, they show signs of adaptation to growth in mammalian species. These adaptations include an ability to bind to mammalian cells, and to grow at temperatures close to the normal body temperature of mammals (which is lower than that of birds).

5. What is known about previous human infections with H7 influenza viruses globally?

From 1996 to 2012, human infections with H7 influenza viruses (H7N2, H7N3, and H7N7) were reported in the Netherlands, Italy, Canada, United States of America, Mexico and the United Kingdom. Most of these infections occurred in association with poultry outbreaks. The infections mainly resulted in conjunctivitis and mild upper respiratory symptoms, with the exception of one death, which occurred in the Netherlands. Until now, no human infections with H7 influenza viruses have been reported in China.

6. Is the influenza A(H7N9) virus different from influenza A(H1N1) and A(H5N1) viruses?

Yes. All three viruses are influenza A viruses but they are distinct from each other. H7N9 and H5N1 are considered animal influenza viruses that sometimes infect people. H1N1 viruses can be divided into those that normally infect people and those that normally infect animals.

7. How did people become infected with the influenza A(H7N9) virus?

Some of the confirmed cases had contact with animals or with an animal environment. The virus has been found in a pigeon in a market in Shanghai. It is not yet known how persons became infected. The possibility of animal-to-human transmission is being investigated, as is the possibility of person-to-person transmission.

8. How can infection with influenza A(H7N9) virus be prevented?

Although both the source of infection and the mode of transmission are uncertain, it is prudent to follow basic hygienic practices to prevent infection. They include hand and respiratory hygiene and food safety measures.

Hand hygiene:

• Wash your hands before, during, and after you prepare food; before you eat; after you use the toilet; after handling animals or animal waste; when your hands are dirty; and when providing care when someone in your home is sick. Hand hygiene will also prevent the transmission of infections to yourself (from touching contaminated surfaces)

and in hospitals to patients, health care workers and others.

• Wash your hands with soap and running water when visibly dirty; if not visibly dirty, wash  your hands with soap and water or use an alcohol-based hand cleanser.

Respiratory hygiene:

• Cover your mouth and nose with a medical mask, tissue, or a sleeve or flexed elbow when coughing or sneezing; throw the used tissue into a closed bin immediately after use; perform hand hygiene after contact with respiratory secretions.

Wendy looks across the beach at Sandy Bay and dreams of the morsels tomorrow may bring washed up on the tide

9. Is it safe to eat meat, i.e. poultry and pork products?

Influenza viruses are not transmitted through consuming well-cooked food. Because influenza viruses are inactivated by normal temperatures used for cooking (so that food reaches 70°C in all parts— “piping” hot — no “pink” parts), it is safe to eat properly prepared and cooked meat, including from poultry and game birds.
Diseased animals and animals that have died of diseases should not be eaten.
In areas experiencing outbreaks, meat products can be safely consumed provided that these items are properly cooked and properly handled during food preparation. The consumption of raw meat and uncooked blood-based dishes is a high-risk practice and should be discouraged.

10. Is it safe to visit live markets and farms in areas where human cases have been recorded?

When visiting live markets, avoid direct contact with live animals and surfaces in contact with animals.  If you live on a farm and raise animals for food, such as pigs and poultry, be sure to keep children away from sick and dead animals; keep animal species separated as much as possible; and report immediately to local authorities any cases of sick and dead animals. Sick or dead animals should not be butchered and prepared for food.

11. Is there a vaccine for the influenza A(H7N9) virus?

No vaccine for the prevention of influenza A(H7N9) infections is currently available. However, viruses have already been isolated and characterized from the initial cases. The first step in development of a vaccine is the selection of candidate viruses that could go into a vaccine. WHO, in collaboration with partners, will continue to characterize available influenza A(H7N9) viruses to identify the best candidate viruses. These candidate vaccine viruses can then be used for the  manufacture of vaccine if this step becomes necessary.

12. Does treatment exist for influenza A(H7N9) infection?

Laboratory testing conducted in China has shown that the influenza A(H7N9) viruses are sensitive to the anti-influenza drugs known as neuraminidase inhibitors (oseltamivir and zanamivir). When these drugs are given early in the course of illness, they have been found to be effective against seasonal influenza virus and influenza A(H5N1) virus infection. However, at this time, there is no experience with the use of these drugs for the treatment of H7N9 infection.

13. Is the general population at risk from the influenza A(H7N9) virus?

We do not yet know enough about these infections to determine whether there is a significant risk of community spread. This possibility is the subject of epidemiological investigations that are now taking place.

14. Are health care workers at risk from the influenza A(H7N9) influenza virus?

Health care workers often come into contact with patients with infectious diseases. Therefore, WHO recommends that appropriate infection prevention and control measures be consistently applied in health care settings, and that the health status of health care workers be closely monitored. Together with standard precautions, health care workers caring for those suspected or confirmed to have influenza A(H7N9) infection should use additional precautions.

15. What investigations have begun?

Local and national health authorities are taking the following measures, among others:

• Enhanced surveillance for pneumonia cases of unknown origin to ensure early detection and laboratory confirmation of new cases;

• Epidemiological investigation, including assessment of suspected cases and contacts of known cases;

• Close collaboration with animal health authorities to determine the source of the infection.

16. Does this influenza virus pose a pandemic threat?

Any animal influenza virus that develops the ability to infect people is a theoretical risk to cause a pandemic. However, whether the influenza A(H7N9) virus could actually cause a pandemic is unknown. Other animal influenza viruses that have been found to occasionally infect people have not gone on to cause a pandemic.

17. Is it safe to travel to China?

The number of cases identified in China is very low. WHO does not advise the application of any travel measures with respect to visitors to China nor to persons leaving China.

18. Are Chinese products safe?

There is no evidence to link the current cases with any Chinese products. WHO advises against any restrictions to trade at this time.

If you found this article interesting you may like to read some of my other articles in similar subjects. These can be found using the links below:

10th March 2013: New Killer Corona Virus – could it turn into another SARS (or worse)?  

29th December 2012: Spreading diarrhea and vomit through the washing machine – The Norovirus propagator in our kitchen 

1st September 2012: Multiple antibiotic resistance transferred between harmless soil bacteria and the killer pathogens found in hospitals 

18th August 2012: Polar Bear dies of Encephalitis after catching Herpes from a Zebra in Wuppertal Zoo near Düsseldorf 

11th August 2012: Do you have killer rats/mice in your cellar? Over 2000 people attacked in Germany so far this year (Hantavirus Infections at record levels) 

11th August 2012: The next pandemic: Will it be created by man? The debate about research using killer viruses like Avian Flu (H5N1) and Ebola

There are also numerous other articles which you may find of interest on my ‘Alpine Press‘ page.

Keep informed and look after yourself!

Chris Duggleby.

My pretty partner decides to take off just as the sun goes down at Sunset Rocks

Please remember that the birds are also innocent victims in the Influenza A (H7N9) saga!

Please share your comments on the site with me (or use this box to simply contact me). Add 'confidential' at the top if you do not want your comments to be published. Thanks - Chris

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