Response to Human Infection with Avian Influenza A(H7N9) Virus Liu - - PowerPoint PPT Presentation

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Liu Zhiqiang Heanlth Emergency Response Office National Health and Family Planning Commission of P. R. C. (NHFPC) Aug 13, 2013

Response to Human Infection with Avian Influenza A(H7N9) Virus

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Response strategy and prevention and control measures

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Next step priorities

Content

Overview of the epidemic

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Overview of the epidemic 1

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Detection, Confirmation and Notification of the Epidemic

China CDC confirmed it as the new China CDC confirmed it as the new China CDC confirmed it as the new China CDC confirmed it as the new-

• type avian influenza

type avian influenza type avian influenza type avian influenza A(H7N9) virus A(H7N9) virus A(H7N9) virus A(H7N9) virus. . . . N N N NH H H HFPC organized experts to confirm the 3 cases of H7N9 FPC organized experts to confirm the 3 cases of H7N9 FPC organized experts to confirm the 3 cases of H7N9 FPC organized experts to confirm the 3 cases of H7N9 human infections human infections human infections human infections N N N NH H H HFPC notified WHO of the epidemic and released the FPC notified WHO of the epidemic and released the FPC notified WHO of the epidemic and released the FPC notified WHO of the epidemic and released the information to the public information to the public information to the public information to the public China CDC isolated the virus China CDC isolated the virus China CDC isolated the virus China CDC isolated the virus China CDC found the RT China CDC found the RT China CDC found the RT China CDC found the RT-

• PCR test result of the sample

PCR test result of the sample PCR test result of the sample PCR test result of the sample positive positive positive positive

March March March March

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Shanghai reported 3 cases of pneumonia with unknown cause Shanghai reported 3 cases of pneumonia with unknown cause Shanghai reported 3 cases of pneumonia with unknown cause Shanghai reported 3 cases of pneumonia with unknown cause Anhui CDC delivered Anhui CDC delivered Anhui CDC delivered Anhui CDC delivered pharynx pharynx pharynx pharynx-

• mop sample of one case to

mop sample of one case to mop sample of one case to mop sample of one case to China CDC China CDC China CDC China CDC Shanghai CDC delivered Shanghai CDC delivered Shanghai CDC delivered Shanghai CDC delivered pharynx pharynx pharynx pharynx-

• mop sample of 2 cases to

mop sample of 2 cases to mop sample of 2 cases to mop sample of 2 cases to China CDC China CDC China CDC China CDC

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Number of H7N9 Human Infections

（ （ （ （as of Aug 10） ） ） ）

Province Province Province Province Total Total Total Total Outcome Outcome Outcome Outcome Discharged Discharged Discharged Discharged In Hospital In Hospital In Hospital In Hospital Dead Dead Dead Dead Beijing Beijing Beijing Beijing 2 2 2 2 2 2 2 2 Hebei Hebei Hebei Hebei 1 1 1 1 1 1 1 1 Shanghai Shanghai Shanghai Shanghai 33 33 33 33 15 15 15 15 18 18 18 18 Jiangsu Jiangsu Jiangsu Jiangsu 2 2 2 28 8 8 8 17 17 17 17 2 2 2 2 9 9 9 9 Zhejiang Zhejiang Zhejiang Zhejiang 46 46 46 46 35 35 35 35 11 11 11 11 Anhui Anhui Anhui Anhui 4 4 4 4 2 2 2 2 Fujian Fujian Fujian Fujian 5 5 5 5 4 4 4 4 1 1 1 1 Jiangxi Jiangxi Jiangxi Jiangxi 6 6 6 6 5 5 5 5 1 1 1 1 Shandong Shandong Shandong Shandong 2 2 2 2 2 2 2 2 Henan Henan Henan Henan 4 4 4 4 3 3 3 3 1 1 1 1 Guangdong Guangdong Guangdong Guangdong 1 1 1 1 1 1 1 1 Hunan Hunan Hunan Hunan 2 2 2 2 1 1 1 1 1 1 1 1 Taiwan Taiwan Taiwan Taiwan 1 1 1 1 1 1 1 1 Total Total Total Total 13 13 13 135 5 5 5 87 87 87 87 4 4 4 4 44 44 44 44

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Clinical Attributes

• Exhibit such flu symptoms as fever and cough at the outset.
• Lab test found out a normal or decreased level of PBL, deceased level of

lymphocyte and platelet.

• A significant proportion of the cases developed into severe pneumonia

and worsened in one or two days. Some cases developed into stubborn hyoxemia and multiple organ failure which lead to death.

• Cases of light ailments and pathogen carriers were found, showing

possibility of silent affection.

Geographical Distribution (Jun 30)

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Most Cases Are Sporadic

• 135 cases，

， ， ，most cases are sporadic.

• Out of the near 3000 close contacts in the 135 cases, except 4 family clusters,
• thers are normal.
• The 3 family clusters can not exclude the possibility of limited human to human，

， ， ， 1 family cluster can not exclude the possibility of co-exposure.They don't change

• ur judge at public health risk

– Shanghai case: spouse – Shanghai cases: father and son – Jiangsu cases: father and daughter – Shandong cases: father and son

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Etiological Attributes

H7N9 virus is a new reassorted bird flu virus. The virus strain from human cases are highly isogenous with that from the birds (pigeon and chicken). According to test by China CDC, there is no generic mutation of the genes of the 39 collected virus strains. As reported by Chinese Ministry of Agriculture, the virus is not pathogenic for birds.

Exposure to Birds or Live-poultry Markets

Exposure Exposure Exposure Exposure Cases Cases Cases Cases Percentage (%) Percentage (%) Percentage (%) Percentage (%) Yes Yes Yes Yes 94 70 70 70 70 No No No No 41 3 3 3 30 Total Total Total Total 135 100

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Response Strategy and Prevention and Control Measures

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Safeguard Human Health Safeguard Human Health Safeguard Human Health Safeguard Human Health

Key priorities Key priorities Key priorities Key priorities Scientific Scientific Scientific Scientific response response response response Differentiated Differentiated Differentiated Differentiated guidance guidance guidance guidance

Goal & Principle

Enhance ICU care Enhance ICU care Enhance ICU care Enhance ICU care

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International International International International Health Regulations Health Regulations Health Regulations Health Regulations (2005) (2005) (2005) (2005)

Response to H7N9 human infection Response to H7N9 human infection Response to H7N9 human infection Response to H7N9 human infection

Legal Basis

State Emergency State Emergency State Emergency State Emergency Preparedness Plan Preparedness Plan Preparedness Plan Preparedness Plan for Pandemic for Pandemic for Pandemic for Pandemic Influenza Influenza Influenza Influenza

Law on Prevention Law on Prevention Law on Prevention Law on Prevention and Control of and Control of and Control of and Control of Infectious Diseases Infectious Diseases Infectious Diseases Infectious Diseases Regulations on the Regulations on the Regulations on the Regulations on the Response to Public Response to Public Response to Public Response to Public Health Emergencies Health Emergencies Health Emergencies Health Emergencies

Prevention & Control Measures（1 ）

• Multi-level joint prevention and control working mechanism

Joint prevention and control working mechanism Joint prevention and control working mechanism Joint prevention and control working mechanism Joint prevention and control working mechanism N P F P C

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Qu alit y Sup ervi sio n, Ins pec tion & Qu ara ntin e

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Hu ma n Re so urc es an d So cial We lfar e Ar me d Pol ice & Ar my

Regional joint prevention and control working mechanism Regional joint prevention and control working mechanism Regional joint prevention and control working mechanism Regional joint prevention and control working mechanism Intro Intro Intro Intro-

• provincial joint prevention and control working mechanism

provincial joint prevention and control working mechanism provincial joint prevention and control working mechanism provincial joint prevention and control working mechanism Joint prevention and control working mechanism of professionals Joint prevention and control working mechanism of professionals Joint prevention and control working mechanism of professionals Joint prevention and control working mechanism of professionals State Inter- province Provincial level Professional

Prevention & Control Measures （2）

• Treat and cure at full power

– Develop diagnosis and treatment protocols – Develop technical plans for hospital infection control – Guide localities · early detection, early reporting, early diagnosis

and early treatment

• Treat cases at local level, differentiated guidance,

pooling expers andresouces for concentrated treatment, combination of Chinese and western medicine

– On May 5, new anti-flu medicine Peramivir was allowed to the market.

Prevention & Control Measures （3）

• Close livestock market to reduce

human-to-bird contact

• Regulate transportation of live

birds to control bird-to-bird infection.

Prevention & Control Measures （4）

• Enhance epidemic surveillance

– Health departments enhanced surveillance of pneumonia with unknown cause, flu-like cases and etiology – Agricultural departments lifted control levels and enhanced surveillance and test on animals – Forestry departments enhanced test and surveillance on diseases of wild animals – Enhanced test on live birds and bird food supplied to Hong Kong and Macau

Prevention & Control Measures （5）

• Consolidate findings on epidemic situation

– Conducted risk assessments – Experts in China CDC held daily meetings on the epidemic since the first case was reported.

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Prevention & Control Measures （6）

• Enforce prevention & control measures:

– Develop prevention and control plan on H7N9 human infection – Guide localities to enhance source tracing, logistics, health procedure, surveillance and inspection – Conduct training on health workers at all levels, organize multi-sector joint supervision

Prevention & Control Measures （7）

• Information release and risk

communication

– Release latest news on epidemic timely – Timely notification of the epidemic to WHO, FAO, OIE, related countries, and Hong Kong, Macau, Taiwan regions – Spread prevention and control knowledge

Prevention & Control Measures （8）

• Strengthen R&D

– Establish H7N9 prevention & control research taskforce

• Diagnosis technology, vaccine, etiology,

epidemiology, clinical treatment, and animal model.

• Provide virus strain to China’

’ ’ ’s Hong Kong and Taiwan regions timely.

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Prevention & Control Measures （9）

• Strengthen international cooperation

– Closely communicate and cooperate with WHO、 、 、 、FAO、 、 、 、OIE and other international organizations.

• Hold conferences with foreign experts to discuss the epidemic situation
• Hold joint press conference with WHO to release information on the

epidemic situation and prevention and control measures

• Invite international experts to investigate the epidemic situation and

responses

– Timely share the data of the virus’s genetic sequence, diagnosis plan and virus strain with the international community

Initial Achievements

• Since May, there have been decreasing new cases.
• Since late Jun，

， ， ，normalization management phase.

• According to WHO’s joint investigation team, the Chinese government’s

response to the epidemic is well-prepared, rapid, effective and professional.

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Findings from Current Cases

H7N9 virus is pathogenic to human but not birds. Virus infection is mainly caused by infected birds or their

• environment. Exposure to birds or live-poultry markets is a key risky

factor. Human infections with H7N9 are still sporadic. There has been no virus mutation. There has been no qualitative change of the epidemic. The avian influenza A (H7N9) is preventable and controllable. Until the traditional sources are completely under control, new cases and new locations may still pop out. Our knowledge about the virus and the disease is still limited, so we should remain vigilant.

Next Step Priorities 3

Next Step Priorities

• Continue to play the role of the joint prevention and control mechanism,

enhance inter-sector information exchanges and coordinated actions.

• Continue to control the infection sources and contain the spreading of the

epidemic.

• Ensure early diagnosis and treatment, consolidate treatment of severe cases and

reduce deaths.

• Strengthen surveillance and provide information to the judgment on the epidemic.
• Reinforce source tracing of the epidemic
• Keep information open and transparent and announce the relevant information

timely.

• Continue to enhance research on diagnosis technology, vaccine, etiology and source

tracing, epidemiology, clinical treatment, and animal model, etc.

• Keep active cooperation and exchange with the international organizations.
• Improve various preplans and get better prepared.

Eerging infectious diseases, such as avian influenza A(H7N9), are common challenges to humanity. The international community needs to work actively to strengthen the institutional capacity building of public health, facilitate epidemic communications, exchange experiences in prevention, control and treatment, share scientific findings, and jointly cope with epidemic threat. We are ready to join hands with all countries to curb any emerging infectious disease and protect life and health.

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THANKS! THANKS! THANKS! THANKS!