Response to Human Infection with Avian Influenza A(H7N9) Virus Liu Zhiqiang Heanlth Emergency Response Office National Health and Family Planning Commission of P. R. C. (NHFPC) Aug 13, 2013 1
Content Overview of the epidemic 1 Response strategy and prevention and 2 control measures Next step priorities 3
Overview of the epidemic 1 3
Detection, Confirmation and Notification of the Epidemic 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 22 22 22 22 Shanghai CDC delivered Shanghai CDC delivered pharynx pharynx- -mop sample of 2 cases to mop sample of 2 cases to Shanghai CDC delivered Shanghai CDC delivered pharynx pharynx - - mop sample of 2 cases to mop sample of 2 cases to 24 24 24 24 China CDC China CDC China CDC China CDC Anhui CDC delivered Anhui CDC delivered Anhui CDC delivered pharynx Anhui CDC delivered 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 25 25 25 25 China CDC China CDC China CDC China CDC China CDC found the RT- China CDC found the RT -PCR test result of the sample PCR test result of the sample 26 26 26 26 China CDC found the RT China CDC found the RT - - PCR test result of the sample PCR test result of the sample positive positive positive positive March March March March 28 28 28 28 China CDC isolated the virus China CDC isolated the virus China CDC isolated the virus China CDC isolated the virus 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 29 29 29 29 A(H7N9) virus. A(H7N9) virus A(H7N9) virus A(H7N9) virus . . . N N N NH H HFPC organized experts to confirm the 3 cases of H7N9 H 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 30 30 30 30 human infections human infections human infections human infections 31 31 31 31 N N NH N HFPC notified WHO of the epidemic and released the H H 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 4
（ （ as of Aug 10 ） （ （ ） ） ） Number of H7N9 Human Infections Outcome Outcome Outcome Outcome Province Province Province Province Total Total Total Total 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 0 0 0 0 0 0 0 0 Hebei Hebei Hebei Hebei 1 1 1 1 0 0 0 0 1 1 1 1 0 0 0 0 Shanghai Shanghai Shanghai Shanghai 33 33 33 33 15 15 15 15 0 0 0 0 18 18 18 18 Jiangsu Jiangsu Jiangsu Jiangsu 2 28 2 2 8 8 8 17 17 17 17 2 2 2 2 9 9 9 9 Zhejiang Zhejiang Zhejiang Zhejiang 46 46 35 35 0 0 11 11 46 46 35 35 0 0 11 11 Anhui Anhui Anhui Anhui 4 4 4 4 0 0 0 0 0 0 0 0 2 2 2 2 Fujian Fujian Fujian Fujian 5 5 5 5 4 4 4 4 0 0 0 0 1 1 1 1 Jiangxi Jiangxi Jiangxi Jiangxi 6 6 6 6 5 5 5 5 0 0 0 0 1 1 1 1 Shandong Shandong Shandong Shandong 2 2 2 2 2 2 2 2 0 0 0 0 0 0 0 0 Henan Henan Henan Henan 4 4 4 4 3 3 3 3 0 0 0 0 1 1 1 1 Guangdong Guangdong Guangdong Guangdong 1 1 1 1 0 0 0 0 1 1 1 1 0 0 0 0 Hunan Hunan Hunan Hunan 2 2 1 1 0 0 1 1 2 2 1 1 0 0 1 1 Taiwan Taiwan Taiwan Taiwan 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 5 Total Total Total Total 13 13 13 135 5 5 5 87 87 87 87 4 4 4 4 44 44 44 44
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. 6
Geographical Distribution (Jun 30)
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, others 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 our judge at public health risk – Shanghai case: spouse – Shanghai cases: father and son – Jiangsu cases: father and daughter – Shandong cases: father and son 8
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. 9
Exposure to Birds or Live-poultry Markets Cases Cases Exposure Exposure Exposure Exposure Cases Cases Percentage (%) Percentage (%) Percentage (%) Percentage (%) 70 70 Yes Yes Yes Yes 94 70 70 No No No No 3 30 3 3 0 0 0 41 Total Total Total Total 135 100
Response Strategy and 2 Prevention and Control Measures 11
Goal & Principle Safeguard Human Health Safeguard Human Health Safeguard Human Health Safeguard Human Health Enhance ICU care Enhance ICU care Enhance ICU care Enhance ICU care Scientific Scientific Scientific Scientific Differentiated Differentiated Differentiated Differentiated Key priorities Key priorities Key priorities Key priorities response response response response guidance guidance guidance guidance
Legal Basis Law on Prevention Law on Prevention Law on Prevention Law on Prevention State Emergency State Emergency State Emergency State Emergency and Control of and Control of and Control of and Control of International International International International Preparedness Plan Preparedness Plan Preparedness Plan Preparedness Plan Infectious Diseases Infectious Diseases Infectious Diseases Infectious Diseases Health Regulations Health Regulations Health Regulations Health Regulations for Pandemic for Pandemic for Pandemic for Pandemic Regulations on the Regulations on the Regulations on the Regulations on the (2005) (2005) (2005) (2005) Influenza Influenza Influenza Influenza Response to Public Response to Public Response to Public Response to Public Health Emergencies Health Emergencies Health Emergencies Health Emergencies Response to H7N9 human infection Response to H7N9 human infection Response to H7N9 human infection Response to H7N9 human infection 13
Prevention & Control Measures （ 1 ） • Multi-level joint prevention and control working mechanism State Joint prevention and control working mechanism Joint prevention and control working mechanism Joint prevention and control working mechanism Joint prevention and control working mechanism Sta Stat Mi Mi e te nis Mi nis Ad Sta try Ad Sta try m. te nis of of of Mi Mi m. te Ar In Ad N Hu CP try Mi Qu du m. N nis nis of Ad Fo me ma alit str Of C of nis e n y y try try In m. res d Tr P Re Pr Sci an try Sup adi ws of of du of try Pol d so ervi tio F op en of Inf urc sio Ci Ag str Fo Bu nal ice O or es n, aga ce Fin Ch P ma vil ric y od rea & an Ins ffi ine tio nd an anc d pec Aff ult C & & u se Ar n So tion a d e Te ce Me airs cial ure Co Dr my & ch dic Te We Qu nol ine m ug lfar ara og ch Inter- e y Regional joint prevention and control working mechanism Regional joint prevention and control working mechanism me ntin Regional joint prevention and control working mechanism Regional joint prevention and control working mechanism e province rce Provincial Intro- Intro -provincial joint prevention and control working mechanism provincial joint prevention and control working mechanism Intro Intro - - provincial joint prevention and control working mechanism provincial joint prevention and control working mechanism level Professional 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
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