Anyone else keeping a little eye on the new flu virus?

[OhYouBadBadKitten]

Seems that we have a newly emerging avian flu virus in the Shanghai region of China. Utterly unrelated to H5N1, this one is an H7N9 strain and never been seen before in humans. I spotted it at the beginning of the week (while ironically looking for the latest news on the new corona virus -emerging diseases are a bit of an interest of mine)

So far it has killed 6 and 14 are officially declared to be infected. It seems to have first popped up mid February but since identified at the weekend the cases seem to be starting to pop up quite quickly.

From what I've read it's a low pathogen avian flu, which means that it doesn't tend to kill birds off, but it has aquired genes which are adapted to mammalian infection. (Flu viruses are great at swapping genes amongst themeselves) Yesterday the Chinese authorities said they have found it in pigeons in a market and so are closing down poultry markets in the area.

Some are linking it to the 14,00 pig deaths found in rivers in shanghai in mid march and indeed pigs can be a good carrier of some flu strains, but authorities say they haven't found any evidence of flu in the pigs though they still don't know what killed them.

WHO currently say there is no evidence of sustained human to human transmission. It could stay that way, lots of viruses don't really adapt properly to a species and fade out. On the very positive side, scientists are really alert to emerging viruses now and detect new ones very quickly. This means that alerts go up very quickly about diseases that fail to get hold in the human population. So hopefully it may well be the same with this virus.

[saintlyjimjams]

It does look very new! And quite nasty.

[OhYouBadBadKitten]

I found a treasure trove of links on emerging diseases here but I'm actually after a new book.

[OhYouBadBadKitten]

And half the links don't work or are outdated. Oh well

[ripsishere]

I am pretty concerned about it TBH. We are in Malaysia, I don't think there have been any cases here. Yet.
We live in a very student area, a lot of the students are from mainland China.
One of the children at DDs school, visited China a couple of months ago and came back with H1N1.

[HollyMadison]

I'm keeping an eye on it too as I live in Singapore. It's a very long way from Shanghai but there is so much travel between here and China. It's big news in Singapore and the authorities work hard to try to protect Singapore as much as they can. Employees at DH's work have been asked to notify management if they are going to be traveling to China or HK (we were thinking of visiting Beijing next month but changed plans). I guess so they can make contingency plans if anyone gets ill.

A Chinese friend has just had some sort of smoked Beijing duck product confiscated at the airport on the way in to SG. Chinese people often bring back food when they go back to china but no idea why she thought that particular product was a good idea at the moment!

[4pinkbabies]

We live in Shaghai. Every year at the same time there is an outbreak of a different variety. We have guidelines at school and from officials. I was on the metro last weekend and many people were wearing masks, then an old man got on and started shouting at everyone to take them off. We are avoiding the wet markets and are always careful about where we buy our food. We can never really relax here..there is always a crisis of some sort going on. I am more worried about Korea than this.

[meditrina]

The bloody Govt have moved the highly informative JCVI website to the useless slimmed down gov.uk site, removed most of the archive and changed their downloads so my iPad doesn't do them any more. Ugh. Are they trying to hide information?

Or does anyone know if the lovely 'old' site still exists, or the level of info posted on it is ow posted elsewhere (maybe a .ac site?)

For outbreak monitoring used to be on there, plus full minutes of meetings on decision making about influenza vaccine policy for NHS.

Currently, the most recent minutes on anything are from October 2012 and there are non whatsoever from the flu sub committee.

[laptopwieldingharpy]

Checking in from Hong Kong, where health authoruties have issued recommendations to step up precautionary measures such as sanitising door handles, buttons in lifts etc........at morebregular intervals.
We received leaflets through the post and we see a few more posters and sanitising solution dispensers in public buildings......

Nothing to loose sleep over, they do this regularly for example when there is an outbreak of HFM in kindergartens etc....
Like in Singapore its reassuring to see that health authorities here are quite pro-active and have specific levels of response that kick in quickly.

And everyone respects the guidelines. At the first sneeze they put on face masks. Am always amazed at how good even small children are compliant.

I id see live poultry at wanchai market this morning though.....So does not seems too serious just yet.

[ripsishere]

No news about any cases in Malaysia and no advice about anything either.
I saw a man with a load of live chickens in boxes on the back of his motorbike.

[OhYouBadBadKitten]

4pink, i did wonder whether Korea would be shadowing things there.

I think we are up to 38 cases and 10 deaths. It is very evident that the news is being ,managed' as there are reported to be around 12 people being detained for spreading false rumours. At the moment it is said to still be just limited human-human with most infections coming animal-human. They still seem to be insisting it is birds, but it seems interesting that the virus seems to have genetic changes suggesting mammalian adaptation, so I think the argument that there has been a mammal host is still quite a strong one.

Another flu watch forum

Thank you to everyone who is posting from the region, it gives an insight that fascinating and informative. I think that since SARS HK have become very vigilant and it seems to be a bit of a 'first post' for viruses that have been brewing in China.

[OhYouBadBadKitten]

Meditrina, the irony of a government site called 'transparency' being shut down is stark!

[OhYouBadBadKitten]

Interesting FOI request meditrina. Looks like they might not publish them anymore

[OhYouBadBadKitten]

Oh dear. 48 cases reported, which if accurate is still a good sign that its not going human to human in general. Unfortunately the first case in Beijing has been reported:a 7 year old girl who's parents trade in poultry.

[OhYouBadBadKitten]

Up to 61 cases now and an interesting development, a boy across the road from the little girl in Beijing is reported to have tested positive even though he is currently asymptomatic.

Also some evidence that some of the tests are giving false negatives and its only a few days later when they do deep lung tests are they finding h7n9 so there could be lots more like the little boy ( conjecturing at this point!) who have it but are asymptomatic and perhaps testing negative. Perhaps this is a virus that for many causes no issues but for some unlucky ones severe illness. Pure speculation of course!

[spacechimp]

Should the false negatives and asymptomatic case be seen as worrying for potential to spread or reassuring that severity might be less than seems the case when looking at numbers hospitalised? I guess maybe both. I'm quite concerned about this but not sure whether I'm right to be. Was initially not too worried as UK media reports reassuring but looking at updates on twitter from WHO, science journalists and others makes me wonder. I am not at all scientific but am interested in health related stuff, also have a tendency to worry. Kitten you seem well informed and logical - what do you think about situation as it is now, and as it might develop?

[MasterOfTheYoniverse]

Quick update, in Hong Kong some kindergsrdens have sent home notices to keep ill children at home but there are no compulsory temperature checks.

I also went to visit a friend in hospital this morning and people come and go without any screening at all as would be the case should matters escalate.
My friend actually is being treated for a pulmonary problem and the Dr only advised him to avoid wet markets were live poultry is sold+ reassured him that tamiflu seems to effective.

So thinking you are likely to be quite safe in the UK.

[OhYouBadBadKitten]

Thanks Master :) good to get an update from the region! Unfortunately one of the 3 samples of flu virus that China have issued outside the country (why arent they releasing more?) has a tamiflu resistant gene in it.

spacechimp, I think you are right - both is the right answer. We certainly don't want a virus out there with such an apparent high fatality rate (14 deaths out of 62 reports but most of those having had to spend time in critical care). But if we have a novel flu virus spreading silently and only affecting some severely, whilst that looks good, it does give the virus more chance to re-assort (flu viruses like swapping genes with other strains of flu) and that makes it more unpredictable.

The good news is that it doesn't seem to have escaped the borders and HK and Taiwan have superb surveillance so we will know if it does escape pretty quickly.

China do appear to be asking for help from international experts: [[
www.bloomberg.com/news/2013-04-14/china-said-to-invite-four-flu-experts-as-disease-outbreak-widens.html bloomberg report]]

I really wouldnt like to conjecture about what might happen, lots and lots of new viruses emerge each year and most stay confined to the region and then burn out or pootle away in the background. Its only down to technology that we have such a grasp on what is happening and its probably distorting our risk perception. It is a concern, and I've read that it is more concerning than h5n1, but we really just dont know.

I keep reminding myself that h1n1 first looked pretty horrific when it started in mexico, but the actual result was an overall very mild pandemic (as flu pandemics go)

[spacechimp]

Thanks Kitten. Hadn't heard about the tamiflu resistant gene in one of the samples - that doesn't sound good. I've also read that there are more concerns about this than h5n1 because of the re-assortment possibilities and the fact that it has already adapted. What you say about technology making every little development seem like a massive deal makes complete sense and I think it's probably skewing my perception of risk to some extent....but, it is new and unpredictable, and it is spreading in the region. I know the experts don't know how it's going to work out, but it is reassuring that international experts are going to China in the next couple of days, and that HK and Taiwan are so good at surveillance.

I was just thinking about the start of h1n1 - was glued to BBC news channel and the beginnings in Mexico did look pretty horrible, but ended up being the most severe cases rather than the majority. I wasn't using twitter then, so can't compare. I was also thinking about SARS, and how that played out. Not sure that is at all comparable, but just trying to calm myself down. Do flu viruses emerge each year in this way? I guess that with this it is just a case of wait and see, unsettling though that is

[OhYouBadBadKitten]

They do, but the unique thing about this one is that an H7 has never been seen in humans before and that's one of the things that has people looking closely I think.

[OhYouBadBadKitten]

(ought to make it clear that I'm not a health professional, its just a rather strange interest of mine!)

[MasterOfTheYoniverse]

here is the latest in the local press.
The asymptomatic little boy is a real worry

the schools have also started forwarding formal letters from the health authorities (the "surveillance and epidemic centre") to step up hygiene and completely stay away from wet markets.
I cant see that they have banned the trade of live birds yet but its been very hotly debated.

[OhYouBadBadKitten]

Thank you for the update Yoni, very interesting. I don't suppose they would issue that advice lightly.

Since that article was written we are up to 88 reported cases and 17 deaths. It's still not growing (and hopefully) wont in a way that suggests efficient human to human transmission. There does seem to have been a family cluster of 6 but that of course could mean they were all exposed to the same source of infection.

However one concern is that they still don't know what is the natural host. Forty percent of cases are reported not to have had contact with poultry and despite the huge number of avian samples that have been taken very few cases of infections in birds have been found relatively. And they don't share the exact gene pattern as the human infections, there is that switch in there of a gene that shows it has adapted to mammals.

Who knows which way this will go - hopefully it will just vanish after this season and end up a biological curiousity but from what I've seen I can understand why the experts are becoming concerned.

[OhYouBadBadKitten]

First case has been discovered in Taiwan in a traveller. Worryingly he tested negative twice before testing positive, showing how unreliable the tests are. No reported interactions with any birds.

Still very few detections of infection in birds despite intensive investigations.

China report 109 infections and 22 deaths.

[Meglet]

I preferred it when you were talking about snow oybbk

[OhYouBadBadKitten]

Looks like we have creative news reports.

Taiwanese version chap didn't seem to go to hospital for a few days after returning to Taiwan.

Chinese report infers he was intercepted at the airport.

Someone appears to be muddled!