# #H7N9 Influenza



## westend (Jul 11, 2012)

Given the pace of this outbreak, I thought it might be good to open a simple, umbrella thread instead of adding to the thread that references the CDC EOC activation.

Over the last twelve hours the case count in China jumped by nine, includes the husband of one of the fatalities, and a new province. 60 confirmed cases total as of about three hours ago.

There are rumors, just early reports, of the mother of the case in Beijing being hospitalized...we should no more about that by tomorrow.

Some of the increase in case numbers is because the testing kits for this flu have just been distributed more broadly --they are testing more and because of that, finding more cases. This was expected.

What is not known right now is...

1. The "base number"...the true scope of infection. It is impossible to know how many mild cases there have been without taking blood samples. Even then it takes several weeks to have the antibodies show up. Right now, close associates of the ill are being interviewed to determine potential illness. Without the base number it is hard to know the scope and the severity of the disease.

2. The source. Despite widespread testing, the definitive source still has not been found. Some positive samples in healthy ducks, pigeons, and chickens have been found, but they are low intensity positives. This means the virus is in the environment and that birds are carrying the virus and not getting sick. This makes it very hard to control the outbreak.

3. The full extent of the mutation in the virus. The virus has adapted to mammals and cells in the upper respiratory tract, but at least at the moment, it is not easily communicable. 

This outbreak is developing quickly, but there is still no clear evidence that this will break towards a full pandemic strain. Something worth watching.


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## westend (Jul 11, 2012)

China invites flu experts (these are some of the best in the business world-wide) in to further the investigation:
http://www.bloomberg.com/news/2013-...r-flu-experts-as-disease-outbreak-widens.html

Also, just being reported, another child in Beijing has been reported (still to be confirmed...they test and retest these cases). http://www.flutrackers.com/forum/showthread.php?t=203835


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## Maura (Jun 6, 2004)

I'll be buying more vitamin C. Though massive doses should be given intravenously, I will be using tablets.


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## Astrid (Nov 13, 2010)

By the way, I would be highly suspect of the low numbers of flu cases. Having worked in China I know about the medical system there and anyone that has any brains will avoid admitting they have a problem until it gets bad enough to ask for medical attention. In the last few days it jumped from Shanghai to Beijing which is over 600 miles away. That doesn't happen without a lot of cases in between. Additionally, this flu was proven to have mutated into a human flu and is no longer considered a bird flu by Yoshihiro Kawaoka the Japanese flu researcher that UWisc has. 

http://www.asianscientist.com/in-the-lab/h7n9-bird-flu-strain-adapted-humans-2013/


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## Helena (May 10, 2002)

My PA suggested that I actually get this vaccine..haven't yet..don't know if it is needed..???


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## westend (Jul 11, 2012)

Helena -- Maybe your PA meant the normal flu vaccine (a bit different and needed each year)?

There is no vaccine for H7N9. Not even close to being created. Intense research is being done now for an effective seed vaccine...that will take weeks to a couple of months. Once an effective vaccine is created, then it will be produced. With H7 base flu (not this one, a cousin) that has been extraordinarily difficult in the past. There has never been H7N9 in people or mammals. 

Once a seed vaccine is created, then it can go into production which will take many months and compete with the limited production capacity, a difficult choice between deciding to produce the seasonal vaccine or a pandemic vaccine will have to be made. That decision on producing the H7N9 vaccine will not be made until it is overwhelmingly clear that the virus is a pandemic strain.

---

As far as the jump to Beijing and other provinces...best guess right now is that the source host is wild birds. Wild birds that are currently migrating. 

And there is overwhelming agreement that there are many cases not reported (that base number). People who never got sick but had it or people who had milder cases and recovered. Hard to sort that out. It took 3 years to determine the true scope of the 2009 H1N1 pandemic --turns out 1 out of 5 had the virus, it was just a mild pandemic strain. 

With flu you can be carrying and shedding virus for days before showing any symptoms. Adding to the difficulty. Everyone fully expects the spread of the virus to continue at this point.

Still not acting like it is easily transferred between humans though, one small good thing.

And yes. This is no longer really a "bird flu", it's not making birds sick. It is heavily adapted to mammals at this point, with undetermined hosts in the environment.


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## where I want to (Oct 28, 2008)

I appreciate this information. Thank you.


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## ovsfarm (Jan 14, 2003)

In my opinion, now is the time for all good preppers to calmly check on their flu supplies and procedures. 

This is a good general reference: http://www.getpandemicready.org/Portals/5//downloads/flu_manual.pdf I printed this one out for my Emergency Notebook.

And this one is pretty intense, for the more hard core prepper: http://crofsblogs.typepad.com/h5n1/files/ComingPandemic.pdf I printed select portions of this one but realize that it is not for everyone's sensibilities.

Every time I hear of a new flu strain that is becoming a threat, I review these two articles and my list of meds and supplies I want to have on hand. Then I check my cabinets and make sure I still have plenty of them. If need be, I can go to the stores and restock while there are still ample supplies on the shelves. That way I am not out there, having to fight for the last bottle of electrolyte replacement on the shelf with some other desperate, terrified person, if the threat mushrooms overnight and becomes a BIG deal all of a sudden.

Once my supplies are in place, I can calmly watch and wait to see what happens. If the threat dies down as quickly as it popped up, no harm due to my having refreshed my supplies. If it does become a big deal, or a BIG deal, then I am prepared and able to stay home and avoid potential exposure, thus increasing my family's chances for survival.


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## unregistered29228 (Jan 9, 2008)

Thanks for the links - I'm printing off some of the first one just as a double check for my supplies. I have a "sick pack" already made up and ready for whatever family member comes down with something. I have it in a hall closet so it's ready to grab and go immediately. It has a large supply of nitrile gloves, N95 masks, homemade pedialyte, hand sanitizer, Lysol spray. I also have hospital gowns, vomit basin, extra sheets and blankets, thermometer, stethoscope (to check for pneumonia mainly), flashlight, baby wipes, battery operated fan, hot hands, notebook and pencil, and all kinds of OTC meds. My plan is to isolate the sick person in a bedroom and have one person care for them (probably me) so the exposure is limited. 

The one thing I'm missing is a couple of those waterproof pads for the bed - in case someone vomits, pees or poops, or sweats. And after looking at this article, I need to get some squeeze bottles for administering liquids, or at least add some straws.


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## westend (Jul 11, 2012)

ovsfarm ...those are great. MomofFour, you've got a really great plan. 

I did something similiar. Just a quick inventory and rounded out things like bleach, soap and detergent, papertowels, and clorox wipes (I keep one in the car for after gas pump handles and the steering wheel), tea, and other supportive items.


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## Rainy (Jan 21, 2010)

Still watching all the news about this very closely...and checking all my med.preps, i have to pick up some things this week that i thought i had but have used it all...


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## lorian (Sep 4, 2005)

I always have flu prep on hand and it includes generous amounts of herbal tinctures like goldenseal for infection and slippery elm for stomach issues.


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## westend (Jul 11, 2012)

Best article of the day: http://www.nature.com/news/h7n9-bird-flu-poised-to-spread-1.12801

Declan Butler has been at this a long time, one of the best.


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## ovsfarm (Jan 14, 2003)

Thank you for the link. That is a good, factual, non-sensationalized account of what is going on, and I really appreciate that! It can be so hard to separate the hype - at both ends of the spectrum - from reality. Oh how I wish the media would promote guys like this author instead of the "We're all going to die!" or the "It's no big deal, stop living in fear." guys.


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## westend (Jul 11, 2012)

Trying to keep it pragmatic . There are some really good investigative journalists as well as flu researchers that are the ones I watch for information, not hype. Too much sensationalism in our world today or like you said, discounting of real situations.

Helen Branswell is another journalist who has been in the thick of things for almost two decades. Here is her article in Scientific American today. Sane, serious.

http://www.scientificamerican.com/a...zzling-new-bird-flu-should-be-taken-seriously


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## westend (Jul 11, 2012)

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/apr1613china.html

Detailed summary of the case counts as of today.


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## westend (Jul 11, 2012)

CIDRAP has created a page for the outbreak. It will be updated often. H7N9 resources including graphs of the development of the situation.

http://www.cidrap.umn.edu/cidrap/content/influenza/h7n9/resources/h7n9_resources.html


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## manygoatsnmore (Feb 12, 2005)

When you start seeing family members of known cases also coming down with the virus, it makes you wonder if they caught it the same way as the original victim, or if it is starting to mutate into person to person transmission. Worrisome, as I'm a hospital RN, and hunkering down/sheltering in place is not an option for me.  The death rates so far are high in the number of confirmed cases...hopefully that only means that many mild cases are just not reported and the actual death rate per infection is much lower, more in line with average flu strains.


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## westend (Jul 11, 2012)

yeah... They did find a fully asymptomatic case (4yr old) in Beijing, but they found him by total accident. They are not testing contacts of severe patients. They have been interviewing them..asking if they have been ill. Given during SARS they locked up people who had been sick or weren't but carried, so the answer, of course is "no, I'm fine". 

Until they start requiring a test of contacts, there is no way to know how far this has spread. 

In addition, there is some concern that PCR test (swab) is not the best test and there is no blood test for this strain yet. 

The diagnostic situation combined with still not having the source, is making this unique and difficult.


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## westend (Jul 11, 2012)

Great article by Helen Branswell this morning that deals with the issue of not finding the source of H7N9 (and why it matters). http://www.canada.com/health/positives+tests+poultry+pigs+question+Where+H7N9/8258923/story.html

And yes, the case count jumped again overnight. So far, this one continues.


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## westend (Jul 11, 2012)

Ok folks. We have a little escalation today. We shouldn't read too much into it, but it is a step.

This afternoon the CDC called a conference call with medical providers nationwide to put out new, interim, guidance on the treatment of _potential_ H7N9 infections. Advising all providers to treat undetermined flu-like illness and/or severe respiratory disease in people who have been to China or are close to someone that has been to China, aggressively and as if it was H7N9. This is for patients that when tested don't have a conclusive diagnosis. (This is the "better to treat early and hard while tests are being confirmed even if it turns out to be harmless" approach).

In addition to treatment guidelines, the CDC advised all medical providers and organizations to review and revise their pandemic plans. (This is not something they go around doing on an average day).

We aren't in a pandemic yet. But the CDC is leaning well forward now. 

Scott McPherson who is the CIO for the State of Florida and been through a cycle or two of pandemic planning in his state, took some notes. http://www.scottmcpherson.net/journ...ly-looking-for-h7n9-in-the-united-states.html

If you are a healthcare provider, it might be time to ask your facility if they were on the call and what their take on this new outbreak and the CDC guidance is...


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## LonelyNorthwind (Mar 6, 2010)

so... 16,000 dead pigs and thousands of dead ducks (that they've so far admitted to) thrown into China's rivers followed by this new deadly strain of flu virus a couple weeks later. I suppose there's no connection,... right?


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## OnlyMe (Oct 10, 2010)

Thank you for this information.

Sports "squeeze" bottles can be used for a lot of things. If you need a quick one at home, you can pick up a squeeze bottle of spring water when you are out. If you go to home shows or other such events, often squeeze bottles are promotional giveaways.


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## westend (Jul 11, 2012)

So far there is zero evidence of the dead pigs being connected. And it is very very unlikely given the vast geographic spread of the virus, where patients are originating, and the fact that pigs can carry but rarely die from influenza virus. Also the first cases in people appeared before the pigs started showing up dead in Shanghai. 

The environment is a complete mess of toxins so it makes _that_ investigation difficult. Still a mystery.

Right now they have sampled over 48,000 market birds (chickens, ducks, pigeons) and have around forty weak positives. Either the virus is not being carried widely in domestic birds or the new test is poor (or the testing proceedures). Regardless, if it is in birds, it is not making them sick.

Here is a more comprehensive piece on the CDC announcement today. _Very_ important read. http://afludiary.blogspot.com/


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## ovsfarm (Jan 14, 2003)

So, if I am interpreting the information correctly, this new flu seems to be infecting people in the traditional at-risk age groups (the young and the old) and not following the less standard pattern of taking out healthy early adult populations. Is this what you all are getting also?

So is it correct then to assume that the "cytokine storm" problem with the last flu crisis is less of a concern with this flu, while risk from typical secondary illnesses are a bigger problem with this one?

I want to be sure to stock extra of the right stuff for this flu and not waste my money on medications with a specific shelf life unless there's a high liklihood that I would need them.


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## westend (Jul 11, 2012)

Its just too early to tell right now... the combination of not testing, a poor test, and the fact only the most severe cases seek medical attention, make it impossible to know the true extent of this disease and who it is most likely to infect. 

There are 30/40yr olds showing up in the hospital as well as the elderly. 

The hospitalized cases are suffering from classic secondary pneumonia infection with widespread organ involvement. 

Without knowing where the virus is coming from, this is simply impossible to control and very difficult to predict.


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## westend (Jul 11, 2012)

It's been a helluva week in this country... but this situation continues to develop.

The World Health Organization held a briefing today. Here is the transcript: http://www.wpro.who.int/china/topics/h7n9_influenza/20130419/en/index.html

And this: http://www.npr.org/blogs/health/2013/04/19/177793443/with-bird-flu-right-now-anything-is-possible Solid, non-speculative.


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## where I want to (Oct 28, 2008)

I saw a story about the Dutch researchers saying that the virus had already sufficient genetic diversity to indicate that it had been spreading unobserved for some time.
Does that mean it is less lethal as there are relatively less death per infected popultion than previously thought? Or does it mean that it has recently mutated to something much more dangerous?


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## DryHeat (Nov 11, 2010)

> virus had already sufficient genetic diversity to indicate that it had been spreading unobserved for some time.


Do you have a link to the exact context of the statement? The Erasmus researchers are the real deal on flu situations, but one question I would have on the context would be whether it referenced the spread of H7N9 *including* its animal hosts (wild birds, poultry, pigs, perhaps dogs, cats, rats, and so on), or was limited to the very few full sequence samples (4?) of humans that Chinese researchers have thus far made public. If discussing possible spreading through a number of host species, the diversity in a rather newly-infected human population limited to eastern China could be low with the unobserved spread having been more through those other species. The process of "passaging" as it's called through a newly-infected type of host is often how real dangers arise; the billions of slightly differing viral particles being cranked out inside any one person infected become their own little experiment in natural selection with the variants that just happen to be really good at infecting various cells and spewing out close copies of themselves more likely then to be the ones to infect some other human contacts. The danger of truly initially mild infections is that at some critical mass number of infected hosts, a whole series of these better-adapted versions will also be virulent forms, infecting many tissues quickly, as well as spreading human-to-human more efficiently. The 1918 pandemic may have been like that, spreading as a rather mild disease early in the spring and summer (medical people reportedly even doubted it was the flu at all at first) then blowing up as a deadly form worldwide later in the year. The pattern of this flu is a "tierra incognita," an unknown land that doesn't correspond much to versions we've seen in the past. A lot of recent human spread of a mild form could *in retrospect* turn out to have been no big deal if it fizzles out, and conversely a crushing disaster if it becomes highly contagious between people with a moderately high fatality rate as well.


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## westend (Jul 11, 2012)

From the samples that have been analyzed and the mutations observed, it has the markers for having been mammal adapted for some period of time. Given historical experience, it is likely that the virus has been present but not identified. So far (from what I've read) the Eramus researchers are analyzing human samples. No positive samples have been obtained from any mammal other than humans at this point...and I haven't heard anything about them testing cats for example.

Bottom line it all bits of the puzzle, but no clear picture yet.

The Chinese released more samples into the global databank today. That should help further the analysis.

But truly, given the widespread lack of testing...identifying mild cases is simply not happening. The way flu works however, if you are seeing some number of severe cases it is a general rule that you have many more mild and even asymptomatic cases in the environment.

For those of you who are visually orienteed here is the link to a great graphic from Bloomberg: http://www.bloomberg.com/infographics/2013-04-18/h7n9-bird-flu.html


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## DryHeat (Nov 11, 2010)

This may be the study referenced above?
http://news.yahoo.com/gene-data-show-china-bird-flu-mutated-under-151923439.html


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## hsmom2four (Oct 13, 2008)

Is Sambucol (elderberry syrup) effective for this type flu? I'm very concerned as I have a little one with a heart defect.


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## westend (Jul 11, 2012)

Yes, that is some of the analysis being done... The CIDRAP site I think also has some of the latest.

Sambucol has been called out as a possible supportive anti-viral...not a lot of mainstream data, but I know it was used widely by some when H1N1 was in pandemic stage and people use it as immune support during average flu season. 

I keep some on hand, despite the "evidence", just as a non-toxic, low-risk, might-help kind of thing.


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## westend (Jul 11, 2012)

here we go...more details on who is getting sick. http://afludiary.blogspot.com/2013/04/h7n9-riddle-of-ages.html


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## bama (Aug 21, 2011)

thank you for keeping this updated.


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## DryHeat (Nov 11, 2010)

I've never used the exact brand Sambucol but years ago thought the general reports and minor testing done on it were somewhat encouraging; during a couple of more troubling flu seasons, I've slugged down the less expensive elderberry extract, several brands available on Amazon last I looked.

Let me give a mild caution on Dr. Osterholm and his CIDRAP operations. Early on in the H5N1 spread around 2005 or so, he was one of the most informative and useful voices discussing its dangers, imo. However, over the last four or five years, he's joined up with a fellow named Sandman running a consultant service catering to various governments, the US and China among them, on how to handle "risk communications." This means that Osterholm and by extension CIDRAP have a very large pat of butter on their toast associated with phrasing discussions about influenza and other possible pandemic threats like the new coronavirus in a "carefully parsed" manner. They make money helping TPTB present info to the public in the least-alarming fashion possible, that is, by avoiding the response directions that would lead to discussions of closing schools, limiting travel, closing borders, stocking up supplies for more than a few days (or perhaps a couple weeks max) of sheltering in place... anything that might "panic" the public and lead to unusual patterns in the planned flow of essential supplies through the pervasive just-in-time supply system. Of course, they also facilitate worldwide and high-up governmental policies intended to avoid general economic disruptions, like from travel and tourism drops, avoidance of any particular food item, and especially failures to report to work, collect paychecks, and spend ongoing income in the general economic cycles.

In addition, I suspect that even the best of general reporters and analysts like Helen Branswell and Declan Butler tread carefully with followup questions in these areas. The game obviously is that you can lose access to various sources IF you challenge them on weasel words and parsed language and "things left out" in their carefully-phrased statements.


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## westend (Jul 11, 2012)

DryHeat ...I think the point to be aware of sources and thoughtful of their potential biases is a good one. I've met Peter Sandman and sat through a four day course with him several years ago. His message is generally, at least at that time, one of transparency. Meaning he encourages the governments and organizations he works with to communicate more and in a more effective way. Of course now that I've said I've been in one if his workshops, you might question everything I'm saying 

On the CIDRAP front, I don't think I have seen any change in tone from them or Osterholm since 2005. Still the same boring, geeky scientists. 

The CDC has to parse language much more than any other domestic source, largely because they walk a tough line of being equally accused of scaring people and/or not scaring them (informing them).

I look for changes from these folks and what they are leaving out as much as what they are saying. 

For example. WHO reports started several weeks ago with "there has been no person to person transmission of the virus" to "there is no ongoing person to person transmission of the virus" to "there is no sustained person to person transmission of the virus". Key one word shift.

WHO also lags other sources simply because they have set a bar for themselves that requires considerable testing and confirmation before they will say something is happening. It's methodical and sound science, also sometimes slow. And like the CDC they don't want to be accused of scaring people.

Anyway, all part of the fun...


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## westend (Jul 11, 2012)

The case count reported by the Chinese is 102, the WHO has confirmed 96 of those cases. 

http://crofsblogs.typepad.com/h5n1/2013/04/china-confirms-102-h7n9-cases-21-deaths.html


And more details here: http://afludiary.blogspot.com/2013/04/zhejiang-adds-5-h7n9-cases-2-fatalities.html

The 4 year old boy who was positive for the virus but not sick is NOT included in the Chinese count... I think this is for a variety of reasons on the Chinese side. I think it possible he and the others in Beijing weren't supposed to be actually tested, but interviewed like in Shanghai, but it happend and the doctors then shared what they found. Counting the 4yr old, it would be 103 reported from China. Michael Coston has more at the link above.


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## westend (Jul 11, 2012)

Updated graphic from Bloomberg (current as of today). http://www.bloomberg.com/infographics/2013-04-18/h7n9-bird-flu.html

104 cases now. Still no clear source of the infection despite widespread testing. Also, no clear reason as to why, but of those infected, twice as many men as women have contracted the virus. This is abnormal --flu generally doesn't have a genetic gender lean. Researchers are trying to sort out why more men than women are ill with the virus --some habit, common environmental source or the like.


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## westend (Jul 11, 2012)

Hey all. You need to read this. http://www.nature.com/news/mapping-the-h7n9-avian-flu-outbreaks-1.12863 Amazing maps of current spread and potential spread.

The situation contiunes to progress. Up to 109 confirmed cases now.

There is also this very good (long) article from Laurie Garrett http://www.foreignpolicy.com/articles/2013/04/23/the_big_one?page=0,0

A couple of quotes:
"We are at a mysterious fork in the road. One path leads to years, perhaps decades, of spread of a new type of influenza, occasionally making people sick and killing about 18 percent of them. It's not a pleasant route, strewn as it is with uncertainties, but no terror seems to lurk on its horizon. The other path, however, wrenches the gut with fear, as it brings worldwide transmission of a dangerous new form of flu that could spread unchecked throughout humanity, testing global solidarity, vaccine production, hospital systems and humanity's most basic family and community instincts.
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1985, researchers showed that two key mutations in bird flu viruses occurring simultaneously could switch them to forms capable of spreading among mammals...The H7N9 virus now circulating in China has those mutations
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Nearly all known bird-to-human flu jumps have occurred in rural settings, unfolding on and around farms. But not this H7N9: _This may well be the first truly urban influenza in history._ No infected rural flocks or farmers have been found in China. This outbreak started in one of the most modern, densely populated metropolises in the world: Shanghai.
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The age distribution of H7N9 human cases is striking -- quite unlike any other flu outbreak. Flu generally infects males and females equally, but H7N9 has struck twice as many males as females. (In the over-60 age group, three times as many males, versus females, have been infected.) Bird flus tend to afflict children in large numbers because the youngsters play among ducks and chickens. More than 80 percent of confirmed H5N1 cases, for example, have been in youngsters under 17 years of age. But very few kids have come down with H7N9, and by far the majority of cases have been in adults over 60 years of age. It is unlikely this is due to a unique vulnerability in the bodies of over-60 males. Rather, this may be another clue to the identity of the mysterious viral host -- behaviorally, elderly Chinese urban men are engaged in some activity that puts them at greater contact with the unknown carrier creature.
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To date, only one asymptomatic human carrier -- a 4-year-old child in Beijing -- has been found, and just a handful of patients have had mild flu disease. Nine of the 108 identified cases have been cured -- 99 have either died or still suffer some influenza. These startling clinical numbers point to a very dangerous, lethal virus -- but one that is still hard for people to get, or to spread to other people."
----



​


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## DryHeat (Nov 11, 2010)

Thanks, that article by Garrett is pretty much the best I've seen in the month and a half since the human H7N9 infections began being identified. Also, there's a report this morning that a traveller from Taiwan to mainland China returned there with a H7N9 infection and is hospitalized in critical condition. http://uk.news.yahoo.com/taiwan-confirms-first-case-h7n9-bird-flu-outside-091456862.html#MLqwFE6


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## westend (Jul 11, 2012)

I thought the Garrett article was exceptional --very, very thorough. And yes, the virus has left mainland China and is in Taiwan. The extra kicker on that case was that they had a very hard time getting the diagnosis...the first oral test didn't do it. Luckily, the Taiwanese are taking this very, very seriously.

A little good news today --no new cases in Shanghai announced today.


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## westend (Jul 11, 2012)

Here's a great summary of today's reports and activity, including details on the Taiwan case.

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/apr2413china.html

Good to note that the man in Taiwan has underlying health conditions --perhaps (as in previous flu outbreaks) making him more at risk of infection.


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## westend (Jul 11, 2012)

Update time!

H7N9 continues to spread and knowledge about the virus continues to develop. China CDC has gone to weekly reporting of case numbers to the WHO, but case reports continue daily. 

The CDC released a very detailed update yesterday. The key read is in the editorial section.

The emergence of this previously unknown avian influenza A(H7N9) virus as a cause of severe respiratory disease and death in humans raises numerous public health concerns. First, the virus has several genetic differences compared with other avian influenza A viruses. These genetic changes have been evaluated previously in ferret and mouse studies with other influenza A viruses, including highly pathogenic avian influenza A(H5N1) virus, and were associated with respiratory droplet transmission, increased binding of the virus to receptors on cells in the respiratory tract of mammals, increased virulence, and increased replication of virus (_5_). Epidemiologic investigations have not yielded conclusive evidence of sustained human-to-human H7N9 virus transmission; however, further adaptation of the virus in mammals might lead to more efficient and sustained transmission among humans. Second, human illness with H7N9 virus infection, characterized by lower respiratory tract disease with progression to ARDS and multiorgan failure, is significantly more severe than in previously reported infection with other H7 viruses. Over a 2-month period, 24 deaths (19% of cases) have occurred, compared with only one human death attributed to other subtypes of H7 virus reported previously. Third, H7N9-infected poultry are the likely source of infection in humans, but might not display illness symptoms. Consequently, efforts to detect infection in poultry and prevent virus transmission will be challenging for countries lacking a surveillance program for actively identifying low-pathogenicity avian influenza in poultry. In the United States, an active surveillance program is in place that routinely identifies low&#8211;pathogenicity viruses. If this newly recognized H7N9 is detected, public health and animal health officials should identify means for monitoring the spread of asymptomatic H7N9 virus infections in poultry and maintain vigilance for virus adaptation and early indications of potential human-to-human transmission. ​Link to the full post is here: http://www.cdc.gov/mmwr//preview/mmwrhtml/mm62e0501a1.htm?s_cid=mm62e0501a1_w

There is also a pretty nasty SARS like virus that has been on the radar for months, but turns out Saudi had a big cluster of seven cases (and five deaths) they jut informed WHO about yesterday.


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## where I want to (Oct 28, 2008)

Thank you again.


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## DryHeat (Nov 11, 2010)

That Saudi SARS-like coronavirus cluster just got increased to ten confirmed, too. I saw one discussion speculation that the timing and location of this outbreak would be consistent with bats feeding on fig crops acting as the initial seeding of the virus.
Edit add: CIDRAP is now reporting that it was said earlier but not officially by the Saudis that this was a hospital cluster, which would be consistent with older victims having "comorbidities" (other health problems). http://www.cidrap.umn.edu/cidrap/content/other/sars/news/may0313corona.html

It still remains the case that those key mammalian genetic adaptations/ mutations in H7N9 have been present in *all* the human sequences published by the Chinese (a limited number that should be increased quickly IF they're actually trying to be "transparent") but in contrast are listed in *none* of the isolations they've found from extensive sampling of birds, neither poultry nor wild species. Yet everyone, including that CDC writeup, continues to claim people get it in almost all cases from the birds. The theory is that in *all* these sampled infections the exact genetic configuration has internally advanced/ mutated during the infection to that found by the point of sampling of the human patient, usually during hospitalization. But the CDC does mention the "mutated" form does experimentally kill mice and ferrets with heavy-dose inoculation. But the Chinese say nothing about trying to sample rodents, like rats which would be running around all these live poultry markets AND hitching rides on vehicles to expanding areas, you know, just in case maybe somehow this shifted mammalian-adapted H7N9 might be more often spread from rats or mice to humans (and more frequent human-to-human already than they want to admit) rather than from the chickens and ducks.to humans. The CDC could also run a few easy experiments trying infecting mice and/or rats with NON-lethal virus exposures to see if maybe lab rodents could run around with sub-lethal infections shedding the virus either airborne and/or in droppings infecting other rodents with that same mutated H7N9. And if they *have* done so, maybe tell us?

I suspect they're playing polite "softball" with their Chinese and WHO colleagues trying to get information in a face-saving fashion. Clearly this hasn't turned into a fully-enabled airborne sustained human infection, and hopefully never will while this virulent, anyway. But, the most respected information sources... WHO, CDC, their Chinese equivalents, and the top reporters who should ask the tough questions, are all dancing around avoiding some of the logic that at the least could lead those inclined to prepping to review and update their situations.


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## sisterpine (May 9, 2004)

I think the fact that this illness seems not to have spread outside of China speaks to the ability of it spreading human to human.


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