31 January 2014 - On 29 January 2014, the National Health and Family Planning Commission (NHFPC) of China, and the Centre for Health Protection (CHP), Hong Kong SAR, China notified WHO of six additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus including one death.

All of the six cases are males. The age range is 2 to 63 years old. The cases are reported from Fujian (1), Guangdong (1), Hong Kong SAR (1), and Zhejiang (3). Four of the cases are currently in critical or serious condition. Four of the cases are reported to have had exposure to poultry or a live poultry market.

Details of the five additional cases as notified by NHFPC of China:

• A 37-year-old farmer from Wenzhou City, Zhejiang Province, who became ill on 19 January. He was admitted to hospital on 27 January and was transferred to another hospital on 28 January. He is currently in a critical condition. The patient has a history of exposure to a live poultry market.
• A 60-year-old man from Hangzhou City, Zhejiang Province, who became ill on 23 January. He was admitted to hospital on 28 January and is currently in a serious condition. The patient has a history of exposure to poultry.
• A 63-year-old man from Hangzhou City, Zhejiang Province, who became ill on 24 January. He was admitted to hospital on 27 January and is currently in a serious condition. He has a history of exposure to a live poultry market.
• A 2-year-and-8-month old boy from Xiamen City, Fujian Province, who became ill on 26 January. He was admitted to hospital on 28 January and has a mild illness. His family slaughter and sell ducks.
• A 17-year-old man from Guangzhou City, Guangdong Province, who became ill on 22 January. He was admitted to hospital on 27 January and is currently in a serious condition.

Details of the case as notified by the CHP, Hong Kong SAR:

• A 75-year-old man with underlying illnesses who travelled alone to Shenzhen between 20 to 26 January became ill while in Shenzhen on 26 January. He was admitted to hospital in Hong Kong on 28 January and died on 29 January. During his stay in Shenzhen it is reported that he stayed with relatives who lived close to a live poultry market. His five home contacts in Hong Kong have remained asymptomatic but have been admitted to hospital for observation. Further investigations into the man’s travel and exposure histories are ongoing, in parallel with tracing of other contacts of the case, including four patients with whom he shared a hospital room, and healthcare and ambulance staff. Preliminary findings suggest that the man was infected outside of Hong Kong SAR.

So far, there is no evidence of sustained human-to-human transmission.

The Chinese Government continues to take the following surveillance and control measures:

• strengthen surveillance and situation analysis;
• reinforce case management and treatment;
• conduct risk communication with the public and release information;
• strengthen international collaboration and communication; and
• conduct scientific studies.

Sporadic human cases

While the recent report of avian influenza A(H7N9) virus being detected in live poultry imported from the mainland to Hong Kong SAR, shows the potential for the virus to spread through live poultry, at this time there is no indication that international spread of avian influenza A(H7N9) has occurred through humans or animals.

Further sporadic human cases of A(H7N9) infection are expected in affected and possibly neighbouring areas, especially given expected increases in the trade and transport of poultry associated with the upcoming Lunar New Year.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid poultry farms, or contact with animals in live bird markets, or entering areas where poultry may be slaughtered, or contact with any surfaces that appear to be contaminated with faeces from poultry or other animals. Travellers should also wash their hands often with soap and water. Travellers should follow good food safety and good food hygiene practices.

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions.

As always, a diagnosis of infection with an avian influenza virus should be considered in individuals who develop severe acute respiratory symptoms while travelling or soon after returning from an area where avian influenza is a concern.

WHO encourages countries to continue strengthening influenza surveillance, including surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns, in order to ensure reporting of human infections under the IHR (2005), and continue national health preparedness actions.