Avian Influenza H7N9Situation Analysis and Prevention             Dr. Tong Ka Io              2013.04.18
Spatial distribution   Shanghai municipality   Zhejiang province: Hangzhou, Huzhou, Jiaxing   Anhui province: Xuzhou, H...
Spatial distribution
SpatialdistributionBeijing04.11~ 1 case 0 deathHenan04.06~ 3 cases 0 deathJiangsu03.19~ 21 cases 3 deathsAnhui03.09~ 3 cas...
Interpersonal distributionOf the first 87 cases   ŸAge range = 2~87y, median = 63y, elder people more    common, only 3 c...
Suspect clusters1)   Shanghai Li’s family        55y son became ill on 11th Feb, with severe         pneumonia, died on 2...
Suspect clusters2)   Jiangsu Zhang’s family        32y daughter became ill on 21st Mar, H7N9 PCR         positive       ...
Suspect clusters3)   Shanghai Gu’s     family    52y wife became ill     on 27th Mar, died on     3rd Apr, H7N9 PCR     p...
Hypothetical mixing of avian flu viruses from east Asiamigratory birds and east China ducks and chickens.
Animal and environment testing   Since 20th Mar, animal facilities around human    cases in Anhui, Jiangsu and Shanghai h...
Animal and environment testing   As of 16th Apr, provincial and national AI    reference laboratories had collected a tot...
Positive testsDate        Sampling sites        Positive rate                          Positive samples04.04 Shanghai Huhu...
Negative tests    Date               Location                     Sample           quantity       Tests04.02         Shang...
Ducks along the bank of Changjiang river                                    may be all infectedSource of H7N9 virus may be...
H7N9 continuously evolves, hard to predict risk The virus is still searching for a more compatible combination
Risk assessment1.   The reassortment of avian influenza viruses had     occurred, probably in East China2.   The reassorte...
Avian influenza dynamics
Phase 1                                  Phase 2                           Phase 3   Bird-to-bird transmission            ...
Risk assessment5.   It is probably that the virus spreads beyond East     China to Central and North China by migratory bi...
Animal-animal line of defense   Separate poultry with migratory birds and wild    birds   Separate water fowls and land ...
  Significant measures taken in Macao      All local poultry farms eliminated      Raising poultry prohibited      Impo...
Animal-human line of defense   Biosafety measures for poultry industry. In case    of animal epidemic, handling infected ...
Human-human line of defense   Raising people’s alert for prompt seeking medical    advice if severe acute respiratory ill...
Avian influenza h7 n9 situation analysis and prevention
Avian influenza h7 n9 situation analysis and prevention
Avian influenza h7 n9 situation analysis and prevention
Avian influenza h7 n9 situation analysis and prevention
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Avian influenza h7 n9 situation analysis and prevention

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Avian Influenza H7N9 epidemiological situation analysis and lines of defense

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Avian influenza h7 n9 situation analysis and prevention

  1. 1. Avian Influenza H7N9Situation Analysis and Prevention Dr. Tong Ka Io 2013.04.18
  2. 2. Spatial distribution Shanghai municipality Zhejiang province: Hangzhou, Huzhou, Jiaxing Anhui province: Xuzhou, Haozhou Jiangsu province: Nanjing, Suqian, Suzhou, Wuxi, Rugao, Zhenjiang, Yaozhou, Changshou, Jiangying, Yancheng, Kunshan Henan province: Kaifeng, Zhoukou, Zhengzhou Beijing municipality
  3. 3. Spatial distribution
  4. 4. SpatialdistributionBeijing04.11~ 1 case 0 deathHenan04.06~ 3 cases 0 deathJiangsu03.19~ 21 cases 3 deathsAnhui03.09~ 3 cases 1 deathShanghai02.19~ 32 cases 11 deathsZhejiang03.07~ 27 cases 2 deaths
  5. 5. Interpersonal distributionOf the first 87 cases ŸAge range = 2~87y, median = 63y, elder people more common, only 3 child cases with milder clinical presentations M:F = 2.4:1 Occupational exposure to birds in at least 19 cases, retired people account for 44 cases, none HCW It was said that most fatal cases were male smokers
  6. 6. Suspect clusters1) Shanghai Li’s family  55y son became ill on 11th Feb, with severe pneumonia, died on 28th Feb, no sample collected for H7N9 testing  87y father became ill on 19th Feb, with severe pneumonia, died on 4th Mar, H7N9 PCR positive  69y son became ill on 19th Feb, with milder clinical course, H7N9 PCR negative, retrospective serological test positive
  7. 7. Suspect clusters2) Jiangsu Zhang’s family  32y daughter became ill on 21st Mar, H7N9 PCR positive  Her father had been ill before, H7N9 tests negative
  8. 8. Suspect clusters3) Shanghai Gu’s family 52y wife became ill on 27th Mar, died on 3rd Apr, H7N9 PCR positive 56y husband became ill on 1st Apr, H7N9 PCR positive
  9. 9. Hypothetical mixing of avian flu viruses from east Asiamigratory birds and east China ducks and chickens.
  10. 10. Animal and environment testing Since 20th Mar, animal facilities around human cases in Anhui, Jiangsu and Shanghai had been checked, with no animal illness found. Until 3rd Apr, agricultural departments of Shanghai, Jiangsu, Zhejiang, and Anhui did not have specific testing agents for H7N9.
  11. 11. Animal and environment testing As of 16th Apr, provincial and national AI reference laboratories had collected a total of 84444 samples, covering 473 live poultry markets, 32 slaughterhouses, 896 farms, 79 wild bird habitats, 36 pig slaughterhouses, and 137 environmental sampling spots. Tests for 47801 samples had been concluded, yielding only 39 positive results (0.05%), of which 38 were poultry and environment samples from live markets of Shanghai, Anhui, Zhejiang and Jiangsu, 1 was from wild pigeon from Nanjing, Jiangsu.
  12. 12. Positive testsDate Sampling sites Positive rate Positive samples04.04 Shanghai Huhuai Market ?/? Shanghai Huhuai Market Pigeon Huhuai Market Chicken, environment Jingchuan Market Chicken, environment04.05 Shanghai live markets 19/738(2.6%) Chicken, pigeon, Fengzhuang Market environment Zhejiang Hangzhou Zhejiang Hangzhou Bangsheng04.06 5/12(41.7%) Environment Bangsheng Market Market Zhejiang Huzhou Zhebei Market Duck Farms and live markets Anhui Hefei Huishangcheng04.10 in Jiangsu, Zhejiang and 14/2099(0.7%) Duck Market Anhui province 3 markets in Jiangsu Chicken Jiangsu Nanjing Wild pigeon Suspect samples from04.16 5/12/? Zhejiang Huzhou Zhebei Market Chicken Jiangsu and Zhejiang Zhejiang Huzhou Daoxiang Market Chicken
  13. 13. Negative tests Date Location Sample quantity Tests04.02 Shanghai natural Migratory and wild birds 229 H7 gene preservation district and zoos~04.09 Shanghai farms Animals 366 AI common PCR04.01~04.11 Farms, parks, wild bird Chickens, pigs, ducks, 5609 ? habitats and supermarkets gooses, pigeons, crows, in 16 districts of Beijing wild birds, animal products04.14 Gucheng villange in Beijing Poultry 61+ Virology+ 95 SerologyEnd of Mar 35 pig farms and 11 pig Pigs 2050+ Virology+~04.17 slaughterhouses in 2000 Serology Shanghai, Anhui, Zhejiang, and Jiangsu
  14. 14. Ducks along the bank of Changjiang river may be all infectedSource of H7N9 virus may be the migratory birdsin Changjiang river mouth
  15. 15. H7N9 continuously evolves, hard to predict risk The virus is still searching for a more compatible combination
  16. 16. Risk assessment1. The reassortment of avian influenza viruses had occurred, probably in East China2. The reassorted virus massively go across the animal-human boundary to infect human3. The virus is low pathogenic for birds and highly pathogenic for human4. Up to the moment, there is no evidence that the virus further go across the boundary to sustained human- to-human transmission, though limited human-to- human transmission can not be excluded
  17. 17. Avian influenza dynamics
  18. 18. Phase 1 Phase 2 Phase 3 Bird-to-bird transmission Bird-to-human transmission & Widespread limited human-to-human transmission human-to-human transmission H7N9 H1~H16Avian disease surveillance, Minimizing human exposure Ensuring care for patientsprevention and control Detection and isolation of Slowing down spread human cases
  19. 19. Risk assessment5. It is probably that the virus spreads beyond East China to Central and North China by migratory birds, which infect local Poultry and the latter infect human6. Comparing with H5N1, H7N9 infection in poultry seems more widespread and persistent, constituting a greater threat for human7. At this moment, it is impossible to precisely predict if the virus will come to Macao, or how (birds or human?), but preparedness is necessary
  20. 20. Animal-animal line of defense Separate poultry with migratory birds and wild birds Separate water fowls and land fowls Separate poultry from different regions Separate infected poultry with other poultry
  21. 21.   Significant measures taken in Macao  All local poultry farms eliminated  Raising poultry prohibited  Importation of live water fowls prohibited  Management in the source, surveillance, separation, and double quarantine for poultry provided from inland to Macao  Culling of all live poultry before the live markets close everyday
  22. 22. Animal-human line of defense Biosafety measures for poultry industry. In case of animal epidemic, handling infected poultry under strict protection General people avoiding contact with live poultry or presenting in places with live poultry, washing hands after contact with raw poultry meat or egg, eating poultry meat or eggs thoroughly cooked According to situational, government adopting appropriate risk management measures in sites for poultry wholesale, sale, or watching
  23. 23. Human-human line of defense Raising people’s alert for prompt seeking medical advice if severe acute respiratory illness develops Raising HCW alert, strengthening surveillance system, building laboratory capacity, testing acute respiratory patients with travel, poultry or patient contact history, and patients with pneumonia of unknown cause, for early detection of cases Strengthening infection control in medical facilities. Early isolation and treatment of detected cases Tracing and health management of close contacts of cases

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