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H7N9 cases appear in Beijing, Henan
The new strain of bird flu, H7N9, had spread to two previously uninfected regions over the weekend, after two cases were detected in Henan Province on April 14 and one in Beijing on April 13.

Reactions

China:

Beijing
Beijing on April 6 activated emergency measures to prevent the disease and suspended all pigeon-flying activities.

Public health authorities in Beijing said on April 2 that they are keeping a close eye on the H7N9 bird flu virus that has killed two in east China.

Shanghai
Shanghai has banned all live poultry from other parts of the country entering the city since April 6 after the agricultural authority detected H7N9 virus in 19 samples collected at three markets from the city on April 5 and ordered a shutdown of the markets. Meanwhile, all performances involving birds in the city's parks and tourist attractions have been suspended.

Shanghai launches the Influenza Pandemic Contingency Plan (Level III) on April 2, according to a post on the Shanghai Municipal Government Weibo account.

No bird flu virus was found in dead pig samples from a river that provides drinking water to residents in Shanghai where two died in the first human infections of a new avian influenza strain, authorities said on April 1.

Hongkong
The city government will immediately upgrade the preparedness plan from "alert" to "serious" response level when the virus is detected in poultry, or there is human infection in Hong Kong.

A spokesman for the Centre for Health Protection (CHP) of the Department of Health (DH) said on April 1 that the CHP will enhance surveillance for suspected H7 cases in Hong Kong, according to GovHK, the one-stop portal of the Hong Kong Special Administrative Region Government.

Nanjing, capital of Jiangsu Province
The city government has stopped transporting birds out of Nanjing.

Hangzhou, capital of Zhejiang Province
Hangzhou on April 6 suspended the trade of live poultry in a farm produce market after the H7N9 virus was detected in quails sold on the market.

Taiwan
Taiwan has set up a special command center for the H7N9 bird flu to closely monitor the situation and listed H7N9 bird flu as a notifiable disease.

International:

The US
US health authorities said on April 4 they are liaising with domestic and international partners to develop a vaccine for the H7N9 bird flu virus that has killed five people in China.

Japan
The government has asked China to promptly provide H7N9 bird flu virus samples so Japanese researchers can move quickly to make a new vaccine, Health, Labor and Welfare Minister Norihisa Tamura said on April 5.

Vietnam
The Vietnam Ministry of Health has dispatched health officials at the provincial level nation-wide and put them on high alert of any development of the disease and ordered them to carry out prompt actions if necessary.

Passengers crossing the border will be closely monitored at points of entry and attention will be focused on those who have come from infected areas.

Singapore
Singapore's health ministry on April 6 issued an advisory for travellers returning from China's bird flu-hit provinces to look out for certain symptoms, though it fell short of advising against travelling to these provinces.

The ministry also advised travellers to the affected areas in China to remain vigilant, observe good personal hygiene, and try to avoid direct contact with poultry, birds or their droppings.

Source: Agencies

About H7N9 flu virus

Symptoms

Victims showed early symptoms of fever and coughing, which later developed into serious pneumonia and dyspnoea, said the National Health and Family Planning Commission.

Because there is still so much unknown about H7N9 bird flu, it is not clear whether the virus will yield a few isolated cases or other clinical manifestations, said the Shanghai-based Oriental Morning Post.

Prevention
Testing reagents for the H7N9 avian influenza virus have been distributed among 409 flu monitoring sites across the country, China's center for disease control said on April 7.

Be sure to wash your hands properly and regularly, pay attention to indoor ventilation, eat right, exercise and make sure to cover your mouth when coughing or sneezing.

Stay away from feathers and excrement from sick poultry, and avoid slaughtering live chicken or duck.

Treatment

According to a statement issued by the China Food and Drug Administration on April 6, the potential of injections of peramivir diluted in sodium chloride injection has been proven by preliminary tests.

Peramivir is a neuraminidase inhibitor.

Source: Agencies

Viewpoints

Experts:

●Zhong Nanshan, a fellow at the Chinese Academy of Engineering
After a year of research, my studies show that the isatis root is somewhat effective in preventing strains of flu such as H1N1 and H3N2, but it is still unknown whether it can fight H7N9.

●Jiang Qingwu, a professor with the School of Public Health, Fudan University
As temperatures rise, flu stricken areas in northern China should be closely monitored, and in the long term we should be vigilant for any issues associated with poultry and fowl.

●Xie Guoxiang, deputy director of the Center for Disease Control and Prevention in Nanjing
Generally people don't need to wear face masks, but I recommend wearing one when attending to those who have contracted the flu or are coughing. 

●Lu Hongzhou, deputy director of Shanghai Public Health Clinical Center
For H7N9 bird flu, the entire medical field doesn't have mature studies yet. I don't suggest people take medicine blindly, and the best way to prevent illness now is to stay away from live poultry.

●Michael O'Leary, WHO Representative in China
O'Leary said at this point, there is no evidence for human-to-human transmission.

"…the virus is closely related to avian viruses, so it makes us most suspicious that [poultry] is the source of infection," he said.

According to the WHO, the H7N9 virus has been recognizedfor years as existing in wild birds in certain locations, but not frequently. In Asia, it's only been identified in wild birds in Mongolia and South Korea, but never in China.

●Xu Jianguo, director of the Institute of Infectious Disease Prevention and Control with the China CDC
At this point, great attention should be paid to this new virus but there is no need to panic.

●Leng Guangming, an official with the Shanghai Municipal Center for Disease Control and Prevention
Given only three cases have been confirmed, there is limited research material to investigate the disease, and experts are researching the virulence of H7N9 and the possibility of human-to-human transmission.

Organizations:

●The UN Food and Agriculture Organization (FAO)
The quick response and release of detailed information on the nature of the virus allow the public to take precautions and give related institutions more time to evaluate its potential impact on humans and animals, FAO Chief Veterinary Officer Juan Lubroth said.

Precautions recommended by FAO include keeping all birds and livestock separate from people's living areas, and not eating sick or dead animals.

●The National Health and Family Planning Commission
The country's 16 confirmed H7N9 cases were isolated and there has been no sign of human-to-human transmission.

All people to have come into close contact with the infected patients have been placed under medical observation, and only one of them has shown symptoms, though bird flu infection has already been ruled out as the cause of this person's illness, it added.

●Chinese Center for Disease Control and Prevention
"Currently, some regions have detected a limited number of cases and no secondary cases have arisen among those close to the patients. Judging from the limited evidence, the risk of public infection from the virus is relatively low," the China CDC said in a post on its website.

●The WHO
The WHO said there was so far no epidemiological link between the cases that have been identified. Up till now, no further cases have emerged among the 88 identified contacts under follow-up. The source of infection and the mode of transmission are under investigation.

The health organization said the Chinese government was engaged in an active investigation and had instituted enhanced surveillance, laboratory strengthening and training of healthcare professionals for detection, reporting and treatment.

WHO said it was in close contact with the national authorities to follow up the event, and updates would be issued as soon as new information becomes available.

Chinese media:

●Global Times:
Editorial: Anxiety should not harm poultry industry
The media should push for transparency when it comes to efforts to prevent the spread of bird flu. Meanwhile, it's important for the media to ease public confusion. Prevention work should be carried out on a scientific basis rather than knee-jerk reactions. Chinese society must adapt mechanisms to respond to the situation, and demonstrate a collective spirit beyond individualism.

Editorial: Flu reveals dangers of 'developed areas'
Higher standards in animal farming, food processing and consumption should be established and enforced from urban to rural areas. Even some traditional ways of cooking and eating foods need to be reassessed due to their health risks.

● Virus shows China's progress and limitations
All these pose pragmatic constraints to China's domestic epidemic prevention and control. Clearly, the world is witnessing a cooperative and responsible China fulfilling its promises. But the tasks ahead are much heavier and involve more than just information transparency.

●Xinhua
Ten years after SARS, what has China learned?
If there is anything that SARS has taught China and its government, it's that one cannot be too careful or too honest when it comes to deadly pandemics. The last 10 years have taught the government a lot, but it is far from enough.

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