Saturday, April 6, 2013

Information Office of Shanghai Municipality: Features of the Virus

 This is a press conference on April 5th.  Specifically I post the virus features below:

15:30  Xu Wei (government spokesman): Dear Reporter, good afternoon and welcome to participate in the municipal government press conference.
  Today's press conference will introduce the latest progress of the Shanghai people infected with the H7N9 avian flu prevention and control work. Participate in the conference, including: Mr. Xu Jianguang, director for the City Health and Family Planning Commission, Municipal Center for Disease Control Director Wu Fan President, the Agriculture Commission deputy director of Mr. Shao Linchu influenza treatment experts, the National Health Planning Commission, City Public Health Clinical Center expert, Mr. Lu Hongzhou , City of Industry Marketing Director Mr. Zhang Jingbao.

Excerpt:

The H7N9 avian influenza has such a feature, at an early stage is basically three to five days, a cough, but rarely sputum, fever, low platelet, in general body temperature five days to subside, this patient is very dangerous serious illness occurs often five to seven days, five to nine days, and within 24-48 hours sudden respiratory failure. Reported yesterday that the death of the patient is within one day, appear respiratory failure, respiratory failure and his liver, kidneys have been involving a patient with multiple organ failure, we re-treatment effect on the very poor. We stand for the early diagnosis and treatment, the more difficult for ordinary people, just onset nothing to do with the common cold. Early to the hospital with fever after fever clinics of medical staff have been trained, they are to be screened for this disease, and also to the specimens sent to the relevant departments to detect, if after testing positive, the fastest speed as soon as possible antivirals are used up. View, taking antiviral effect is very obvious, the patient from becoming severe does not mean the death occurred within 48 hours, which is very important information.

http://www.shio.gov.cn/shxwb/xwfb/u1ai10031.html 

New Bird Flu Seen Having Some Markers of Airborne Killer







‘More Concern’

Fouchier authored a study last year that showed five genetic tweaks to the deadly H5N1 virus, which has killed more than 600 people since 2003, made it airborne in ferrets, the mammals whose response to flu most closely resembles that of humans.

One of the mutations he made is in an enzyme called polymerase; another was in a protein called hemagglutinin on the surface of the virus. H7N9 has both mutations, he said.

Full article:  http://www.bloomberg.com/news/2013-04-05/new-bird-flu-seen-having-some-markers-of-airborne-killer.html

Worrying Traits of H7N9 Bird Flu Strain Concern Experts

[editing is mine]
by Kathy Jones on  April 06, 2013

Experts say that a mutated bird flu virus that has killed six people in China displays worrying traits that warrant high vigilance.
-snip-
"I am cautiously worried," virologist John Oxford of the Queen Mary University of London told AFP.

"If there were four cases in Shanghai, I would be much less concerned, but because it is so geographically widespread I think it is trying to tell us something.

"It is not a deadly virus for chickens so it could spread in chickens without anyone knowing it. I suspect it's probably wider than we think."
-snip-
"Any influenza that jumps from an animal species to a human has pandemic potential," Alan Hampson, chairman of the Australian Influenza Specialist Group, said in a statement issued by the Science Media Centre.

"If it learns to spread in humans, if it actually acquires that ability, then it's a high likelihood that it will become pandemic."

Deadly new bird flu vindicates controversial research

From http://diseaseclimate.blogspot.com/
By Kate Kelland, Health
and Science Correspondent
 
Posted 2013/04/04 at 10:27 am EDT

Excerpt:
Above all else, what the world needs to know about this new strain of H7N9 bird flu is how likely it is to be able to spread efficiently among human populations.
And according to Ab Osterhaus, a world leading flu researcher who is head of viroscience of the Erasmus Medical Center in the Netherlands, studies his team and another in the United States have been doing are the best way to find out.
"At the moment we don't know whether we should go for a full-blown alert or whether we can sit back and say this is just a minor thing," Osterhaus told Reuters in a telephone interview.
"(To answer that) we need to know what this virus needs to become transmissible."
-snip-
Osterhaus, who has looked at genetic sequencing data from the new H7N9 bird flu strain samples in China and found some worrisome mutations have already occurred in the H7N9 strain, says such concerns are far outweighed by the fear of not knowing the potential risk of an emerging new virus.
"This virus might be on the brink of gaining function of transmissibility (in humans). I think it's crucial to know the rules of the game."

http://www.newsdaily.com/stories/bre9330m8-us-birdflu-ressearch/
 

FAO: Strong biosecurity measures required in response to influenza A(H7N9) virus

FAO supports China and neighbouring countries in disease detection and animal health management

5 April 2013, Rome - Responding to the occurrence of the A(H7N9) influenza virus in China requires strong biosecurity measures, FAO said today. Unlike other influenza strains, including highly pathogenic avian influenza H5N1, this new virus is hard to detect in poultry because the novel virus causes little to no signs of disease in animals.

"Unlike H5N1, where chickens were dying off on a large scale, with this virus we don't have a red flag that immediately signals an infection. This means farmers may not be aware that virus is circulating in their flock. Biosecurity and hygiene measures will help people protect themselves from virus circulating in seemingly healthy birds or other animals," said Juan Lubroth, FAO Chief Veterinary Officer.

FAO commends China's quick notification of human cases and subsequent release of detailed information to the public on the nature of the virus and other precautionary measures. With this information, FAO and the international scientific community have been analyzing the virus sequence in hopes of better understanding its behavior and its potential impact humans and animals.

"With the virus harder to detect, good biosecurity measures become even more essential to reducing the risk of virus transmission to humans and animals. Good biosecurity and hygiene measures implemented by farmers, livestock producers, transporters, market workers and consumers represent the first and most effective way to protect the food chain," Lubroth said.

While this new virus is being evaluated, FAO continues to recommend the following standard precautions:

Continued:  http://www.fao.org/news/story/en/item/173655/icode/

 

#H7N9: China CDC: first time developed human infection with the H7N9 avian influenza diagnostic reagents

From the China CDC Website:

2013 -04-06
China CDC viral disease of the National Influenza Center each epidemic occurred provinces submitted cases and close contacts, as well as environmental specimens to carry out laboratory testing, optimized nucleic acid detection methods, preliminary reverse agglutination test for serological detection method, to the provinces and the People's Armed Police CDC infectious diseases of major projects related laboratory sends the H7N9 virusReal-time PCR nucleic acid detection reagent.

http://www.chinacdc.cn/jkzt/crb/rgrgzbxqlg_5295/zjjdqlg_5307/201304/t20130406_79523.htm 

Shanghai Details on 2 New Confirmed Cases #H7N9

Excerpt (translated)

2 new cases as follows: patients Zhou, male, 74 years old, the people of Shanghai, farming. Patients 28 March consciously fatigue, shortness of breath, fever, March 31 to Fengxian District Chinese Medicine Hospital for treatment, transferred to East hospital on April 5, diagnosed with severe pneumonia. In the morning of April 6, the Shanghai Municipal Center for Disease Control laboratory test results for the H7N9 avian influenza virus nucleic acid positive. Organization municipal clinical expert group in accordance with the relevant requirements, the Shanghai Municipal Health and Family Planning Commission to discuss the cases, the experts based on the clinical performance of laboratory testing and epidemiological data, the diagnosis of the cases of human infection of H7N9 avian influenza confirmed cases . After investigation, a total of five people in the close contacts of the cases so far have not found an exception.

Patients Yang, male, 66 years old, the people of Shanghai, retirees. Patients chills symptoms on March 29, on April 2 to the Tenth People's Hospital for treatment, diagnosis of acute upper respiratory tract infection, given symptomatic treatment.April 4 patients symptoms were not relieved, and a cough, fever symptoms, once again to the Tenth People's Hospital for treatment, diagnosis of left lower pneumonia. In the morning of April 6, the Shanghai Municipal Center for Disease Control laboratory test results for the H7N9 avian influenza virus nucleic acid positive. Organization municipal clinical expert group in accordance with the relevant requirements, the Shanghai Municipal Health and Family Planning Commission to discuss the cases, the experts based on the clinical performance of laboratory testing and epidemiological data, the diagnosis of the cases of human infection of H7N9 avian influenza confirmed cases . The patient's condition is stable and under active treatment. After investigation, the close contacts of the case has a total of 6 people, so far not found exception

http://news.163.com/13/0406/19/8RQ6G5HM000146BE.html  

Shanghai fever woman uninfected contact with H7N9 patients

Translation
2013 04 06

April 3, H7N9 infection by certain death. Particular, female, 52 years old, the people of Shanghai, retirement home. Shanghai reported that certain close contacts of a total of 31 people, including a fever and other symptoms. At 18:53 on April 4, has been transferred to the Shanghai Public Health Clinical Center, isolation and treatment.
  The good news came yesterday, said Wu Fan, director of Shanghai Municipal Center for Disease Control, after laboratory testing, close contacts fever mild flu-like symptoms for H7N9 negative. This proved that the patient was not infected with the H7N9 virus.
  The patient is a smooth recovery.
  The close contact with those infected with the H7N9 virus message, many people breathed a sigh of relief, which indicates that there is no evidence that the H7N9 virus can spread from person to person.

Shanghai Wei Planning Comm. Confirms 2 New Cases - Retirement Personal & Farmer

4/6/13
Shanghai two cases of new confirmed cases of human infection with the H7N9 avianinfluenza 

As of today 18:30, the city newly diagnosed cases of human infection of H7N9 avian influenza cases are in active treatment, close contacts of the two cases were not found abnormal. Far, a total of eight cases of human infection with the H7N9 influenza confirmed cases, including four cases of death, the other four cases is where. Shanghai Wei Planning Commission today 19:00 Bulletin, Shanghai, and then diagnosed two cases of human infection with the H7N9 avian influenza cases: patients Zhou, male, 74 years old, the people of Shanghai, farming; patients Yang, male, 66 years old, the people of Shanghai, retirement personnel.

http://news.qq.com/a/20130406/000731.htm 

Shanghai new confirmed cases of human infection with the H7N9 avian influenza in two cases

  BEIJING, April 6, according to the Shanghai Municipal Government Information Office official microblogging publish "news, as of 18:30 today, the Shanghai newly confirmed cases of human infection of H7N9 avian influenza in active treatment, two close contacts of cases were not unusual.
  Far, a total of eight cases of human infection with the H7N9 avian influenza confirmed cases, including four cases of death, and the other four cases is where.

http://news.jcrb.com/jxsw/201304/t20130406_1082148.html 

Nanjing district a lot of sparrows death sample has been sent to the relevant departments to detect

2013-04-06 17:39:09 Source : China Youth Net 
Translation

The picture shows the users on the microblogging sparrow death photo.   

Youth Network, April 6 (Reporter wins and cold) Nanjing Municipal Government pm today on the latest situation of Nanjing people infected with the H7N9 avian influenza held a news conference.
  Internet users concerned about the Jianye District the dead sparrow phenomenon this urban emergency departments have early morning inspection and samples sent to the provincial departments detection. Nanjing market is not infected with H7N9 live birds, experts recommend not to eat birds of unknown origin. No evidence to show that the Keren-human transmission of H7N9 addition, it is therefore not necessary to wear a mask.

China more transparent in handling epidemics: experts

April 6, 2013
Experts have praised China for its increased transparency in handling public health incidents, after the emergence of the lesser-known H7N9 bird flu, which has killed six people since the deadly strain was exposed a week ago.
The Chinese government has been credited with timely releases of information about the H7N9 bird flu, whereas in 2003, authorities were criticized for initially trying to cover up an epidemic of Severe Acute Respiratory Syndrome (SARS) which claimed the lives of several hundred people on the Chinese mainland, Hong Kong and Taiwan.
"China has learned a lesson from the past in dealing with public health emergencies," said Prof. Wang Yukai of the Chinese Academy of Governance.
"The government's response to the disease is completely different from 10 years ago, when information disclosure systems were not established."

Continued:  http://news.xinhuanet.com/english/china/2013-04/06/c_132287755.htm

China's confirmed H7N9 cases isolated: authorities

April 6, 2013

Chinese health authorities said on Saturday that the country's 16 confirmed H7N9 cases were isolated and there has been no sign of human-to-human transmission.
As of 5 p.m. on Friday, 16 people had been confirmed as infected by H7N9 bird flu, and six of them had died, said the National Health and Family Planning Commission in a brief statement posted online.
Six cases, including four deaths, were reported in Shanghai, and three cases, including two deaths, were reported in east China's Zhejiang Province.
Elsewhere, Jiangsu Province reported six cases and Anhui Province one case.
The statement said no epidemiological link between those cases has been identified to date.

Continued:  http://news.xinhuanet.com/english/china/2013-04/06/c_132287771.htm

Singapore Health Ministor Issues Advisory for Travellers Back From China's Bird Flu Hit Provinces #H7N9

April 6, 2013

Singapore's health ministry on Saturday 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 said that travellers who have gone to Shanghai, Anhui, Jiangsu and Zhejiang should look out for symptoms of respiratory illness, such as fever and cough.
They are advised to seek early medical attention if ill with such symptoms and inform doctors of their travel history.

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.

Continued:  http://news.xinhuanet.com/english/china/2013-04/06/c_132288048.htm

2 Cities In China's Zhejiang Province Ban Poultry Trade -- Quail in Hangzhou, Shangcheng Township Detected #H7N9

4/6/13
So far overnight no new confirmed or suspected cases of H7N9 appear at the Xinxua website.  The city of Nanjing and the city of Hangzhou, in Zhejiang have both banned poultry trade.


"Sales of live poultry at the three main poultry trade markets -- Zijinshan, Tianyinshan and Jianye -- which account for 90 percent of all poultry in the city, have been banned," said Wang Zhixi, deputy director of the Industrial and Commercial Bureau of Nanjing.
"Meanwhile, we will ban live poultry from other places from entering the city, as well as stop transporting birds out of Nanjing," Wang added.
and from Hangzhou, in addition to suspending trades of live poultry, they detected H7N9 in quails sold from a market in Shangcheng Township:

Authorities in east China's Hangzhou city on Saturday suspended trades of live poultry in a farm produce market after H7N9 bird flu virus was detected from quails sold on the market.
The second confirmed H7N9 case in east China's Zhejiang Province has been found to have eaten quails bought from the Binsheng Agricultural and Sideline Products Market in Shangcheng District, Hangzhou city.
The disease control and prevention center of Hangzhou detected H7N9 bird flu virus from the quails in the market on Friday. And the virus sample has been sent to national disease control and prevention center for recheck.
Relevant departments in Hangzhou began to slaughter the live poultry in the market earlier Saturday.

Friday, April 5, 2013

MOH Cambodia & WHO: Tenth New Human Case of Avian Influenza H5N1 in Cambodia in 2013

Joint Press Release from the Ministry Of Health and the World Health Organization (WHO)
Phnom Penh, 4 April 2013


The Ministry of Health (MoH) of the Kingdom of Cambodia wishes to advise members of the public that one more new human case of avian influenza has been confirmed positive for the H5N1 virus.

The tenth case, a five-year-old boy from Boeung Tapream village, Sangkat Treuy Kors, Kampong Bay district in Kampot province was confirmed positive for influenza H5N1 on 2 April 2013 by Institut Pasteur du Cambodge.
He developed fever, convulsions and dyspnea on 27 March 2013. On 2h March, his mother bought some medicines from a local pharmacy for him. His condition worsened and on 29 March he was taken to the Treuy Kors Health Centre.

The boy was then referred to the Kampot Provincial Hospital the same day. On 31 March, his dyspnea worsened and he was sent to the Kantha Bopha Hospital in Phnom Penh. In Kantha Bopha Hospital, the boy has been treated with Tamiflu. He is currently in a critical condition.

It is not known whether the boy had direct contact with poultry. The boy is the tenth person this year and the 31st person to become infected with the H5N1 virus in Cambodia. Of the 31 confirmed cases, 21 were children under 14, and 19 of the 30 were female.

"Avian influenza H5N1 remains a serious threat to the health of all Cambodians,” said H.E. Dr. Mam Bunheng, Minister of Health. “This is the tenth case of H5N1 infection in humans this year. Children also seem to be most vulnerable and are at high risk because they like to play where poultry are found.”

“I urge parents and guardians to keep children away from sick or dead poultry and prevent them from playing with chickens and ducks. Parents and guardians must also make sure children wash their hands with soap and water after any contact with poultry. If they have fast or difficult breathing, they should seek medical attention at the nearest health facility and attending physicians must be made aware of any exposure to sick or dead poultry.”

The Ministry of Health's Rapid Response Teams (RRT) are currently in the village to identify the boy’s close contacts, any epidemiological linkage among the 10 cases and initiate preventive treatment as required. In addition, a public health education campaign is being conducted in the village to inform families on how to protect themselves from contracting avian influenza.

The Government's message is - wash hands often; keep children away from poultry; keep poultry away from living areas; do not eat dead or sick poultry; and all poultry eaten should be well cooked.

Continued:  http://www.un.org.kh/index.php?option=com_content&view=article&id=621:2012-h5n1-seventhreport&catid=65:avian-influenza-h5n1&Itemid=119

CDC Health Advisory: Human Infections with Novel Influenza A (H7N9) Viruses

[This Emergency CDC Advisory will be located on the right side-bar for future reference].

Summary and Background

As of April 4, 2013, Chinese public health officials have reported 14 cases of human infection with a novel avian influenza A (H7N9) virus from four different provinces in China. All patients were hospitalized with severe respiratory illness, and six persons have died. These are the first human infections identified with an avian influenza A (H7N9) virus infection. Six cases are from Shanghai, one is from Anhui Province, four are from Jiangsu Province, and three are from Zhejiang Province. Thirteen cases are in adults aged 27 through 87 years, and one case is in a child aged 4 years; all cases had illness onset from February 19 through March 31, 2013. No person-to-person transmission or epidemiologic link between any of the cases has been identified. We are aware of reports of possible sources of infection but these have not been confirmed. We are investigating and will provide that information when it is available.
Preliminary functional data of the isolated viruses from the first 3 cases suggest that they are likely susceptible to neuraminidase inhibitors. Investigations by Chinese public health officials are ongoing. These cases are a reminder that novel A influenza viruses can infect and cause severe respiratory illness in humans. Novel influenza A viruses are influenza viruses that are different from currently circulating human influenza A virus subtypes and include influenza viruses from predominantly avian and swine origin. In recent years, human infections with highly pathogenic avian influenza A (H5N1) virus in several Asian countries and Egypt, highly pathogenic avian influenza A (H7N3) virus in Mexico, and variant influenza A (H3N2)v viruses in the United States have been reported (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6136a4.htm, http://www.who.int/influenza/human_animal_interface/EN_GIP_20130312CumulativeNumberH5N1cases.pdf, http://emergency.cdc.gov/HAN/han00325.asp). The clinical presentation of human infection with avian influenza A viruses varies considerably--from mild illness, including conjunctivitis, fever, and cough, to severe illness, including fulminant pneumonia leading to death in cases of H5N1 and in these recent cases of H7N9 virus infections. To date there has been no evidence of person-to-person transmission of influenza A (H7N9) viruses.
At this time, no cases of human infection with avian influenza A (H7N9) viruses have been detected in the United States. Rapid detection and characterization of novel influenza viruses remain a critical component of national efforts to prevent further cases, evaluate clinical illness associated with them, and assess any ability for these viruses to spread among humans. As a result, clinicians are reminded to consider influenza as a possible diagnosis when evaluating patients with acute respiratory illnesses, including pneumonia, even outside of the typical influenza season.
Clinicians should consider the possibility of novel influenza A (H7N9) virus infection in persons with respiratory illness and an appropriate travel or exposure history. Although the majority of novel influenza A (H7N9) cases have resulted in severe respiratory illness in adults, infection with this virus may cause mild illness in some and may cause illness in children as well. When performing influenza diagnostic testing in patients with respiratory illness for whom an etiology has not been confirmed, clinicians may identify human cases of avian influenza A virus infection or new cases of variant influenza in the United States. Patients with novel influenza A (H7N9) virus infections should have a positive test result for influenza A virus via reverse-transcription polymerase chain reaction (RT-PCR) testing but be unsubtypeable.
Suspected infections with novel influenza A (H7N9) viruses in the United States should be reported to CDC within 24 hours of initial detection, and state health departments should notify CDC promptly of all patients under investigation for possible novel influenza A virus infection.

Interim Recommendations for Clinicians and State and Local Health Departments

Case Investigation and Testing

  • Patients with illness compatible with influenza who also meet either of the exposure criteria below should be candidates for RT-PCR testing for influenza. Decisions about diagnostic testing for influenza using RT-PCR should be made using available clinical and epidemiologic information, and additional persons in whom clinicians suspect influenza A (H7N9) virus infection may also be tested.
    1. Patients with recent travel to countries where human cases of novel influenza A (H7N9) virus infection have recently been detected, especially if there was recent direct or close contact with animals (such as wild birds, poultry, or pigs) or where influenza A (H7N9) viruses are known to be circulating in animals. Currently, China is the only country that has recently reported novel influenza A (H7N9) human cases.
    2. Patients who have had recent contact with confirmed human cases of infection with novel influenza A (H7N9) virus.
  • Clinicians should obtain a nasopharyngeal swab or aspirate from these patients, place the swab or aspirate in viral transport medium, and contact their state or local health department to arrange transport and request a timely diagnosis at a state public health laboratory or CDC. For additional guidance on diagnostic testing of patients under investigation for novel influenza A (H7N9) virus infection, please see Interim Guidance for Laboratory Testing of Persons with Suspected Infection with Highly Pathogenic Avian Influenza A (H5N1) Virus in the United States at http://www.cdc.gov/flu/avianflu/guidance-labtesting.htm.
  • If infection with influenza A (H7N9) virus is suspected based on current clinical and epidemiological screening criteria recommended by public health authorities, specimens should be collected with appropriate infection control precautions for novel virulent influenza viruses and sent to the state or local health department for testing. Viral culture should not be attempted in these cases.
  • All unsubtypeable influenza A virus specimens should be submitted to CDC immediately for additional diagnostic testing. At this time, confirmatory testing for avian influenza A (H7N9) will be conducted at CDC.
  • Commercially available rapid influenza diagnostic tests (RIDTs) may not detect avian or variant influenza A viruses in respiratory specimens. Therefore, a negative rapid influenza diagnostic test result does not exclude infection with influenza viruses. In addition, a positive test result for influenza A cannot confirm variant or avian influenza virus infection because these tests cannot distinguish between influenza A virus subtypes (they do not differentiate between human influenza A viruses and avian or variant viruses). Therefore, when RIDTs are positive for influenza A and there is concern for novel influenza A virus infection, respiratory specimens should be collected and sent for RT-PCR testing at a state public health laboratory. Clinical treatment decisions should not be made on the basis of a negative rapid influenza diagnostic test result since the test has only moderate sensitivity.

Infection Control

  • Clinicians should be aware of appropriate infection control guidelines for patients under investigation for infection with novel influenza A viruses. Because it has been shown to cause severe respiratory illness in cases identified so far, healthcare personnel (HCP) caring for patients under investigation for novel influenza A (H7N9) virus infection should adhere to Standard Precautions plus Droplet, Contact, and Airborne Precautions, including eye protection, until more is known about the transmission characteristics of the A (H7N9) virus.
  • All clusters of respiratory illness in HCP caring for patients with severe acute respiratory illness should be investigated.

Treatment

  • For persons hospitalized with suspected influenza, including suspected novel H7N9 virus infection, clinicians should start empiric treatment with influenza antiviral medications (oral oseltamivir or inhaled zanamivir) as soon as possible, without waiting for laboratory confirmation.
  • For high-risk persons (persons <5 years of age, ≥65 years of age, and those with certain underlying medical conditions) with suspected influenza of any severity , including suspected novel H7N9 virus infection, clinicians should start empiric treatment with influenza antiviral medications (oral oseltamivir or inhaled zanamivir) as soon as possible, without waiting for laboratory confirmation.
  • Antiviral treatment is most effective when started as soon as possible after influenza illness onset. Early initiation of treatment provides a more optimal clinical response, although treatment of moderate, severe, or progressive disease begun after 48 hours of symptoms may still provide benefit. 
Link:  http://emergency.cdc.gov/HAN/han00344.asp

For More Information

Shanghai bans entry of live poultry

2013-04-06
Excerpt:

SHANGHAI, April 6 (Xinhua) -- Shanghai authorities on Saturday started banning all live poultry from other parts of the country from entering the city after temporarily closing three markets to battle the H7N9 bird flu.
The authorities will launch inspections on roads to prevent live poultry from being transported into the city, said the Shanghai Municipal Agricultural Commission.
The latest move came after six H7N9 bird flu cases, including four fatalities, were reported in the city.

HK Med. Assoc. Met w/CHP -- Issued Rpt. Guidelines

4/5/13
Translation
Excerpt:


The Mainland 3-year-old youngster sick is recovering after he returned to Hong Kong in the evening, said the team worked with experts from the Mainland to study some of the serious cases, the majority of the clinical manifestations are symptoms of the flu, rapid changes in the part of the human condition, and also study part mild disease cases, including a 3-year-old boy is in stable condition and is recovering. 

He said the two experts also examined the patient's blood test and chest X-ray films, and discuss doses of drug use, and that the current use of Tamiflu remains effective for the treatment of influenza. 

In addition, the Hong Kong Medical Association last night meeting with the CHP to discuss the bird flu epidemic. President of the Medical Association, Xie Hongxing said after the meeting, Dr. Xiang Huiyuan issued reporting guidelines recommend that doctors found patients with acute respiratory diseases, such as fever and severe pneumonia, plus the last seven days had contact with birds or to over to have infections region, even contact with H7N9 patients, should be made ​​to the CHP.

http://www.hkdailynews.com.hk/news.php?id=278141 

Hong Kong: Experts Returned from 2-day Meeting in Shanghai

4/6/13
From one source:
Translation/Excerpt
Mainland avian flu epidemic is raging! HKU Professor Yuen Kwok-yung HA experts visited the two-day Shanghai, mainland experts avian flu, returned to Hong Kong last night. The infection and Emergency Services Chief Manager Liu Shaohuai team has analyzed multiple avian influenza in patients with the disease, and found that some patients after the onset of the condition deteriorated rapidly, and high mortality.

Government executives held a joint meeting yesterday, decided to enhance the prevention and control measures, managing stepping up checks temperature of travelers at all land crossings next week H7 viruses detected for the importation of live chickens, avian reached in Hong Kong.
And another source:
Translation/Excerpt:

The HA panel of experts to Shanghai exchange diagnosis and treatment of the H7N9 avian flu, returned to Hong Kong last night. HA said that the team finishing the access to information, the next week will report to the Committee of Experts of the Hospital Authority, update and develop new influenza virus infection control guidelines. Medical Association recommends that Member doctors noticed has confirmed occurrence of H7N9 avian flu patients, even if it does not fully comply with the reporting criteria, such as the patient's condition deteriorated within 24 hours, and should require the patient to follow-up appointments and evaluate.

The the HA panel of experts visited yesterday to continue the second day in Shanghai yesterday morning to the Hospital of Fudan University in Shanghai, to understand hospital diagnosis and treatment of avian flu patients. HA infection and Emergency Services Chief Manager Liu Shaohuai H7N9 avian influenza, although not yet signs of human to human transmission, but the actual ability to communicate [get infected] is still to be studied, it needs to gather more information, I believe that will help doctors make a clinical diagnosis.

Hong Kong: Suspected Case (7 yo) Tests Negative

Translation
From Information Svc. Dept. of Hong Kong

The Department of Health announced today (April 5), the preliminary test results showed that one had influenza H7 virus negative reaction to the seven-year-old girl in Shanghai, Jiangsu and Hunan and fever after returning to Hong Kong.    From March 23 to April 3, the girl with his family to Shanghai, Jiangsu and Hunan, fever and sore throat, to the Queen Elizabeth hospital emergency room for treatment, and is currently receiving treatment in isolation ward, in stable condition.

http://www.news.gov.hk/tc/categories/health/html/2013/04/20130405_233153.lin.shtml 

Hong Kong: Saturday 4/6 Will Start Random Temp. Checks on Incoming Travelers

Hong Kong on higher alert as 7-year-old girl tested for H7N9 bird flu



4/5/13
Excerpt:
Starting on Saturday, the Department of Health will deploy staff from the Auxiliary Medical Services and the Civil Aid Service and Health Surveillance Assistants to all immigration control points in Hong Kong to conduct random temperature checks on travelers, using hand-held temperature devices.
He said the department would implement the health declaration arrangement at all control points.

Tests will be conducted on imported chickens at the Man Kam To boundary checkpoint next week to ensure the birds are virus-free. If infected birds are found, the Hong Kong government will consider culling all poultry and suspending mainland poultry imports.
Other measures include enhancing the inspection and cleaning of poultry wholesale markets, public markets and streets.

Ko added that the Hong Kong Hospital Authority has 38 million surgical masks and 1.4 million N95 masks, which is sufficient for all medical staff for three months.

Continued:  http://news.xinhuanet.com/english/china/2013-04/05/c_132286856.htm


#H7N9 Mortality Rate 67%...pharmacy's cold medicine sold out...

Translated out of China:
4/5/13

Pigeons in the agricultural market in Shanghai is detected the H7N9 virus, all culling of all poultry in the market, officially announced by Saturday to suspend the market live poultry trading. Shanghai to become infected with high-risk area, the city snapped H7N9 prevention supplies phenomenon.  

Hong Kong media criticized the mainland authorities still anti-people rather than disease prevention.  

Chinese mainland H7N9 epidemic continues to spread, the Zhejiang Provincial Health Department on Friday informed of Huzhou one case of H7N9 patients due to rescue invalid death Thursday, Jiangsu Provincial Health Department informed of new two confirmed cases. As of Friday evening, confirmed infection of H7N9 avian influenza in patients of 16 patients, of whom six died. 

 Hong Kong is also the first case of suspected H7N9 cases, the patient was a 7-year-old girl, went to the end of March, at the Queen Elizabeth Hospital for treatment under isolation.  

The epidemic is serious global vigilance, Reuters reported on Friday, the White House is closely following the outbreak, the U.S. Centers for Disease Control and Prevention Center said to have begun to develop a vaccine, just in case. The Japan Airport is also the Immigration Department posters, warning all passengers if so, cold symptoms, seek medical help. Hong Kong released the preliminary alert and take precautionary measures at the airport. While Hong Kong stocks fell 610 points on Friday, analysis refers to the decrease was attributable mainly by variants of avian influenza H7N9 epidemic. 

 Health and Family Planning Commission of infectious diseases in China Key Laboratory Director Li Lanjuan Thursday to the media that is currently not possible to determine the source of infection and mode of transmission of H7N9. "H7N9 virus and other avian influenza viruses should be from poultry, but we feel that it is the source of infection is still unclear. Speaking from past experience, a lot of spread through the respiratory tract, now H7N9 respiratory communication, there is no particular evidence. " the Ministry of Agriculture on Thursday in a market in Shanghai Songjiang District pigeons samples detected H7N9 virus, the Shanghai municipal government announced the closure of the trading range of the market live poultry immediately.  

4:00 to Friday, the market 20,536 birds were all culled, and the harmless treatment. The Shanghai government held a press conference on Friday afternoon, said the citywide from April 6 will suspend the market live poultry trading, the temporary closure of live bird markets in the city. 

 Xinhua News Agency reported on Thursday in Shanghai a person close contact with H7N9 patients fever, runny nose and other symptoms be treated in isolation.Shanghai, said at Friday's press conference that the person has been tested and may be infected with the H7N9 avian flu has been ruled out. Close contact with patients diagnosed 119 people, and 118 A person does not have fever or respiratory symptoms.
While stressed, infected with the H7N9 virus, not all severe, a patient's condition has improved, while another 4-year-old pediatric patients during the recovery period.However, people in Shanghai six confirmed cases, death four cases, the mortality rate as high as 67%, only to announce the infected person is not severe and can not lift the hearts of the concerns. 

 Jiangsu Provincial Health Department has said Banlangen granules can prevent H7N9, although it became a more than Chinese medicine practitioner online no basis for this statement, Banlangen not abuse, but the people of Shanghai Mr. Zhao told this station Friday, currently the city's many pharmacies Banlangen granules have been sold out. Radix, we go fifty-six (pharmacy), have been sold out and other cold medicines, these drugs can cure a cold virus in buy, some also sold out soon. " netizens "Donovan Uncle" said: department epidemic conceal, cause we do not understand the epidemic, before blindly rely Banlangen to prevent.  

Friday news conference in Shanghai has also been a lot of criticism, refers to have the public is most concerned about the dead pigs, pigeons, the pathogens are not related to people once cold symptoms must seek medical treatment as soon as possible. Netizens "West Lake": suppose being still foggy.Your conference ended, avian flu will end? 

 Many Hong Kong media sent reporters to conduct field interviews in East China over the past few days with plenty of coverage of the outbreak, and delivered from all walks of life comment. "Oriental Daily News" published an editorial Thursday, said the mainland authorities to squeezing toothpaste on avian flu, not entirely true, it is dubious. The most baffling is that even if the epidemic is spreading, and still can not see the central government or the Ministry of Health to come forward to co-ordinate the work of national immunization, but continue to be fragmented by the local government. The face of a new round of epidemic outbreak, authorities are still hiding, hiding the notification provisions exist in name only.Could China's human life really not worth the money? Could the so-called "China Dream" is just a nightmare? Hong Kong's Apple Daily "published an editorial on Friday" anti-China and even in epidemic prevention Xi Li inevitably repeat the same mistakes ", Hangzhou just arrested four spreading the epidemic" rumors "online netizens immediately confirmed two H7N9 avian influenza outbreak. Local authorities to prevent Internet users in the disclosure of information rather than to prevent the spread of the epidemic, people ask: whether to forget the painful lesson to conceal the SARS epidemic? Xi Li can avoid making the same mistakes? 

The above is a special correspondent of Radio Free Asia sail coverage
http://www.rfa.org/mandarin/yataibaodao/huanjing/sh-04052013113508.html

#H7N9: First 2 Days Of Symptoms Tamiflu is Most Effective

[As with H5N1 Avian Influenza, it remains the same with this strain...]
Translated out of China
4/5/13
Excerpt:

The first two days of the onset is the critical period
Delay attending longest a case from Zhejiang, the onset of the 38-year-old chef surnamed Hung on March 7, but dragged on for a full 12 days, that is, until March 18 to Hangzhou Jiande the hospital for treatment, the results The patient's condition continued to deteriorate until she died on March 27. Extended consultation time is longer, the lower the chance of cure.
Bryan So, said face of the respiratory tract infection disease, if it is a bacterial infection, but the virus infection. Treatable H7N9 anti-flu drugs Tamiflu and Relenza, and medication is the best treatment in the first two days after the onset of medication to suppress viral replication, reduce the amount of virus and complications .

http://news.guhantai.com/2013/0405/224828.shtml

#H7N9 Confirmed Case List & Statistics

I have included a H7N9 Case Statistic block in the upper righter corner of the side-bar.  It will be updated as needed.
Case Statistic Block

Below is the current case list of confirmed humans, in China.  For future reference it can be found on the right side-bar, under the heading "H7N9".  The Map of cases is located on the right side-bar also.  That is updated periodically.

 
H7N9 Human Cases 2013

Date of Report:  3/8/13
Name:  Li Family – Father & 2 Sons
Ages:  55 & 69 (below)

55(M)  Son of 87(M)
Adm:  yes between Feb 14-24 w/pneumonia
Confirmation:  no
DOD:  2/28
Note:  Cause of death under investigation.

69(M) Eldest son of 87(M)
Adm:  Between Feb 14-24 w/pneumonia
Confirmation:  no
Note:  Recovered and discharged.

Shanghai
Date of Report 3/31/13
Name:  Lee 87(M) Father of 2 above
From:  Minhang District, Shanghai
Adm:  2/24 (?)Shanghai No. 5 People’s Hospital
Onset:  2/19
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Notes: No mutual infections among the 3 cases.  88 contacts are fine.  H7N9 has never been contracted to humans before.  Virus shows no signs of being highly contagious.  All sym’s were fever, cough developing into severe pneumonia & difficulty breathing in later stage.  No contact with poultry.  Contact with Pork. (Cidrap: 4/10/13).
Confirmation:  3/30/13
DOD:  3/4

Shanghai
Date of Report:  3/31/13
Name:  Wu 27(M) Pork Dealer in wet market
From:  Minhang District, Shanghai
Onset:  2/27
Adm:  Small clinic
Adm:  3/3  Shanghai No. 5 People’s Hospital, diag: pneumonia
3/6:  ICU, critical condition.
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Notes: No mutual infections among the 3 cases.  88 contacts are fine.  H7N9 has never been contracted to humans before.  Virus shows no signs of being highly contagious.  All sym’s were fever, cough developing into severe pneumonia & difficulty breathing in later stage.  No contact with poultry.  Contact with Pork.
Confirmation:  3/30/13
DOD:  3/10


Anhui Province
Date of Report:  3/31/13
Name:  Mr. Han 35(F)
From:  Chuzhou City, Anhui Province
Onset:  3/9
3/14 fever 39.  3/15 Comm. Clinic.
Than another Clinic, fever 40.  No relief.
Adm:  3/19 – Chinese & Western Medicine, Chuzhou
Adm:  3/20 – First People’s Hospital, Chuzhou City
Adm:  3/20 – Afternoon - Nanjing Zhongshan Univ. Hospital, Jiangsu, ICU
Notes:  Critical Condition 3/31.  Contact with birds 5 days before onset, purchased live chickens.  Cut chicken up made soup.   No mutual infections among the 3 cases.  88 contacts are fine.  H7N9 has never been contracted to humans before.  Virus shows no signs of being highly contagious.  All sym’s were fever, cough developing into severe pneumonia & difficulty breathing in later stage.
Confirmation:  3/30/13

Jiangsu Province
Date of Report:  4/2/13
Name:  Xu - 45(F)
From:  Jiangning District, Jiangsu Province
Onset:  3/19, dizzy, fever, aches, fatigue
Adm:  3/27, ICU Nanjing Drum Tower Hospital
Confirmed:  3/30 – Prov. Ctr for Disease Detection
Confirmed:  4/2 – China CDC
Notes:  Critical Condition.  49 contacts being monitored.  Worked as poultry butcher at local market.

Jiangsu Province
Date of Report:  4/2/13
Name:  48(F) – sheet metal processing
From:  Suqian Shuyang, Jiangsu Province
Onset:  3/19, fever, dizzy, cough
Adm:  3/30, Nanjing Hospital ICU
Confirmed:  3/30 Jiangsu Provinial Ctr for Dis. Detection
Confirmed:  4/2  China CDC
Notes:  Critical Condition.  60 contacts monitored.

Jiangsu Province
Date of Report:  4/2/13
Name:  Shen  83(M)
From:  Suzhou Wujiang District, Jiangsu Province
Onset:  3/20, fever, cough, sputum production
Adm:  3/29 Transferred  Wujiang Area Hospital
Confirmed:  4/1 Jiangsu Provincial Ctr for Disease Detection
Notes:  Critical Condition.  15 contacts monitored.
DOD:  4/9

Jiangsu Province
Date of Report:  4/2/13
Name:  Zhang  32(F)
From:  Wuxi City, unemployed, Jiangsu Province
Onset:  3/21
Adm:  3/28 Wuxi ICU
Confirmed:  3/31 Jiangsu Prov. Ctr for Dis. Detection
Confirmed:  4/2 – China CDC
Notes:  Critical Condition.  43 contact monitored.  Lives alone, rural area.  No large-scale farms or famers’ markets, but habit of backyard poultry & livestock in rural areas.

Zhejiang Province
Date of Report:  4/3/13
Name:  Hong (38) – Cook, worked in Taicang City, Jiangsu Province
From:  Hangzhou Jiande, Zhejiang Province
Onset:  3/7
Adm:  3/18
DOD:  3/27
Confirmed:  4/1 Zhejiang Province CDC
Confirmed:  4/3 China CDC
Notes:  125 contacts monitored.

Zhejiang Province
Date of Report:  4/3/13
Name:  Yang (67)M, Retired, unemployed
From:  Hangzhou, Zhejiang Prov.
Onset:  3/25
Adm:  3/25 Hangzhou Hospital
Adm:  4/2 Zhejiang Univ. School of Med Hospital
Confirmed:  4/2 Zhejiang Province CDC
Confirmed:  4/3  China CDC
Notes:  Critical Condition.  58 contacts monitored


Zhejiang Province
Date of Report 4/4/13
Name:  Zhang 64(M) Farmer
From:  Wuxing district, Huzhou City, Zhejiang Province
Onset:  3/29
Adm:  3/31 Huzhou
Confirmed:  4/3
Notes:  55 contacts monitored
DOD:  4/4/13

Shanghai
Date of Report:  4/4/13
Name:  Chu 48(M) Transported Chickens & Ducks
From:  Shanghai
Onset:  3/28 cough, sputum, fever
Adm:  4/1 private clinic
Adm:  4/3 Tongji Hospital (deteriorated sharply)
Confirmed:  4/4 Shanghai CDC
Note:  Died 3 hours after admission.  8 contacts monitored.
DOD:  4/3/13

Shanghai
Date of Report:  4/4/13
Name:  52(F)
From:  Shanghai
-->
3/27: Emer. Rm -fever, chills, X-ray showed small patchy shadow in lower lob of right lung.  Antibiotics intravenously for 3 days.
Emer. Rm again (date ?) – shortness of breath.  Put on vent.  Diag: sev. flu, pneumonia, hypoxia.  Treated w/methylprednisolone, antibiotics, immune globulin treatment.
Adm:  Huashan Hospital
DOD:  4/3/13
Confirmed:  4/4/13
Note:  Husband developed fever and runny nose.  Husband later tested negative.  Case had no contact with poultry.  Poultry conf. at local market near her.
Group said animal-to-human transmission and human-to-human transmission are both being considered in her case.


Shanghai
Date of Report:  4/4/13
Name:  4(M)
From:  Shanghai
Confirmed:  yes
Note:  Recovering from mild illness. Satisfactory.

Shanghai
Date of Report:  4/4/13
Name:  67(F)
From:  Shanghai
Adm:  Ruijin Hospital
Confirmed:  Yes
Note: Critical Condition


Shanghai – Close Contact to 52(F)
Name: 
From:  Shanghai
Adm:  Quarantine
Confirmed:  Tested Negative

Jiangsu Province
Date of Report:  4/5/13
Name:  Yin (61)F – Retirement Home
From:  Qinhuai District, Nanjing, Jiangsu Province
Onset:  3/20
Adm:  4/2 Nanjing Hospital
Confirmed:  4/3 Jiangsu Province CDC
Confirmed:  4/5 China CDC
Note:  12 contacts monitored.  Critical condition.

Jiangsu Province
Date of Report:  4/5/13
Name:  Lu (79)M – Retirement Home
From:  Qinhuai District, Nanjing, Jiangsu Province
Onset:  3/21
Adm:  3/31
Confirmed:  4/2 Jiangsu Province CDC (Weak result, nucleic acid)
Confirmed:  4/5, Test Again – Weak Positive, nucleic acid
Confirmed:  4/5  China CDC  - lung aspirate
Note:  53 contacts monitored.


Shanghai
Date of Report:  4/6/13
Name:  Zhou (74)M
From: Shanghai
Onset:  3/28 fatigue, fever, shortness of breath
Adm:  3/31 Fengxian Dist. Chinese Med. Hosp.
Confirmed:  4/6
Note:  Diag. pneu. on 4/5.  5 contacts monitored.

Shanghai
Date of Report:  4/6/13
Name:  Yang (66)M
From:  Shanghai retiree
Onset:  3/29 chills
Adm:  4/2 10th People’s Hosp.  Diag: UPPA
Confirmed:  4/6
Notes:  Stable condition.  6 Contacts monitored.


Shanghai
Date of Report:  4/7/13
Name:  Shen (59)M
From:  Anhui
Onset:  3/25 fever, cough
Adm:  4/4 Yan Chai Hospital
Confirmed:  4/6
Note:  Retiree.  2 contacts monitored.  Critical Condition.

Shanghai
Date of Report:  4/7/13
Name:  Lee (67)M
From:  Shanghai
Onset:  3/29  body aches, fever
Adm:  3/29  First People’s Hosp. (Southern Branch)
Confirmed:  4/7
Note:  2 contacts monitored.  Mild Case.


Anhui Province
Date of Report:  4/7/13
Name:  Lee (55)M – Poultry Sales & Slaughter
From:  Bozhou Qiaocheng, Anhui Province
Onset:  3/28
Adm:  4/1 Bozhou Hospital
Confirmed:  4/6  Anhui Province CDC
Confirmed:  4/7  China CDC nucleic acid
Note:  12 contacts monitored.  Stable Condition.

-->
Jiangsu Province
Date of Report:  4/8/13
Name:  Shumou (85)M – Retirement home
From:  Nanjing Shimonoseki, Jiangsu Province
Onset:  3/28
Adm:  4/1 Nanjing Hospital
Confirmation:  4/8 Jiangsu Province CDC
Notes:  34 contacts monitored.  Critical Condition.

Jiangsu Province
Date of Report:  4/8/13
Name:  Qiumou (25)F  unemployeed
From:  Zhenjiang City, Runzhou Dist., Jiangsu Province
Onset:  ?
Adm:  3/30  Jhenjiang City Hospital
Confirmed:  4/8 Jiangsu Province CDC
Notes:  18 people monitored.  Critical Condition.

Shanghai
Date of Report:  4/8/13
Name:  (64)M  Retiree
From:  Shanghai
Onset:  4/1  chills, temp not taken
4/3 temp 39.
Adm:  4/3 no. Ruijin Hospital diag: pneumonia.
Adm:  4/7 .Ruijin Hospital diag: severe pneumonia.  Isolation.
DOD:  4/7/13
Confirmation:  4/7 Shanghai CDC
Notes:  4 contacts monitored.  Total cases in Shanghai:  11.
Total Deaths in Shanghai:  5.  

-->
Shanghai
Date of Report:  4/9/13
Name:  Lin (61)M Retiree
From:  Shanghai
Onset:  4/1 fever 36.
4/1 – Go First People Hospital North, Diag: UPPA
4/5 – First Municipal People’s Hospital North, Diag: Pneumonia
Confirmed:  4/8 Shanghai CDC
Note:  Stable Condition.  5 Contacts monitored. 

Shanghai
Date of Report:  4/9/13
Name:  Wang (77)M Retiree
From:  Shanghai
Onset:  4/3
Adm:  Go to Putuo Dist. People’s Hospital, Diag: UPPA
Adm:  4/7:  Go to Jing’an Dist. Ctrl Hosp, Diag:  pneumonia
Confirmed:  4/9 Shanghai CDC
Note:  Stable Condition.  5 Contacts monitored.   13 confirmed cases.

Zhejiang Province
Date of Report:  4/9/13
Name:  Jiamou (51)F  Retiree
From:  Huzhou City
Adm:  yes
Confirmed:  4/9 Zhejiang Province CDC
Notes:  Severe condition.

Zhejiang Province
Date of Report:  4/9/13
Name:  Shentu (79)M  Retiree
From:  Hangzhou
Adm:  yes
Confirmed:  4/9 Zhejiang Province CDC
Note:  Critical Condition

-->
Jiangsu Province
Date of Report:  4/10/13
Name:  Chen (70)M
From:  Wuxi Huishan
Onset:  3/29
Confirmed:  4/10 Jiangsu CDC
Note:  18 contacts monitored.  Critical Condition
 
Jiangsu Province
Date of Report:  4/10/13
Name:  XU (74)M
From:  Jiangyin City, Wuxi City.
Onset:  4/2
Confirmed:  4/10 Jiangsu CDC
Note:  13 contacts monitored.  Serious condition.

Zhejiang Province
Date of Report:  4/10/13
Name:  Humou (65)M  - Farmer
From:  Hangzhou
Adm:  yes.
Confirmed:  4/10 Zhejiang Province CDC
Notes:  Stable condition.

 
Jiangsu Province
Date of Report:  4/11/13
Name:  Yin (31)M - Chef
From:  Yangzhou
Onset:  3/31
Adm:  Hospital in Nanjing
Confirmation:  4/11 Jiangsu CDC
Note: Critical condition.

Jiangsu Province
Date of Report:  4/11/13
Name:  Qian (56)M – teacher
From:  Suzhou, Jiangsu Province
Onset:  4/3
Adm:  Hospital in Suzhou
Confirmation:  4/11 Jiangsu CDC
Note:  Critical condition.  Total cases 35.


Shanghai
Date of Report 4/11/13
Name:  Jeong (74)M – retiree
From:  Shanghai
Onset:  3/31 weakness, drowsy, dizzy
Adm:  4/5 Putuo Dist. Ctrl Hosp., Diag: inflammation left upper lobe
4/10  Diag:  severe pneumonia
Confirmed:  4/10 Shanghai CDC
Note:  7 contacts monitored.
DOD:  4/11


Shanghai
Date of Report:  4/11/13
Name:  Kang (83)F – retiree
From:  Shanghai
Onset:  4/2 fev. cough, sputum
4/2:   Yangpu Dis. City East Hosp, no improvement
Adm:  4/7 Changhai Hosp fever (3 days), cough, sputum
Confirmed:  4/10  Shanghai CDC
Note:  44 contacts monitored.  Stable condition.


Shanghai
Date of Report:  4/11/13
Name:  Tangmou (68)M
From:  Shanghai
Onset:  4/4 fever, aches, took tylenol
4/6 :  Jiading ist. Ctr Hospital
Adm:  4/9 Ruijin Hosp. N. – diag: pneumonia right lower
Confirmed:  4/10 Shanghai CDC
Note: 19 contacts monitored.  Stable Condition.