AVIAN INFLUENZA--CHINA UPDATE JAN/FEB 2009

UNCLAS SECTION 01 OF 02 BEIJING 000257

HHS FOR OGHA
CDC ATLANTA FOR CCID, AND PASS TO FLU COX AND MOUNTS AND COGH BLOUNT
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E.O. 12958: N/A
TAGS: TBIO KFLU EAGR PREL HHS CH

SUBJECT: AVIAN INFLUENZA--CHINA UPDATE JAN/FEB 2009

REF: A)GUANGZOU 055 B)BEIJING 199 C)BEIJING 162 D)BEIJING 031
E)GUANGZHOU 006 F)08 GUANGZHOU 737 G)08 BEIJING 4675 H)08 SHANGHAI
556

SUBJECT: AVIAN INFLUENZA--CHINA UPDATE JAN/FEB 2009


1. SUMMARY: (U) As the country shut down and the population
traveled home for the Chinese New Year, four more cases of human
infection with highly pathogenic avian influenza (HPAI),influenza
A/H5N1, were confirmed (during the January 24-31 period) in the
provinces of Guizhou and Hunan, as well as in the regions of
Xinjiang and Guangxi, resulting in two additional deaths. The total
number of confirmed cases reported in 2009 of humans infected by the
highly-pathogenic H5N1 virus now stands at eight, five of which
resulted in death. Official communications of confirmed cases to
the public through state media, as well as to the World Health
Organization (WHO) have been prompt, and in each case,
provincial-level authorities implemented local "Highly Pathogenic
Avian Influenza (HPAI) Rapid Response Plans," which reportedly
involved comprehensive epidemiology investigations and quarantine
and close medical observation of patient contacts. According to
Chinese Ministry of Health (MOH) reports, epidemiological
investigations found that all eight patients had contact with live
poultry or sick birds prior to their illness. END SUMMARY.


2. (U) Mission China previously reported on four confirmed cases of
HPAI A/H5N1 (REFS B/C/D)(confirmed January 6-19, 2009) that resulted
in three deaths occurring in several different geographic areas
ranging from the city of Beijing to Shanxi, Shandong, and Hunan
Provinces. The lead-up to the Lunar New Year on January 26 saw an
additional four cases, also involving varied regions. MOH has
confirmed each of the cases, and Chinese media has reported widely
on the below information.


3. (U) On January 24, the Xinjiang Autonomous Region Health Bureau
confirmed a 31 year-old female in Urumqi was infected with influenza
A/H5N1. Initial onset was on January 10 and the patient was
hospitalized soon after. The Xinjiang Center for Disease Control
(CDC) collected a sample of respiratory secretions from the patient
on January 22 for testing, and confirmed infection with influenza
A/H5N1 on January 24. The patient had already passed away on
January 23, before the case was conclusively confirmed. The
epidemiological investigation found the patient to have been exposed
to a live poultry market. Observation of the patient's contacts
yielded no abnormal symptoms. The woman was the fourth case to die
in China in January.


4. (U) On January 25, the sixth case this year of human infection
with influenza A/H5N1 in China was reported. A 29 year-old male
resident of Guiyang City, Guizhou Province fell ill on January 15.
The Guizhou CDC collected a sample on January 23, and infection with
influenza A/H5N1 was confirmed and announced on January 25. This
patient also had exposure to a live poultry market. Medical
observations showed no additional illness among family members and
close contacts.


5. (U) As reported in REF A, MOH on January 26 confirmed that an 18
year-old man in south China's Guangxi Zhuang Autonomous Region
became the seventh human case and fifth fatality in China from
influenza A/H5N1 in 2009. The patient began showing symptoms on
January 19 while in the city of Beilu. Samples from the patient
were tested and confirmed an unspecified number of days afterwards,
and the patient was transferred to a Red Cross hospital in Yulin.
The patient died on January 26, the same day the case was made
public. The likely cause of infection is still under investigation,
although since the patient was from a rural village area, officials
speculate that he had come in contact with sick chickens.


6. (U) The final confirmed human case of infection with influenza
A/H5N1 thus far in 2009 was reported on January 31, involving a 21
year-old female from Xupu County in Hunan Province. The woman
initially exhibited symptoms on January 23, was eventually
transferred to the provincial capital of Changsha on January 29,
where samples were collected and tested. She reportedly had contact
with sick and dead poultry before falling ill. Hunan CDC confirmed
on January 30 that she had been infected with influenza A/H5N1. The

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patient remains in hospital in stable condition.


7. (SBU) In six of the eight cases, a 10 to 14 day period elapsed
from the date the patient initially fell ill to when the influenza
A/H5N1 virus was confirmed and officially announced, indicating a
long period during which the symptoms presented were likely assumed
to be caused by a human seasonal influenza virus or other common
respiratory pathogen. This would have prompted patients either to
refrain from seeking prompt medical attention or doctors to delay in
moving the case from village or neighborhood clinics to major
hospitals in provincial capitals, which are better equipped to
collect clinical samples, and/or where a provincial CDC or key
laboratory would be able to confirm infection by the influenza
A/H5N1 virus. Two other cases were confirmed and reported seven and
eight days after initial symptoms (paras 5 and 6); however, one
patient died the day the case was confirmed, the other is in stable
condition.


8. (U) Separately, an infant girl living in Shenzhen was treated in
a Hong Kong hospital in late December 2008 (REFS E/F) and confirmed
to have had a different strain of influenza virus found in birds,
influenza A/H9N2. Press reports placed her family's residence in
Shenzhen near a restaurant that deals with live poultry. The infant
is assumed to have recovered fully.


9. (SBU) COMMENT: No epidemiologic or virologic link has been
established among any of the cases reported this year. In addition,
the Ministry of Agriculture's (MOA) surveillance of domesticated
poultry flocks has not reported any die-offs or outbreaks in
domestic flocks associated by time and place with any of these human
cases. However, MOA acknowledges that the HPAI virus is widely
circulating in China. Despite no corroborating evidence, some
health officials have speculated that migratory birds may be the
source of these human infections.


10. (SBU) Over the same AI "peak" period a year ago (November 2007
- March 2008),only five human cases of influenza A/H5N1 were
confirmed and reported in China. This "season," only halfway
through the five-month "season," eight human cases of influenza
A/H5N1 and one of influenza A/H9N2 already have been confirmed in
China. According to the CDC country director in Beijing, it is not
yet clear whether the larger number of identified cases this year
simply represents improved human cases surveillance and reporting
practices employed by local authorities, an absolute increase in
incidence of the virus in humans, or a combination of both. More
clarity to this question may come as the season progresses.
Finally, the current situation also raises questions of how
effective public education has been in the most rural areas,
especially on prevention practices for "high threat" populations
that live and work in close proximity to live poultry, their
readiness to seek medical attention when influenza symptoms are
first observed, and for local health workers, who for the cases this
year still allowed several days to pass before referring cases
upwards to a facility equipped to deal with suspected cases of
infection with highly pathogenic avian influenza (HPAI). In spite
of this, there have been no documented cases of easy, sustained
human-to-human transmission among these cases. END COMMENT.

PICCUTA