China Said to Invite Four Flu Experts as Disease Outbreak Widens

Four international flu experts will arrive in China within days to help authorities respond to the country’s widening bird-flu emergency, according to two people familiar with the matter.

Nancy Cox, director of the flu division at the U.S. Centers for Disease Control and Prevention in Atlanta, Anne Kelso, director of a World Health Organization flu research center in Melbourne, Malik Peiris from the University of Hong Kong, and Angus Nicoll, head of the Stockholm-based European Centre for Disease Prevention and Control’s flu program, will arrive on about April 17 to offer technical advice, said the people, who declined to be identified because the Chinese government hasn’t announced that the experts are being invited.

The group will seek to assist Chinese authorities grappling to identify the source and mode of transmission of the H7N9 avian influenza that has infected at least 60 people and killed 13. Beijing yesterday said that a 7-year-old girl has the virus, and Henan province reported its first two cases, opening a new front in the spread of the new pathogen in the world’s most populous nation.

“There’s no way to predict how this will spread,” Michael O’Leary, the WHO’s China representative, told reporters in Beijing yesterday. “The good news is we have no evidence of sustained human-to-human transmission. That’s a key factor in this situation.”

Cox referred questions to the WHO, while Kelso, Peiris and Nicoll didn’t immediately respond to emails seeking comment. Gregory Hartl, a spokesman for the Geneva-based WHO, said the agency has discussed a mission to China, but declined to comment on specifics. Two calls to the press office of China’s National Health and Family Planning Commission weren’t answered.

Fresh Infections

Shanghai’s government said yesterday that the virus killed two more people, taking the country’s death toll to 13. The city also reported three fresh infections while the eastern provinces of Jiangsu and Zhejiang also confirmed new cases, raising the national tally to 60 from 49 on April 13.

The cases of the child in Beijing and two men in Henan widen the geographic spread of H7N9, adding impetus to the government’s efforts to gauge the magnitude of the infection in poultry and wild birds. Live-poultry trading has been banned in some cities and the Ministry of Agriculture last week ordered local governments to collect tissue samples from birds at markets nationwide to contain the outbreak.

Looking Intensively

The source of infections remains “under active investigation,” O’Leary said. “We’re still looking intensively for the reservoir of infection but the suspicion remains in birds, chicken, ducks and poultry.”

The first three cases of H7N9 in China were announced by the central government on March 31 and until April 13 all of those infected were in Shanghai and the provinces surrounding it.

In Henan, central China, the health bureau said yesterday a 34-year-old male cook living near Kaifeng city in the northeast of the province is in a critical condition. A 65-year-old farmer in Zhoukou city, some 130 kilometers (82 miles) further south, who had frequent contact with poultry, is stable, it said.

Nine of the 13 deaths are in Shanghai, according to government data. The two reported in the city yesterday were of a 67-year-old woman diagnosed April 4 and a 77-year-old man diagnosed April 9, according to a statement on the National Health and Family Planning Commission website.

Early Treatment

The four new cases in Zhejiang, all in a serious condition, take the province’s total to 15. The tally in Jiangsu rose to 16 yesterday after a 50-year-old man living in the capital Nanjing and a 26-year-old male living in Yancheng city were confirmed with the virus. Anhui province has so far reported two cases.

The Beijing case is very important, said Nikki Shindo, a medical officer on the influenza team at the WHO in Geneva. “Theoretically all China’s coastline provinces are touched by this virus, which means the great majority of China is at risk,” Shindo said in an e-mail, adding that early treatment with an anti-flu medicine may aid the girl’s recovery.

The child infected with H7N9 is recovering after treatment at Beijing Ditan Hospital Capital Medical University, the official Xinhua News Agency reported yesterday, citing the city’s disease control and prevention center. Yao’s parents, who live and sell poultry in the Shunyi district of northeast Beijing, have been placed under medical surveillance and have not yet shown symptoms of infection, it said.

The recovery of the 7-year-old shows that early treatment with proper anti-viral medication can be effective, O’Leary said. “We know also that the virus when untreated is very serious,” he said, “so we advocate for early treatment and good medical care.”

Human Transmission

Shanghai now has 24 human infections. The government said April 13 that a 56-year-old man surnamed Gu, the husband of a woman diagnosed on April 4, was found with the virus.

There isn’t enough evidence to conclude that Gu, who is in a critical condition, was infected by his wife and there’s no evidence that there has been human-to-human transmission among any of the cases, the National Health and Family Planning Commission said on its website.

“We can’t say yet” if the latest Shanghai infection represents human-to-human transmission, O’Leary said, adding that each case must be investigated very carefully.

“In cases where there might be two people in close proximity who both have the disease, it’s also difficult to determine whether that’s because of human-to-human or because they were both exposed to the same source, for instance chickens,” he said. “That’s not so easy to sort out.”

Negative Impact

The spread of the virus may negatively affect insurance, airlines, consumer staples and retailing, Hong Kong-based Citigroup Inc. analysts Shen Minggao and Ben Wei wrote in an April 8 report. It may also spur food-price inflation if supplies of poultry are cut, they said.

Louisville, Kentucky-based Yum! Brands Inc., said April 10 that publicity associated with bird flu has had a “significant, negative impact” on sales at its KFC restaurant chain in China “within the past week.” KFC offers chicken products including sandwiches, drumsticks and wings.

Beijing has halted live-poultry trading as part of its measures to step up prevention of the disease, Zhong Dongbo, a spokesman with the Beijing Municipal Health Bureau, said in a news conference broadcast live on China Central Television April 13. Shanghai and Nanjing are among other cities to ban such trade.

Complex Situation

Authorities have yet to order a mass slaughter of birds across the capital because no H7N9 infections have been detected in more than 5,600 samples collected from domestic and wild birds, Xinhua reported, citing Liu Yaqing, deputy director of the city’s agriculture bureau.

“If we can determine that poultry are major sources of the infection to people then culling is one of the measures that can be taken,” WHO’s O’Leary said. “But this is a complex situation because the virus does not appear to be very lethal or even serious in animal populations so it’s more difficult to detect.”

China has enough flu medication to fight the outbreak, and the government is also preparing a vaccine that it expects will be ready within seven months, Xinhua reported April 10.

The Beijing Drug Administration has been ordered to stock up on medicines, including enough Tamiflu for 2 million people, Xinhua has reported. Schools in Beijing were told to increase daily temperature checks and report possible cases to the education authorities within an hour of their discovery, it said.