On January 13, 2014, officials from the China Health and Family Planning Commission confirmed two more H7N9 influenza infections in Guandong Province and two more H7N9 influenza infections in Zhejiang Province, indicating the risk and threat of H7N9 influenza transmission remain. Currently, the Taiwan Centers for Disease Control (Taiwan CDC) has issued a travel notice of Level 2: Alert for avian influenza to Guangdong Province, Zhejiang Province, Jianxi Province, Jiangsu Province, Hunan Province, Shanghai City, Beijing City and Fujian Province and a travel notice of Level 1: Watch for avian influenza to the other provinces and cities in China, excluding Hong Kong and Macau. Travelers visiting China are urged to practice good personal hygiene and avoid contact with poultry and birds.

Among the four newly confirmed cases, two patients are women aged 41 and 59 from Ningbo City, Zhejiang Province and both were diagnosed on January 13 and are currently hospitalized with severe infections. The other two patients from Foshan City, Guandong Province are a 28-year-old woman who works as a poultry seller became ill on January 8 and was administered with antivirals on January 9 and then admitted to a hospital on January 12, hospitalized in stable condition, and a 46-year-old man who works as a driver and keeps poultry at home became ill on January 6 and was admitted to a hospital on January 9. He is currently hospitalized in critical condition. After closely monitoring close contacts of the confirmed cases, no sign of sustained human-to-human transmission has been observed. Hence, the provincial health ministry determined that the two cases are sporadic since no epidemiologic links between cases have been identified. In addition, the government officials in Nanhai District, Foshan City ordered a 2-day shutdown of live-poultry markets during January 13 and 14.

Since October 1, 2013, a cumulative total of 38 H7N9 influenza infections, including 4 deaths, have been confirmed in China and Hong Kong. Among the cases, 14 were confirmed in Zhejiang Province, 15 were confirmed in Guandong Province, 3 were confirmed in Shanghai City, 2 were confirmed in Jiangsu Province, 1 was confirmed in Fujian Province, and 3 imported from Guangdong Province were confirmed in Hong Kong. On the other hand, since March 31, 2013, a cumulative total of 172 H7N9 influenza infections, including 51 deaths, have been confirmed in China and Hong Kong.

Since “H7N9 influenza” was listed as a Category V Notifiable Infectious Disease in Taiwan on April 3, 2013, thus far, a cumulative total of 487 suspected H7N9 cases have been reported to Taiwan CDC. Infection with avian influenza A (H7N9) has been confirmed in two imported cases. The possibility of H7N9 infection has been ruled out in 485 cases.

The Central Epidemic Command Center (CECC) for H7N9 influenza points out that since fall 2013, additional H7N9 cases have been confirmed in China. Recently, three specimens collected from cutting boards and sewage water in the kitchen of a restaurant in Guangzhou City were tested positive for avian influenza A (H7N9) virus. At the time of writing, none of the staff working at the restaurant have been detected with any suspected symptoms. As of now, besides Shenzhen City, Guangzhou City and Zhuhai City, 8 environmental specimens collected from a market in Shantou City were tested positive for avian influenza A (H7N9) virus. As a result, it can be inferred that the ongoing outbreak in southern China may be spreading. Travelers visiting China are advised to avoid visiting traditional markets with live poultry and direct contact with poultry and birds or their droppings/dead bodies. At the same time, physicians are reminded to reinforce inquiry about patients’ travel and contact history in order to facilitate diagnosis of H7N9 infection and notify any suspected cases to the health authority immediately to help implementation of subsequent measures that can prevent further transmission of the disease.

CECC for H7N9 influenza once again reminds travelers visiting China to practice good personal hygiene such as washing hands frequently and putting on a mask when coughing, take preventive measures such as avoiding direct contact with poultry and birds or their droppings/dead bodies, and consuming only thoroughly cooked poultry and eggs. If influenza-like illness symptoms develop upon arriving in Taiwan, please voluntarily notify the airline crew and the quarantine officer at the quarantine station in the airport. If the above-mentioned symptoms such as fever and cough develop after returning to Taiwan, please put on a surgical mask and seek immediate medical attention.  Moreover, please inform the physician of the recent travel history to facilitate diagnosis and treatment. For more information, please visit the Taiwan CDC’s website at http://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Care Hotline, 1922, or 0800-001922 if calling from a cell phone.