On January 27, 2014, officials from the China Health and Family Planning Commission confirmed six new H7N9 influenza infections in Fujian Province, Guangdong Province, Hunan Province, and Jiangsu Province, indicating the risk and threat of H7N9 influenza transmission remain. Currently, the Central Epidemic Command Center (CECC) for H7N9 influenza 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. In addition, physicians are advised to pay additional attention to patients with pneumonia and inquire about such patients’ travel history.

Among the six newly confirmed cases, two cases are from Fujian Province, including a 69-year-old male and a 72 year-old female, who were both diagnosed on January 27. They are both currently hospitalized in critical condition. This third case is a 77-year-old female from Shenzhen City, Guangdong Province who was diagnosed on January 26 and is currently hospitalized in critical condition. The fourth case is a 68-year-old male from Jiangmen City, Guangdong Province who died on January 25 and was diagnosed on January 26. The fifth case is a 58-year-old female from Yueyang City, Hunan Province who is the first confirmed case in Hunan Province since fall 2013. The case had been exposed to poultry and was diagnosed on January 27. She is currently hospitalized. None of her close contacts has developed suspected symptoms. The sixth case is a 74-year-old female from Suzhou City, Jiangsu Province who was diagnosed on January 27 and is currently hospitalized.

Since October 1, 2013, a cumulative total of 115 H7N9 influenza infections, including 11 deaths, have been confirmed in China and Hong Kong. Among the cases, 55 were confirmed in Zhejiang Province, 31 were confirmed in Guandong Province, 8 were confirmed in Shanghai City, 6 were confirmed in Jiangsu Province, 10 were confirmed in Fujian Province, 1 was confirmed in Beijing City, 1 was confirmed in Hunan Province, and 3 imported from Guangdong Province were confirmed in Hong Kong. On the other hand, since March 31, 2013, a cumulative total of 249 H7N9 influenza infections, including 58 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 513 suspected H7N9 cases have been reported to Taiwan CDC. Infection with avian influenza A (H7N9) has been confirmed in two imported cases, including one death. The possibility of H7N9 infection has been ruled out in 508 cases. The test results for 3 cases are still pending.

CECC for H7N9 influenza points out that since fall 2013, most new H7N9 cases have been confirmed in Zhejiang Province and Guangdong Province in China. As a result, it can be inferred that the ongoing outbreak in southern China may be spreading. Thus far, most human cases were exposed to poultry. Nevertheless, the possibility of limited, non-sustained human-to-human transmission cannot be ruled out.

CECC for H7N9 influenza reminds physicians 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 and urges 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.