On April 8, 2014, officials from the China Health and Family Planning Commission and Hong Kong Centre for Health Protection confirmed eight new H7N9 influenza infections in Guangdong Province, Anhui Province, Jiangsu Province, and Hong Kong. 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, Jiangsu Province, Hunan Province, Fujian Province, and Anhui 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. 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.

All the eight newly confirmed cases are currently hospitalized for treatment. The first case is a 28-year-old male from Jiangsu Province whose family keeps dove and chicken at home. His infection was confirmed on April 2 and he is now in critical condition. The second case is a 68-year-old male from Guandong Province. His infection was confirmed on March 31 and he is now in critical condition. The third case is a 37-year-old male from Guandong Province. His infection was confirmed on April 1 and he is now in stable condition. The fourth case is a 30-year-old male from Anhui Province. His infection was confirmed on April 3. The fifth case is a 62-year-old male from Guandong Province. His infection was confirmed on April 3 and he is now in critical condition. The sixth case is a 65-year-old male from Guandong Province who visited the wet market to buy slaughtered doves. His infection was confirmed by the health authority in Hong Kong on April 4 and he is now in stable condition. The seventh case is a 73-year-old male from Jiangsu Province. His infection was confirmed on April 5 and he is now in critical condition. The eighth case is a 28-year-old female from Jiangsu Province who bought a live chicken from a market and consumed it at home before her illness onset. She is now in critical condition.

Since March 31, 2013, a cumulative total of 412 H7N9 influenza infections, including 121 deaths announced by WHO on April 5, 2014, have been confirmed around the world. Since October 1, 2013, a cumulative total of 275 H7N9 influenza infections have been confirmed in China and Hong Kong. Among the cases, 97 were confirmed in Guandong Province, 92 were confirmed in Zhejiang Province, 19 were confirmed in Jiangsu Province, 18 were confirmed in Hunan Province, 17 were confirmed in Fujian Province (one of which was imported from Zhejiang Province), 8 were confirmed in Shanghai City, 8 were confirmed in Anhui Province, 3 were confirmed in Guangxi Province (one of which was imported from Guangdong Province), 2 were confirmed in Beijing City, 1 was confirmed in Guizhou Province (imported from Zhejiang Province), 1 was confirmed in Jilin Province, 1 was confirmed in Shandong Province (imported from Jiangsu Province), and 8 were confirmed in Hong Kong (all cases were imported from Guangdong Province).

Since “H7N9 influenza” was listed as a Category V Notifiable Infectious Disease in Taiwan on April 3, 2013, thus far, a cumulative total of 571 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 568 cases. The test result for one case is still pending.

CECC points out that according to the data announced by the Ministry of Agriculture of the People’s Republic of China, during January and March, 2014, 148 serum samples were tested positive for influenza A virus subtype H7 and 28 were tested positive for avian influenza A (H7N9) virus. The samples were respectively collected from Zhejiang Province, Guandong Province, Fujian Province, Hebei Province, Hunan Province and Guanxi Province. Thus far, most human cases were exposed to poultry. They had contact with poultry or live-bird markets. Nevertheless, the possibility of limited, non-sustained human-to-human transmission cannot be ruled out.

CECC for H7N9 influenza 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.