On February 13, 2017, the Taiwan Centers for Disease Control (Taiwan CDC) successfully isolated the H7N9 virus from the first imported case confirmed on February 4. On February 15, Taiwan CDC completed the genome sequence of the isolated virus. On February 16, Taiwan CDC shared the genome sequence data simultaneously with the Council of Agriculture (COA) and the international community on the Global Initiative on Sharing Avian Influenza Data (GISAID) website. On February 20, 2017, the Influenza Control and Prevention Advisory Committee determined during the Expert Meeting that the virus’ erythrocyte lectin (HA) and neuraminidase (NA) protein gene were similar to that of the H7N9 influenza virus isolated from China. Other combinations of its internal protein genes are slightly different when compared with the currently circulating virus, which means it could be a new genotype. In other words, the virus poses a high pathogenicity towards poultry, but does not enhance poultry-to-human or human-to-human transmission.

According to Taiwan CDC, the addition of three basic amino acids at the HA protein cleavage in the H7N9 virus isolated from the case may improve its pathogenicity in poultry. In addition, further gene sequence analysis showed that the NA protein of the virus has a mutation that is resistant to antiviral drugs such as Tamiflu and Relenza. The experts speculated that the drug resistant mutation might have emerged as a result of the treatment process. When the drug resistance was detected on February 15, Taiwan CDC immediately notified the healthcare team of the information to serve as treatment reference. Currently, the case is hospitalized in critical condition. COA and Taiwan CDC will continue to closely monitor international H7N9 activity in poultry and humans to detect variation and reinforce the existing real-time outbreak and virus surveillance. Further, on February 20, the updated clinical guidance for infections with novel influenza A vriuses was released to ensure the health of the people in Taiwan.

On the other hand, Taiwan CDC rebuts a recent claim that the first imported H7N9 case was poorly handled. Taiwan CDC reiterates that when the case arrived in Taiwan on January 25, he was detected with a fever by the airport fever screening system and was advised to seek immediate medical attention by the quarantine officer. On the same day, the case sought medical attention. On the next day, when he was transferred to a medical center, his doctor immediately suspected the case had mild H7N9 infection, collected specimens from the case for laboratory testing and reported the case to the health authority. In other words, both the quarantine officer and the doctor were highly vigilant and did their duties to report the case promptly without any delay or misdiagnosis. Moreover, the local health authority has been in touch with the doctor on a daily basis to follow up on the case’s condition. When infection with H7N9 was confirmed in the case, the local health authority immediately compiled a list of contacts to investigate and follow up. All close contacts have been provided with relevant health education and asked to monitor their own health. The local health authority followed up on the health of all 141 contacts till February 13, 2017.

According to the Disease Outbreak News released by the World Health Organization (WHO) on April 2013 (http://www.who.int/csr/don/2013_04_01/en/), China’s first H7N9 cases respectively included 2 cases reported from Shanghai and 1 case reported from Anhui. The cases’ disease onset was between February 19 and March 15, 2013. All three progressed to sever pneumonia. The cases were only laboratory confirmed on March 29 by the China Center for Disease Control and Prevention (China CDC). The numbers of days between disease onset and laboratory confirmation ranged between 13 and 38 days, which is contradictory to the rumor that when the world’s first H7N9 case occurred in Shanghai in 2013, the local healthcare facility confirmed the case and completed the virus genome sequence in only one day.

Since October 1, 2016, a cumulative total of 426 H7N9 influenza infections, which is way higher than that during the same period in the past years, have been confirmed in China, including 124 cases in Jiangsu Province, 75 cases in Zhejiang Province, 47 cases in Guangdong Province, and 45 cases in Anhui Province. The majority of the cases age 50 and above and had exposure to poultry or live poultry markets. Since March 31, 2013, a cumulative total of 1,224 H7N9 influenza infections, including 359 deaths announced by the World Health Organization (WHO) on January 16, 2017, have been confirmed around the world.

As H7N9 activity in China remains at its peak at the moment, Taiwan CDC urges travelers visiting China to adhere to the “5 Do’s and 6 Don’t’s” guidelines to ward off avian influenza. The “5 Do’s” include: Consume only thoroughly cooked poultry and eggs; Wash hands with soap and water thoroughly; Wear a mask and seek immediate medical attention when symptoms develop, and inform the doctor of your job and exposure history; People who have long-term or repeated exposure to poultry, including poultry growers and workers, should receive influenza vaccine; Eat a balanced diet and exercise regularly. The “6 Don’t’s” include: Don’t consume raw or undercooked poultry, eggs and poultry products; Don’t smuggle or purchase poultry from unknown sources; Don’t touch or feed migratory birds or poultry; Don’t release poultry into the wild or randomly abandon poultry; Don’t keep domesticated and wild poultry together; Don’t visit crowded and poorly ventilated public places.