On January 21, 2014, officials from the China Health and Family Planning Commission confirmed six new H7N9 influenza infections in Zhejiang Province and Guangdong 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, the first case is a 57-year-old male from Linhai City, Taizhou Perfecture, Zhejiang Province who was diagnosed on January 19 and he is currently hospitalized in critical condition. The second case is a 49-year-old male from Hanzhou City, Zhejiang Province who was diagnosed on January 20 and he is currently hospitalized in critical condition. The third case is a 70-year-old male from Shaoxing City, Zhejiang Province who was diagnosed on January 20 and she is currently hospitalized in critical condition. The fourth case is a 39-year-old female from Shenzhen City, Guangdong Province who was diagnosed on January 21 and she is currently hospitalized in stable condition. The fifth case is a 59-year-old female from Shenzhen City, Guangdong Province who developed her illness on January 13 and was diagnosed on January 21. She is currently hospitalized in critical condition. The sixth case is a 76-year-old male from Shenzhen City, Guangdong Province who developed his illness on January 9 and he is currently hospitalized in critical condition.

On the other hand, a fatal case in a physician was announced in Shanghai City on January 20. The case developed his illness on January 11, and he sought medical attention and was given antivirals on January 15. He died on January 18 and infection with H7N9 influenzas virus was confirmed on January 19. According to the epidmemiological investigation conducted by the local health authority, on January 4, the case stayed with his parents whose neighbor keeps doves as pets and there is a live poultry market across from the hospital where the case worked at. Ten days prior to his illness onset, the case had not had any direct contact with patients with influenza-like illnesses. Thus far, none of the case’s close contacts and the patients the case had come into contact with has developed any suspected symptoms. Hence, the local health authority considered the case to be sporadic, avian-to-human transmission.

Since October 1, 2013, a cumulative total of 79 H7N9 influenza infections, including 10 deaths, have been confirmed in China and Hong Kong. Among the cases, 35 were confirmed in Zhejiang Province, 25 were confirmed in Guandong Province, 7 were confirmed in Shanghai City, 2 were confirmed in Jiangsu Province, 7 were 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 213 H7N9 influenza infections, including 57 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 498 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 492 cases. The test results for 4 cases are still pending.

CECC for H7N9 influenza points out that since fall 2013, new H7N9 cases have been confirmed in China. 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.