In the evening of April 25, 2014, the Taiwan Centers for Disease Control (Taiwan CDC) confirmed the fourth imported case of H7N9 avian influenza in a 39-year-old male Taiwanese businessman who runs a company in China. He traveled to Beijing and Kunshan, Jiangsu in China during March 31 to April 19, 2014. As he developed symptoms, including fever, cough with yellow sputum and difficulty in breathing, after his arrival in Taiwan on April 19, he consequently visited some local clinic and hospital to seek medical attention. On April 23, he sought further medical attention at the emergency department and was hospitalized in a negative pressure ward in a medical center due to the development of left lower lobe pneumonia. Oseltamivir was then administered to the patient. His first sputum specimen was tested negative for influenza A (H7N9). However, when his symptoms persisted, the medical center reported the case to Taiwan CDC. Infection with influenza A (H7N9) was confirmed through his subsequent sputum specimen at 6 o’clock on April 25. Currently, the patient is in severe condition and being treated at the Intensive Care Unit (ICU) with negative pressure.
The infectious agent is currently under investigation in light of the fact that the patient had no poultry exposure history in China. After he returned to Taiwan, he had mostly stayed at home besides visiting the clinic and hospital for medical assistance. At the time of writing, no symptoms have been identified in members of his family in Taiwan and this one colleague who picked him up from the airport. Taiwan CDC is now working on obtaining the list of people who have come into contact with the patient, including passengers on the same flight and healthcare workers at the clinic and the hospital where the case has sought medical attention, for investigation and follow-up activities. Close contacts that were issued “Self-Health Management Advice for H7N9 Influenza” will be followed up by the public health authority closely until the period of voluntary contact tracing is lifted. Close contacts were also provided with oseltamivir prophylaxes and asked to put on a mask when they develop influenza-like illness such as fever and cough. In addition, the public health authority will voluntarily assist the sick individual in seeking medical attention. At the time of writing, Taiwan CDC is in the process of reporting this case to the World Health Organization (WHO) through the National IHR Focal Point.
Since “H7N9 influenza” was listed as a Category V Notifiable Infectious Disease in Taiwan on April 3, 2013, thus far, a cumulative total of 577 suspected H7N9 cases have been reported to Taiwan CDC and infection with avian influenza A (H7N9) has been confirmed in 4 imported cases (from Mainland China).
According to WHO, since October 1, 2013, a cumulative total of 296 H7N9 influenza infections have been confirmed around the world. All of the cases are either Chinese nationals or imported from China. Taiwan CDC has issued a travel notice of Level 2: Alert for avian influenza to Hunan Province, Anhui Province, Jiangsu Province, Guangdong Province, Fujian Province and Jiangxi 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.
As the risk and threat of H7N9 influenza transmission remain, Taiwan CDC once again urges travelers visiting China to practice good personal hygiene such as washing hands frequently and putting on a mask, take preventive measures such as avoiding direct contact with poultry and birds or their droppings, avoiding visiting traditional markets with live poultry, consuming only thoroughly cooked poultry and eggs. If 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).