On February 21, 2014, officials from the China Health and Family Planning Commission confirmed eight new H7N9 influenza infections in Hunan Province, Guangdong Province, Anhui Province and Jilin 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, Fujian Province, Guangxi Province, Anhui Province and Jilin 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 eight newly confirmed cases, besides one died, all the other cases are currently hospitalized for treatment. The first case is a 29-year-old female from Changsha City, Hunan Province who was diagnosed on February 18. The second case is a 79-year-old male from Foshan City, Guangdong Province. The third case is an 81-year-old male from Guangzhou City, Guangdong Province. The fourth case is a 46-year-old female from Zhaoqing City, Guangdong Province. The fifth case is a 64-year-old male from Guanzhong City, Guangdong Province who died. The sixth case is a 69-year-old male from Jiangmen City, Guangdong Province. The second through sixth cases were respectively diagnosed between February 18 and 20. The seventh case is a 60-year-old male from Jing County, Anhui Province who was diagnosed on February 19. The eighth case is a 50-year-old male from Changchun City, Jilin Province who was diagnosed on February 21 and was exposed to sick and dead poultry. His condition is currently stable.

Since October 1, 2013, a cumulative total of 227 H7N9 influenza infections, including 33 deaths, have been confirmed in China and Hong Kong. Among the cases, 89 were confirmed in Zhejiang Province, 73 were confirmed in Guandong Province, 15 were confirmed in Fujian Province (one of which was imported from Zhejiang Province), 13 were confirmed in Jiangsu Province, 8 were confirmed in Shanghai City, 12 were confirmed in Hunan Province, 2 were confirmed in Beijing City, 5 were confirmed in Anhui Province, 3 were confirmed in Guangxi Province (one of which was imported from Guangdong Province), 1 was confirmed in Guizhou Province (imported from Zhejiang Province), 1 was confirmed in Jilin Province, and 5 were confirmed in Hong Kong (3 deaths and all cases were imported from Guangdong Province. On the other hand, since March 31, 2013, a cumulative total of 361 H7N9 influenza infections, including 80 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 545 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 543 cases.

In 2014, the Ministry of Agriculture of the People’s Republic of China has identified 3 specimens that were tested positive for serum antibody response and 14 specimens that were tested positive for the avian influenza A (H7N9) virus, which respectively came from Shanghai City, Anhui Province, Zhejiang Province, Jiangsu Province, Henan Province, Shandong Province, Guangdong Province, Jiangxi Province, Fujian Province, Hebei Province, Hunan Province and Guangxi 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.