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#259045 - 04/13/13 06:35 PM H7N9 flu on the move
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Anyone else following the H7N9 flu outbreak in China? I'm surprised that it isn't getting more attention because it's actually rather worrisome although we're still in the very early stages of the outbreak. Your average Chinese person is pretty worried about it already. One Chinese-American person here I know has already cancelled her trip to China in May in anticipation of trouble.

H7N9 is a bird flu, like the H5N1 bird flu that we've been warned about for almost a decade now. Like H5N1, it's highly lethal to people if you catch it. But H5N1 has remained a bird flu and is hard for people to catch. It hasn't mutated into a form that is more adapted to people, so it hasn't posed an urgent pandemic risk.

However, in a very short time, we're already seeing H7N9 strains that are adapting to people. Scientists have already experimented with H5N1 in the lab to see what kinds of genes will make a human pandemic flu, and from what I've read, wild H7N9 has already acquired one of two genes that will allow it to spread easily among people.

The outbreak started in Shanghai with a few dozen known cases, but the first case (a child) just popped up in Beijing, 600-700 miles away. Officially, there hasn't been any human-to-human transmission, but I think at least some of them were passed from human-to-human. So in a short time, H7N9 is evolving in a way that we've been dreading with H5N1 for many years.

The known numbers are small so far, but at the moment, it is 90% fatal. If it ever (and hopefully it does NOT) become easily transmissible, it can go from small numbers to exponentially increasing numbers very quickly.

H1N1 never worried me that much since it wasn't that deadly to adults in the US, but this does worry me. It's not here in the US, but might be something to be aware of down the road. We just came out of a worse than average flu season, so many of us are aware of how easily it can spread and how awful even a normal case of the flu can be.

As the weather warms up, maybe one of the best preps for this spring is to get yourself healthy with good food, lot's of sunshine (want to boost vitamin D levels from sun exposure) and physical activity to keep that immune system healthy.

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#259060 - 04/13/13 07:42 PM Re: H7N9 flu on the move [Re: Arney]
dougwalkabout Offline
Crazy Canuck
Carpal Tunnel

Registered: 02/03/07
Posts: 2617
Loc: Alberta, Canada
I've been hearing rumblings about this too. We dodged the bullet the last time so a lot of people became cynical, mostly because of the breathless media hype. But it's still entirely possible for one of these strains to mutate and take hold in the human population. When is anybody's guess.


Edited by dougwalkabout (04/13/13 07:43 PM)

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#259065 - 04/13/13 08:41 PM Re: H7N9 flu on the move [Re: Arney]
Am_Fear_Liath_Mor Offline
Carpal Tunnel

Registered: 08/03/07
Posts: 3077


Pandemic H7N9 flu would probably be much like a nuclear bomb exploding, not much you can do about except not to be around when it goes off.

The disease vector is other folks. Staying away from the crowds is the key so just bug out to areas where there isn't any other folks. Planning for 3+ to 6 months at the BOL would be probably be required.

Getting out of the City could prove to be difficult though when marshal law restrictions to movement are enforced.

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#259069 - 04/13/13 10:00 PM Re: H7N9 flu on the move [Re: Arney]
spuds Offline
Old Hand

Registered: 06/24/12
Posts: 822
Loc: SoCal Mtns
Flu makes a good story,when it happens THEN I'll worry.....they cry wolf every year,someday it will happen and they will be right,until then YAAAWNNNN!!!

I have masks,doesnt matter,I work in a hospital so will be exposed period,and first world countries have high tech supportive care not found in 3rd world so until a 1918 outbreak,we are fine.

There are plenty other diseases out there that scare me a lot more if went pandemic.

Thats my take

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#259071 - 04/13/13 10:24 PM Re: H7N9 flu on the move [Re: Arney]
frediver Offline
Enthusiast

Registered: 05/17/04
Posts: 213
Loc: N.Cal.
The only reason the 1918 flu stopped was that no one was left TO infect.
IIRC only a couple pacific islands dodged that bullet due to remoteness of there location. IMO camping for 6months will only mean you catch it on the 2nd or 3rd. go'round.

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#259091 - 04/14/13 01:18 PM Re: H7N9 flu on the move [Re: Arney]
ILBob Offline
Old Hand

Registered: 02/05/10
Posts: 776
Loc: Northern IL
A flu that so few manage to acquire even if it really is 90% fatal is not much of a threat as a pandemic.
_________________________
Warning - I am not an expert on anything having to do with this forum, but that won't stop me from saying what I think. smile

Bob

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#259092 - 04/14/13 04:24 PM Re: H7N9 flu on the move [Re: ILBob]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Originally Posted By: ILBob
A flu that so few manage to acquire even if it really is 90% fatal is not much of a threat as a pandemic.

Remember recently that two separate groups of scientists artificially mutated the H5N1 flu strain in their labs to make it easily transmissible in mammals? And the government blocked the publication of their research because they considered the information too dangerous? Well, H7N9 is halfway to acquiring the mutations that the scientists found would make it easily transmissible.

A disease that spreads easily but kills 90% of the infected would burn out very quickly and not be a "good" pandemic disease. Anyone remember the mortality from Spanish Flu? Only three percent. Just three percent! So H7N9 can weaken dramatically and still be the worst thing since the Spanish Flu.

Although the numbers are small on an absolute scale, they are increasing rapidly. Since yesterday, the number of cases has increased by 20%. And the geographic area that the cases are coming from is expanding.

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#259093 - 04/14/13 04:30 PM Re: H7N9 flu on the move [Re: frediver]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Originally Posted By: frediver
The only reason the 1918 flu stopped was that no one was left TO infect.

Experts estimate that only about a third of humanity was infected by the Spanish Flu.

That doesn't say anything about the rest. Were they immune somehow or just lucky to avoid exposure? We don't know.

Remember some of these ridiculous sounding potential mortality estimates when H1N1 swine flu was starting to go pandemic? Well, take the world's population, take a third of that, and then multiply by 3%. That's roughly the Spanish Flu's experience translated to today's global population.

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#259096 - 04/14/13 05:52 PM Re: H7N9 flu on the move [Re: Arney]
Lono Offline
Old Hand

Registered: 10/19/06
Posts: 1013
Loc: Pacific NW, USA
Influenza is an area that I don't know enough, but neither does the general public which means general discussions are prone to misinformation and panic, which I don't do well. I can say this

Comparisons to the Spanish flu pandemic are apples and oranges: you are comparing societies based upon 19th century medicine to our current one with 21st century capabilities of detection and treatment. The Chinese have already published genetic profiles and health organizations are already producing candidate vaccinations. In 1918 they hardly knew what those things were.

Watch for evidence of sustained human to human transmission - one to many. By then it will be nearly too late to isolate yourself, but that's when you will know to 'panic.'. meantime it may be prudent to stock up on food and necessities to sustain you through your chosen public contact. Remember that pandemics are like tsunamis, they come in a sequence of waves over time, with a variety of lethality and probably a good chance of immunity provided by the initial ones. You never know which wave could getcha.

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#259097 - 04/14/13 06:02 PM Re: H7N9 flu on the move [Re: Arney]
Brangdon Offline
Veteran

Registered: 12/12/04
Posts: 1201
Loc: Nottingham, UK
Originally Posted By: Arney
The known numbers are small so far, but at the moment, it is 90% fatal.
References? According to Io9, it's infected 16 people and killed 6. A more recent report from Forbes says it has infected 60 and killed 13. When does the 90% fatality come from?

In general terms, a pandemic is one of the few threats that has a chance of affecting me in the UK. This one is still too low-level to require specific action, other than as a reminder.
_________________________
Quality is addictive.

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#259100 - 04/14/13 07:11 PM Re: H7N9 flu on the move [Re: Brangdon]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Originally Posted By: Brangdon
Forbes says it has infected 60 and killed 13. When does the 90% fatality come from?

A case fatality rate can only be calculated for people where you know the outcome. At the time I wrote that, 9 people had died and one was considered recovered. That's 90%. You could have a million more people sick with it at the same time, but until you know whether they survive or recover, it doesn't factor into that statistic.

When I wrote my post yesterday, there were thirty-something cases reported, so if you're seeing 60 cases in the press today, that's almost a doubling in less than a day.

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#259102 - 04/14/13 07:33 PM Re: H7N9 flu on the move [Re: Arney]
Lono Offline
Old Hand

Registered: 10/19/06
Posts: 1013
Loc: Pacific NW, USA
Early numbers on any influenza strain can be deceiving: they seldom separate out new detections versus finding past detections hidden in existing data. So 20% increases can be accounted for by newly discovered detections hidden in the data, and lethality figures are relative - most influenza As are known to carry human lethality potential, whether its proves to be 60% or 90% or some other number really remains to be seen.

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#259130 - 04/15/13 02:20 PM Re: H7N9 flu on the move [Re: Arney]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Interesting new development--a 4-year old, symptom-less carrier has been found in Beijing.

The boy's neighbor bought chicken from the parents of the 7-year old girl, who is Beijing's first confirmed H7N9 case. The parents of the girl sell live chickens. Since the boy did not have direct contact with the chicken sellers or any chicken sold by the chicken sellers, it seems likely that he was infected through another person.

That could be good news, if it turns out that far more people than we currently know have actually gotten H7N9 and not even noticed it. Then it wouldn't be so lethal. In other words, it could mean H7N9 is far milder than initially thought.

Or, it could be bad news, if the virus is actually highly lethal and a small percentage of carriers allow the disease to spread undetected and unknowingly far and wide, person-to-person. The virus also doesn't seem to sicken birds much, if at all, which makes monitoring its spread in the bird population much more difficult.

Up to 63 cases now, last that I've read. That already exceeds the number of H5N1 cases ever seen in China over the course of a decade.


Edited by Arney (04/15/13 05:26 PM)
Edit Reason: Modified description of boy's connection to 7-year old girl

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#259206 - 04/16/13 09:37 PM Re: H7N9 flu on the move [Re: Arney]
ILBob Offline
Old Hand

Registered: 02/05/10
Posts: 776
Loc: Northern IL
Originally Posted By: Arney
Originally Posted By: Brangdon
Forbes says it has infected 60 and killed 13. When does the 90% fatality come from?

A case fatality rate can only be calculated for people where you know the outcome. At the time I wrote that, 9 people had died and one was considered recovered. That's 90%. You could have a million more people sick with it at the same time, but until you know whether they survive or recover, it doesn't factor into that statistic.

When I wrote my post yesterday, there were thirty-something cases reported, so if you're seeing 60 cases in the press today, that's almost a doubling in less than a day.


Its 90% of those hospitalized as I understand it.

It seems reasonable that only people who are really sick will be hospitalized.

Those who get mild cases may not even realize what they have.
_________________________
Warning - I am not an expert on anything having to do with this forum, but that won't stop me from saying what I think. smile

Bob

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#259255 - 04/17/13 03:49 PM Re: H7N9 flu on the move [Re: ILBob]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Originally Posted By: ILBob
Its 90% of those hospitalized as I understand it.

Case fatality rate includes all known cases, whether hospitalized or not, but only cases where we know whether they recover or whether they die. You want an idea of how deadly a disease is overall, not just in the worst cases.

Think about it, if you had a million people infected and then got over some bug and only one elderly, frail person who became hospitalized and then died, the case fatality rate would be 100% if we only consider hospitalized people. That would seem misleading, doesn't it?

Now, where you'll find wiggle room in the definition is whether you only include laboratory confirmed cases or whether you go with a symptom-based one. In a fast developing epidemic, there are just too many cases to send to a lab, so you just use symptoms. So far, China seems to only be reporting laboratory confirmed cases to the press, and it seems like all cases are being hospitalized for now, even the 4-year old case who doesn't seem sick at all.

Up to 77 confirmed cases, last I read. Half or more of the cases (depending on who you ask) don't seem to have any direct connection to live poultry. So in my mind, either the disease vector is something else besides chickens, like pigeons, or else many of these people are catching it directly from another person.

The very limited number of genetic sequences released by the Chinese so far supports the theory that person-to-person transmission is already occuring in some cases. There are samples from infected people which share genetic markers that don't occur in any of the bird samples released so far. This suggests that the virus was acquired from another human rather than from a bird.

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#259446 - 04/19/13 06:23 PM Re: H7N9 flu on the move [Re: Arney]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Last night I was reading a webpage (sorry, I closed the window and forgot where I found it) where a senior Chinese veterinarian (reporting under an alias) reported that authorities have been hiding a widespread poultry epidemic since last year. The area of the outbreak coincides with the areas where the inital human H7N9 cases appeared. In Shaanxi province IIRC, he mentions that the normal 20 million poutry population is down to 7 or 8 million (however, it's not clear if he means that they all died from the bird flu or if this figure includes flocks culled by the authorities and never reported in the media).

It sounds plausible to me. The mass cullings that have been going on periodically for more than a decade over bird flu fears have taken a heavy toll on poultry farmers and local economies. Locals want as little of it as possible since everyone loses out. Political advancement by local Chinese authorities often hinge on promoting good news and minimizing or hiding bad news in your area (well, this happens everywhere but it a particular problem in China). China is so spread out that Beijing often has little control over what happens on a day-to-day basis out in the provinces. A lot of what Beijing gets blamed for is decided at the local/regional level.

Anyway, so it's possible that the H7N9 virus has been around longer than the apparently sudden emergence in humans last month. It does raise interesting questions about whether people have been sick of it earlier, but was being mistaken for something else.

This is the only whiff of this story that I've seen anywhere, so I can't corroborate with any other sources.

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#259465 - 04/19/13 09:44 PM Re: H7N9 flu on the move [Re: Arney]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Bloomberg is reporting that CDC has advised US hospitals to be on the lookout for possible H7N9 patients among people who have travelled to China recently and are exhibiting flu-like symptoms. It's just a precautionary advisory.

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#259508 - 04/20/13 05:10 AM Re: H7N9 flu on the move [Re: Arney]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
This article was released a week ago by a company that deals with genetic analysis and vaccine development, but it's pretty chilling reading if H7N9 ever develops sustained human-to-human transmission.

"Is H7N9 virus a 'stealth virus'"? reports this company's findings that the H7N9 virus has an unusually low number of epitopes.

Epitopes are the unique protein bits that present on the virus envelope. It's what the human immune system "sees" and what antibodies target. Antibodies are also used for quick diagnostic tests. The human immune system could basically be tricked into letting the virus proliferate right under its nose until it's too late and the host is seriously ill.

Few epitopes suggests that vaccines will be difficult to develop and may provide little protection. I've already read elsewhere that H7 strain vaccines tend to provoke a poor immune response to people, even when much larger amounts of antigen (the substances that provoke an immune reaction) are administered in each vaccine dose to a person.

Imagine a pandemic situation where governments are struggling to manufacture enough vaccine to protect everyone as quickly as possible. Instead of a company being able to produce 100 million doses, it's possible that each flu shot would require several times more antigen than usual, thus resulting in a fraction of the 100 million flu shots it could normally produce.

The other alternative is that chemicals that hyperstimulate the body's reaction to a flu shot is added, i.e. adjuvants, so that less antigen needs to be included in each dose. Adjuvants have never been used in US flu shots before and there is some controversy around them. In Europe, the H1N1 vaccine Pandemrix containing the adjuvant AS03 has been strongly linked to hundreds of new cases of narcolepsy in several countries by multiple studies.

The low immunogenicity of H7N9 also means that it could be difficult to develop a cheap, quick diagnostic test if things heat up even more. If a pandemic situation arises, it will be important to distinguish pandemic cases from other illnesses, and that will be hindered by lack of a cheap, quick test for H7N9. That could mean, for example, that limited supplies of antiviral meds could be administered to people who are sick with something other than a pandemic flu.

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#259532 - 04/20/13 04:42 PM Re: H7N9 flu on the move [Re: Arney]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
The Chinese released the genetic sequence from another case. It's missing the mammalian adapted gene from earlier sequences, but it does have a different mammalian sequence that H5N1 research has found increases transmission. Yet another example of this bird flu adapting itself to humans.

It's also another case where mammalian genes are found in a human case, but in none of the bird sequences released so far. This new sample still supports the theory that the virus is picking up these mammalian genes by passing between people.

Although many have praised the Chinese for their transparency, especially in light of how they hid the SARS outbreak until it burst onto the international scene, experts have wondered why the Chinese have released so few genetic sequences from the 91 confirmed cases so far. They certainly have the technological means and capacity to sequence all of the samples very rapidly and publish the results.

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#259536 - 04/20/13 06:04 PM Re: H7N9 flu on the move [Re: Arney]
Pete Online   content
Veteran

Registered: 02/20/09
Posts: 1333
"Remember recently that two separate groups of scientists artificially mutated the H5N1 flu strain in their labs to make it easily transmissible in mammals? And the government blocked the publication of their research because they considered the information too dangerous? Well, H7N9 is halfway to acquiring the mutations that the scientists found would make it easily transmissible. "

A flu virus is probably the ultimate bio-weapon - intentional or otherwise. How do we know that HN79 isn't a mutation from a lab? Why do these things always keep popping up in China, anyway :-)

Pete2

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#259569 - 04/20/13 09:37 PM Re: H7N9 flu on the move [Re: Pete]
hikermor Offline
Geezer in Chief
Geezer

Registered: 08/26/06
Posts: 6085
Loc: southern Cal
China is big and has lots of people.
_________________________
Geezer in Chief

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#259617 - 04/21/13 02:54 AM Re: H7N9 flu on the move [Re: Arney]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Up to 96 cases now. Case fatality rate is currently 66% (18 dead, 9 discharged from hospital).

So far, H7N9 seems to be hitting the elderly the hardest, which is more like seasonal flu and unlike certain pandemic strains in the past, which strike down the young. However, that could totally change, depending on the kinds of mutations that it may undergo in the days ahead.

I'll be out of the country and out of touch for a week starting tomorrow, so no more updates from me for a while. So, breathe easy while I'm gone! wink

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#260108 - 04/30/13 03:56 PM Re: H7N9 flu on the move [Re: Arney]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Well, I'm back. Kind of nice to not really see any news for a whole week.

Not many dramatic developments over the H7N9 flu while I was gone, but no encouraging news. We're up to 126 cases since a week ago, and their locations are spreading outward and southward. Taiwan reported its first case, a Taiwanese businessman who frequently traveled to mainland China. More ominously, three healthcare workers tending to H7N9 patients and wearing full protective gear have also fallen ill.

This week includes the May Day holiday in China, so I would not be surprised to see a spike in cases about a week from now as people return from holiday travels to or through affected areas.

The Chinese government has officially announced that genetic testing has shown that poultry from live markets are the source of the infection. But as I reported before, this flu virus does not seem to really sicken chickens, which makes it much more difficult to monitor chicken flocks for disease, and likely increases the incentive for poultry farmers to try and hide sick birds and avoid having their whole flocks culled as a preventative measure.

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#260321 - 05/05/13 07:16 PM Re: H7N9 flu on the move [Re: Arney]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Seems the pace of new infections has leveled off, likely due to regional closure of live poultry markets, thus minimizing the contact between live chickens and humans. However, there is still much that is unknown about where the virus is coming from and how it is being transmitted.

Massive closure of poultry markets is not really a long term solution and is costing billions in lost business. More like the Chinese have bought themselves some time. Since the virus is mild in chickens, unlike another bird flu, H5N1, I doubt H7N9 will burn itself out anytime in the near future without massive cullings of flocks or an effective bird vaccine is created.

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#260358 - 05/07/13 02:43 PM Re: H7N9 flu on the move [Re: Arney]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
It's interesting that I haven't seen the case fatality rate statistic used anymore. Instead, I see a generic "mortality" used instead, and quote about 20-25% because about 1 out of 4 or 5 confirmed cases have died. The thing is, many of those patients are still in the midst of being sick so we don't know which way they will go yet.

There's an equal number of patients who have died as have recovered, so the case fatality rate is 50%, not 20%, and is a more appropriate measure of the lethality of H7N9 during the midst of an epidemic than the "mortality" statistic being bounced around the news.

Remember, in comparison, the Spanish Flu had a case fatality rate (or since it's over and done with, a mortality rate) of 2-3%.

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#260542 - 05/14/13 02:30 AM Re: H7N9 flu on the move [Re: Arney]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
More good news on the H7N9 front. Shanghai, ground zero for H7N9 cases, has recently announced that emergency surveillance measures will be ended. Activities involving live poultry are still banned in the city, though (including raising or selling them).

New cases have crept up very slowly only to 131, which is good, but the location of new cases continues to spread from southeast China, which is worrisome since the route is transmission is still unknown.

The case fatality rate is now 38%, with 35 deaths. The Chinese released the results of tests on 20,000 people with possible flu-like symptoms, and they found only a handful of infected with H7N9 among them, indicating that mild cases of H7N9 seem to be rare. Basically, if you catch it, chances are, you get very, very sick.

The lone case outside China, a Taiwanese businessman, has been transferred out of the ICU. That's a good sign because he was previously on a ventilator and also undergoing ECMO--the desperate last-ditch measure that became widespread during the H1N1 "swine flu" pandemic. The healthcare workers who tended to him and became ill turned out not to have H7N9.

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#260675 - 05/19/13 02:12 AM Re: H7N9 flu on the move [Re: Arney]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
More Chinese provinces are ending their H7N9 emergency measures. Zhejiang, Jiangsu and Shandong are the three new ones. So, the immediate threat of H7N9 is rapidly receding.

There was an interesting report about Taiwan's lone H7N9 case. His body carried both a drug-sensitive and drug-resistant strain of the virus at the same time, which made his treatment tricky. The theory is that he caught the drug-sensitive strain but that it acquired the drug-resistant mutation while he was infected.

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#286876 - 10/25/17 01:51 AM Re: H7N9 flu on the move [Re: Arney]
Famdoc Offline
Journeyman

Registered: 04/29/09
Posts: 74
Loc: PA
H7N9 increasing again; stay tuned:

Washington Post article on H7N9

Included in the comments is a link to this downloadable book that is very detailed:
Bird flu book

No affiliations

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