http://www.reuters.com/article/2013/12/02/us-hongkong-birdflu-idUSBRE9B10MA20131202

(Reuters) - Hong Kong confirmed its first case of deadly H7N9 bird flu on Monday in a further sign that the virus is continuing to spread beyond mainland China's borders.

The case coincides with the 10th anniversary of the outbreak of Severe Acute Respiratory Syndrome, which killed nearly 300 people in Hong Kong and had a significant impact on the city's travel and retail industry.

A 36-year-old Indonesian domestic helper with a history of contact with poultry and travel to Shenzhen in mainland China just north of Hong Kong has been confirmed infected by H7N9 and has been hospitalized in critical condition, Secretary for Food and Health Ko Wing-man told reporters late on Monday.

(Reporting By Twinnie Siu and Donny Kwok; Editing by Mark Heinrich)

There is clearly a growing epidemic going on right now. Many cases undetected. Maybe we'll see a first case outside of China soon.

Deadly H7N9 Bird Flu Surfaces in Hong Kong — Government Hunts for Travel Companion of Infected to Avoid Pandemic


Staff Writer | December 2, 2013 | 7:30pm EDT
In what can only be described a scary, the deadly H7N9 made its way into Hong Kong and possibly further.




HONG KONG (INTELLIHUB) — The deadly H7N9 bird flu virus has been confirmed to have made its way into the country. Pok Fu Lam, 36, female, remains in critical condition at the Queen Mary Hospital and is under assisted breathing via an artificial lung after contracting what has been refereed to by scientists as the deadliest flu strain in history.

Lam was said to have slaughtered and prepared a chicken for a meal while visiting Shenzhen.

What is extremely alarming about the whole situation is the fact that the Chinese government has already enacted pandemic preparedness plans in the region and is on a massive manhunt for another person which authorities believe had contact with Lam.

Lam “developed flu symptoms four days later. She was first treated at Tuen Mun Hospital, but was transferred to Queen Mary last Wednesday.

Ko said two earlier tests for the virus came back negative, but a third test last night confirmed she had contracted H7N9.

He added that the risk of human-to-human transmission could not be ascertained yet, but he activated the city’s three-level response system set up to deal with a potential flu pandemic.

It was set at the “serious level”, one step below the top emergency level. Live poultry imports from three Shenzhen farms will be suspended until the Centre for Health Protection completes an investigation.

Since the first case of H7N9 infection in a human was reported in February, the virus has killed 45 people, all on the mainland.

About 138 people on the mainland were infected and one in Taiwan. Most of the cases were in Zhejiang and Jiangsu provinces and Shanghai.”, reported the South China Morning Post.[1]


This also dovetails with another report, “French jet placed in quarantine after passengers develop symptoms of swine flu and crew discover they had all recently been to Asia”, by the Daily Mail. In the article Alex Ward wrote, “A plane full of passengers on a French runway has been quarantined after many developed swine flu-like symptoms.

During the flight, 47 passengers started coughing and spluttering while others developed signs of a fever, local media reported.

As flight attendants questioned passenger, it emerged that many were returning from Asia.”[2]

A similar bout took place on a plane in Arizona Monday as it was reported a passenger has Tuberculosis raising a few eyebrows domestically in the U.S.. CNN reported, “Passengers aboard US Airways Flight 2846 were waiting on the tarmac at Phoenix’s Sky Harbor Airport when their pilot came on the intercom.

“We’ve been notified about a health emergency aboard the aircraft,” passenger Dean Davidson heard.

A few minutes later, Davidson saw a flight attendant walk toward another passenger sitting a few rows ahead of him. The flight attendant handed the slender middle-aged man a medical mask.

Emergency personnel boarded the plane a short time later and removed the man, Davidson said. A firefighter then came on the intercom and announced that the passenger had active tuberculosis and was contagious and that other passengers on the flight had been exposed. He advised them to contact their physicians immediately, Davidson said.”



Sources:

[1] Hong Kong’s first case of H7N9 bird flu virus confirmed – South China’s Morning Post

[2] French jet placed in quarantine after passengers develop symptoms of swine flu and crew discover they had all recently been to Asia – Mail Online

[3] Passenger with possible TB infection pulled from plane – CNN

coyote wrote: Ko said two earlier tests for the virus came back negative, but a third test last night confirmed she had contracted H7N9...

Scary that even this late in the game, they're still unable to get reliable test results in a critically ill patient who is obviously showing enough symptoms that they felt the need to keep retesting. Makes you wonder about the validity of the testing done by the Chinese government to downplay the extent of the spread on the mainland. Between spurious test results and China's information filter, we truly have no idea how widespread this outbreak is, but I agree with Chuck - hitting Hong Kong makes it a lot easier to track, although it ups the ante somewhat based on the region's proven ability to create novel H2H viruses.

I think it's interesting that the UK's pandemic preparedness plan used to have an estimated time frame of two to four weeks for a pandemic virus to go global following it's emergence in - you guessed it - Hong Kong

Hi Jacksdad...Thanks for posting..Ya, sure is starting to look scary..This may be the start of it mushrooming out of control.

Jacksdad, you are such an ignorant fear monger. I eat all manner of poultry, chickens,
cows, and pigs. I am not even 1% terrified of getting ill. What do you think these animals
exist for dumbasss? To be fed, bred and worshipped like the fat asss medical profession?

---

17 people in isolation amid scare over Hong Kong's first H7N9 bird flu case

Seventeen people are in isolation after coming into contact with an Indonesian domestic helper who is the first person in Hong Kong to be infected with the deadly H7N9 strain of bird flu.

They are among more than 200 people who have been placed under observation as a precaution, the Centre for Health Protection said yesterday.

Those in isolation either lived in the same Tuen Mun flat as the patient or were in the same cubicle as her when she was treated in Tuen Mun Hospital.

The Indonesian consulate confirmed the patient was 36-year-old Tri Mawarti.

The centre's controller, Dr Leung Ting-hung, said: "There is so far no evidence to show the virus has spread to another person. According to the assessments of the World Health Organisation and Centre for Health Protection, the risk of locals contracting H7N9 has not increased or changed."

Tri was transferred to the intensive care unit at Queen Mary Hospital in Pok Fu Lam on Saturday, where she is in critical condition. Indonesia's vice-consul for public affairs Sam Aryadi said she would be offered as much help as possible.

Of the 17 classified as high-risk, 11 had tested negative in preliminary examinations but would undergo more tests, Leung said.

They are 10 members of the family the helper lived with and an Indonesian friend, aged 33, who accompanied her on November 17 to Shenzhen, where they killed and cooked a chicken.

All 17 were isolated at Princess Margaret Hospital in Kwai Chung. Five of them, who had shown no symptoms, would be transferred to the Lady MacLehose Holiday Village in Sai Kung, a site the government had reserved for quarantine purposes, Secretary for Food and Health Dr Ko Wing-man said.

Six of the 17 who had yet to be tested were patients at Tuen Mun Hospital while Tri was there for four days. Others under observation include staff from the clinics of Dr Simon Wong Siu-shan on Castle Peak Road - which Tri visited on November 25 - and Dr Wong Chun-yan in Tuen Mun, which she visited the next day. The rest are staff and patients of the two public hospitals and a member of ambulance staff who handled Tri's transfer.

Medical experts said that as Tri's infection was only confirmed after a third H7N9 test, this suggested a preliminary viral test might not be accurate enough. The University of Hong Kong's chair of virology, Professor Malik Peiris, said the virus might not be detectable when the strength was low.

"The avian influenza virus is found deep in the lungs. The patient's first two samples were taken from the upper respiratory tract because she was not so sick at the time. The third time it was taken from her lungs."

His university colleague, Ho Pak-leung, said evidence in four clusters of patients on the mainland suggested the virus could have developed a limited ability to pass from person to person.

The H7N9 virus has killed 45 of the 138 people infected on the mainland since the first human case was reported in February. One person has also been infected in Taiwan.

Additional reporting by Phila Siu


http://www.scmp.com/news/hong-kong/article/1371744/search-bird-flu-contacts-widens-after-first-h7n9-hong-kong-case

I have quite alot of experience with killing, plucking, gutting and then eating chickens, as we breed and then kill about 30 big fat meat chickens for our own consumption each year. 

Kilt2 Watch for H2H clusters and when one cluster gets to 100 people long - shut the gates - the pandemic will begin in a matter of days.   [/QUOTE wrote:   Ok - I know that H2H is Human to Human - but what does it mean when you say a cluster gets to 100 people long?  Is that a chain A gives to B gives

100 in a close group ,village,town

Here’s What You Need to Know About the Bird Flu Case in Hong Kong

http://news.yahoo.com/know-bird-flu-case-hong-kong-161003064.html

By Alice Park

11 hours ago

Health officials say the situation is “serious” after a domestic worker was hospitalized in November.

H7N9, an influenza virus that normally infects birds such as chickens and wild geese, first jumped to human hosts in China in April. According to the Centers for Disease Control and Prevention (CDC), about 20% of those infected have died, but the virus does not spread easily from person to person – at least not yet. So far, the World Health Organization says 137 people have been sickened by H7N9 and 45 have died. Here’s what you need to know about the latest bird flu and whether it poses a threat in the U.S.

How did the latest patient get infected?

The 36-year old woman had visited Shenzhen, China where she slaughtered and ate a chicken, according to Hong Kong health officials. She felt ill, with fever, chills and difficulty breathing and was hospitalized after returning to Hong Kong.

Has anyone in the U.S. been infected with H7N9?

So far, no cases of the infection have been reported in the U.S., and the CDC says the risk of H7N9 infection is “low.” All of the human cases so far have been reported in Asia. But it is possible that travelers to Asian countries where the virus has been found in chickens and other poultry could become infected and bring this bird flu to the U.S.

Will my flu shot protect me against H7N9?

No, there is no vaccine against H7N9 yet, although researchers are working on developing one. This year’s flu shot protects against H1N1, H3N2, and either one or both of the B group influenza viruses currently circulating around the world.

Is H7N9 more dangerous than the previous bird flu, H5N1?

That’s hard to tell so far, since so few human cases have been reported. But flu experts are watching H7N9 closely since the virus seems to be making genetic changes that might help it to infect people more easily.

What are Hong Kong officials doing to contain H7N9?

The government halted imports of live poultry from three farms in Shenzhen, and alerted WHO and Chinese health officials.

I agree Chuck - since sovereignty was handed over in 1997, the colony hasn't gone through the drastic changes everyone expected and still remains very distinct from mainland China in both it's policies and dealings with the rest of the world. It's still very much it's own boss when it comes to public health issues and doesn't play by the same rules, and I'm sure that it's anxious to prevent a rerun of SARS and it's perceived involvement in it's spread (as well as the initial outbreak of H5N1, which most people seem to have forgotten first infected humans in Hong Kong).
It's population density and the fact that it will continue to be fed by the farms of neighboring Guandong province make it a scary place for a novel virus to end up though, and it's potential as a springboard to the rest of the world thanks to it's international airport shouldn't be understated. Arriving in Hong Kong could be just what H7N9 has needed to escape the Far East.

 Does anyone want to hazard a guess as to why this incident has not been mentioned anywhere on the WHO website at all?  I would have expected it to turn up in the GAR yesterday morning, yet it is strangely absent.

http://www.who.int/csr/don/en/index. - http://www.who.int/csr/don/en/index.html

Thanks!  I've seen this referred to elsewhere but wasn't sure exactly what it meant to be watching for..now I know - AWESOME - thanks guys!

...personally, I think the world could use a good pandemic!   Just thinkin' out loud....

CStackDrPH wrote: ...personally, I think the world could use a good pandemic!   Just thinkin' out loud....

Wow, thought I was coming to a serious forum to discuss this.  Seems that you cannot escape stupid comments anywhere.

Seawolfe wrote: Wow! So we are talking about clusters of 100 and 4 groups of clusters to clarify if we are off to the races while the reports from Hong Kong talk about 200 people being monitored. Sounds to me like the starting gate has sprung open.

Firstly where has the ‘100’s’ figure come from, last reports state 17 people who had contact with the infected patient and all have been tested to and have been confirmed as not be positive for infection: source:  http://www.timesofoman.comews/Article-26555.aspx - http://www.timesofoman.com/News/Article-26555.aspx.  I cannot find an update on this anywhere.

Secondly, surely when we talk about clusters, this is when we have a cluster of people known to have the infection?  They do not as far as we know.  Therefore it is too early to be using these terms.  This is just a group of people who unfortunately happen to have been in close proximity to the patient, they are so far only a collection of ‘unfortunate bystanders’.  As far as we know, this is no different than any of the China mainland infections we have seen thus far.  It is most likely the same virus which has difficulties transmitting between humans, we do not know. The difference here is that with it hitting Hong Kong, it raised the profile, adds a bit of developed world response which, given Hong Kong’s history with SARS, is a very risk averse approach.

The most worrying thing I have observed so far is the lack of any acknowledgement of these latest events on the WHO website.  Yesterday they published the minutes of the latest meeting of the emergency committee regards MERS-CoV, but nothing about the events in Hong Kong. I have trawled the internet for explanations and to see if anyone else has picked up on this and have found nothing.  This makes me think that they are looking into further before releasing a statement or it could be as simple as the guy who updates the GAR is on annual leave!

Anyway, while this is a worrying situation lets reign the fear mongering.  As far as I am aware there is as equal chance that this virus will mutate to severely threaten us as there is that it will not.  H5N1 has not done so thus far.  Given, there are differences with this virus to H5N1 that make this one a more likely candidate; however that is in reference to H5N1.  Taken on its own it is 50/50.

So before anyone posts any comments on number of ‘clusters’ and the amount involved in each, make sure you have a source to back you up and it is not just your own postulating.

CStackDrPH wrote: ...personally, I think the world could use a good pandemic!   Just thinkin' out loud....

I agree, not necessarily for the mass casualties that will come from it, but to wake up the world and realize that a mass pandemic isn't just a Hollywood film idea, its reality.

     Incidentally  CHP of Hong Kong confirmed "non-specific symptoms" in four of the contacts, Albert.  Of course I usually try to confirm my sources.  This is not fear mongering, it is not being caught asleep when the enemy bombers are coming in at Pearl Harbor.  That is what we do not want.  Some peolple also appear to be ignoring the likelihood that less serious, weaker cases of this flu will test false-negative intially.  I of course still hedge my bets-it is after all flu season, the four people mentioned out of all those being quaratined may simply have seasonal flu or even RSV, not bird flu.  You are quite correct in stating however that this situation merits our close monitoring.   I for one am not close yet to recommending a raising of our DEFCON level without sutained H2H transmisision.  And I am aware Albert that you also are  conservative regarding this   Best, John L.

     Newest update, we now have 13 contact with non specific symptoms, these have tested negative in initial testing and that is good.  However, so did the first victim, so I will feel a lot better after further testing.  John L.

Confusing news coming out of China/Hong Kong as usual - the SCMP was saying 17 in isolation a few days ago, but still no positive test results. How hard is it to count that far?

17 people in isolation amid scare over Hong Kong's first H7N9 bird flu case

Seventeen people are in isolation after coming into contact with an Indonesian domestic helper who is the first person in Hong Kong to be infected with the deadly H7N9 strain of bird flu.

They are among more than 200 people who have been placed under observation as a precaution, the Centre for Health Protection said yesterday.

Those in isolation either lived in the same Tuen Mun flat as the patient or were in the same cubicle as her when she was treated in Tuen Mun Hospital.

The Indonesian consulate confirmed the patient was 36-year-old Tri Mawarti.

The centre's controller, Dr Leung Ting-hung, said: "There is so far no evidence to show the virus has spread to another person. According to the assessments of the World Health Organisation and Centre for Health Protection, the risk of locals contracting H7N9 has not increased or changed."

Tri was transferred to the intensive care unit at Queen Mary Hospital in Pok Fu Lam on Saturday, where she is in critical condition. Indonesia's vice-consul for public affairs Sam Aryadi said she would be offered as much help as possible.

Of the 17 classified as high-risk, 11 had tested negative in preliminary examinations but would undergo more tests, Leung said.

They are 10 members of the family the helper lived with and an Indonesian friend, aged 33, who accompanied her on November 17 to Shenzhen, where they killed and cooked a chicken.

All 17 were isolated at Princess Margaret Hospital in Kwai Chung. Five of them, who had shown no symptoms, would be transferred to the Lady MacLehose Holiday Village in Sai Kung, a site the government had reserved for quarantine purposes, Secretary for Food and Health Dr Ko Wing-man said.

Six of the 17 who had yet to be tested were patients at Tuen Mun Hospital while Tri was there for four days. Others under observation include staff from the clinics of Dr Simon Wong Siu-shan on Castle Peak Road - which Tri visited on November 25 - and Dr Wong Chun-yan in Tuen Mun, which she visited the next day. The rest are staff and patients of the two public hospitals and a member of ambulance staff who handled Tri's transfer.

On Wednesday morning, two private clinics visited by the Indonesian domestic helper infected with the deadly H7N9 strain of bird flu remained open.

A clinic nurse of Dr Simon Wong Siu-shan, who was among the 200 people placed under observation for having contact with the infected helper, said the doctor was seeing patients and declined an interview.

A male patient who was seen by Dr Wong at the Castle Peak Road clinic said he was not worried that the doctor may have been exposed to H7N9.

"It is not likely that there is any big risk," he said.

A staff member working at a cake shop next to the clinic said the fact that the helper's live-in family had not been infected proved that there was nothing to worry about.

Medical experts said that as Tri's infection was only confirmed after a third H7N9 test, this suggested a preliminary viral test might not be accurate enough. The University of Hong Kong's chair of virology, Professor Malik Peiris, said the virus might not be detectable when the strength was low.

"The avian influenza virus is found deep in the lungs. The patient's first two samples were taken from the upper respiratory tract because she was not so sick at the time. The third time it was taken from her lungs."

His university colleague, Ho Pak-leung, said evidence in four clusters of patients on the mainland suggested the virus could have developed a limited ability to pass from person to person.

The H7N9 virus has killed 45 of the 138 people infected on the mainland since the first human case was reported in February. One person has also been infected in Taiwan.

http://www.scmp.com/news/hong-kong/article/1371744/search-bird-flu-contacts-widens-after-first-h7n9-hong-kong-case

It is good that  the sample taken from the infected patient shows no significant mutations.  At the moment, reading between the lines and removing all of the, very understandable and appreciated, Hong Kong response, this appears no different to any of the cases that have appeared on the mainland.

This is probably the best news we could have hoped for at this point.  Now even better would be to hear that the contacts are confirmed fine the the infected patient makes a full recovery.

The key thing though is that they are at least isolated and have only been in contact with a patient were it has been confirmed had the known H7N9 type.  We have already heard of it being passed between close family members and contacts already.  They would also become symptomatic in isolation as well.

I would like to take the optimistic stance on this one (someone has to ) and maintain that there is no reason to suspect change (outside of a cover-up) from the other reports we have seen this year so far.

Albert wrote: I'm curious to see which flu strain the contacts have.

I'm pinning my hopes on the close contacts have nothing more than a seasonal flu strain and that no further spread is indicated, but they should have been much easier to diagnose than H7N9 (which is seemingly only found deep in the lungs) so I'm not sure what to make of the lack of news on that one.