Biological Health Hazard – Disease Outbreak H7N9 (HPAI) mutations (fatal): Taiwan, Guangxi, China
AVIAN INFLUENZA, HUMAN (28): CHINA (GUANGXI) TAIWAN, H7N9, MUTATIONS
Published Date: 2017-03-02 14:06:00
Subject: PRO/AH/EDR> Avian influenza, human (28): China (GX) Taiwan, H7N9, mutations
Archive Number: 20170302.4874114
In this update:
 China (Guangxi Zhuang Autonomous Region)
 Taiwan: 1st fatal case 2017
 Viral mutations
 China (Guangxi Zhuang Autonomous Region)
Date: Wed 1 Mar 2017 19:54 PM CST
Source: FIC (Flu Information Centre/Flu in China) [edited]
[On 1 Mar 2017, 2 human cases of avian influenza A (H7N9) ] were reported in Yulin city of Guangxi Zhuang Autonomous Region. Both patients are in stable condition after treatment.
The 68-year-old female patient, had onset of respiratory symptoms on the morning of [24 Feb 2017]. The 28-year-old female patient, had onset of respiratory symptoms on [23 Feb 2017]. Both patients had history of contact with sick or dead poultry within 10 days prior to the onset of symptoms, and received medical treatment in local medical institutions for ILI [influenza-like illness] symptoms such as fever, cough, headache. The patients were transferred to Yulin Red Cross hospital on the afternoon of [27 Feb 2017]. The samples of both patients were confirmed to be H7N9 positive by both Yulin City and Guangxi Zhuang Autonomous Region CDCs.
 Taiwan: 1st fatal case 2017
Date: Wed 1 Mar 2017
Source: Taipei Times [edited]
The Centers for Disease Control (CDC) has confirmed the nation’s 1st human fatality from the H7N9 avian influenza virus.
The CDC yesterday [1 Mar 2017] said a Taiwanese man who was infected with the virus while he was in China died on [Mon 27 Feb 2017] after about one month of hospital treatment.
Airport quarantine personnel detected flu symptoms in the 69-year-old man, who worked in China, when he arrived in Taiwan on [25 Jan 2017] after he sought medical attention and was hospitalized. It was confirmed that the man had contracted the virus.
“Although the medical team at the hospital’s intensive care unit and infection specialists tried their best to treat the patient, he unfortunately died of multiple organ failure,” CDC Deputy Director-General Philip Lo said.
He said the patient was hospitalized for serious pneumonia, but the virus developed resistance to common antiviral drugs during treatment. A novel antiviral agent that was purchased from Japan for treating Ebola was administered to try and save him.
“The man was more than 60 years old and had a history of chronic hypertension. Antiviral drug resistance developed during his treatment, as well as serious pneumonia and increased oxygen demand, which are known risk factors associated with H7N9 avian influenza deaths,” Lo said. “We express deep regret over his death.”
Since 2013, 5 human H7N9 avian influenza virus infections have been reported in Taiwan, all contracted in China, among them an 86-year-old Chinese visitor who died of the disease in January 2014, the centers said. A total of 461 human H7N9 avian influenza virus infections have been confirmed in China since October last year , including 128 in Jiangsu Province, 79 in Zhejiang Province, 52 in Guangdong Province, and 50 in Anhui Province, Lo said.
The CDC urged people who are in or planning to visit China to avoid contact with birds, maintain proper hygiene, avoid eating raw poultry or eggs, and wear a mask. People should report to an airport quarantine station if flu-like symptoms occur after returning to Taiwan.
[Byline: Lee I-chia]
[Maps of Taiwan can be seen at http://www.tmf.org.tw/index.php/maps-taiwan-overall-english-cd and http://healthmap.org/promed/p/193. – Sr.Tech.Ed.MJ]
 Viral mutations
Date: Thu 2 Mar 12:12 CST
Source: South China Morning Post [edited]
Medical experts have called for a swift investigation into the possibility that a mutation of the H7N9 bird flu virus in China was becoming resistant to a drug commonly used to treat infected people.
The Nanfang Daily reported this week that 2 patients in Guangdong province with the new and more virulent strain of the virus have shown signs of failing to respond to Tamiflu [oseltamivir], citing Zhong Nanshan, an expert in respiratory diseases.
Virologists said the finding did not mean the drug was ineffective against bird flu but the situation should be examined.
There have been more than 1200 laboratory confirmed cases of human infection of bird flu on the mainland since the emergence of H7N9 in 2013. As of [Sun 26 Feb 2017], the death toll this year  was 94, already surpassing last year’s 73 fatalities.
The World Health Organisation said on [Wed 1 Mar 2017] it noticed virus mutations were spreading but the risk of the transmission among people remained low.
In about 7 per cent of human infections, scientists have identified genetic changes suggesting resistance to Tamiflu, the recommended treatment for the disease and the drug that is being stockpiled worldwide in preparation for a flu pandemic. The resistance was found in two patients with the mutation, the Nanfang Daily reported. The new strain was identified by the China Centre for Disease Control and Prevention.
Taiwan’s Centres for Disease Control announced earlier last month [February 2017] that gene sequence analysis of one H7N9 patient, who fell ill after visiting Guangdong, revealed the virus had a mutation that was resistant to antivirals such as Tamiflu and Relenza [zanamivir]. The 69-year-old businessman died this week.
Zhong was quoted in the Nanfang Daily as saying most patients on the mainland were responding to Tamiflu, suggesting the mutated strain was not the dominant one or that “a considerable amount of viruses” had mutated.
He Jianfeng, the top infectious diseases expert at the Guangdong Provincial Centre for Disease Control and Prevention, told the newspaper both patients with the new strain had taken Tamiflu before. It was not clear if the resistance was caused by previous use of the treatment or the mutation.
Professor Malik Peiris, a virologist at the University of Hong Kong said Tamiflu resistance occurred occasionally in patients treated with the drug before.
He published a paper in the medical journal The Lancet 4 years ago saying patients in Shanghai had previously shown antiviral resistance. His further work showed the patients could be treated with other antivirals.
Peiris called for a quick investigation into the latest mutation. “We need more information on how widespread this resistance is in recent viruses, especially those with the high pathogenic mutation,” he said.
[Byline: Zhuang Pinghui]
[The neuraminidase (NA) inhibitors oseltamivir and zanamivir are currently the front-line therapeutic options against the novel H7N9 influenza viruses, which possess an S31N mutation that confers resistance to the M2 ion channel blockers [amantadine and rimantadine]. It is therefore important to evaluate the sensitivity of the clinical isolates to NA inhibitors and to monitor for the emergence of resistant variants.
Early research work by Yen et al in 2013 showed that the human A/Shanghai/1/2013 (H7N9) isolate carried a mixed population of R/K at NA residue 292. While the clinical isolate exhibited a phenotype of sensitivity to NA inhibitors using the enzyme-based NA inhibition assay, the plaque-purified A/Shanghai/1/2013 virus with dominant K292 was resistant to zanamivir, peramivir, and oseltamivir. Resistance to NA inhibitors conferred by the R292K mutation in a human influenza virus H7N9 isolate can be masked by a mixed R/K viral population, and this should be taken into consideration while monitoring antiviral resistance in patients with H7N9 infection (http://mbio.asm.org/content/4/4/e00396-13.short).
The higher the number of human cases, the greater the opportunities for novel avian influenza A/H7N9 viruses to evolve with the risk of better transmission fitness, and also show mutational events that could make them resistant to neuraminidase inhibitors. – Mod.UBA
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/193.]
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