Avian Flu (H7N9) in China
|Warning - Level 3, Avoid Nonessential Travel|
|Alert - Level 2, Practice Enhanced Precautions|
|Watch - Level 1, Practice Usual Precautions|
Updated: November 15, 2013
What is the current situation?
According to the World Health Organization (WHO), there have been 139 confirmed human cases of avian influenza A (H7N9) with 45 deaths reported from China since April 2013. Cases have been reported in the following provinces and municipalities: Anhui, Beijing, Fujian, Guangdong, Hebei, Henan, Hunan, Jiangsu, Jiangxi, Shandong, Shanghai, and Zhejiang. A case in Taiwan also has been reported in a person who had traveled to an area of China where other H7N9 cases have been reported.
This is the first time this virus has been seen in people. Symptoms include fever, cough, and shortness of breath. Infection with the new virus has resulted in severe respiratory illness and, in some cases, death. Chinese authorities are conducting animal and human health investigations to learn more about this situation. Available evidence suggests that most people have been infected with the virus after having contact with infected poultry or contaminated environments.
CDC is following this situation closely and coordinating with domestic and international partners in a number of areas. More information will be posted as it becomes available.
There is no recommendation against travel to China at this time.
What can travelers and Americans living in China do to protect themselves?
There is currently no vaccine to prevent H7N9. CDC is repeating its standard advice to travelers and Americans living in China to follow good hand hygiene and food safety practices and to avoid contact with animals.
- Do not touch birds, pigs, or other animals.
- Do not touch animals whether they are alive or dead.
- Avoid live bird or poultry markets.
- Avoid other markets or farms with animals (wet markets).
- Eat food that is fully cooked.
- Eat meat and poultry that is fully cooked (not pink) and served hot.
- Eat hard-cooked eggs (not runny).
- Don’t eat or drink dishes that include blood from any animal.
- Don’t eat food from street vendors.
- Practice hygiene and cleanliness:
- Wash your hands often.
- If soap and water aren’t available, clean your hands with hand sanitizer containing at least 60% alcohol.
- Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
- Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
- Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups, with people who are sick.
- See a doctor if you become sick during or after travel to China.
- See a doctor right away if you become sick with fever, coughing, or shortness of breath.
- If you get sick while you are still in China, visit the US Department of State website to find a list of local doctors and hospitals. Many foreign hospitals and clinics are accredited by the Joint Commission International. A list of accredited facilities is available at their website (www.jointcommissioninternational.org).
- According to a message issued by the US Embassy in Beijing, patients with fever and other symptoms of flu will be sent to designated hospitals for evaluation.
- Delay your travel home until after you have recovered or your doctor says it is okay to travel.
- If you get sick with fever, coughing, or shortness of breath after you return to the United States, be sure to tell your doctor about your recent travel to China.
Clinicians should consider the possibility of avian influenza A (H7N9) virus infection in persons presenting with respiratory illness within 10 days of an appropriate travel or exposure history. Although the majority of H7N9 cases have resulted in severe respiratory illness in adults, infection with this virus may cause mild illness in some and may cause illness in children as well. Influenza diagnostic testing in patients with respiratory illness for whom an etiology has not been confirmed may identify human cases of avian influenza A virus infection or new cases of variant influenza in the United States. If patients are infected with H7N9 virus, reverse-transcription polymerase chain reaction (RT-PCR) testing will be positive for influenza A but will be unsubtypeable. Clinicians suspecting H7N9 infection should obtain appropriate specimens and notify their local or state health department promptly. State health departments should notify CDC of suspected cases within 24 hours. For more information, see the Health Alert Notice issued April 5, 2013.
Because of the potential severity of illness associated with H7N9 virus infection, it is recommended that all confirmed and probable H7N9 case-patients and H7N9 case-patients under investigation receive antiviral treatment with a neuraminidase inhibitor as early as possible. Treatment should be initiated even if it is more than 48 hours after onset of illness. Laboratory testing and initiation of antiviral treatment should occur simultaneously. For more information, see CDC’s interim recommendations on the use of antivirals in treating H7N9 influenza.