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GPs warned of new bird flu threat

The Department of Health has warned GPs to be alert to the possibility of bird flu in people who have recently returned from China.

The warning was sent last week after China confirmed it had identified eleven cases of human infection with the new strain of avian influenza A (H7N9), including five deaths.

GPs are told they should consider anyone who develops a serious respiratory illness in the seven days following arrival in the UK from China a potential case.

Latest figures from the World Health Organisation put the number of laboratory confirmed cases at 21, with one further death. The remainder of cases are in a critical condition or recovering.

So far no link between cases has been identified and there is no clear evidence of human-to-human transmission of the virus.

The virus, which is sensitive to the antiviral treatments Oseltamivir (Tamiflu) and Zanamivir (Relenza), causes typical flu symptoms, with high fever and cough progressing to breathing difficulties, pneumonia and acute respiratory distress syndrome.

In a letter sent to all GPs in England, chief medical officer Dame Sally Davies says Public Health England has intensified surveillance and revised the avian influenza investigation algorithm.

‘Screening tests can be carried out by designated regional Public Health Laboratories but samples will need to be sent to the national influenza reference laboratory for a definitive test,’ the letter states.

GPs who need further advice on H7N9 testing and infection control should contact their local health protection centre.


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Readers' comments (2)

  • I wonder what the threshold for such alerts is?

    WHO tweeted earlier: "So far, WHO has been notified a total of 24 laboratory-confirmed #H7N9 cases, including 7 deaths, 14 severe and 3 mild cases #influenza"

    Now, China's a big place. Quite a lot of people live there. (That's called litotes, by the way.) So the rate of this illness in the population probably isn't very high - even if you assume that only 1% of cases has been detected. In fact, the number of people in China is so huge that the number of lab confirmed cases, as a proportion of the population, is - well, effectively zero.

    I expect that quite a few people travel between China and the UK every day. Given a rate of approximately zero cases in the Chinese population - that's the prior probability in Bayesian terms - if a GP sees a patient with flu like symptoms who's recently been in China, that would make the posterior probability of this being a case of influenza H9N7 (or is it H7N9 - I do find this naming system hard to remember!) - well, approximately zero.

    So why did they send out the letter?

    No doubt it's a PR stunt, with the cluttering up of GP email inboxes and consequent loss of credibility in GPs' eyes being considered by the civil servants who make these decisions to be reasonable collateral damage...

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  • Vinci Ho

    (1) The system of reporting of infectious diseases in China is always questionable. This was well demonstrated in the past incidents e.g. H5N1 and also SARS in 2003. Hence , there could have been more cases than being reported . Furthermore , mortality appears to be high with H7N9 .
    (2) Hong Kong is in high alert in checking for proven cases of H7N9 . So far no cases were proven. This year is 10 years post SARS crisis in Hong Kong . One can understand why the sensitivity to action is so high although we are dealing with a different virus.
    (3) In fact , there is a new strain of SARS identified , though less disseminating but can be fatal as well.

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