Should Bird Flu in China Worry You?

Since the 2013 H7N9 bird flu in China outbreak great improvements have been made with far fewer cases each year. However, the disease, which appears mainly in winter and spring, does find new victims each year.

Shanghai expats, therefore, should keep alert for bird flu in China updates, especially during the winter.

In the first half of January 2016 at least 2 cases of H7N9 were reported in Shanghai. Fortunately both of these patients were later reported to be out of danger.

In December 2016, the first case of H7N9 bird flu in Shanghai since March of the same year was reported. A second case was then reported on Dec. 29th.

Several more cases of bird flu in China have been reported near Shanghai in the winter of 2016, 2017. Two people have died in nearby Anhui province, marking the first deaths from the disease this winter.

As reported by the Shanghai Daily, 269 H7N9 human infections with at least 87 deaths have been reported in China between January and mid-February 2017.  Two deaths from bird flu in Hong Kong were also reported in early 2017.

Authorities have started to take more measures such as tightening control of live poultry markets to stop the spread of bird flu around the country.

Other Strains of Bird Flu in China

Apart from the more prevalent H7N9 strain of bird flu, other strains have also caused casualties in China. In March 2015 one person in Sichuan died from H5N1 bird flu. In January 2016 another man in Chengdu, Sichuan became critically ill from this strain.

In 2015 a person in Yunnan province also died after contracting the H5N6 strain of avian flu. This strain of bird flu has appeared in Taiwan in 2017.

The Outbreak of Bird Flu in China in 2013

In the spring of 2013, Shanghai expats were exposed to a new health danger; H7N9, a strain of Bird Flu. No Shanghai expats were reported to have been victims of this influenza, but some panic did spread through the Shanghai expat community.

Several foreign companies activated their Business Continuity Plans (BCP), otherwise known as Business Continuity Management System (BCMS), and many well attended seminars and talks on the issue were organized by various Chambers of Commerce in Shanghai and other expat organizations.

Western bars and restaurants, along with KFC and Peking Duck restaurants, were hit hard, as both locals and expats went out to eat less and avoided poultry items.

Warnings about Bird Flu led to the reduction in sales of live birds, and chicken food products

What is Bird Flu?

Otherwise known as Avian Flu, bird flu is a virus that primarily affects birds and poultry, but some strains have jumped to humans, causing devastating effects.

H7N9 proved to be one of these strains after its first confirmed case was reported in Shanghai in late March 2013.

The bird flu in China outbreak was centered in-and-around Shanghai, but also spread to Beijing in the North and Guangdong in the South, as well as Taiwan.

The Chinese government ordered extensive testing at live chicken farms and markets around the country, and mass culling at those found to have any H7N9 virus. Fortunately, the major danger was declared over in May 2013, with all government emergency measures stopped on May 31.

Foreign government and health organization advisories were also ended in late April to May 2013.

Bird Flu in China: New Outbreak

In July and August 2013, however, another two cases appeared in China, of which one person died, raising the total number of detected infections to 134, of which 45 people have died, and causing more than US$6.5 Billion in losses.

H7N9 kills about 30 percent of those infected, which still exceeds the approximate 20 percent death rate of those hospitalized with the H1N1 swine flu which quickly spread around the world in 2009, killing more than 200,000 people.

Chinese Medical Authorities working on Vaccine

The antiviral drugs Tamiflu and Relenza have shown some effectiveness in curing H7N9 when taken within five days of the infection.

However, it has also shown that resistance to these drugs is easily developed. The Chinese medical authorities, therefore, have been working hard on developing a vaccine, which has already shown to be effective in animal tests

US researchers also began human testing of a H7N9 vaccine in September 2013. 

Another breakthrough was reported recently in efforts to develop a Universal flu vaccine that could protect against all forms of the flu. But such a vaccine will likely not be ready for many years.

We discuss more about the bird flu vaccine in our other article.

Source of Bird Flu in China

The major channel of infection of Bird Flu H7N9 to humans was concluded to be live bird and poultry markets in China, otherwise known as wet markets.

The Chinese public, as well as restaurant owners, traditionally like to buy their poultry freshly slaughtered direct from wet markets rather than frozen, which increases the risk of bird flu spreading.

A study done by Chinese scientists revealed that the virus found in many of the victims had a similar genome sequence to that found in live poultry markets.

Shanghai Government Measures to Fight Bird Flu

In order to stop the spread of the disease, the Shanghai government ordered all its 79 live poultry markets to close on April 6, 2013. This action brought quick results, with the spread of the virus coming under control.

But the Shanghai government realized a permanent ban would not be accepted by the public and, therefore, gradually started to allow the markets to reopen, after stricter monitoring and health and safety measures were put in place.

The Sanjiaodi wet market in downtown Hongkou District, Shanghai’s largest downtown live poultry market, now segregates live poultry from other food sections.

Since the initial breakout the government requires all live poultry markets to close each year around Chinese New Year. In 2016 these markets were closed from February 8 to April 30 in Shanghai.

The government says such live poultry markets will slowly be phased out.

Unique Danger of the H7N9 Virus

One of the major dangers of this particular flu strain is that, unlike H5N1 which directly killed thousands of chickens, it does not cause serious sickness in birds and poultry.

So the existence of H7N9 in poultry farms and wet markets cannot easily be detected by observation alone.

Human to Human transmission of the H7N9 Bird Flu Virus

The major risk of any virus is Human to Human infection. H1N1 Swine flu ended up killing many more people than Bird Flu strains, even though it had a lower death rate, primarily because it mutated to a form that was easily passed from human to human.

As most of the cases of H7N9 were easily traced back to direct contact between the infected person and live birds or poultry, scientists and doctors said the risk of immediate human to human infection was low, but did warn that this could change quickly.

In August 2013, a study done by Chinese scientists and published in the British Medical Journal for the first time concluded that at least one victim of the disease more than likely contracted it from her sick father, who she was caring for, as she herself had no contact with live birds or poultry. Moreover, samples taken from both victims showed such a genetic similarity that the virus was most likely to have spread directly from father to daughter.

Other studies by Chinese scientists proved that the disease could pass easily between ferrets, a strong indication this could be replicated among humans.

As no other such human to human cases have been detected so far, and hundreds of people who came into contact with infected patients tested negative themselves, the risk of human to human infection for H7N9 is still considered quite low.

For anyone coming into contact with infected patients, however, it is recommended by the American CDC (Centers for Disease Control) to wear a N95 face mask respirator.

Thousands of birds and thousands of people packed into Shanghai's live poultry markets make the potential for Bird Flu to spread far higher

Symptoms of Bird Flu in China, Strain H7N9

According to the World Health Organization (WHO), symptoms for mild infection of Bird Flu include sore throat, running nose and muscle aches.

More severe infection will lead to severe pneumonia, respiratory illness, difficulty breathing, nausea, abdominal pain, diarrhea, vomiting, and dizziness.

How can Shanghai Expats Can Keep Informed About Bird Flu in China

  • Consulate, Embassy Advisories and Health Warnings: make sure you are registered with your Consulate to receive these warnings.
  • Foreign clinics and health care providers: Sign up for their newsletters.
  • Chinese state-run media: It is acknowledged that the Chinese media provided very good information about this disease outbreak, having learned a lot from their mistakes during the SARS outbreak in 2002, when they were heavily criticized for a lack of transparency.
  • National Health and Family Planning Commission of the People's Republic of China (Previously called the Ministry of Health)
  • Your own company Human Resources Department
  • Other Expat Organizations and websites

Actions Shanghai Expats Can Take to Reduce the Risk of Bird Flu in China

(Drafted by the International SOS)

  • Avoid contact with sick animals, including cats and dogs.
  • Do not go to live animal markets, poultry farms or pig farms.
  • Do not handle sick or dead birds. Prevent children from doing so.
  • Avoid touching any surfaces that may be contaminated by bird droppings. Do not swim in any body of water that is used by birds.
  • Always maintain high levels of personal hygiene. Frequent hand washing is very important. Wash hands before and after food preparation and before eating.
  • Thoroughly cook all poultry products, including eggs.
Live poultry markets like this one have been a source of the spread of bird flu. The Chinese government plans to phase them out over time.

Further Information About Bird Flu in China


Human to Human Transmission

Losses for Chicken Farmers

Shanghai's Largest Live Poultry Market, Sanjiaodi Wet Market, Opens After the H7N9 Outbreak

New Strain H7N7

Technical Details about Bird Flu H7N9

Bird Flu Infected Woman Gives Birth

Sources of Information

Go from Bird Flu in China to the Shanghai Expat home page

For a list of Shanghai hospitals click here