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Yellow Fever – China

Between 4 and 12 April 2016, the National IHR Focal Point of China notified WHO of 2 additional imported cases of yellow fever (YF). To date, a total of 11 laboratory-confirmed YF cases imported from Angola have been reported in China.

The tenth imported case is an 18-year-old male from Fujian Province, China, who had been living in Angola. On 12 March, he had onset of fever and other symptoms, and visited a local hospital in Angola. On 27 March 2016, the patient travelled to Fuzhou City, Fujian Province, China via Dubai, United Arab Emirates and Beijing, China. He was afebrile on arrival in China. On 28 March, the patient sought medical care. Yellow fever infection was confirmed by polymerase chain reaction (PCR) at the Fujian International Travel Health Centre. Test results were corroborated by the Fujian Centers for Disease Control (CDC). The patient was hospitalised in Fuzhou and remains under treatment.

The eleventh imported case is a 29-year-old male from Jiangsu Province, China, who had been working in Angola. On 5 April, he had onset of fever and other symptoms, and sought medical care at a local hospital in Angola. On 9 April, the patient was reported to have tested positive for YF in Angola by PCR. He flew back to China via Dubai, arriving in Beijing on 10 April. On arrival, the patient was transferred by ambulance to a hospital. His sample was tested at Beijing CDC and found to be positive for YF by PCR. On 12 April, expert consultation organised by the Beijing Health and Family Planning Commission confirmed the patient as an imported YF case based on the epidemiological history, clinical manifestations and laboratory findings. The case is currently stable.

Public health response

The Chinese government has taken the following measures:

• intensifying multi-sectoral coordination and collaboration,
• strengthening surveillance, vector monitoring and risk assessment,
• enhancing clinical management of yellow fever cases,
• conducting vector control activities,
• carrying out public risk communication activities,
• deploying a medical team to Angola to provide yellow fever vaccination to unvaccinated Chinese nationals.

WHO risk assessment

The report of yellow fever infection in non-immunized travellers returning from a country where vaccination against the disease is mandatory underlines the need to reinforce the implementation of vaccination requirements, in accordance with the International Health Regulations (2005). Furthermore, this report highlights the risk of international spread of yellow fever through non-immunized travellers. However, the risk of establishment of a local cycle of transmission in China is low due to the current climatic condition, which is unfavourable for the competent vector, the Aedes aegypti mosquito. WHO continues to monitor the epidemiological situation and conduct risk assessment based on the latest available information.

WHO advice

WHO urges Members States especially those where the establishment of a local cycle of transmission is possible (i.e. where the competent vector is present) to strengthen the control of immunisation status of travellers to all potentially endemic areas.

WHO does not recommend any travel or trade restriction to China based on the current information available.

WHO

Human infection with avian influenza A(H7N9) virus – China

On 5 February 2016, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 28 additional laboratory-confirmed cases of human infection with avian influenza A (H7N9) virus, including five deaths.

Onset dates ranged from 21 December 2015 to 25 January 2016. Cases ranged in age from 14 to 91 years, with a median age of 58 years. Of these 28 cases, 18 (64%) were male. The majority (25 cases, 89%) reported exposure to live poultry or live poultry markets; the exposure history of three cases is unknown or no clear exposure to poultry. No clusters were reported. Cases were reported from six provinces and municipalities: Zhejiang (13), Jiangsu (5), Guangdong (4), Fujian (3), Shanghai (2) and Hunan (1). See attachment for individual case information.

Detailed information concerning these cases can be found in a separate document (see related links).

Public health response

The Chinese Government has taken the following surveillance and control measures:

• strengthening outbreak surveillance and situation analysis;
• reinforcing all efforts on medical treatment; and
• conducting risk communication with the public and dissemination of information.

WHO risk assessment

WHO is assessing the epidemiological situation and conducting further risk assessment based on the latest information. Based on the information received thus far, the overall public health risk from avian influenza A(H7N9) viruses has not changed.

If the pattern of human cases follows the trends seen in previous years, the number of human cases may rise over the coming months. Further sporadic cases of human infection with avian influenza A(H7N9) virus are expected in affected and possibly in the neighboring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during travels or after arrival. If this were to occur, community level spread is considered unlikely as the virus has not demonstrated the ability to transmit easily among humans.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid poultry farms, contact with animals in live bird markets, entering areas where poultry may be slaughtered, or contact with any surfaces that appear to be contaminated with faeces from poultry or other animals. Travellers should also wash their hands often with soap and water. Travellers should follow good food safety and good food hygiene practices.

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions. As always, a diagnosis of infection with an avian influenza virus should be considered in individuals who develop severe acute respiratory symptoms while travelling or soon after returning from an area where avian influenza is a concern.

WHO encourages countries to continue strengthening influenza surveillance, including surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns, in order to ensure reporting of human infections under the IHR (2005), and continue national health preparedness actions.

CA: A Cancer Journal for Clinicians

With increasing incidence and mortality, cancer is the leading cause of death in China and is a major public health problem. Because of China’s massive population (1.37 billion), previous national incidence and mortality estimates have been limited to small samples of the population using data from the 1990s or based on a specific year. With high-quality data from an additional number of population-based registries now available through the National Central Cancer Registry of China, the authors analyzed data from 72 local, population-based cancer registries (2009-2011), representing 6.5% of the population, to estimate the number of new cases and cancer deaths for 2015. Data from 22 registries were used for trend analyses (2000-2011).

The results indicated that an estimated 4292,000 new cancer cases and 2814,000 cancer deaths would occur in China in 2015, with lung cancer being the most common incident cancer and the leading cause of cancer death. Stomach, esophageal, and liver cancers were also commonly diagnosed and were identified as leading causes of cancer death.

Residents of rural areas had significantly higher age-standardized (Segi population) incidence and mortality rates for all cancers combined than urban residents (213.6 per 100,000 vs 191.5 per 100,000 for incidence; 149.0 per 100,000 vs 109.5 per 100,000 for mortality, respectively). For all cancers combined, the incidence rates were stable during 2000 through 2011 for males (+0.2% per year; P = .1), whereas they increased significantly (+2.2% per year; P < .05) among females. In contrast, the mortality rates since 2006 have decreased significantly for both males (−1.4% per year; P < .05) and females (−1.1% per year; P < .05). Many of the estimated cancer cases and deaths can be prevented through reducing the prevalence of risk factors, while increasing the effectiveness of clinical care delivery, particularly for those living in rural areas and in disadvantaged populations. CA Cancer J Clin 2016. © 2016 American Cancer Society.

Lancet

In 1990, 16 of 33 provinces had lower respiratory infections or preterm birth complications as the leading causes of YLLs (years of life lost ).

15 provinces had cerebrovascular disease and two (Hong Kong and Macao) had ischaemic heart disease.

By 2013, 27 provinces had cerebrovascular disease as the leading cause, 5 had ischaemic heart disease, and 1 had lung cancer (Hong Kong).

Road injuries have become a top ten cause of death in all provinces in mainland China.

The most common non-communicable diseases, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and cancers (liver, stomach, and lung), contributed much more to YLLs in 2013 compared with 1990.

HISTORY

WHO

On 11 January 2016, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 10 additional laboratory-confirmed cases of human infection with avian influenza A (H7N9) virus, including 3 deaths.

The cases were reported in the provinces of Zhejiang (6), Jiangsu (2), Guangdong (1) and Jiangxi (1). The median age of the patients is 52.5 years old (ranging from 29 to 77 years old). The cases are split equally between men and women. One of the patients is a health care worker. All cases reported a history of exposure to live poultry.

Detailed information concerning these cases can be found in a separate document (see related links).

Public health response

The Chinese Government has taken the following surveillance and control measures:

• strengthening outbreak surveillance and situation analysis;
• reinforcing all efforts on medical treatment; and
• conducting risk communication with the public and dissemination of information.

WHO risk assessment

WHO is assessing the epidemiological situation and conducting further risk assessment based on the latest information. Based on the information received thus far, the overall public health risk from avian influenza A(H7N9) viruses has not changed.

If the pattern of human cases follows the trends seen in previous years, the number of human cases may rise over the coming months. Further sporadic cases of human infection with avian influenza A(H7N9) virus are expected in affected and possibly in the neighboring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during travels or after arrival. If this were to occur, community level spread is considered unlikely as the virus has not demonstrated the ability to transmit easily among humans.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid poultry farms, contact with animals in live bird markets, entering areas where poultry may be slaughtered, or contact with any surfaces that appear to be contaminated with faeces from poultry or other animals. Travellers should also wash their hands often with soap and water. Travellers should follow good food safety and good food hygiene practices.

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions. As always, a diagnosis of infection with an avian influenza virus should be considered in individuals who develop severe acute respiratory symptoms while travelling or soon after returning from an area where avian influenza is a concern.

WHO encourages countries to continue strengthening influenza surveillance, including surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns, in order to ensure reporting of human infections under the IHR (2005), and continue national health preparedness actions.

Lancet

In 2012, the lowest provincial level under-5 mortality rate in China was about five per 1000 livebirths, lower than in Canada, New Zealand, and the USA.

The highest provincial level under-5 mortality rate in China was higher than that of Bangladesh.

29 provinces achieved a decrease in under-5 mortality rates twice as fast as the MDG 4 (Millennium Development Goal (MDG) 4 ) target rate;

The reduction of under-5 mortality rates in China at the country, provincial, and county level is an extraordinary success story. Reductions of under-5 mortality rates faster than 8·8% (twice MDG 4 pace) are possible. Extremely rapid declines seem to be related to public policy in addition to socioeconomic progress. Lessons from successful counties should prove valuable for China to intensify efforts for those with unacceptably high under-5 mortality rates.