VZCZCXRO2219
RR RUEHCN RUEHDT RUEHGH RUEHPB RUEHVC
DE RUEHBJ #0257/01 0342310
ZNR UUUUU ZZH
R 032310Z FEB 09
FM AMEMBASSY BEIJING
TO RUEHC/SECSTATE WASHDC//FOR EAP/CM, OES/IHA, AIAG, CA/OCS/ACS/EAP, AN
INFO RUEHOO/CHINA POSTS COLLECTIVE
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUCPDOC/DEPT OF COMMERCE WASHDC
RUEATRS/DEPT OF TREASURY WASHINGTON DC
RHMFIUU/DEPT OF HOMELAND SECURITY WASHINGTON DC
RUEKJCS/SECDEF WASHDC//USDP/ISA/AP//
RHEHNSC/NSC WASHDC
RUCNARF/ASEAN REGIONAL FORUM COLLECTIVE
RUEAIIA/CIA WASHDC
RHMFISS/CJCS WASHINGTON DC//J2/J3/J5//
RHMFIUU/CDR USPACOM HONOLULU HI//J00/J2/J3/J5//

UNCLAS SECTION 01 OF 02 BEIJING 000257 
 
HHS FOR OGHA 
CDC ATLANTA FOR CCID, AND PASS TO FLU COX AND MOUNTS AND COGH BLOUNT 
AND KELLY 
 
SENSITIVE 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: TBIO KFLU EAGR PREL HHS CH
 
SUBJECT: AVIAN INFLUENZA--CHINA UPDATE JAN/FEB 2009 
 
REF:  A)GUANGZOU 055  B)BEIJING 199  C)BEIJING 162  D)BEIJING 031 
E)GUANGZHOU 006  F)08 GUANGZHOU 737 G)08 BEIJING 4675 H)08 SHANGHAI 
556 
 
SUBJECT: AVIAN INFLUENZA--CHINA UPDATE JAN/FEB 2009 
 
¶1. SUMMARY:  (U) As the country shut down and the population 
traveled home for the Chinese New Year, four more cases of human 
infection with highly pathogenic avian influenza (HPAI), influenza 
A/H5N1, were confirmed (during the January 24-31 period) in the 
provinces of Guizhou and Hunan, as well as in the regions of 
Xinjiang and Guangxi, resulting in two additional deaths.  The total 
number of confirmed cases reported in 2009 of humans infected by the 
highly-pathogenic H5N1 virus now stands at eight, five of which 
resulted in death.  Official communications of confirmed cases to 
the public through state media, as well as to the World Health 
Organization (WHO) have been prompt, and in each case, 
provincial-level authorities implemented local "Highly Pathogenic 
Avian Influenza (HPAI) Rapid Response Plans," which reportedly 
involved comprehensive epidemiology investigations and quarantine 
and close medical observation of patient contacts.  According to 
Chinese Ministry of Health (MOH) reports, epidemiological 
investigations found that all eight patients had contact with live 
poultry or sick birds prior to their illness. END SUMMARY. 
 
¶2. (U) Mission China previously reported on four confirmed cases of 
HPAI A/H5N1 (REFS B/C/D)(confirmed January 6-19, 2009) that resulted 
in three deaths occurring in several different geographic areas 
ranging from the city of Beijing to Shanxi, Shandong, and Hunan 
Provinces.  The lead-up to the Lunar New Year on January 26 saw an 
additional four cases, also involving varied regions.  MOH has 
confirmed each of the cases, and Chinese media has reported widely 
on the below information. 
 
¶3.  (U) On January 24, the Xinjiang Autonomous Region Health Bureau 
confirmed a 31 year-old female in Urumqi was infected with influenza 
A/H5N1.  Initial onset was on January 10 and the patient was 
hospitalized soon after.  The Xinjiang Center for Disease Control 
(CDC) collected a sample of respiratory secretions from the patient 
on January 22 for testing, and confirmed infection with influenza 
A/H5N1 on January 24.  The patient had already passed away on 
January 23, before the case was conclusively confirmed.  The 
epidemiological investigation found the patient to have been exposed 
to a live poultry market.  Observation of the patient's contacts 
yielded no abnormal symptoms.  The woman was the fourth case to die 
in China in January. 
 
¶4.  (U) On January 25, the sixth case this year of human infection 
with influenza A/H5N1 in China was reported.  A 29 year-old male 
resident of Guiyang City, Guizhou Province fell ill on January 15. 
The Guizhou CDC collected a sample on January 23, and infection with 
influenza A/H5N1 was confirmed and announced on January 25.  This 
patient also had exposure to a live poultry market.  Medical 
observations showed no additional illness among family members and 
close contacts. 
 
¶5.  (U) As reported in REF A, MOH on January 26 confirmed that an 18 
year-old man in south China's Guangxi Zhuang Autonomous Region 
became the seventh human case and fifth fatality in China from 
influenza A/H5N1 in 2009.  The patient began showing symptoms on 
January 19 while in the city of Beilu.  Samples from the patient 
were tested and confirmed an unspecified number of days afterwards, 
and the patient was transferred to a Red Cross hospital in Yulin. 
The patient died on January 26, the same day the case was made 
public.  The likely cause of infection is still under investigation, 
although since the patient was from a rural village area, officials 
speculate that he had come in contact with sick chickens. 
 
¶6.  (U) The final confirmed human case of infection with influenza 
A/H5N1 thus far in 2009 was reported on January 31, involving a 21 
year-old female from Xupu County in Hunan Province.  The woman 
initially exhibited symptoms on January 23, was eventually 
transferred to the provincial capital of Changsha on January 29, 
where samples were collected and tested.  She reportedly had contact 
with sick and dead poultry before falling ill.  Hunan CDC confirmed 
on January 30 that she had been infected with influenza A/H5N1.  The 
 
BEIJING 00000257  002 OF 002 
 
 
patient remains in hospital in stable condition. 
 
¶7.  (SBU) In six of the eight cases, a 10 to 14 day period elapsed 
from the date the patient initially fell ill to when the influenza 
A/H5N1 virus was confirmed and officially announced, indicating a 
long period during which the symptoms presented were likely assumed 
to be caused by a human seasonal influenza virus or other common 
respiratory pathogen.  This would have prompted patients either to 
refrain from seeking prompt medical attention or doctors to delay in 
moving the case from village or neighborhood clinics to major 
hospitals in provincial capitals, which are better equipped to 
collect clinical samples, and/or where a provincial CDC or key 
laboratory would be able to confirm infection by the influenza 
A/H5N1 virus.  Two other cases were confirmed and reported seven and 
eight days after initial symptoms (paras 5 and 6); however, one 
patient died the day the case was confirmed, the other is in stable 
condition. 
 
¶8.  (U) Separately, an infant girl living in Shenzhen was treated in 
a Hong Kong hospital in late December 2008 (REFS E/F) and confirmed 
to have had a different strain of influenza virus found in birds, 
influenza A/H9N2.  Press reports placed her family's residence in 
Shenzhen near a restaurant that deals with live poultry.  The infant 
is assumed to have recovered fully. 
 
¶9.  (SBU) COMMENT:  No epidemiologic or virologic link has been 
established among any of the cases reported this year.  In addition, 
the Ministry of Agriculture's (MOA) surveillance of domesticated 
poultry flocks has not reported any die-offs or outbreaks in 
domestic flocks associated by time and place with any of these human 
cases.  However, MOA acknowledges that the HPAI virus is widely 
circulating in China.  Despite no corroborating evidence, some 
health officials have speculated that migratory birds may be the 
source of these human infections. 
 
¶10.  (SBU) Over the same AI "peak" period a year ago (November 2007 
- March 2008), only five human cases of influenza A/H5N1 were 
confirmed and reported in China.  This "season," only halfway 
through the five-month "season," eight human cases of influenza 
A/H5N1 and one of influenza A/H9N2 already have been confirmed in 
China.  According to the CDC country director in Beijing, it is not 
yet clear whether the larger number of identified cases this year 
simply represents improved human cases surveillance and reporting 
practices employed by local authorities, an absolute increase in 
incidence of the virus in humans, or a combination of both.  More 
clarity to this question may come as the season progresses. 
Finally, the current situation also raises questions of how 
effective public education has been in the most rural areas, 
especially on prevention practices for "high threat" populations 
that live and work in close proximity to live poultry, their 
readiness to seek medical attention when influenza symptoms are 
first observed, and for local health workers, who for the cases this 
year still allowed several days to pass before referring cases 
upwards to a facility equipped to deal with suspected cases of 
infection with highly pathogenic avian influenza (HPAI).  In spite 
of this, there have been no documented cases of easy, sustained 
human-to-human transmission among these cases.  END COMMENT. 
 
PICCUTA