Transcript of press conference in Beijing

The China-WHO joint mission on H7N9 assessment

24 April 2013 (Q and A Session)

JOURNALIST: With CNN. I want to ask, there have been more than 100 cases of this virus found and more than 20 people have been killed, or died as a result of it, is that more lethal or at the average for a flu virus? How does this compared to other cases of avian flu when it comes to how lethal this has been?

DR FUKUDA: When we look at influenza viruses, this is an unusually dangerous virus for humans. There are some other examples of other influenza viruses which are very dangerous for humans. You know, the H5N1 bird flu virus is one of the most famous examples of how dangerous an influenza virus can be for people in terms of being lethal. This H7N9 is definitely one of the most lethal influenza viruses that we have seen so far, but I want to give you a caveat, or give you a little bit of context: we really are at the beginning of our understanding of this virus, and right now we may just be seeing the most serious infections, and it may be possible that there are people who have mild infections. We don’t really know that right now. So it’s hard to give the definitive picture on that right now. But it has been one of the striking features of this overall outbreak.

I think this partly explains why both China and WHO have taken this outbreak so seriously, and why our joint team has been working so hard in a very concentrated time to try to understand what is going on.

The last point here, is that the work, the research and the studies being done in China, will really help us to understand much more about how ultimately dangerous the virus is or is not to people. And also I think that over the next several months, much of the work being done here, will really improve our understanding of the overall situation.

JOURNALIST: With Reuters. I have two questions. The first is, is the H7N9 virus much more transmissible to humans than the H5N1 virus? And the second question is, what kind of poultry are we looking at here, are we looking at ducks, chickens or migratory birds? Thank you.

DR FUKUDA: Thank you. Let me answer the first question, and then I’ll turn to some my colleagues for the kinds of poultry that have been identified. Right now, based on the evidence that we see, and I want to stress that we’re at the beginning of our understanding of this virus, but based on the evidence that we see, we think that this virus is more easily transmitted from poultry to humans than H5N1. This is what we see right now. Again, there are a number of studies that are being started, and over the next several months I hope that we come to much better understanding about the transmissibility of this virus. But that is our current understanding based on the data.

DR NANCY COX: Yes, thank you. As Dr. Fukuda has said, and I will repeat, and of course, my colleagues will probably repeat the same thing, we’re at the very early stages of this investigation, and so there’s a lot that remains to be learned both on the human health side and especially on the animal health side. So far, the Ministry of Agriculture and the Ministry of Forestry have both collected many, many samples from birds. So far no samples from migratory birds or their habitats have been positive for H7N9. In contrast, samples from chickens, ducks and pigeons have been positive for H7N9, from poultry markets, and also environmental samples taken from poultry markets have been positive. So this is what we can say at the moment, it’s limited information, there are relatively few positive samples, but at least we can now understand that the likely source of infection is poultry - the virus originates from poultry. Thank you.

JOURNALIST: My question is, in the past few days, we found the number of the newly infected cases remains quite stable or the growth has slowed down. In Shanghai, there has not been any new case reported in the past few days. However, in northern cities in China, we found some new cases. So does that represent a new trend of the development because of the climate or the migration routes of birds?

(After Director-General Liang’s answer)
DR ANNE KELSO: Thank you very much for this important question at a time when we are all watching very closely the evolution of this outbreak in China. Of course I agree completely with Director-General Liang’s comments which are very wise and insightful about where we believe the situation is today. But I’d like to comment particularly on one point that you made, and that is the dramatic slowdown of cases in Shanghai. This is very encouraging at this stage of the outbreak. We know that Shanghai, rapidly, on 6 April, closed down the live poultry market in the municipality. And it’s been very encouraging to see that almost immediately there was a decline in the detection of new cases. And the cases that did occur, occurred in the next week, which you might expect to be within the incubation period of the virus. There’ve been no more cases that we know of since then, and so the evidence suggests that the closing of live poultry markets was an effective way to reduce the risk of infection with the H7N9 virus, and of course, these reports fit with the current hypothesis that live poultry, particularly in live markets where many birds are brought together, is a major source of infection of humans with this new virus. Now we can’t relax yet, it’s going to be very important to watch over the next days, weeks, even months, what happens as a result of the shutdown of the live markets. It’s possible that other routes of infection will be found, that we don’t know about yet. It’s possible that the coming of the spring time, which we all appreciate, is leading to a reduction in the transmission of influenza viruses as we see with seasonal influenza and with other avian influenza viruses. And so there are other contributing factors, but just the same, this is, I think, a very encouraging outcome so far, from the very quick and appropriate response of the Shanghai Municipality.

There are also encouraging results from other cities which have taken similar actions a little later than Shanghai, for example, Nanjing. And so it’s going to be important, again over the coming weeks, to see whether there’s a similar, long-term decline in the number of new cases. It’s also notable that there’ve been very few cases reported yet from Beijing, which also, of course as you know, closed its live poultry market system in 2008. So this is really useful information at this early stage of the epidemic. Of course, everyone is also acutely aware of the economic and other impacts of change in the live poultry market system. So it’s very important that there is active replacement of that system with mechanisms for the chilling and freezing of poultry so that there can continue to be access to this very important source of food. And that people can restore their confidence in chicken as a food source, so that the very important poultry industry, which affects so many people, can continue to be viable and be strong. So whatever actions are taken, of course, I’m sure the health and agriculture authorities in China will be acutely aware of the need to balance between protection of all the people from a health point of view and also protection from economic aspects as well of this outbreak. Thank you.

JOURNALIST: I’m of the Associated Press. Earlier you mentioned that samples have been taken from live poultry markets as well as from birds in the markets themselves. What about farms, and in particular, the backyard-type farms that spread across the country and that are not easy to regulate? Do you have any evidence coming out from those areas? Also, how forthcoming have Chinese agricultural and animal health officials been with their information, given that for many officials in this type of work, there are almost little incentives to report disease outbreaks because it’ll have severe economic impact for them.

DR MALIK PEIRIS: Thank you for your question. So the agricultural authorities in China have tested a large number of specimens from farms as well as the live poultry markets, as was mentioned before. I remember over [8,000] farms have been tested. But so far, there have been no positive specimens from farms. Now, one has to keep in mind that, it doesn’t appear that this infection is widespread in farms, I think that’s what one can say from the data that’s available so far. You have to keep in mind that you don’t need to have many infected farms to have the virus amplifying in the live poultry markets, and spread to humans. So I think what will be done in the next weeks, months ahead would be to search further to see if source of infection in farms can be identified. In regard to the second part of your question, of the openness and transparency of the agriculture authorities, just as we had very open and transparent discussions with the health authorities, we also had very good open interactions with the agriculture authorities. I would say that these discussions have been very frank, open and constructive.

JOURNALIST: From NBC news. The second infection in Beijing, the 4-year-old boy, was carrying the virus but showing no symptoms. Is that encouraging or is that worrying?

DR ANGUS NICOLL: Thank you. They gave me the difficult question. You can see it in an encouraging way, because it could be, that there are a large number of individuals with very mild, asymptomatic illness and that this is more like seasonal influenza which is especially harmful to people of my age. We have seen some of these mild cases, mostly in children. [If so] then the rate of fatality would come down. But equally it could mean that we could have more cases than we imagined. I would emphasize at this point just how sporadic these cases are when you look at them. We are not seeing groups in clusters, but in particular, we are not seeing increasing clusters, which is why Keiji Fukuda and someone emphasizes that there were saying that we’re not seeing person-to-person transmission in any efficient sense as yet. But I would emphasize as the other members of the teams have done: we’re at the start of this, a lot more research needs to be done. In particular, serological studies need to be done, where you look at the people around these cases, to see if there’s any more infections out there, and what the level of immunity is in the community. China has started those studies, and those studies also need to be done in other parts of the world, particularly looking at the immunity that there is naturally in the populations. This is going to be a long haul and why we emphasize so much that this needs to be continuing both in China and in other parts of the world.

JOURNALIST: Thank you. I’m with CCTV news. My question is, what is WHO’s comment on Chinese government’s efforts in containing this virus? And are you confident that Chinese government can finally win this battle against the infections?

DR MICHAEL O’LEARY: Thank you very much. I think from the beginning, we have been very pleased with the approaches of the Chinese government and the openness of the Chinese government in addressing this outbreak. We’ve seen a high capacity of the technical staff involved, the ability to address this situation in the field, to gather information and to readily share the information. So that’s been a very positive observation throughout the three plus weeks now of this outbreak. In terms of the capacity to control and to end this problem, we’ve seen gradual expansion here. Cases, new sporadic cases occurring, we’ve said that, I think from the beginning, that that’s expected because of the sporadic nature of these cases. And we would expect to continue to see more. But we’ve dealt with flu viruses now for many, many years, and we’re confident over time that we’ll be able to learn much more about the virus, and we’ll be able to achieve good accommodation and control.

DR FUKUDA: I can just augment the words of Dr. O’Leary. You know, from influenza we have learned a lot over the past several decades. It’s a very difficult infection to deal with. But the ingredients that you need are the right strategies, the right tools, and the political will and the leadership to implement these strategies and tools. That’s what we’ve seen, and that’s why we’ve been so impressed in our contact both with the health authorities in Shanghai and in Beijing. Those essential elements are all in place. So that’s why we [reached] the assessment that those essential elements are in place in China. We can’t do [everything] overnight with such a complex and difficult issue, but the fundamentals are all in place.

JOURNALIST: My question is about the research and development in serving the vaccine. It is reported that the key protein of the virus has already been identified and it is also said that CFDA has already authorized some companies to develop the H7N9 vaccine. So what is the latest development concerning the vaccines?

DR NANCY COX: Thank you very much. So I have to, first of all, say that I’m not actually clear precisely what is being done in China, but I can talk a little bit about what’s going on globally. The WHO has for many years, coordinated the selection of candidate vaccine viruses, which are often produced by laboratories that belong to WHO’s global influenza surveillance and response network. And the individuals involved in this network look at the viruses and then determine which are the most appropriate to use as potential vaccine viruses. So a lot of work has been going on in China and in other countries as well. Over the past three weeks, some potential vaccine viruses have been developed. They are being developed-- just in case. So right now, there is no recommendation to go ahead and produce vaccines against the virus for humans. But we all think that it is wise to take the first steps, so that if something should happen, we would be ready; we would have candidate vaccines, potential vaccine viruses that have been selected based on appropriate characteristics, they will have been safety tested in animal models, and we would understand quite a bit about the behavior of these viruses, whether they grew well in the production systems that are used to make influenza vaccines. So by doing all this work upfront, we’ll be much better prepared as I just said before –if should something happen, and we would need to go that next step. Now I believe also that in some countries, and I’m not sure about China but I know in some countries, there may be some additional steps taken, which would help us understand how large the dose of vaccine would be. So in other words, clinical trials can be done, and the dosing requirements for inducing or producing an appropriate immune response to be protective against infection could be determined in advance. So all this knowledge is really critical so that we would be as prepared as possible for whatever might come in the future. Thank you.