1. Human Infection with Avian Influenza A(H7N9) Virus: Situation and Response, China Zijian FENG Center for Public Health Emergency Center Chinese Center for Disease Control and Prevention

2. Overview of human H7N9 cases reported in Mainland China One confirmed case was reported in Taiwan （ onset date: Apr 12) and he returned to Taipei from Suzhou via Shanghai 3 days before date of onset ProvinceNo. of casesDeath % Zhejiang481124 Shanghai331855 Jiangsu28932 Jiangxi6117 Fujian5120 Anhui4250 Henan4125 Hunan2150 Shandong200 Beijing200 Hebei100 Guangdong100 Total13644 33

3. Epidemic curve of human H7N9 cases in Mainland China Onset date No. of cases Hebei Jiangxi Fujian Shandong Hunan Beijing Henan Anhui Jiangsu Zhejiang Shanghai 3 stages of the epidemic ： Feb 19 ～ Mar 27, Sporadic cases in Shanghai, Zhejiang, Jiangsu and Anhui; Mar 28 ～ Apr 18, Increasing stage, spread to 10 provinces; Apr 19 ～ Aug10, Declined stage, sporadic cases.

4. Human H7N9 cases and deaths by sex and age (as of 10 Aug 2013 ， 134 cases and 44 deaths) Sex: Male 70%, Female 30% Age: median 62 yrs ， range: 2 ～ 91yrs Deaths

5. Virological features of H7N9 Virus: HA gene:  Similar to H7N3 isolated from duck in Zhejiang NA gene:  Similar to H7N9 isolated from wild bird in South Korea All six internal genes:  Shared highest similarity with A/brambling/Beijing/16/2012-like viruses (H9N2) Gao R, et al. N Engl J Med, 2013, 368(20):1888-97.

6. Serology study of H7N9 virus Sera collected from 1544 poultry workers from Shanghai, Zhejiang, Jiangsu and Anhui during Jan-Nov 2012, all tested negative for H7N9 specific antibody by MN Sera from 90 persons (30 children,30 adults and 30 elderly) before and after influenza vaccination for 2012-13 season, no pre-existing immunity for H7N9, no cross-reactive antibody against H7N9 virus Bai T, Zhou J, Shu Y. N Engl J Med,2013,368(24):2339-2340; Zhou J, Wang D, Gao R, et al. Nature,2013.

7. Serological study in seven provinces (as of Aug 14) No. serum HI positive ( titer≥160 ） （ % ） MN( titer ≥20) （ % ） Close contacts （ HCW ） 480（0）0（0） 0（0）0（0） Other close contacts 4836(1.24)2 （ 0.41 ） Poultry workers** 12250（0）0（0） 0（0）0（0） Note ： study provinces included Henan, Shanghai, Hunan, Fujian, Shandong, Anhui, Jiangxi **269 serum specimens from poultry workers in Shanghai were excluded.

8. Exposure history of H7N9 cases （ N=133 ） Types of ExposureNumber (%) Exposed to poultry or live market, n/N (%) 92/133(69%) Exposed to mammal (pig, dog, cat, rabbit ） 8/133(6%) Poultry workers, n(%) 8/133(6%) Exposure history of one case who was retrospectively diagnosed and reported on July 2 in Jiangsu, is unknown (onset date: Apr 25)

9. Risk factors of H7N9 infection Case-control study in Jiangsu –25 cases, 93 controls; age, sex, and location were matched –Risk factors: contact with poultry, birds (pigeon, quail) within 2 weeks before illness onset; with underlying chronic diseases ( exclude hypertension); environment exposure (visiting live market) National case-control study –89 cases, 340 controls; age, sex, and location were matched –Risk factors: visiting live poultry market, direct/indirect contact with poultry, backyard poultry death, Obesity, COPD, long-term taking immunosuppressive medication Ai J, Huang Y, Xu K, et al. Euro Surveill. 2013;18(26):pii=20510.

10. Case-Control Study of Risk factors associated with H7N9 virus infections (89 cases, 340 controls)