title: Epidemiology of the avian influenza A (H7N9) outbreak in Zhejiang Province, China.
abstract: BACKGROUND
  A novel influenza A virus infection was identified on March 31, 2013 in China and a total of 134 cases were identified in 12 provinces of China between March 25 and September 31, 2013. Of these, 46 cases occurred in Zhejiang Province and the number of patients is the largest in China.
  
  
  METHODS
  Field investigations were conducted for each confirmed H7N9 case. A standardized questionnaire was used to collect information about demographics, exposure history, clinical signs and symptoms, timelines of medical visits and care after onset of illness, and close contacts. Descriptive statistics were used to analyze the epidemiological and clinical characteristics. Samples from the patients were collected and tested by real time reverse transcriptase-polymerase chain reaction and viral culture.
  
  
  RESULTS
  A total of 46 laboratory confirmed cases of H7N9 influenza infection were identified in the Zhejiang province between March 31 and September 31, 2013 of which 29 were male and 17 were female. The median age of patients was 61.5 years and 76.09% of cases occurred in persons aged ≥50 years old. Unlike other province, 34.78% of cases in Zhejiang Province were rural residents. Among 11 deaths, 9 were male, 10 were older than 60 years old, and 10 had underlying diseases. 30 of 38 cases with available data had a recent history of poultry exposures and 8 cases had multi-exposure history. The estimated median incubation period was two days which was shorter than corresponding data in other provinces. All cases were hospitalized and the median time from illness onset to hospitalization was 5 days. Symptoms at the onset of the illness included fever, cough, expectoration, shivering, fatigue, muscular aches, nausea, vomiting. Only 4.91% contacts developed respiratory symptoms, but their samples were tested negative for H7N9 virus designating lack of human-to-human transmission of the virus.
  
  
  CONCLUSIONS
  All cases were sporadic and there was no evidence of an epidemiologic link between them. Control measures including closing affected poultry and slaughtering backyard poultry are needed not only in urban areas but also in rural areas to reduce human H7N9 infection risk.
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Gong
authors.forename: Huakun
authors.initials: H
authors.lastname: Lv
authors.forename: Hua
authors.initials: H
authors.lastname: Ding
authors.forename: Jiankang
authors.initials: J
authors.lastname: Han
authors.forename: Jimin
authors.initials: J
authors.lastname: Sun
authors.forename: Chengliang
authors.initials: C
authors.lastname: Chai
authors.forename: Jian
authors.initials: J
authors.lastname: Cai
authors.forename: Zhao
authors.initials: Z
authors.lastname: Yu
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China. zjcdccfs@126.com.
authors.forename: Enfu
authors.initials: E
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002681:China / Q000453:epidemiology; D021821:Communicable Diseases, Emerging / Q000453:epidemiology*; D003371:Cough / Q000821:virology; D004196:Disease Outbreaks; D005260:Female; D006760:Hospitalization; D006801:Humans; D064766:Influenza A Virus, H7N9 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D060888:Real-Time Polymerase Chain Reaction; D020133:Reverse Transcriptase Polymerase Chain Reaction