The first case of human infection with highly pathogenic avian influenza in China

2. The first case of human infection with highly pathogenic avian influenza in China.
　
In mid-October, 2005, an outbreak of H5N1 subtype highly pathogenic avian influenza occurred in Shebu Town, Xiangtan County, Xiangtan City, and the first case of human infection with highly pathogenic avian influenza appeared in mainland China. The child He Mou, male, 9 years old, from Xiangtan County, became ill on October 10th. Due to the resolute and decisive response to the epidemic and scientific and perfect measures, the epidemic was put out in time, minimizing the impact of the epidemic. On November 15th, 2005, the epidemic area in Xiangtan County lifted the blockade as scheduled. On November 12th, He Mou, a child, recovered and was discharged from hospital, which became the first confirmed case of human infection with highly pathogenic avian influenza successfully treated in mainland China, further enriching China’s experience in dealing with the avian influenza epidemic.
I. What happened
(1) Discovery and report of epidemic situation
At 15: 30 p.m on October 18th, 2005, the office of the headquarters for the prevention and control of highly pathogenic avian influenza in Xiangtan County received an epidemic report from Shebu Town in this county, and 42 chickens and 360 ducks died in Liu Liqiu’s family of Heping Group in Wantang Village of Shebu Town. The office of the county headquarters immediately sent technicians to the scene. The investigation found that there were 15 poultry farmers in Heping group, and 687 poultry were kept in cages, including 293 chickens and 394 ducks. There were 13 households with poultry diseases, and 545 birds died, including 182 chickens and 363 ducks. After preliminary diagnosis, it is suspected to be avian influenza, and the epidemic situation should be reported immediately.
(2) Confirmation of epidemic situation
On October 19th, Xiangtan Animal Epidemic Prevention Supervision Station sent the collected disease materials to the Diagnosis Center of Hunan Veterinary Station for testing. On October 21st, the Provincial Veterinary Station diagnosed a suspected case of H5 subtype highly pathogenic avian influenza. On the 22nd, a special person was sent to the National Avian Influenza Reference Laboratory of Harbin Veterinary Research Institute for diagnosis. On October 25th, the National Avian Influenza Reference Laboratory was diagnosed as H5N1 subtype avian influenza. On October 26th, the Ministry of Agriculture confirmed and announced the outbreak. On November 11th, the Ministry of Health confirmed a case of human infection with highly pathogenic avian influenza in Shebu Town, Xiangtan County, which is the first confirmed case of human infection with highly pathogenic avian influenza in mainland China.
(3) Disposal of epidemic situation
After receiving the epidemic report, the Hunan Provincial Party Committee, the provincial government, the Party committees and governments of Xiangtan City and Xiangtan County and relevant units mobilized urgently and immediately put themselves into the epidemic disposal work. Carefully organize and deploy, fully implement various measures, put out the epidemic at the epidemic point, and block the spread of the epidemic to people.
1 emergency action, comprehensive organization and deployment of epidemic prevention work. On the evening of October 18th, Hunan Veterinary General Station, Hunan Provincial Health Department and other departments immediately sent experts and working groups to the epidemic spot to discuss with Xiangtan City and Xiangtan County overnight to guide the epidemic prevention and personnel protection monitoring. On the evening of October 19th, the provincial headquarters for the prevention and control of major animal diseases held a prevention and control meeting with the participation of veterinary and health departments, studied and deployed various specific prevention and control measures, and decided that the provincial headquarters should enter an emergency state, stick to 24-hour duty, and implement the zero reporting system of epidemic situation to ensure smooth information, strong command and timely handling of epidemic situation. Governor Zhou Bohua and Deputy Secretary of the Provincial Party Committee Qi Heping presided over the governors’ meeting of each city and the video conference of the whole province on October 20 and October 28, respectively, to deploy the prevention and control of avian influenza. On October 21st, Vice Governor Yang Taibo rushed to Xiangtan County to inspect the epidemic prevention work. On November 2nd, Yang Taibo presided over a meeting of heads of relevant provincial departments to further study the prevention and control measures, and once again sent seven inspection teams and five unannounced visits to Xiangtan and other cities and counties to urge the implementation of prevention and control measures.
2. Start the emergency plan and fully carry out the epidemic prevention. On the morning of October 19th, Xiangtan County held an emergency meeting on the prevention and control of highly pathogenic avian influenza, launched an emergency plan decisively, and set up an avian influenza emergency disposal headquarters, which consists of eight working groups, namely, an epidemic disinfection group, an epidemic prevention investigation group, a technical guidance group, a quarantine blocking group, a publicity group, a medical monitoring group, a stability maintenance group and a logistics support group, and went all out to carry out the epidemic prevention work.
3. Strict blockade and decisive disposal of the epidemic. On October 19th, Xiangtan county government issued a blockade order, and set up five blockade checkpoints at the four major traffic arteries in the east, west, south and north of Shebu town and at the exits of Heping Group in Wantang Village and Tanhua Highway to strictly block the epidemic areas. Close all poultry and poultry products trading markets within 10 kilometers around the epidemic area, and prohibit live poultry from entering and leaving, poultry products and other suspicious pollutants from being shipped out; All the poultry in the epidemic area were culled, and 2487 poultry were culled and treated harmlessly; Thoroughly disinfected the site and environment that may be polluted; Carry out emergency immunization for all caged poultry in threatened areas. By October 23rd, 252,000 poultry had been immunized.
4. Carry out medical monitoring to prevent personnel infection. The health department took preventive medicine for 1367 people, injected influenza vaccine for 495 people, and timely followed up and monitored 41 people who had close contact with sick birds and 151 people who had close contact with patients. No abnormalities were found.
5. Conduct epidemic investigation and monitoring to eliminate hidden dangers. Xiangtan county organized forces to carry out a comprehensive epidemic investigation in seven towns around the epidemic area. At the same time, in view of Liu Liqiu’s purchase of 140 ducks from Quanjing Village in this town in mid-September, 2005, the epidemic situation in Quanjing Village was mainly investigated, and no suspected epidemic situation was found. On October 24th, Hunan Veterinary General Station sent people to collect 15 blood samples and 30 cotton swabs from chickens and ducks in the threatened area, and 14 cotton swabs and 10 blood samples from 10 pigs raised by 3 farmers in the epidemic area. After pathogen monitoring, they were all negative.
(4) lifting the blockade in epidemic areas
On November 12th, it was 21 days since the last poultry was culled in the epidemic area of Xiangtan County, and no new epidemic situation was found after monitoring. Upon the application of Xiangtan County Command for Prevention and Control of Highly Pathogenic Avian Influenza, Hunan Veterinary General Station, Xiangtan Animal Husbandry and Fisheries Bureau, Xiangtan City and Xiangtan County Animal Epidemic Prevention Supervision Station, Xiangtan City and Xiangtan County Center for Disease Control and Prevention and other units appointed a provincial and municipal joint inspection team composed of seven experts to conduct on-site inspection and acceptance of the highly pathogenic avian influenza epidemic area in Shebu Town, Xiangtan County according to the requirements of the Ministry of Agriculture, and collected 119 blood samples of caged poultry in threatened areas for emergency immunization effect testing. According to the results of on-site acceptance and laboratory test, the joint acceptance team believes that the epidemic area in Xiangtan County conforms to the relevant regulations on lifting the blockade. After the Hunan Provincial Command for Prevention and Control of Major Animal Diseases reported to the National General Command for approval, Xiangtan County Government announced that it would officially lift the blockade of the epidemic area on November 15, 2005.
(5) Do a good job in the aftermath in time.
The first is to cash the culling subsidy. Xiangtan City and Xiangtan County actively raised funds, and in the case that the central financial subsidies were not in place, they paid in advance, and the poultry culled in the epidemic areas were distributed in place according to the standard of subsidizing 10 yuan on average. In the process of implementing the subsidy, it has been declared truthfully, posted, fair and transparent, and stabilized people’s hearts. The second is to do a good job in summarizing and evaluating the epidemic situation. According to the investigation and evaluation of the expert group, the epidemic situation of avian influenza in Xiangtan County has had a great impact on the aquaculture industry in Hunan Province, as well as the development of agriculture and rural economy and the increase of farmers’ income. For a period of time after the outbreak, the export of poultry in the province basically stopped, the market consumption in the province shrank sharply, and the market price of poultry dropped sharply. In this regard, on November 11th and 17th, Governor Zhou Bohua presided over the executive meeting of Hunan Provincial Government and the governor’s office meeting successively, to study and implement the spirit of the relevant meeting in the State Council, study and solve the problems in the prevention and control of highly pathogenic avian influenza, and issued the Emergency Notice of Hunan Provincial People’s Government on Further Strengthening the Prevention and Control of Highly Pathogenic Avian Influenza. For a period of time to come, we should make overall plans and do both: on the one hand, we should continue to pay attention to the prevention and control of highly pathogenic avian influenza, on the other hand, we should pay attention to the implementation of various policies to support the poultry industry, promote the recovery and development of the aquaculture industry, and effectively combine the prevention and control of highly pathogenic avian influenza at that time with long-term animal epidemic prevention work; Combine the prevention and treatment of highly pathogenic avian influenza with rural health and epidemic prevention; Combine the prevention and control of highly pathogenic avian influenza with economic development and social stability to further consolidate the good momentum that has emerged in the development of rural agriculture.
Second, the experience and enlightenment of epidemic situation disposal
After the baptism of the highly pathogenic avian influenza war in the spring of 2004, in the prevention and control work, Hunan Province insisted on putting prevention first, relying on science, preventing and controlling according to law, preventing and controlling by groups, making efforts to improve the emergency command system, pre-plan system and grass-roots epidemic prevention system, perfecting the emergency mechanism, safeguard mechanism and joint prevention and control mechanism, and striving to build a long-term mechanism for animal epidemic prevention, which achieved remarkable results and significantly improved the ability and level of responding to sudden outbreaks, laying a solid foundation for successfully extinguishing the epidemic situation in Xiangtan County.
(A sound emergency command and epidemic prevention system provides a key organizational guarantee for the successful eradication of the epidemic.
In order to effectively strengthen the organization and leadership of avian influenza prevention and control, governments at all levels have established and improved four organizational systems:
1. Establish a command system with leaders at all levels in charge and leaders in charge directly. Provincial, city, county and township governments have set up headquarters for the prevention and control of major animal diseases. Once an epidemic occurs, the headquarters for the prevention and control of major animal diseases will be automatically transferred to emergency headquarters.
2. Establish an animal epidemic prevention and health supervision system led by the top leaders of veterinarians and health departments at all levels. The veterinary department is responsible for the prevention and control of avian influenza, and the health department is responsible for the prevention and control of avian influenza. Veterinary and health departments should cooperate closely to do a good job in prevention and control in accordance with the requirements of "three simultaneities" of arriving at the scene at the same time, conducting investigations at the same time and handling the epidemic situation at the same time.
3. Establish a market supervision system in which the top leaders of industrial and commercial departments at all levels are responsible and the heads of other relevant departments participate. To be responsible for the prevention and control of all links in the circulation field in case of emergency.
4. In 2004, the reform of township animal epidemic prevention institutions was initiated, 2,277 township animal epidemic prevention stations were re-established and the township animal epidemic prevention system was improved. After the outbreak, Governor Zhou Bohua, Deputy Secretary of the Provincial Party Committee Qi Heping, Vice Governor Yang Taibo and other leading comrades of the provincial party committee and government made important instructions and instructions for many times, and held meetings to study and deploy prevention and control work. Under the unified leadership and command of the local government, the relevant functional departments of Xiangtan County, such as veterinary, health, industry and commerce, public security, publicity and so on, have carried out their duties and cooperated closely, forming a strong working force. Township animal epidemic prevention personnel obey the deployment, fulfill their duties, conscientiously implement the basic work such as epidemic investigation, emergency immunization and disinfection treatment, and play a vital role in timely extinguishing the epidemic.
(2) Early prediction and early warning provide a prerequisite for the successful eradication of the epidemic.
Timely and effective prediction and early warning can enable us to grasp the initiative of prevention and control, take the initiative to take countermeasures in advance, and control the epidemic risk. In late July, 2005, the Office of the Hunan Provincial Command for the Prevention and Control of Major Animal Diseases, through long-term tracking and analysis of the epidemic situation of avian influenza at home and abroad, the evolution characteristics of avian influenza virus transmission, the infection of foreign personnel and the current situation of prevention and control in Hunan Province, predicted that the threat of human infection with highly pathogenic avian influenza in southern China was significantly increased. At the symposium on pig industrialization in Hunan Province held on August 16, the Hunan Provincial Party Committee and the provincial government readjusted and deployed the prevention and control of highly pathogenic avian influenza. On September 22, the Hunan Provincial Government held a video conference to mobilize and deploy the work of preventing and controlling highly pathogenic avian influenza again. After the Ministry of Agriculture held a national video conference on the prevention and control of highly pathogenic avian influenza on September 29, Comrades in charge of the Hunan Provincial Command for the Prevention and Control of Major Animal Diseases are keenly aware of the imminent threat of the epidemic, and have a great sense of "rain is coming". They resolutely decided to give up the National Day holiday break, hold a meeting of Hunan Provincial Animal Husbandry and Fisheries Directors on October 2, and hold an emergency response drill for the sudden outbreak of avian influenza in Hunan Province on October 14, and make emergency mobilization again to fully prepare for the emergency.
Based on the prediction of the epidemic situation, on September 22nd, Hunan Province, on the basis of the national confirmation that all poultry kept in cages, large and medium-sized cities and their suburbs, poultry farms, areas where epidemic has occurred, and areas where migratory birds and wild birds are concentrated (migration routes), requested that only poultry kept in poultry farms (households) with more than 50 caged birds be fully immunized, which greatly expanded the scope of immunization. More than 96 million milliliters of avian influenza vaccine were stored and allocated in time. At that time, when the supply of avian influenza vaccine was tight in the whole country, the need of immunization work in Hunan Province was ensured and the initiative was obtained. The high immune density of birds plays a key role in the effective prevention and control of avian influenza.
(3) A complete emergency mechanism provides institutional guarantee for the successful eradication of the epidemic.
To prevent and control highly pathogenic avian influenza, a virulent infectious disease with high morbidity and mortality, only by establishing a scientific and complete epidemic emergency mechanism, making emergency preparations and realizing rapid response can we win the initiative in our work. By summing up the previous experience of prevention and control and learning from foreign advanced practices, in 2005, the Hunan Provincial Government issued the Emergency Plan for Major Animal Epidemic in Hunan Province. Based on this, the Hunan Provincial Command formulated the Emergency Response Measures for Major Animal Epidemic in Hunan Province and the Emergency Response Norms for Highly Pathogenic Avian Influenza in Hunan Province, thus forming a set of forward-looking, scientific, targeted and operational emergency plan system, which provides an action guide for emergency response. In accordance with the requirements of the emergency plan, emergency reserve teams have been set up at all levels to reserve emergency disposal materials, ensuring the "three in place" of personnel preparation, capital preparation and material preparation for the disposal of major animal epidemics. On October 14th, 2005, the Hunan Provincial Government held an on-site observation meeting in Liuyang City, which was attended by leaders in charge of municipal and state governments. The observation meeting adopted the form of "indoor exercise+outdoor on-site disposal", and the whole disposal procedure was standardized and clear, easy to understand. The exercise achieved multiple effects of emergency mobilization, team training and skilled disposal process, which provided important prevention and control experience for the successful eradication of the epidemic.
(D) Resolute emergency response has provided an important guarantee for the successful eradication of the epidemic.
The key to emergency work is "fast". Once there is a highly pathogenic avian influenza epidemic, we must respond quickly, deal with it strictly, and resolutely put it out at the epidemic point, and we must never delay the opportunity. In accordance with the principle of "early detection, quick response and strict disposal", Hunan Province has adopted the method of "investigation, treatment and verification", requiring that birds with clinically suspected avian influenza be decisively culled without waiting for the test results, and sick materials should be collected for inspection and reported in time, which can effectively prevent the pollution and spread of the epidemic source. On the evening of October 18th, Xiangtan County organized epidemic prevention personnel to deal decisively with the poultry of the affected households. On October 19th, in order to reduce the threat to people, Xiangtan County, under the guidance of provincial and municipal expert groups, decisively culled all poultry in the epidemic area and blocked the epidemic area. At the same time, carry out county-wide epidemic investigation and monitoring, and carry out emergency immunization for poultry raised in threatened areas. On October 21st, when it was diagnosed as suspected highly pathogenic avian influenza at the provincial level, Xiangtan County strengthened comprehensive epidemic prevention measures in strict accordance with the requirements of the emergency plan, ensuring that no loopholes were left in the blockade of epidemic areas, no hidden dangers were left in culling and destruction, no gaps were left in compulsory immunization, and no dead ends were left in strict disinfection. Finally, the epidemic situation in Xiangtan County was put out in time, and only more than 2,000 poultry feathers were culled. This "proactive attack" in Hunan Province played a key role in putting out the epidemic and reducing losses as soon as possible, and was highly praised by the inspection team of the State Council and the inspection team of the Ministry of Agriculture.
(5) The joint prevention and control of animals (doctors) and people (doctors) has played a key role in blocking the spread of avian influenza to people.
Highly pathogenic avian influenza is a zoonotic disease. To do this work well, it is necessary to treat both animals (doctors) and people (doctors) in order to be effective. After the outbreak in Xiangtan County, the Hunan Provincial Department of Agriculture and the Hunan Provincial Health Department worked in coordination and cooperated closely, established a daily epidemic notification mechanism, held regular and irregular consultation meetings to inform the situation and discuss countermeasures, and jointly issued the "Emergency Notice on Doing a Good Job in Personal Protection and Environmental Disinfection of People with High Exposure to Avian Influenza", which clarified the specific measures to prevent personnel from being infected. The Hunan Provincial Center for Disease Control and Prevention and the relevant health disease prevention and control departments of cities and counties promptly launched the emergency response plan for human avian influenza, and adopted strict protective measures and equipped with necessary protective equipment for the staff in the epidemic area and the relevant personnel involved in culling, resolutely blocking the infection of avian influenza to people; Together with the animal husbandry and veterinary departments, the epidemiological and clinical characteristics of relevant cases were investigated to find the source of the disease in time and investigate the epidemic situation. The close cooperation between veterinary medicine and human medicine has played a key role in blocking the spread of avian influenza to people.
(six) the correct guidance of public opinion has created a good social atmosphere for the successful eradication of the epidemic.
In 2005, after the first case of human infection with avian influenza occurred in Xiangtan County, China, the leaders were worried, the masses panicked and the society paid attention. How to seek advantages and avoid disadvantages, and give full play to the positive role of media and public opinion in emergency response, Hunan Province has made comprehensive and detailed thinking and research on this, formulated the principle of "extensive publicity, positive guidance, unified caliber, timely notification, timely and appropriate", defined the spokesperson, reported the progress of prevention and control work realistically, reported the epidemic situation according to the unified caliber of the Ministry of Agriculture, and vigorously publicized epidemic prevention knowledge and mass prevention and control skills, measures taken by relevant government departments and prevention and control work. The Information Office of Hunan Provincial People’s Government held a press conference on November 11th, held several press conferences in the name of Hunan Provincial Department of Agriculture, and received more than 100 media interviews to introduce the progress of avian influenza prevention and control in Hunan Province, clarify the facts, correct some false reports, and maintain the normal consumption and circulation of poultry products and the economic and social order in epidemic areas. Xiangtan County urgently printed 200,000 copies of bird flu prevention and control materials and distributed them to every farmer in the county, so that the broad masses can understand the characteristics of epidemic spread, prevention and control methods and self-protection measures, so that farmers can correctly safeguard their legitimate rights and interests, form a joint force of prevention and control by the whole society, and realize mass prevention and control.