Beijingers still unprepared for influenza pandemics

by Michael Woodhead
Despite the many deaths from H7N9 influenza over the last year, most Beijingers lack basic knowledge about influenza prevention and do not use basic hygiene practices to avoid spread of the infection, a study has found.
In a survey of more than 13,000 Beijing residents found that only 7% had the minimum standard of knowledge and behaviour in relation to influenza prevention.
When asked to complete a survey on influenza, only 24% had adequate influenza-related knowledge, 12% showed influenza prevention behaviour although 43% possessed influenza prevention skills,
The survey tested Beijingers on their knowledge about the disease and its symptoms; and also assessed practices towards influenza and people with influenza-like-illness such as cough etiquette, use of masks, hand washing, and the need to seek medical care for influenza.
The survey also measured skills necessary to avoid and manage influenza such as use of a thermometer, attitudes towards flu vaccine and understanding of information materials related to influenza such as medication instructions.
The low levels of "health literacy" showed that more work was needed to encourage Chinese
"Improvements are needed in terms of certain aspects [of health literacy], particularly for the elderly and the population of rural districts," said Dr Zhang Li and colleagues from the Beijing Centre for Disease Prevention and Control. 
Update: A study from Guangzhou has also shown widespread misunderstanding about the threat of H7N9 infection. In a survey of more than 1000 city residents, more than 80% did not believe they would be at risk of H7N9 infection from live poultry markets. Resident wrongly believed that poor hygiene practices in markets were responsible for the disease risk, and the vast majority opposed permanent closure of live poultry markets, instead favouring 'rest days' when trading is suspended for cleaning and disinfection.

Six of the top medical news stories from China

1. China has a huge shortage of midwives, and would need a further 800,000 to meet the WHO standard of one for every thousand women of child-bearing age, according to a new report. Health officials say the problem will worsen as China adopts a two child policy.

2. Efforts to control pneumococcal disease and Haemophilus influenzae type b (Hib) in children by vaccination are failing due to low immunisation rates and delayed immunisation, a study from Shanghai shows. A review of vaccination records for 28,000 children up to the age of seven found that 51% had one dose of Hib vaccine and 11.4% had one dose of pneumococcal vaccine. Only 8.2% of children had Hib vaccine at the right time and only 0.5% had timely pneumococcal vaccine. Rates were particularly poor for migrant children, the study found.

3. Rates of hypertension have increased in China and yet treatment and control of the condition remain poor, according to researchers from Shandong. In a study of more than 4000 people they found that the incidence of hypertension increased from 2.9 per 100,000 people in 1991–1997 to 5.3 in 2004–2009 Antihypertensive treatment and control rates for hypertension were 5.7% and 1.7% in 1991–1997 and 19.9% and 7.6% in 2004–2009, respectively.

4. The rate of disabilities from road crashes in China has skyrocketed as the number of cars on the road has increased over the last two decades. The incidence rate for road traffic disabilities increased over time from 1.50 per 100,000 people in 1980 to 11.2 per 100 000 persons in 2005, according to Professor Zheng Xiaoying of the Institute of Population Research, Peking University.

5. Malaria is still a major problem in central China especially during floods and rainy periods of the summer. A study from Mengcheng County, Anhui found that there were 3683 malaria were notified during the study period of May to October 2007 Most of the cases occurred a week to a month after flooding and waterlogging. Public health action should be taken to control the potential risk of malaria epidemics after wet weather, the researchers from Shandong University said.

6. The recent outbreaks of H7N9 avian influenza also resulted in many mild and asymptomatic infections as well as severe life threatening cases, researchers from Guangdong have reported. Their surveillance program noted 21 cases of infection in Guangzhou, China in 2013 and 2014, of which several were mild or asymptomatic infection. Family clusters occurred, suggesting limited person-to-person transmission of the H7N9 virus, they said.

Smoking deprivation | Suicidal ideation in school students | Obesity surgery | Oestrogen in the environment

About 7% of Chinese people smoke so much their spending on cigarettes deprives the household of essential items like food, a study from Beijing has found. Low-income smokers were more likely to have smoking-induced deprivation.

Suicidal ideation occurs in one in three Chinese high school girls and 20% of boys, a study of 5249 students in Anhui Province of China has found.

Laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy are safe and effective for the treatment of morbid obesity, resulting in 63% and 76% loss of excess weight, a study from Nankai Hospital of Tianjin Medical University has shown.

The waist circumference cut off for high risk of central obesity and metabolic syndrome is 85 cm for women and 90 cm for men, researchers from Shandong have shown.

In Shanghai, almost one-in-five boys are obese and 8% of girls are obese. The prevalence of combined overweight and obesity is 49% for boys and 31% for girls aged 8-15-years, according to a study that found rates of obesity started to increase from age 10 years.

Oestrogen hormones are widely used in animal rearing in China and this leads to high levels of the hormones in excreted manure which is then used on crops, perpetuating the environmental contamination and human exposure, researchers from the State Key Laboratory of Water Environment Simulation, Beijing have shown.

The highly pathogenic strain of H7N9 avian influenza is quite different from other H7N9 strains seen in China and appears to have come about by re-assortment with the H9N2 strain, according to researchers from the Guangdong Provincial Center for Disease Control and Prevention.

Infliximab is safe and effective in Chinese patients with ulcerative colitis, resulting in 85% response rates and 62% remission rates after 30 weeks of treatment. However, relapse rates are high, say researchers from the Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou.

Clinical Friday - news briefs from the medical journals

An outbreak of Hand, Foot, and Mouth Disease in Changchun in 2013 affected more than 1125 children and was caused by Coxsackievirus A6 researchers report. They say the finding of a different causative strain means that vaccination against enterovirus EV71 will not solve the millions of cases of the disease in China every year.

More than 80% of elderly people in Beijing are infected with the stomach bug Helicobacter pylori that predisposes to ulcers and gastric cancer, a study has found. The infection rate with the more pathogenic type 1 H. pylori strain was 56%, researchers found.

Patients with H7N9 influenza living in rural areas were more likely to be female and caught the infection from backyard poultry breeding, a study from Zhejiang has shown.

Heart failure has a poor prognosis in China with 40% patients dying within four years if they have chronic heart failure with reduced ejection fraction, a study from the National Center for Cardiovascular Diseases and Peking Union Medical College shows.

More than one in ten patients attending China's overcrowded hospitals leave without being seen, a study has found. Patients who left without waiting for treatment tended to have less serious illness and have arrived on foot, according to researchers from the Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu.

Uric acid may have a role in hypertension, according to researchers from Xinjiang. In a study of 3778 children and adolescents they found that increasing levels of serum uric acid were associated with high blood pressure.

The most common forms of cancer in China are lung cancer (20.5%), stomach (11%), colorectal (10%) and liver cancer (10%) according to new figures from the National Central Cancer Registry.

China has learned the lessons from SARS, praised by WHO for H7N9 reponse

China's response to the H7N9 influenza outbreaks has been praised the World Health Organisation for the sound preparedness, prompt communication and collaboration with international groups. In the latest WHO Bulletin the agency says China has learned the right lessons from the mistakes made with SARS and now has a robust and open system for dealing with infectious disease outbreaks that can be a model for other countries. After SARS, China reformed its systems to improve disease surveillance and make the country’s response to future disease outbreaks both swift and effective, WHO says. The improvements to the system were evident when H7N9 influenza emerged in March 2013. The Chinese surveillance system based on Centres for Disease Control and Prevention allowed the problem to be quickly identified, and there was a good response in terms of follow up testing and identification of new cases. prompt moves were taken to reduce risk by closing poultry markets, and appropriate risk information was disseminated quickly to the public, the report says. It also welcomes the close cooperation between the National Health and Family Planning Commission and WHO in responding to the H7N9 threat. China was praised for being open about the sharing of information about H7N9 to the public and with the wider scientific community, with no barriers to publishing the results of virological and epidemiological investigations in scientific journals "China’s prompt response to the emergence of the A(H7N9) virus as a human pathogen – which spanned multiple governmental departments and ministries at national, provincial and municipal level – was mainly the result of strong leadership in a critical situation." the WHO report concludes.

Illegal ambulances in Beijing ... dogs spread H7N9 ... new vaccines for EV71: eight medical news stories from China

by Michael Woodhead

1. Illegal ambulances in Beijing
One of the most bizarre stories of the week is that of the 'fake' ambulances plying their trade around Beijing hospitals. After hearing about fake drugs and fake doctors being widespread in China it should not come as any surprise to hear that shanzhai (山寨) unofficial ambulances are also operating. According to the Beijing Times the illegal ambulances park near major hospitals in the city and offer their transport services to patients. It is said that the poorly-equipped unofficial ambulances work in collusion with the hospital staff (who receive commissions) to charge patients exorbitant prices for transporting patients to and from hospitals and as transfers between hospitals. "Security guards at many hospitals have tried to stop these illegal ambulances from operating in and around their facilities, but they are afraid of being sued by patients and family members for delaying medical treatment," the article says.The unofficial ambulances have found a gap in the market because there is an insufficient number of genuine ambulances, the article says.

2. Dogs spread H7N9
Feral dogs that live around poultry farms and live poultry markets may be a key to spreading of the disease, say researchers from South China Agricultural University, Guangzhou. In a study of 2357 dogs, they found that 4% showed evidence of influenza A infection (though not specifically H7N9). Writing in Clinical Infectious Diseases, they said that feral animals "may increase the risk of the emergence and transmission of novel influenza A viruses and serve as a threat to both veterinary health and human public health ... As man lives in very close contact with dogs in many areas of the world,we posit that surveillance for novel viruses among feral dogs living in close proximity to
live poultry markets or poultry farms could serve as an early warning system of viral threats to man."

3. Zhejiang markets ground zero for avian flu
In the same vein, researchers in Zhejiang have found that poultry kept in local markets carry a veritable cocktail of influenza viruses including H7, H9 and H5 and two NA subtypes (N9 and N2), as well as H7N9-related reassortment intermediates H9N9. "The co-circulation not only reveals that Huzhou is one of the geographic origins of the novel H7N9 virus, but also poses a potential threat to humans in the future," they conclude.

4. Hand foot and mouth vaccine in the pipeline
More optimistic news in relation to another virus, namely EV71 enterovirus, the causative agent fro hand foot and mouth disease. A review article from the Third Military Medical University and National Engineering Research Center for Immunological Products, Chongqing notes that China has developed three promising vaccines against the disease that have passed Phase III trials, and are expected to be available in the near future.

5. Antivirals in more kindergartens
The scandal over the drugging of kindergarten children with antivirals is widening, with claims that a kindergarten in Jilin has also been giving the drugs without parental consent. The initial reports from Shaanxi that children were being given antiviral prophylaxis supposedly to prevent coughs and cold have justifiably caused outrage among parents. The odd thing is why such an obscure antiviral as the biguanide moroxydine was chosen to give children.

6. Ulcers from fat injections
A 38-year old Beijing woman is taking legal action against a Chaoyang health and beauty spa for half a million yuan in compensation after the "fat dissolving injections" she was given resulted in severe ulcers. In a court case the woman said the 'medical' staff at the clinic were unqualified and the "no side effect" lipolysis injections turned out to be albumen that triggered allergies and skin ulceration requiring skin grafts.

7. Gay 'cure' clinics do thriving business
The Economist has a feature on the 'homosexuality cure clinics' in China, where people can pay around $1700 or a three month program of psychological treatments that supposedly deter them from having gay tendencies by giving them unpleasant injections and treatments in while watching sexual imagery. The clinics are said to be encouraged by the Confucian social pressure to be a good child and conform with traditional Chinese values.

8. Fake medical ads still widespread
And while we are on the subject of dodgy treatment Xinhua reports that advertisements for fake and worthless remedies and clinics are as widespread as ever, despite laws intended to crack down on the. In a long article, Xinhua reporters describe how newspapers are still full of ads for fake treatments or treatments for which exaggerated claims are made. Industry insiders said the marketing of fake medical products and services was a high profit, low risk business as there was little enforcement. Government departments said fake products were widespread and it took a lot of time and resources to track them down and prosecute offenders.

Poultry industry demands 'avian' be dropped from H7N9 influenza virus description, threatens legal action

More than a thousand poultry breeding and trading companies have signed a petition letter calling on government departments to stop using the term 'avian' in respect to the H7N9 influenza virus, saying the link has caused catastrophic losses to their industry.
The letter organised by the China Animal Husbandry Association says that 'avian flu' is not an official term used by WHO and should not be used by ministries such as the National Health and Family Planning Commission.
The companies said the warnings about live poultry had caused panic among consumers who shunned the products, leading to a billion yuan in economic losses fr the industry. The poultry industry leaders said ther use of the term 'avian' was irresponsible and unscientific and should not be used. They said if ministries did not stop using the term they would take legal action to force them "to safeguard the rights and interests of the industry members".
The industry association also called on the government to take immediate measures to save the poultry  industry.

Human-to-human transmission of H7N9 reported in Shandong family cluster

by Michael Woodhead
A probable case of human-to-human transmission of H7N9 avian influenza has been reported by researchers in Shandong province investigating a family cluster of the infection.
A 36-year-old man who developed the infection in April last year in Zaozhuang seems to have transmitted the H7N9 virus to his four year old son, according to Dr Liu Ti and colleagues from the Shandong Provincial Center for Disease Control and Prevention. Writing in the journal BMC Infectious Diseases, they describe the case histories of the family cluster, and conclude that the son had no exposure to poultry as a source of infection but had prolonged contact with his sick father.
The father became infected with H7N9 avian influenza in mid April, possibly from being in proximity to poultry markets, they found. He had no close contact with poultry but there were poultry farms and markets in the area where he lived, the found. The "index case" developed a severe fever and sought medical help. His son became infected seven days later, but he had no exposure to poultry as he remained at home with his sick father before the father was hospitalised with pneumonia. The son had prolonged, close contact with his father, including eating together, and he also became infected with H7N9 and was hospitalised. Both father and son eventually recovered from H7N9 infection and were later discharged from hospital.
“The infection of the index case probably resulted from contact with environmentally contaminated material. For the son, the probable infection source was from the index case during unprotected exposure, but the possibility from the environment or other sources could not be completely ruled out,” the researchers said.
“Though it is difficult to ascertain the infectious source for the two cases, the emergence of H7N9 clusters requires urgent attention because of the possibility that a change in the epidemiological character could spread more easily among people,” they concluded.

My top10 medical stories from China for Saturday 22 February

1. Smoking with a water pipe confers a 'profound' risk of chronic obstructive pulmonary disease (COPD) among people in south west China and also carries a high risk from passive smoking, researchers have shown.

2. Patients with pneumonia of unexplained origin should be promptly investigated for H7N9 risk factors such as exposure to poultry and they should also be given pre-emptive antiviral treatment such as Tamiflu, the Beijing health department has ordered.

3. About 85% of Chinese doctors experience burnout, with those who are younger, unmarried and working in emergcncy medicine having the highest risk of serious burnout, a study shows.

4. Fertility clinics in China need to become more patient-friendly as they are perceived as too impersonal and lacking in transparency and respect for patient informed consent, researchers say.

5. The stigma of mental illness in Chinese culture means that patients with schizophrenia often do not understand their medication and are unwilling to take any anti-psychotic medication, according to a study from the Guangzhou Psychiatric Hospital.

6. H. Pylori infection rates are over 90% among people in their thirties in Jiangsu, which may explain high rates of gastric cancer in the region, say researchers from Nanjing.

7. Babies in Shenyang have increased rates of neurodevelopmental deficits because their mothers were exposed to high levels of organophosphorous pesticides during pregnancy, according to a study in PLOS One.

8. Adenovirus has emerged as a significant cause of serious pneumonia in China, with a study showing that 5% of cases are attributable to the virus.

9.  People with tuberculosis are also at high risk of HIV, with rates of around 3% in groups tested in TB patients from Guangxi, Henan and Sichuan, say Chinese researchers.

10. A mediation service for patients involved in medical disputes with hospitals is to be launched in Shanghai and it will be open to patients where compensation claims exceed 30,000 yuan ($2900) regardless of whether the hospital refers them.

Antibody vaccine for H7N9 is more effective than Tamiflu, say Shanghai researchers

translated by Michael Woodhead
Shanghai researchers say traditional inactivated vaccines cannot be developed against H7N9 but they have developed a gene vaccine which is more efficacious than Tamiflu against the virus.
According to an article in the Workers Daily, an antibody therapeutic vaccine that is effective against the current strain of H7N9 has been developed by Shanghai researchers and is now about to start  clinical trials. Researchers at the Shanghai Public Health Clinical Centre Infectious Disease Research Institute said they had developed antibodies that were effective against H7N9 in vitro and they are now starting tests in humans.
Professor Xu Jianqing of the Infectious Disease Research Institute said that work on the vaccine began in April last year after the first major H7N9 influenza virus outbreaks.  He said the team had made a breakthrough with a gene vaccine in December when they injected the vaccine into 30 mice infected with H7N9. After 30 days none of the mice had died and none had signs of H7N9 infection, which represented the first real proof of efficacy.
Professor Xu said many other research groups in China were doing H7N9 vaccine research but using  traditional inactivated vaccines. However, he said experiments had shown time and again that compared to other influenza viruses, the H7 influenza virus was not amenable to being incorporated into an inactivated vaccine, as it was deformed by the chemicals used, rendering the immune response inadequate. Similar efforts by Dutch researchers to develop a vaccine against the H7N3 virus strain in 2003 were also a failure for a the same reason. This showed that inactivated vaccine technology was not going to catch on for the H7 virus, he said.
The Shanghai researchers had therefore taken the bold step of taking the most important genetic material from the H7N9 virus and implanting it into a mature vaccine carrier. This was the equivalent of putting it into a safe and inserting this into a cell, said Professor Xu. And because the virus structure was not destroyed by putting it into an egg albumen, it elicited a good immune response, he added.
Professor Xu said the new vaccine would be suitable for people at high risk of H7N9 such as those working in live poultry markets and household members.
Within Shanghai's R&D community the new H7N9 vaccine was seen as a breakthrough after an audacious attack. Xu Jianqing said the immune system of H7N9-infected people produced antibodies, and the sooner the body produced antibodies the better the prognosis. He added that Tamiflu was effective if given within the first few days of viral infection, as this was the 'empty' window before the body had started producing its own antibody.  But after more prolonged infection Tamiflu quickly became ineffective,  and drug resistance appeared quickly. Researchers were inspired to try using exogenous antibodies during this initial 'empty window' period when there was no natural H7N9 antibody being produced. The observed effects of the gene vaccine were clearly better than Tamiflu during this period, said Xu Jianqing. In fact, in 2003 during the SARS outbreak, there had also been small scale treatment models of experimental antibody treatment that were successful in curing a patient.
It is reported that at present the H7N9 antibody treatment has already successfully completed two phases of in-vitro testing and it is estimated that Phase 3 testing will be complete within one month. From among the 100+ types of antibody currently in testing the best will be selected for clinical use.

Vaccine for H7N9 | No smoking in medical centres | Cosmetic surgery boom among young Chinese

Vaccine developed for H7N9
Shanghai researchers say they have developed a "gene vaccine" for the H7N9 avian flu virus for humans that has succeeded in primary animal tests, according to Shanghai Daily. The claim was made by officials at an infection disease research body under the Shanghai Public Health Clinical Center

Now influenza H6 is a threat to humans
Yet another kind of avian influenza virus has been found to pose a threat to human health in China - this time it is H6. Researchers from Lanzhou tested samples from live poultry markets in southern China from 2008–2011 and found that among the 257 H6 strains tested, 87 viruses couldbind to human receptors. They found that there were 30 different H6 genotypes, showing that these viruses are actively circulating and reassorting in nature. "Our study demonstrates that the H6 avian influenza viruses pose a clear threat to human health and emphasizes the need for the continued surveillance and evaluation of the H6 influenza viruses circulating in nature," they concluded in the Journal of Virology.

Subway station radiation not a health threat
Operators of subway stations in cities such as Beijing and Chengdu say the radiation from security scanners poses no threat to human health. The doses from a typical security scan are equal to around 0.007 mSv per year if a person is scanned daily. This is lower than the safety standard of 1 mSv per person a year. Most X-rays are contained within the machines by protective curtains that block X-rays from escaping," and environmental expert told the Beijing Daily.

No smoking rule for medical centres
Doctors have been advised to deliver stronger anti-smoking messages to their patients ,according to ECNS. According to the report, doctors have been told by the National Health and Family Planning Commission to inquire and record the smoking history of patients during their initial diagnosis to help smokers quit. The NHFPC also says that there should be no smoking in medical establishment and medical workers are also asked not to put ashtrays in their offices. The NHFPC also recommends that smoking clinics be set up.


Cosmetic surgery rates highest in young people
Cosmetic surgery and other cosmetic procedures such as ear piercing have become very popular with young people during the holiday period, according to Xinhua. Many stalls in a Shenyang market offered ear, lip, tongue, nose and belly button piercing over the New Year holiday. The operators claimed to be trained nurses but failed to produce any medical license.  A cosmetic surgeon said that there had been a rise in young people undergoing minor surgeries too, with children as young as eight or nine getting double-eyelid surgery to give them the appearance of larger or "Western" eyes.

H7N9 may be confined to Chinese due to susceptibility gene?

by Michael Woodhead
A H7N9 influenza pandemic may be confined to Chinese people because of a susceptibility gene that makes them much more prone to severe H7N9 disease, a new review has noted.
The IFITM3 gene (interferon-induced transmembrane protein-3 gene) increases influenza disease severity, but it is uncommon among Caucasians, a report in the journal Clinical Infectious Diseases notes.
The IFITM3 gene is more common in Chinese people and could account for a widespread population risk of severe H7N9 infection, says Dr David Hui of the Chinese University of Hong Kong.
In a commentary on risk factors for H7N9, Dr Hui notes that recent research has shown that 70% of Chinese patients who had severe influenza infection had the susceptibility gene. The gene is associated with a six-fold higher risk of severe influenza, he notes, and has also been linked to higher influenza mortality. A genetic susceptibility may also explain clusters of the infection in family members.
The study released last year concluded that: "because the risk genotype occurs with such a high frequency [in Chinese people], its effect translates to a large population-attributable risk of 54.3% for severe infection in the Chinese population studied compared with 5.4% in Northern Europeans."
Dr Hui also remarks on another surprising finding from a new review of  influenza patients: smoking appears to be protective against hospitalisation for the disease. This 'counter-intuitive finding' might be due to some anti-inflammatory effect of nicotine, he suggests.
The review found that H7N9 influenza tended to affect older men and those with co-morbidities such as cardiovascular disease. It also had a more protracted course than other forms of influenza, with an average time from onset to death of 18 days.

UPDATE: Another recent study has shown that compared to Caucasians, Chinese people have lower levels of an immune protective mechanism against H7N9 influenza virus known as CD8⁺ T lymphocyte (CTL) immunity. The same study also shows that Alaskan and Australian Indigenous people may be particularly vulnerable to H7N9.

China medical news for Saturday 1 February

Light news day today as most Chinese are no doubt at home enjoying (or enduring) the New Year with family...

Ambulances must not refuse penniless patients
The Global Times reports that ambulance and first-aid teams will be forced to treat patients regardless of whether they can pay. A new regulation on management of emergency medical services was adopted by the National Health and Family Planning Commission which bans emergency services from refusing or delaying treatment because the patients cannot pay. The new rules also prohibit ambulances being used for purposes other than offering emergency medical service.

Indemnity insurance to be mandatory
The Chinese government is also said to be planning a move to make medical indemnity insurance compulsory for all doctors. The head of the China Insurance Regulatory Commission, said one goal this year would be to promote compulsory medical liability insurance, with medical institutions and doctors required to purchase such cover. This would ensure that victims of medical malpractice can be assured of compensation, thus stamping out violence in medical establishments.

Say no to cigs
Health groups in China have urged people not to give cigarettes as gifts this New Year and to refuse them if offered. Groups including the Chinese Center for Disease Control and Prevention and the Chinese Medical Association made the plea just prior to the arrival of the Year of the Horse, according to CRI.

H7N9 explained
In the New Scientist Debra McKenzie explains the background to the H7N9 avian influenza virus outbreaks at a molecular as well as epidemiological level. She also provides some ideas of what the solution to possible pandemics might be.

Seven important items of medical research from China

N95 masks don't work for Chinese faces
The specialised N95 face masks used to protect against infections such as influenza are not shaped to fit Chinese faces and most would fail to prevent transmission because of poor fit and leakage, tests by Wuhan researchers have shown. Evaluation tests on ten different types of N95 mask found that only two performed within acceptable limits to prevent transmission of infections. Performance of some masks was better when users were trained and they were specially fitted, the study in PLOS One showed.
"This study indicated that widely used N95 filtering facepiece respirators in China didn't fit well and can't provide desired protection for respirator users," the researchers concluded.

Malaria from Africa now a problem in China
Malaria has been virtually eliminated in China but doctors now face the problem of treating malaria in Chinese workers who have returned from Africa. In Jiangsu there have been 918 malaria cases and six deaths in the last decade due to malaria imported from other countries. The imported cases make up 12% of all malaria cases and account for all malaria deaths, according to researchers from the Jiangsu Institute of Parasitic Diseases, Wuxi, writing in the Malaria Journal.

No cardiovascular treatment for many Chinese patients
Two out of three Chinese people with cardiovascular disease are still going untreated, a major study has found. Data from of 512,891 Chinese adults showed that 5% had a history of cardiovascular disease. However, of these only 35% had been treated with any cardiovascular medicine for secondary prevention such as statins, antiplatelet drugs or antihypertensives. The findings from a team from Oxford and Beijing universities, are published in the International Journal of Cardiology.

Shenzhen women have high rates of HPV
More than one in ten women in Shenzhen are have HPV serotypes that put them at risk of cervical cancer, researchers say. A study of 4, 413 women measured HPV infection rates and the prevalance was 14%. The high risk HPV types 16 and 18 that are likely to cause cervical cancer were found in 3.5% of women and 1.27% of women, according to the study published in the Asia Pacific Journal of Cancer Prevention.

Avian H7N9 flu virus on way to mutation
The H7N9 influenza virus is genetically much more diverse than previously thought, suggesting that it is reassorting and closer to mutating into a pandemic virus, researchers from the Jiangsu Provincial Center for Disease Control and Prevention, have shown. They report their findings in Nature.

Medical teacher burnout
Staff at medical colleges in China have high rates of burnout, a study from Shanxi shows. Staff who had a love of teaching and those who received praise and recognition were less likey to suffere burnout, according to the study in Archives of Environmental & Occupational Health.

Pancreatic cancer in Shanghai
The diagnosis and treatment of pancreatic cancer in Shanghai has room for improvement, according to researchers from Fudan University. In a review of management of pancreatic cancer published in Cancer Letters, they report that most patients miss out on the recommended histologically verified diagnosis and the 1-year and 2-year survival rates were 35% and 14.4%, respectively.

China medical news headlines for Wednesday 29th January

Tuberculosis rates fall by 80%
Rates of tuberculosis in Shandong have fallen by 80% in the last decade, a study of 55,000 adults has shown.The prevalence rate of bacteriologically confirmed TB ases was 34 per 100,000 for adults in 2010. However, diagnosis of TB is now more difficult as half of bacteriologically confirmed cases did not present persistent cough, researchers said in BMC Infectious Diseases.

Man arrested for spreading H7N9 rumours
China's internet is full of stories of doctors and medical staff who have died of H7N9 influenza. Social networks such as Sina Weibo, QQ and WeChat have stories circulated by netizens of deaths of medical staff in Shanghai, Tianjing, Shenzhen and Nantong, according to CRI. However, health authorities have branded the stories as rumours and have arrested one man for spreading false information. In one case, a doctor who was named as having died of H7N9 influenza has startled patients by being on duty at hospital.

Shanghai life expectancy is 82
Life expectancy in Shangahi is 82 and a half years old, the Shanghai Health and Family Planning Commission has said. Women have a life expectancy four and a half years longer than, a report in ECMS said. LIfe expectancy in the city is on a par with developed countries but infant mortality including migrant families, rose from 5.04 per 1,000 in 2013 to 5.73 per 1,000.

High alert as H7N9 cases increase
China has gone on to high alert for H7N9 influenza as the number of cases continues to increase. Bird markets have been shut down in Shanghai and quarantine authorities have stepped up monitoring at airports. However, health authorities have played down the risk of a pandemic, saying the infection is not spread by human-to-human transmission. A vaccine against the H7N9 virus is being developed but is not ready for use in humans yet, authorities have reported.

China's can't cope with dementia
People in China are ill prepared to cope with the huge number of elderly people with dementia and Alzheimers disease, according to an article in SCMP. China has almost six million patients with Alzheimer's, 50% higher than a decade ago and twice as many as earlier estimated by the international health community. However, caring for dementia sufferers in China is left to family members with limited or no training and no support from the state.

Red Cross resuscitation ads are wrong
An advertising campaign by the Red Cross that urges Chinese to help those who have collapsed and need resuscitation is technically inaccurate, according to emergency specialists The picture on the ad shows a woman pressing the soft tissue of the patient's neck, which will lead to obstruction of the airway. First-aid practitioners should place their index finger and middle finger on the patient's chin bone, a doctor has pointed out.

China medical news headlines for Tuesday 28 January

Hospital care declines after switch to contract nurses
China's hospitals are no longer employing career nurses but opting for cheaper contract nurses, resulting in inferior levels of care, researchers from the School of Nursing, Sun Yat-sen University,  Guangzhou have shown.  Their study found that hospitals are moving away from the 'bianzhi' system of state-guaranteed lifetime employment to a contract-based nurse employment system with limited job security and reduced benefits. This may adversely affect both nurse and patient satisfaction in hospitals, the study found.

Tamiflu call for H7N9 flu
The increasing threat of H7N9 avian influenza has prompted Shanghai to shut down bird markets after 12 deaths in surrounding areas.  Live poultry trading has been banned in nearby Zhejiang cities, after 49 human H7N9 infections and 12 deaths were reported this month, says the Shanghai Daily.  Meanwhile Zhong Nanshan, director of the Guangzhou Institute of Respiratory Diseases has suggested early and longer use of antiviral drug Tamiflu for H7N9 patients.

Death sentence for hospital attack
The man who killed a doctor at a Zhejiang hospital in a medical dispute has been sentenced to death by a Taizhou court.  The 33-year old man stabbed a doctor to death at Wenling hospital and wounded two other doctors because he was unhappy with surgery to cure a nose problem which he said was causing extreme pain, according to the Global Times.

Boy died after drip infusion
Shanghai authorities are investigating how an allergy-prone boy died after having an IV drip infusion treatment for a cold at a local hospital.  The boys parents allege that the hospital has covered up the incident and switched the infusion packaging to prevent analysis of the fluid used, according to ECNS.

China medical news headlines for Monday 27th January

Premier pledges social security system
In his first press conference as premier, Li Keqiang affirmed the Chinese government's commitment to building a social security system safety net that will include provision of medical care. According to China Daily, the premier said the government should "weave a network that guarantees the basic living of all the people", covering education, medical care, social insurance and housing.

Blood donations dry up at New Year
China is facing severe shortages in blood donations as the usual donors - students - return home for Chinese New Year. Nanning's blood donation centre now has only 300 donors a day but the city needs 4-500 to meet hospital demand, according to CRI. Cold winter weather also deters people from going to blood donation centers or donation buses, health authorities say.

Whistleblower doctor gets her job back
Mianyang's 'corridor doctor' whistleblower who lost her job after complaining about hospital overservicing will be offered her job back after an inquiry, authorities in Sichuan say, according to Global Times. Lan Yuefeng worked in a corridor for two years after protesting about her hospital offering unnecessary treatments and profiteering.

Laowai not using medical cards
Foreigners who work in China now receive social security cards that allow them to access subsidised medical treatment in the same way as Chinese citizens, according to China Daily. However many foreigners are unsure of their entitlements and do not use them, a professor says.

Social security shortfall
New social security laws compel local authorities to provide financial assistance to the needy including those with severe medical conditions and local officials  face legal action if they refuse to provide it, according to the Beijing Review. However,  local authorities say they do not have the personnel to check every single claim for validity.

Outdoor workers get pollution clinics
Shanghai has set up special drop-in medical centres for outdoor workers who are suffering from the effects of air pollution, according to ECNS. The city authorities have also provided 300 medical cards for outdoor workers because of their high risk of pollution-related ailments.

Leaders call for action on H7N9 response
The Chinese vice premier Liu Yandong has called on all local authorities across China to take action to prevent the spread of H7N9 influenza. Local health departments will face punishment if they do not take action on epidemic surveillance and outbreak response plans in areas such as health institutions and schools. Poultry markets in Beijing have not tested positive for H7N9 influenza virus, according to the Shanghai Daily. However Shanghai has now experienced its eighth case of H7N9 avian influenza of the year, the paper reports.

WHO says H7N9 flu situation changing but still not high risk

A WHO analysis of China’s latest H7N9 avian influenza outbreak shows that that cases are trending slightly younger, with a lower case fatality rate, according to CIDRAP News.
The latest risk assessment by WHO found that the average age in the latest surge of H7N9 was slightly lower than the first wave: 52 years compared with 58 years. H7N9 is still striking males more frequently than females, and the case fatality rate is not as high as the outbreak's first wave, but H7N9 infections are still marked by rapidly progressing severe pneumonia. Tests on the H7N9 virus have not shown resistance to neuraminidase inhibitors such as oseltamivir (Tamiflu). And while most cases are linked to exposure to infected live poultry, the recent death of the doctor from Shanghai shows that continued vigilance is needed, the WHO said.

Today's China medical news headlines

More than half a billion Chinese have health cards. At the end of 2013, 540 million Chinese people, or roughly 40% of the population, had social security cards, which are mainly used to pay for medical expenses.It is hoped to expand numbers to 800 million cards by 2015, according to the Shanghai Daily.

Doctors in Beijing will be allowed to work in private hospitals as well as public ones under new regulations being drawn up by the National Health and Family Planning Commission.
At present doctors are restricted to working in only three local hospitals, according to China Daily. The city's health bureau says lifting the restrictions is aimed at encouraging doctors from top public hospitals to work in private medical institutions, attracting more patients to these institutions and thus alleviating the workload on large hospitals.

China may see human-to-human transmission of the H7N9 bird flu virus on a limited scale the WHO representative to the country has said. But there is no evidence that the virus will become sustained or widespread among humans, Bernhard Schwartlander said, according to the Beijing Daily.

"Since October, only one cluster was detected where human-to-human transmission might have occurred. We continue to expect only sporadic human cases," Mr Schwartlander said.


A Shanghai hospital has donated 'free' plastic surgery to a poor 16-year-old girl who survived the devastating Wenchuan earthquake of 2008. According to Shanghai Daily, the Shanghai Huamei Plastic Surgery Hospital gave Li Wenqian a free operation to separate her ring finger and little finger on her right hand, which had grown together after injuries she received when she was buried under debris for nearly 10 hours after the earthquake.

China is setting up a national health data network advisory group to make better use of population and public health information, CRI reports. A team of 28 experts from fields including medicine, demography, engineering, mathematics and law will provide suggestions for strategy, policy and planning based on population and public health data, according to the National Health and Family Planning Commission.



The New England Journal of Medicine is to expand its presence in China through the Wolters Kluwer publishing group and Ovid, according to a press release.

H7N9 flu death doctor hailed as hero for continuing to work while sick

translated by Michael Woodhead
The Shanghai doctor who died of H7N9 avian influenza is being hailed in the Chinese media as a hero for continuing to go into work despite being sick.
The 32-year old Zhang Xiaodong who worked as a surgeon in the emergency department of the Pudong New Area Renmin Hospital, died on the 18 of January from pneumonia complications of H7N9 infection.
In an article published today, his colleagues said he was a hardworking doctor who worked in a very busy and understaffed department and did not want to let his colleagues down. They said it was extremely exhausting working in the surgical department and it was not unknown for a surgeon to perform five appendix removal operations in one shift.
On the 16th of January Dr Zhang came into work feeling feverish and insisted on staying at work despite feeling sick. The next day he felt worse and had an 'IV infusion' before resuming his work on his shift. However, his condition quickly deteriorated and he became critically ill and was taken to intensive care. He was put on a ventilator when he developed chest pain and breathing problems. A CT scan showed that infection had invaded many lobes of his lung. The top experts of the hospital were called in to oversee treatment and Dr Zhang received the best drugs available, according to a local newspaper, The Morning Times. However, despite the efforts to save him, Dr Zhang died without making a recovery.
His colleagues said Dr Zhang would not have wanted to miss a shift because the lack of staff meant one of the other doctors would have had to have done a 24 hour shift to cover for him.
Dr Zhang left a wife who was seven months pregnant. The hospital has filed a report of industrial injury and his family will receive compensation.