General office of the national health and family planning commission, issue of human infection with H7N9 avian influenza epidemic prevention and control program (third edition) 
 
 
 
The national health and family planning commission of the People's Republic of China 
 
 
 
The 2014-01-29
 
 
 
Countries who do CDC 9 [2014] of the state 

Provinces, autonomous regions and municipalities directly under the central government health and family planning commission (health bureaus), the xinjiang production and construction corps health bureau, the Chinese center for disease control and prevention: 
 
        For further infection H7N9 outbreak of avian flu prevention and control work, to protect people's health and life safety, by organizing experts to the cases of people infected with H7N9 avian influenza epidemic prevention and control program (second edition) "was revised, formed the infected H7N9 avian influenza epidemic prevention and control program (third edition)". Hereby printed and distributed to you, please refer to the actual execution. 
 
        On May 10th, 2013, issued by the people are infected with H7N9 bird flu prevention and control program (second edition) "(who invented electric [2013] no. 30) shall be repealed simultaneously. 

General office of national health and family planning commission
 
On January 27, 2014 

Human infection with H7N9 avian influenza epidemic prevention and control plan
 
(third edition) 

        According to the part about adjusting the legal notice on the management of infectious diseases, the health for disease control and prevention is sent [2013] no. 28) requirements, in order to further infection H7N9 specification guide efforts to develop a human bird flu cases found, reports, epidemiological investigation, laboratory test, virus monitoring and close contacts management prevention and control work, safeguard people's health and life safety, formulates this scheme. 
 
        A, scope of application 
 
        This scheme is applicable to medical institutions to carry out the people at present stage H7N9 avian influenza epidemic prevention and control of infection, and will be subject to the further understanding of the disease and epidemic situation changes timely update. 
 
        Second, case finding, report 
 
        (a) case definition. 
 
        1. People H7N9 suspected cases and confirmed cases of bird flu infection defined by reference to the cases of people infected with H7N9 bird flu diagnosis and treatment schemes (2014 edition) "(countries who do medical hair [2014] no. 6). 
 
        2. Gathered suspected cases refers to seven days in small areas (such as a family, a community, etc.) found in 1 case, confirmed cases and found that more than 1 case and suspected cases, at the same time suggest a possible human-to-human transmission or by common exposure and infection. Under the condition of the above, found that the two confirmed cases, judged to be gathered cases. 
 
        (2) findings and report. All kinds of medical institutions at all levels to see a doctor of influenza-like cases, to ask the birds or live poultry market exposure history, focus on engaging in live poultry breeding, slaughtering, trafficking in, transporting, etc. Shall, after the swine flu H7N9 avian influenza in 24 hours to fill in the infectious disease report CARDS and the network straight newspaper. Report disease category select "b class infectious diseases" in the "H7N9 avian influenza infection. Does not yet have the network straight newspaper condition of medical institutions, shall be within 24 hours after diagnosis to fill in and sending out infectious disease report CARDS, the centers for disease control and prevention at the county level in the network straight newspaper immediately after receiving report. 
 
        Three cases, the epidemiological investigation, sampling and testing 
 
        (a) epidemiological investigation. County CDC received reports of medical institutions within their respective jurisdictions of human infection with H7N9 after confirmed cases of bird flu, shall be formulated according to the Chinese center for disease control and prevention of the infected H7N9 avian influenza epidemiological investigation plan to investigate. 
 
        For single cases, case investigation content mainly includes the basic situation, see through, clinical manifestation, laboratory examination, diagnosis, and outcome of cases, family and household environment, exposure history and situation of close contacts, etc. Of cases may be exposed to poultry farming or trade etc, shall be collected, basket with mop specimens of poultry excrement and environmental samples to carry out the etiology detection. When necessary, according to the investigation organization to carry out the cases of active search. 
 
        Gathered for suspected cases and cases, on the basis of the above work, should be immediately suspected cases, cases and focus on the investigation of epidemiological link between exposure history and cases, the virus isolated from specimens of cases and environment homology analysis, clear whether there is interpersonal communication or by common exposure and infection. 
 
        (2) of the specimen collection, transport and laboratory tests. When medical researchers suspect patient H7N9 avian influenza virus infection, should be the upper and lower respiratory tract samples as soon as possible (especially the lower respiratory tract specimens) and within 7 days of the acute phase and the acute phase serum collection interval between 2-4 weeks of serum, etc. 
 
        Conditional nucleic acid detection of medical institution to the respiratory tract specimens in H7N9 avian influenza virus nucleic acid detection, cases of diagnosis; No conditions to carry out the nucleic acid detection of a medical institution shall as soon as possible, using the rapid antigen detection reagent is used to detect the antigen of influenza a virus, and will test positive for influenza a virus antigen specimens to send further H7N9 local influenza surveillance network laboratory of avian influenza virus nucleic acid detection. Specimen collection, packaging, shipping, etc shall be in strict accordance with the human to infect highly pathogenic pathogenic microbial species (drug) or sample transportation management regulations "(the original health ministry make 45) and other related biological safety regulations. 
 
        For grade bsl-3 biosafety provincial center for disease control and prevention work should be completed within 2 weeks virus separation, sequence determination ability of laboratory should be completed within 72 hours after the virus separation whole genome sequencing work, and will be submitted to national influenza center of the flu virus sequences database. Failed to the virus sequence determined within 48 hours as required to send national influenza center; Failed to carry out the separation of virus network laboratory should be H7 nucleic acid testing positive cases of the original specimen within 48 hours of sending the national influenza center, national influenza center in 2 weeks to complete the virus separation and sequencing work, and will submit the influenza virus sequences database for feedback. 
 
        All medical institutions to collect serum specimens sent local influenza surveillance network laboratory, by the local network laboratory sending serum specimens respectively in national influenza center of provincial center for disease control and antibody detection. 
 
        The CDC at various levels shall strengthen the live poultry markets and farms in key areas such as environmental specimen collection and detection work. 
 
        See specific operation points of the development of the Chinese center for disease control and prevention of human infection with H7N9 avian flu virus specimen sampling and laboratory testing strategy. 
 
        Fourth, information management 
 
        (a) information report. 
 
        For confirmed cases, the reported cases of medical institutions to H7N9 avian flu infection through information management system timely information fill in cases of disease outcomes, and in the discharge or death within 24 hours after online fill the infected H7N9 avian influenza questionnaire - clinical section (see "of human infection with H7N9 avian influenza epidemiological investigation plan). For deaths to fill in the related content of the medical certificate of death, through death registration information system for the network straight newspaper report. District of the centers for disease control and completion of the preliminary investigation at the county level, to fill in online questionnaires, the cases of people infected with H7N9 bird flu cases epidemiological parts "(see" of human infection with H7N9 avian influenza epidemiological investigation plan), and according to the investigation progress, timely complement questionnaire information, updated daily close contacts of these medical observation. 
 
        As has the network straight newspaper cases presenting treatment, the medical institution transfer cases infected by H7N9 bird flu cases transferred out of the information management system entry. Medical institutions to receive cases through this system to query to verify the case information, and input cases admitted. 
 
        Gather cases once confirmed, shall be within 2 hours through a public health emergency report management information system for the network straight newspaper, progress in a timely manner and according to the event progress report and final report. 
 
        Laboratory testing of the centers for disease control and prevention to the specimen information in time entry to China influenza surveillance information system and the test result. 
 
        To pressing demands for information reporting and specimens (strain) submitted to the province, the national health and family planning commission will be criticized. 
 
        (2) the information release and report. 
 
        National health and family planning commission per month regularly publish national H7N9 infection incidence and mortality of bird flu, the provincial family planning administrative department of public health timely release case information in their respective administrative areas. 
 
        External environment samples positive results by the centers for disease control and prevention reports around the family planning administrative department of public health at the same level and the higher the centers for disease control and prevention, informed by the family planning administrative departments of public health at the same level agricultural sector. 
 
        Virus mutates, the important information such as the outbreak of human-to-human transmission, to the national defense spreading mechanism panel released after the review. 
 
        Five, the protective case management and infection 
 
        A medical institution shall refer to the cases of people infected with H7N9 avian influenza hospital infection prevention and control technology guide (2013 edition) "(who invented electric [2013] no. 6), the implementation of patient segregation, hospital infection prevention and control and medical personnel protective measures. 
 
        CDC researchers when conducting epidemiological investigation and sample collection, shall do a good personal protection, and guide the wader practitioners and quarantinable epidemic poultry disposal staff personal protection. 
 
        6, suspicious exposure and the management of close contacts 
 
        (a) management of suspected exposure. Suspicious exposure refers to the exposure to H7N9 test positive for bird flu virus poultry, environment, and exposed when did not take effective protection of the breeding, slaughtering, trafficking in, transporting, etc. Suspicious exposure, the family planning administrative department of public health at the county level shall, in conjunction with the agriculture, industry and commerce, transportation and other relevant departments, organizations inform for health, told the fever (axillary temperature is 37.5 ℃ or higher) and acute respiratory infection symptoms such as cough to timely medical treatment, and take the initiative to inform the poultry exposure. 
 
        (2) close contacts management. Close contacts is refers to the treatment of suspected or confirmed cases that did not take effective protective measures in the process of health care workers or who care for the families of the patients; In suspected or confirmed cases of illness or death before 1 day before to the isolation treatment, and patients have been living together or other personnel with a close contact situation; Or the scene investigators judgment as the management of close contacts to other staff. To close contacts, family planning administrative department of public health at the county level shall organize to track, medical observation and medical observation period for revealing or from the last time contact with the case without effective protection after 7 days. Once close contacts with fever (axillary temperature is 37.5 ℃ or higher) and acute respiratory infection symptoms such as cough, is immediately transferred to see a doctor, medical institutions, and collect the swabs send local influenza surveillance network laboratory for testing. 
 
        Seven, strengthen monitoring influenza-like cases 
 
        To strengthen and unexplained pneumonia monitoring influenza-like cases. Around to always influenza-like cases based on the monitoring work, improve the monitoring intensity, and increase the quantity of specimen collection and detection, the southern province of each influenza surveillance sentinel hospital weekly collection of influenza-like cases and cases of people infected with H7N9 related cases 20 samples of bird flu, the northern province of 4 - related samples per month in September 20, a week in October - the next year on March 20 samples, send the local influenza surveillance network laboratory tests. 
 
        In the event of human infection with H7N9 within the county (district) of cases of the bird flu virus, shall be carried out in cases diagnosed intensified surveillance for 2 weeks. Level 2 and above medical institutions to conform to the definition of influenza-like cases this patients, patients with severe acute respiratory infection and hospitalization, it shall timely collect respiratory specimens, ask history of exposure, and according to the Chinese center for disease control and prevention of the specimen collection H7N9 virus and laboratory testing strategy "to carry out the relevant testing work. Medical institutions weekly summary and report to the total number of influenza-like cases, total number of hospitalized patients with severe acute respiratory infections, sampling number, the number of hospital inspection, send the number of the centers for disease control and testing, the number of positive and positive results. Specific reference issued by the China CDC report way to strengthen monitoring information report to relevant technical requirements. According to working conditions appropriate to expand around the monitoring scope and time. 
 
        Eight, epidemic situation to suggest 
 
        The family planning administrative department of public health at various levels shall, according to human infection with H7N9 avian flu epidemic situation, etiology and research progress monitoring and timely organize experts, epidemic situation to emergency standards, shall, in accordance with the relevant plan timely start the corresponding emergency response mechanism, and timely termination of response in accordance with relevant regulations. 
 
        The family planning administrative department of public health at various levels shall give full play to the role of spreading mechanism led by departments, according to the epidemic situation suggested that the local government to adopt targeted prevention and control measures: in an outbreak of cities, suggest a live poultry markets "a day, cleaning, disinfection on Monday, January, eshoo city"; In the affected cities, Suggestions were closed and disinfection measures; In conditional cities, encourage seasonal closed measures. 
 
        Nine, to do a good job of health education 
 
        Around to get information and public opinion guidance, timely response to social concern, to guide the public scientific and rational way of dealing with the outbreak, and epidemic prevention and control knowledge propaganda, guide and promote the public good hygienic habit, especially should strengthen the engaged in live poultry breeding, slaughtering, trafficking in, transporting, and other industries the crowd health education and risk communication. 
 
        Ten, to strengthen the medical and health institutions professional training and supervising inspection 
 
        Medical and health institutions shall conduct of human infection with H7N9 cases of findings and reports, epidemiological investigation, specimen collection, laboratory testing, case management and infection prevention and control, and risk communication training, etc. 
 
        The family planning administrative department of public health at all levels shall be responsible for the prevention and control work within their respective jurisdictions to supervise and check, found that the problem handled in time. 
 
        Eleven, vigorously carry out the patriotic health campaign 
 
        AiWeiHui at all levels should play a coordinating role, strengthen the organization and management and supervise, combined with the health town of activities, widely launched the masses, mobilize grass-roots unit, in-depth development within the scope of urban and rural environmental health during the action. To focus on strengthening the farmer's market of health management, focus on the solution to the sales, the slaughter of live poultry serious health problems.