Four Critically Ill with H7N9 Virus, New Bird Flu Cases in China

Three women aged 45, 48 and 32 and an 83-year-old retired man were critically ill with the H7N9 virus, a diagnosis confirmed by the Provincial Disease Prevention Center.

According to the bureau's statement, only one of the patients (the 45-year-old woman) appeared to come into daily contact with birds, and has been described as a poultry butcher.

The four cases did not appear to be connected, and people who have had close contact with the patients have not reported having fevers or respiratory problems, it said. However, the World Health Organization said, as of Monday, that despite the lack of evidence that H7N9 could be transmitted between people, they would now be investigating the outbreak.

The provincial health bureau said it was strengthening measures to monitor suspicious cases and urged the public to stay calm, joining Beijing and China's financial capital, Shanghai, in rolling out new steps to respond to the relatively unknown virus.

The four latest cases follow three earlier ones reported on Sunday, including two men who died in Shanghai, resulting in the city activating an emergency plan that calls for heightened monitoring of suspicious flu cases, according to The Telegraph.

Many schools, hospitals and retirement facilities must be alert for fevers and newly reported cases for possible risk of infection.

 Cases of severe pneumonia with unclear causes are to be reported daily by hospitals to health bureaus, up from the weekly norm. The plan also called for stronger monitoring of people who work at poultry farms or are exposed to birds.

The level-3 response plan, the second-lowest in a four-stage scale, reflects higher concern after the H7N9 bird flu virus led to the deaths of two men in Shanghai and seriously sickened a woman in the city of Chuzhou 230 miles west, according to reports.

"The health bureau will take effective and powerful measures to prevent and control the disease, to make sure the flu epidemic is effectively guarded against and to safeguard the health of the city's residents," said Xu Jianguang, head of the Shanghai Health Bureau.

The H7N9 strain, so named for the combination of proteins on its surface, has previously been considered not easily transmitted to humans, unlike the more virulent H5N1 strain, which began ravaging poultry across Asia in 2003 and has since killed 360 people worldwide.

Health officials said this week there was no evidence that any of the three earlier cases, who were infected over the past two months, had contracted the disease from each other, and no sign of infection in the 88 people who had closest contact with them.