H7N9 transported outside mainland China.

The first case of H7N9, has been reported reported in Taiwan marking its first known departure from the borders of mainland China. It seems that the 53-year old businessman imported it from somewhere on the mainland - he visited Suchou city in Jiangsu province, traveling out via Shanghai. He reportedly did not have any live birds or poultry.

There is now a risk of new cases emerging from close/regular/healthcare worker (HCW) contacts (n=138) he had (also also those during travel although he was pre-symptomatic and possibly not shedding), in the 3 three days he spent in Taiwan before showing signs of illness and at the medical facilities where he visited and was eventually admitted. If human-to-human transmission can happen, this will be the first chance to see it spread under the auspices of a different government. Four HCWs have cleared the suspected 7-day incubation period without symptoms while 3 HCWs have "developed" upper respiratory infections.

The patient did not seem to respond to Tamiflu but his infection was well advanced and beyond the recommended 48-hour commencement time (Tamiflu was started 16.04.13, about a week after first symptoms). His condition on 20.04.13 required intubation to manage respiratory failure.

The only upside to this "release" is that we may see and hear about some prospective testing which is sorely needed. Thanks to ClaireW and Jason Gale for the heads up.