
It was no April Fools’ Day. Taiwan on April 1 strengthened monitoring measures at its ports of entry after Chinese health authorities confirmed on March 31 that two Chinese had died after contracting a lesser-known type of H7N9 avian influenza (Bird flu) and another was in critical condition. Though there are no signs of an epidemic but the cases are a reminder that nontraditional threats, not ballistic missiles or fifth-generation aircraft, are most likely to negatively affect large numbers of people in this densely populated and highly mobile part of the world.

Two men from Shanghai, aged 87 and 27, died from H7N9 in early March within two weeks of falling ill, while in Chuzhou, Anhui Province, a 35-year-old female patient remains in critical condition after contracting the disease. Chinese health authorities have noted that those are the three first known cases of H7N9 infection worldwide.

According to the World Health Organization, which is closely monitoring the situation, there is no evidence that H7N9 can be transmitted from person to person. It adds that H7N9, about which little is known, is a low pathogenic strain of avian flu — a claim that would be supported by China’s National Health and Family Planning Commission, which said there were no signs of infection among the 88 people who had been closest to the patients in the past months.

Chinese authorities are trying to determine how the three individuals, who did not appear to have been in contact with one another, contracted the disease. The 87-year-old man died on March 4, while the 27-year-old died on March 10. The Shanghai Health Bureau said on April 1 that the two victims had a history of chronic illness, but did not provide specifics.

Later on Monday, the commission, which had yet to provide much in terms of specifics, said that two sons of one of the victims from Shanghai also suffered from acute pneumonia, though the source of the infection remained unknown.

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Although some Internet users in China complained that the government had “gambled with people’s lives” by taking more than a month before reporting news of the cases, health authorities said it had needed time to confirm that the cases involved the new strain of the avian flu. Chinese scientists only confirmed on Friday that H7N9 was involved in all three cases.

The commission, meanwhile, said the female patient had a history of contact with poultry and that the 27-year-old victim was a butcher, suggesting transmission of the H7N9 subtype may occur from animals to humans. According to the U.S. Centers for Disease Control and Prevention (CDC), most H7 subtype viruses seen in wild birds and poultry globally are low pathogenic avian influenza. The CDC adds that while H7 virus infection in humans is uncommon, it has been documented in persons who have direct contact with infected birds, especially during outbreaks of H7 virus among poultry. Some experts have speculated that the deaths in China could be an indication that the H7N9 strain had morphed to become more lethal to humans.

The Shanghai Daily reported the same day that hospitals across the city had been ordered to monitor patients with respiratory illnesses. Hong Kong is also reported to have increased checks.


There is no vaccine for H7N9, though Taiwan’s Centers for Disease Control says the disease can be treated with Tamiflu.

Although there are no known cases in Taiwan, the island’s CDC stepped up precautionary inspections at all its ports of entry on Monday and intensified monitoring of passengers from China, Hong Kong and Macau.

Amid growing ties between the two sides, China has become Taiwan’s No. 1 source of tourism, with approximately 2.58 million arrivals in 2012, up from less than 1 million just three years earlier. Furthermore, as many as 1 million Taiwanese businesspeople are based in China, mostly in the Shanghai region, resulting in high demand for cross-strait flights.

The rapidly growing exchanges between the two countries, compounded by the liberalization of Taiwan’s laws on Chinese tourists and the launch of direct cross-strait flights in recent years, also provides an opportunity for disease to travel that did not exist — at least not to this extent — just a decade ago, when both China and Taiwan were among the countries affected by the Severe Acute Respiratory Syndrome (SARS) outbreak. The slow response by Chinese authorities at the time, partly due to initial attempts to conceal the scope of the outbreak, are believed to have been a factor in the virus’s ability to spread to other countries.

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A total of 775 people died worldwide of SARS between November 2002 and July 2003, with 8,069 infections. Thirty-seven died in Taiwan, 349 in China and 299 in Hong Kong, WHO statistics show.

J. Michael Cole is a Taipei-based journalist who focuses on military issues in Northeast Asia and in the Taiwan Strait and is wrtier for The Diplomat's Flashpoints blog. He previously served as an intelligence officer at the Canadian Security Intelligence Service. You can follow him on Twitter: @jmichaelcole1.