A(H7N9) and the Secretive Chinese

Emerging Infectious Diseases has published (ahead of print) an article entitled Geographic Co-distribution of Influenza Virus Subtypes H7N9 and H5N1 in Humans, China by Chinese researchers comparing the geospatial epidemiologic characteristics of A(H5N1) and A(H7N9) in China.[1] The authors compare the geographic distribution of cases for A(H5N1) and A(H7N9) throughout China at the township level and determine

 . . . that the high-risk areas for human infection with subtype H7N9 and H5N1 viruses are co-distributed in an area bordering the provinces of Anhui and Zhejiang . . .

The township is a level 4 administrative division in China. Within China, level 1 administrative divisions are provinces, province-level municipalities, autonomous region, and special administrative regions. Level 2 are prefecture-level divisions, and county-level divisions are level 3.  Although the analysis was conducted on township-level divisions the authors present the conclusion by provinces.

Generally, with peer reviewed articles the underlying raw data is available for review by other researchers. A review of the citations in this article does not identify any sources for the geographic locations of the cases for either the A(H5N1) cases or the A(H7N9)cases.  While an intensive online search will produce the county level location of almost all of the A(H5N1) cases in China, from 2005 to 2013 (see map below), this is not true for the  A(H7N9) cases.

The Chinese government has greatly restricted the publicly available information on A(H7N9) cases in China. Beside the minimal reporting of cases to the World Health Organization, little information about individuals cases is available. The only geographic information on A (H7N9) cases is aggregate data by provinces (administrative level 1). Almost no county level locational information is publically available for most of the  A(H7N9) cases. In fact, the information on A (H7N9) is so sparse that an accurate number of A(H7N9) deaths by province is not even available [2].

This article demonstrates the Chinese researchers have an abundance of epidemiological data on A(H7N9) cases.  So why is the Chinese government so secretive and why won’t they release the data? 

[1] Geographic Co-distribution of Influenza Virus Subtypes H7N9 and H5N1 in Humans, China

[2] Why is China not reporting the details of individuals who died from an A(H7N9) infection, not even to WHO?

h/t Giuseppe Michieli