 |
2003 Annual Report
Population growth rate (2002 est.): 0.87%
Birth rate (2002 est.): 15.85 births/1,000 population
Death rate
(2002 est.): 6.77 deaths/1,000 population
Infant mortality rate (2002
est.): 27.25 deaths/1,000 live births
Life expectancy at birth (2002
est.):
- Total population: 71.86 years
- Female: 73.86 years
- Male: 70.02 years
Total fertility rate (2002 est.): 1.82
children born/woman
HIV/AIDS:
- Adult prevalence rate (2002 est.): less than 0.2%
- People living with HIV/AIDS (January 2001): 1.25 million
- Deaths (1999 est.): 17,000
Literacy (definition: age 15 and
over can read and write) (1995 est.):
- Total population: 81.5%
- Male: 89.9%
- Female: 72.7%
| General Health and Safety Issues |
Those contemplating travel to
China should get travel-related health information from the United States' Centers for Disease
Control and the World Health
Organization (WHO). Extensive information is available from the WHO's China Profile and its Western Pacific Region Home Page. The
following websites provide a useful introduction to general health conditions in
the PRC:
General
information is also available from the World
Bank.
| Avian Flu (a.k.a. "Bird Flu") |
From the US Centers for Disease Control
From the World Health Organization
English Language Sources on Veterinary Sciences
Chinese Language Sources
Avian Flu Chronology of Events
(Source: WHO)
12 December
2003
- The sudden death of chickens at a farm in Eumsung district, near
the capital city of Seoul, prompts suspicions of an epidemic of highly
pathogenic avian influenza in the Republic of Korea. Tests are initiated. Of the
24,000 chickens on the farm, 19,000 died between 5 and 11 December. The
remaining 5,000 were culled.
17 December 2003
- Authorities in the Republic of Korea formally report
an epidemic of highly pathogenic avian influenza, caused by the H5N1 strain of
the virus, at the chicken farm. This is the first time that highly pathogenic
avian influenza has ever been reported in the country. No symptoms are reported
in farmers in close contact with the infected chickens.
26 December 2003
- Authorities in the Republic of Korea report the
spread of H5N1 infection to chicken and duck farms in 5 provinces. Altogether,
more than 1.3 million chickens and ducks have died or been destroyed.
5 January 2004
- Health authorities in Viet Nam inform the WHO office
in Hanoi of an outbreak of severe respiratory illness in 11 previously healthy
children hospitalized in Hanoi, with the most recent hospital admission on 4
January. Seven cases were fatal and two patients remain critically ill. A 12th
case, a sibling of one of the Hanoi cases, died of a respiratory illness in a
provincial hospital.
- Included in this report are six children, aged 9
months to 12 years, who died in a Hanoi hospital of respiratory illness of
unidentified cause between 31 October and 30 December 2003. For the first 5
cases, no samples are available for analysis. Samples are available for the 6th
case, a 12-year-old girl who was admitted to hospital on 27 December and died
three days later. All of these cases were identified retrospectively based on
hospital records.
- It is not known whether all cases were caused by the same
pathogen. The pathogen is unknown, but thought to be an influenza virus or an
adenovirus. Arrangements are made for testing.
- WHO assistance in responding
to the outbreak is requested. WHO headquarters and the regional office in Manila
are alerted.
6 January 2004
- A member of the press informs the WHO office in Hanoi
of rumoured chicken deaths in southern Viet Nam. The regional office in Manila
is alerted.
7 January 2004
- WHO informs public health officials worldwide through
its electronically distributed Outbreak Verification List.
8 January 2004
- Authorities in Viet Nam report outbreaks of highly
pathogenic avian influenza, caused by the H5 subtype (later confirmed as the
H5N1 strain), at farms in the southern provinces of Long An (2 farms) and Tien
Giang (1 farm). Around 70,000 birds died or were destroyed. This is the first
time that highly pathogenic avian influenza has ever been reported in the
country.
11 January 2004
- Since the 5 January report, Vietnamese officials have
identified two further cases of severe respiratory illness (another child and
the first adult), bringing the total since end-October in Hanoi¡¯s hospitals to
13.
- Tests on samples from two fatal cases in Viet Nam (the 12-year-old girl
and a 10-year-old boy), performed by Hong Kong¡¯s National Influenza Centre,
confirm infection with the H5N1 avian influenza virus strain.
- WHO alerts
its partners in the Global Outbreak Alert and Response Network (GOARN).
12 January 2004
- Hong Kong¡¯s National Influenza Centre confirms
infection with H5N1 in a third fatal case in Viet Nam, the 30-year-old mother of
the 12-year-old girl.
- Vietnamese health authorities and WHO announce
laboratory confirmation of the three cases of human infection with avian
H5N1.
- Confirmation of these three cases marks the third time in recent
years that the H5N1 strain has jumped from its avian host to infect humans. The
previous human infections occurred in Hong Kong in 1997 (18 cases, 6 of which
were fatal) and again in Hong Kong in February 2003 (2 cases, one of which was
fatal). The 1997 outbreak coincided with highly pathogenic H5N1 avian influenza
in Hong Kong¡¯s poultry farms and live markets. The two cases in 2003 had
returned to Hong Kong following travel in southern China.
- Authorities in
Japan report an outbreak of highly pathogenic avian influenza, caused by the
H5N1 strain, at a farm in Yamaguchi prefecture. This is the first report of
highly pathogenic avian influenza in the country since 1925.
13 January 2004
- Authorities in the Republic of Korea announce the
spread of H5N1 infection to an additional farm, dashing hopes that the epidemic
had been brought under control. To date, about 1.6 million birds have died or
been destroyed.
- Sequencing of virus from one of the fatal cases in Viet Nam
reveals that all genes are of avian origin.
14 January 2004
- WHO sends an urgent request for assistance to GOARN
to identify experts to support the Vietnamese health authorities and the WHO
office in Hanoi. Immediate objectives are to reduce the risk of transmission
from birds to humans and to support health authorities in the epidemiological
investigation and containment of human cases. Expertise is also requested to
increase laboratory capacity, to advise on hospital infection control, and to
strengthen surveillance for human cases.
15 January 2004
- A fourth case of human infection with H5N1 is
confirmed in Viet Nam. All four cases, which had been hospitalized in Hanoi,
were fatal.
19 January 2004
- A fifth fatal case of H5N1 infection is confirmed in
Viet Nam, also in Hanoi.
- A single peregrine falcon is found dead near a
residential development in Hong Kong. Testing begins immediately. Two days
later, H5N1 is confirmed in samples taken from the bird.
- WHO staff and a
GOARN international team arrive in Viet Nam. Members of the team are drawn from
the Centers for Disease Control and Prevention (CDC), USA; the European
Commission (DGAL- Minist¨¨re de l¡¯agriculture, de l¡¯alimentation, de la p¨ºche et
des affaires rurales, France); European Programme for Intervention Epidemiology
Training (EPIET) Network; Health Protection Agency, UK; Institut de Vielle
Sanitaire, France; Institut Pasteur Network, France; Institute for Infectious
Disease Control (SMI), Sweden; National Institute of Infectious Diseases, Japan;
RIVM, the Netherlands, and the Robert Koch Institute, Germany.
20 January 2004
- Laboratories in the WHO Global Influenza Surveillance
Network accelerate work needed to develop an H5N1 vaccine for humans.
22 January 2004
- Network laboratories determine that H5N1 viruses in
the current human and avian outbreaks are significantly different from H5N1
viruses in outbreaks in Hong Kong in 1997 and 2003, indicating that the virus
has mutated.
23 January 2004
- Authorities in Thailand report an outbreak of highly
pathogenic avian influenza, caused by the H5N1 strain, at a farm in Suphanburi
Province. This is the first time that highly pathogenic avian influenza has ever
been reported in the country. Nearly 70,000 birds have died or been destroyed.
Japan, the EU, and other major export markets immediately ban all Thai poultry
products.
- The Ministry of Public Health in Thailand informs WHO of two
laboratory confirmed cases of H5N1 infection in humans. The cases, from
Suphanburi and Kanchanburi provinces, are young boys. Both are alive.
-
Influenza network laboratories report that human H5N1 viruses from Viet Nam are
resistant to one class of antiviral drugs, the M2 inhibitors, amantadine and
rimantadine.
24 January 2004
- SARS Nam reports two more cases of H5N1 infection in
children hospitalized in Ho Chi Minh City- the first cases from the south. One
child died, and the second remains hospitalized in critical condition. The
country has now reported 7 cases, 6 of which were fatal.
- Viet Nam reports
that the H5N1 outbreak in poultry has spread to 23 of the country¡¯s 64
provinces. Nearly 3 million chickens have either died or been destroyed.
-
Cambodia reports H5N1 in chickens in a farm near Phnom Penh.
25 January 2004
- WHO staff and a GOARN international team, with
support from Health Canada, arrive in Thailand.
26 January 2004
- Authorities in Thailand report laboratory
confirmation of the country¡¯s third case, also in a young child. One of the two
previously confirmed cases dies.
27 January 2004
- Thailand¡¯s third case, reported on 26 January, dies.
Of the 3 cases, one remains alive.
- Viet Nam reports its 8th case. The child
has fully recovered and been discharged from hospital.
- The Ministry of
Health in China confirms the presence of highly pathogenic H5N1 avian influenza
in poultry at a duck farm in the Guangxi Zhuang Autonomous Region in the
south.
- Laos reports poultry deaths at a farm near the capital city of
Vientiane. The report states that 2,700 hens in a flock of 3,000 have died.
Initial tests identify H5. Arrangements are made to test for H5N1.
- Cambodia
reports positive influenza A results from geese at a farm near Phnom
Penh.
28 January 2004
- Pakistan reports an outbreak of highly pathogenic
avian influenza. Testing detects the H7 subtype. The report states that 1.7
million hens have either died or been destroyed.
30 January 2004
- Chinese authorities confirm H5N1 infection in poultry
at farms in an additional two provinces, Hunan and Hubei. Suspected outbreaks
are reported in Anhui and Guangdong provinces and in Shanghai municipality.
1 February 2004
- Viet Nam confirms two further cases, both fatal, in
sisters, aged 23 and 30 years. Of the country¡¯s 10 cases, 8 have died, one has
recovered, and one remains hospitalized.
2 February 2004
- Thailand reports its fourth confirmed case of H5N1
infection in a 58-year-old woman from Suphanburi Province, who died on 27
January. Of the country¡¯s four cases, three have been fatal.
- Chinese
authorities report that H5N1 infection is now confirmed or suspected in 10 of
the country¡¯s 31 provinces, autonomous regions, and municipalities.
- A WHO
investigation of a family cluster in Thai Binh Province, Viet Nam, fails to
reveal a specific event, such as contact with sick poultry, or an environmental
source, to explain these cases and concludes that limited human-to-human is one
possible explanation.
- Indonesia reports an outbreak of highly pathogenic
avian influenza in poultry, subsequently confirmed as H5N1. This is the first
time that highly pathogenic avian influenza has ever been reported in the
country.
3 February 2004
- Thailand¡¯s one surviving case, reported on 23
January, dies. To date, Thailand has reported four cases, all fatal.
- Viet
Nam reports an additional three cases, one fatal, all in young adults.
-
Authorities in Viet Nam report that 52 of the country¡¯s 64 provinces have been
affected by H5N1 in poultry.
- Thai authorities estimate that around 26.9
million chickens have been culled nationwide, with slaughtering continuing in 7
provinces. Altogether, 36 of the country¡¯s 76 provinces have been affected.
-
Tests confirm that the poultry outbreaks in Indonesia are caused by H5N1. In
1995, highly pathogenic avian influenza was declared to be present throughout
the country.
4 February 2004
- Chinese authorities report the spread of H5N1
infection in poultry to farms in two additional provinces.
- In Vientiane,
Laos, 17 out of 18 farms (including one duck farm) test positive for the H5
subtype.
5 February 2004
- Viet Nam reports two further cases, both fatal, in
young adults.
- Thailand confirms the country¡¯s fifth case. The patient, a
child, died on 2 February.
- In Thailand, 40 of the country¡¯s 76 provinces
have reported H5N1 disease in poultry.
- The Republic of Korea confirms H5N1
infection at an additional two farms in Asan, south of Seoul, suggesting that
the epidemic in birds is not fully under control.
6 February 2004
- A GOARN international team arrives in Cambodia.
Members of the GOARN team are drawn from the Institut de Vielle Sanitaire, and
the Institut Pasteur Network in France.
- China confirms further spread in
poultry. Altogether, H5N1 infection is confirmed or suspected at farms in 13 of
the country¡¯s 31 administrative districts.
- In Viet Nam, 56 of the country¡¯s
64 provinces are now affected by H5N1 disease in poultry.
- As part of the
investigation of possible human-to-human transmission in a family cluster in
Viet Nam, virus from one fatal confirmed case is fully sequenced. All genes are
of avian origin. This finding does not, however, entirely rule out limited
human-to-human transmission. If this occurred, the chain of transmission reached
a dead end with the death or recovery of all family members in the cluster.
8 February 2004
- US authorities report an outbreak of avian influenza
at a farm in Delaware. H7 is detected in the initial tests. Further tests are
initiated to determine if the H7 subtype is highly pathogenic. Some 12,000 birds
are destroyed.
- OIE reports that half a million birds have been culled at 9
farms in China where H5N1 infection has been confirmed.
9 February 2004
- Viet Nam reports 3 additional cases, two of which
were fatal.
- The total number of cases in the two affected countries, Viet
Nam and Thailand, is now 23 cases, of which 18 were fatal.
- In Viet Nam, 57
of the country¡¯s 64 provinces have been affected by H5N1 in poultry. Around 27
million birds have died or been destroyed.
10 February 2004
- Chinese authorities report a suspected H5N1 outbreak
at a chicken farm in Tianjin Municipality. Spread to additional farms within
other provinces is also reported. Altogether, H5N1 infection is suspected or
confirmed on 39 farms in 14 of the country¡¯s 31 provinces, autonomous regions,
and municipalities. Of the outbreaks at 39 farms, 19 are confirmed as caused by
H5N1.
- Avian influenza is detected at a second farm in Delaware. Some 72,000
birds are destroyed. Japan, China, Poland, Malaysia, Singapore, and the Republic
of Korea ban poultry imports from the US.
11 February 2004
- In the investigation of possible human-to-human
transmission in Viet Nam, results from the analysis of virus isolated from the
second sister in the family cluster show that the virus is of avian origin and
contains no human influenza genes.- WHO issues guidelines for global
surveillance aimed at monitoring spread of H5N1 infection in human and animal
populations.
- The number of farms in China with confirmed H5N1 outbreaks
increases from 19 to 23.
12 February 2004
- Thailand confirms its sixth case, a 13-year-old
boy.
- Viet Nam confirms its 19th case, which was fatal in a 19-year-old man
who had been hospitalized in Ho Chi Minh City.
- The total number of
confirmed cases in these two countries combined is 25, of which 19 have been
fatal.
- The first clinical and epidemiological data on 10 cases in the Viet
Nam outbreak is made public by WHO.
If you are traveling to China, be sure to check out the
traveler alerts on SARS provided by the United States' Centers for
Disease Control and the World Health Organization.
CECC Topic Paper
To read about how the PRC
government's suppression of freedom of expression delayed the response to the
spread of SARS, please look at the CECC Topic Paper: Information Control
and Self-Censorship in the PRC and the Spread of SARS.
CECC Roundtable:
Dangerous Secret: SARS and China's Health Care System (May 12,
2003)
Statements of Panelists:
Written Submissions:
Transcripts:
Third Party
Resources
You can find general
information regarding SARS at the following links:
What are the
symptoms of SARS?
Source:
U.S. Centers for Disease Control Fact Sheet, January 13,
2004
In general, SARS begins with a fever greater than 100.4f (38c). Other
symptoms may include headache, an overall feeling of discomfort, and body aches.
Some people also experience mild respiratory symptoms. After 2 to 7 days, SARS
patients may develop a dry cough and have trouble breathing.
How is SARS spread?
Source: U.S. Centers for Disease Control Fact Sheet, January 13,
2004
The primary way that SARS appears to spread is by close person-to-person
contact. Most cases of SARS have involved people who cared for or lived with
someone with SARS, or had direct contact with infectious material (for example,
respiratory secretions) from a person who has SARS. Potential ways in which SARS
can be spread include touching the skin of other people or objects that are
contaminated with infectious droplets and then touching your eye(s), nose, or
mouth. This can happen when someone who is sick with SARS coughs or sneezes
droplets onto themselves, other people, or nearby surfaces. It also is possible
that SARS can be spread more broadly through the air or by other ways that are
currently not known.
What causes SARS?
Source: U.S.
Centers for Disease Control Fact Sheet, January 13,
2004
Scientists at CDC and other laboratories have detected a previously
unrecognized corona virus in patients with SARS. The new corona virus is the
leading hypothesis for the cause of SARS.
The SARS Chronology
(Source: WHO Update #95)
16 November 2002
-- First
known case of atypical pneumonia occurs in Foshan City, Guangdong Province,
China, but is not identified until much later.
10 February 2003 -- The WHO Beijing office receives an email message
describing a "strange contagious disease" that has "already left more than 100
people dead" in Guangdong Province in the space of one week. The message further
describes "a ¡®panic¡¯ attitude, currently, where people are emptying
pharmaceutical stocks of any medicine they think may protect them."
11 February 2003
-- WHO receives reports from the Chinese Ministry of
Health of an outbreak of acute respiratory syndrome with 300 cases and 5 deaths
in Guangdong Province.
12 February 2003
-- Health officials from Guangdong Province report a total
of 305 cases and 5 deaths of acute respiratory syndrome. The cases and deaths
occurred from 16 November 2002 to 9 February 2003. Laboratory analyses are
negative for influenza viruses.
14 February 2003
-- The Chinese Ministry of Health informs WHO that the
outbreak in Guangdong Province is clinically consistent with atypical pneumonia.
The outbreak is said to be coming under control.
17 February 2003
-- A 33-year-old Hong Kong man, who had traveled with his
family to Fujian Province, China in January, dies of unknown causes in Hong
Kong. His 8-year-old daughter died previously, of unknown causes, while in
mainland China. His 9-year-old son is hospitalized.
19 February 2003
-- An outbreak of "bird flu" in Hong Kong is reported to
WHO following the detection of the A(H5N1) influenza virus in the 9-year-old
boy.
-- WHO activates its global influenza laboratory network and calls for
heightened global surveillance.
20 February 2003
-- The Department of Health in Hong Kong confirms that the
boy's father was likewise infected with a strain of the influenza A(H5N1) virus.
21 February 2003
-- A 64-year-old medical doctor from Zhongshan University
in Guangzhou (Guangdong Province) arrives in Hong Kong to attend a wedding. He
checks into the ninth floor of the Metropole Hotel (room 911). Although he
developed respiratory symptoms five days earlier, he feels well enough to
sightsee and shop with his 53-year-old brother-in-law, who resides in Hong Kong.
22 February 2003
-- The Guangdong doctor seeks urgent care at the Kwong Wah
Hospital in Hong Kong and is admitted to the intensive care unit with
respiratory failure (he had previously treated patients with atypical pneumonia
in Guangdong). He warns medical staff that he fears he has contracted a "very
virulent disease". Health authorities in Hong Kong learn that his symptoms
developed on 15 February, at which point he would have still been on the Chinese
mainland.
23 February 2003
-- A 78-year-old female tourist from Toronto, Canada
checks out of the Metropole Hotel and begins her homeward journey. On arrival in
Toronto she is reunited with her family.
-- A team of WHO experts arrives in
Beijing, but is granted permission to work at the central level only.
24 February 2003
-- The Global Public Health Intelligence Network (GPHIN)
picks up a report stating that over 50 hospital staff are infected with a
"mysterious pneumonia" in the city of Guangzhou.
-- In Hong Kong, a
26-year-old local man develops a respiratory tract infection, but does not seek
medical attention. From 15 to 23 February, he had visited an acquaintance
staying on the ninth floor of the Metropole Hotel.
25 February 2003
-- Brother-in-law of Guangdong doctor is admitted to Kwong
Wah Hospital and discharged.
26 February 2003
-- A 48-year-old Chinese-American businessman is admitted
to the French Hospital in Hanoi with a 3-day history of fever and respiratory
symptoms. His recent travel history includes a January trip to Shanghai, and a
private trip from 8 to 10 February to Guangdong Province, and Macao. He traveled
to Hong Kong on 17 February, departed for Hanoi on 23 February, and fell ill
there. Shortly before his departure from Hong Kong, he had stayed on the ninth
floor of the Metropole Hotel in a room across the hall from the Guangdong
doctor.
-- The businessman is attended by a WHO official, Dr Carlo Urbani,
based in Viet Nam..
28 February 2003
-- Dr Urbani, alarmed by the unusual disease and concerned
it might be a case of avian influenza, notifies the WHO office in Manila. WHO
headquarters moves into a heightened state of alert.
1 March 2003
-- Brother-in-law of the Guangdong doctor is re-admitted to
Kwong Wah Hospital.
-- A 26-year-old woman is admitted to a hospital in
Singapore with respiratory symptoms. A resident of Singapore, she was a guest on
the ninth floor of the Hotel Metropole in Hong Kong from 21 to 25 February.
4 March 2003
-- The Guangdong doctor dies of atypical pneumonia at Kwong
Wah Hospital.
5 March 2003
-- In Hanoi, the Chinese-American businessman, in a stable but
critical condition, is air medivaced to the Princess Margaret Hospital in Hong
Kong. Seven health care workers who had cared for him in Hanoi become ill. Dr
Urbani continues to help hospital staff contain further spread.
-- The
78-year-old Toronto woman, dies at Toronto's Scarborough Grace Hospital. Five
members of her family are found to be infected and are admitted to the hospital.
7 March 2003
-- Health care workers at Hong Kong's Prince of Wales Hospital
start to complain of respiratory tract infection, progressing to pneumonia. All
have an identifiable link with Ward 8A.
8 March 2003
-- In Taiwan, a 54-year-old businessman with a travel history
to Guangdong Province is hospitalized with respiratory symptoms.
According to the UN
Epidemiological Fact Sheet: HIV/AIDS and Sexually Transmitted Infections: China
(2002):
- Estimated number of adults and children living with HIV/AIDS, whether or
not they have developed symptoms of AIDS, alive at the end of 2001: Adults and
children 850,000
- Adults (15-49) 850,000
- Adult rate (%) 0.1
- Women (15-49) 220,000
- Children (0-15) 2,000
- Estimated number of adults and children who died of AIDS during 2001:
30,000
- Estimated number of children who have lost their mother or father or both
parents to AIDS and who were alive and under age 15 at the end of 2001: 76,000
CECC Roundtable: China's
Mounting HIV/AIDS Crisis: How Should the United States Respond? (October 20,
2003)
Statements of Panelists:
- Dr. Phillip Nieburg, Senior Associate, HIV/AIDS Task
Force, Center for Strategic and International Studies
(No written statement
available, please see the transcript below). - Dr. Wan
Yanhai
Director, Beijing AIZHI Education Institute, and World Fellow, Yale
University. - Kevin Robert
Frost
Vice President, Clinical Research and Prevention Programs, American
Foundation for AIDS Research - Amar Bhat
Director, Office of Asia and the Pacific,
Office of Global Health Affairs, Dept. of Health and Human
Services
Transcripts:
CECC Roundtable: HIV/AIDS (September 09, 2002)
Statements of Panelists: - Dr. Don des Jarlais, Director of Research,
Edmond de Rothschild Foundation, Beth Israel Medical Center
(No written
statement available, please see the transcript below) - Dr. Joan Kaufman
Visiting Scholar, East Asian Legal
Studies Program, Harvard Law School - Dr. Bates Gill
Freeman Chair in China Studies, Center for Strategic and International Studies
(CSIS)
Transcripts:
Third Party Resources
The following links provide useful information
on AIDS in China:
WHO Collaborating
Center for Sexually Transmitted Diseases (including HIV / AIDS) In
China:
National Center For Sexually Transmitted Diseases (STD) And Leprosy
Control Address: Institute Of Dermatology Chinese Academy Of Medical
Sciences And Peking Union Medical College 12 Jiangwangmiao Street Nanjing 210042
People's Republic Of China
Tel No: (8625) 5411040
Fax No: (8625) 5414477
E-Mail: CAMS@public1.ptt.js.cn
Head of Centre: DR. YE SHUNZHANG
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