In light of the H7N9 , the Yale-Tulane ESF #8 Planning and Response Program has produced a special report on A(H7N9).The Yale-Tulane ESF #8 Program is a multi-disciplinary, multi-center, graduate-level, program designed to produce ESF #8 planners and responders with standardized skill sets that are consistent with evolving public policy, technologies, and best practices. The group that produced this summary and analysis of the current situation are graduate students from Yale and Tulane Universities. It was compiled entirely from open source materials. Please feel free to forward the report to anyone who might be interested.

1. BACKGROUND
SITUATION
AS OF 1600 HRS EDT
15 APRIL 2013
RISK ASSESSMENT
AVIAN INFLUENZA
HUMAN CASES
CHINESE GOVERNMENT ORGANIZATIONS
 Ministry of Health of the People’s Republic of China
 Chinese Center for Disease Control and Prevention
 Hong Kong Department of Health | Centre for Health Protection
 National Health and Family Planning Commission
INTERNATIONAL ORGANIZATIONS
FAO
OIE
WHO
 World Health Organization Western Pacific Region
 Disease Outbreak News
 Human infection with influenza A(H7N9) virus
 Global Initiative on Sharing All Influenza Data (GISAID)
US GOVERNMENT
CDC – Health Info
EUROPEANUNION
ECDC
PORTALS, BLOGS, AND RESOURCES
 Avian Flu Diary
 CIDRAP
 FluTrackers.com
 Flu Wiki
 Health Map
 ProMed Mail
 Virology Down Under
NEW SOURCES
 People’s Daily Online – China High Alert H7N9
 Forbes
 AlertNet
 Reuters
 NY Times
YALE- TULANE ESF-8 SPECIAL REPORT
A(H7N9)
SCREENING PATIENTS RETURNING
FROM CHINA
MAP
TIPS FOR THOSE VISITING CHINA
RESPONSE
AS OF 15 APRIL 2013
CONFIRMED DEAD
64 14 ECONOMIC IMPACTS
CDC to update clinicians, health
departments on #H7N9 flu. Call in
April 18, 2PM ET:
http://goo.gl/DLm1J

2. BACKGROUND
While the novel A(H7N9) virus has been detected in birds and
environmental specimens at a bird markets in Shanghai and the other
affected provinces, the source of infection in most of the cases still
remains to be determined
It is equally unclear how the virus was introduced into the markets.
China has intensified human and animal surveillance. It has also
implemented public health measures that include the culling of birds and
the closure of some live poultry and bird markets
SOURCE: Global Alert Response, (1 APRIL 2013)
http://www.who.int/csr/don/2013_04_01/en/
Flu.Gov (April 2013) Avian Influenza A (H7N9) Virus
http://www.flu.gov/about_the_flu/h7n9/index.html#
On 31 March 2013, the World Health Organization (WHO) was notified by
China’s Health and Family Planning Commission of three cases of human
infection with the influenza A(H7N9) virus
•Since then, additional cases have been reported. Most reported cases have
severe respiratory illness and, in some cases, have died.
•At this time, no cases of H7N9 outside of China have been reported. The
new H7N9 virus has not been detected in people or birds in the United
States.
•This new H7N9 virus is an avian (bird) influenza (flu) virus. Human
infections with avian influenza (AI, or “bird flu”) are rare, but have occurred
in the past, most commonly after exposure to infected poultry.
• This is the first time that this bird flu subtype (H7N9) has been found in
people. This virus is very different from other H7N9 viruses previously
found in birds.
•Many of the human cases of H7N9 are reported to have had contact with
poultry. However, some cases reportedly have not had such contact.
•Close contacts of confirmed H7N9 patients are being followed to see if any
human-to-human spread of H7N9 has occurred. No sustained person-to-
person spread of the H7N9 virus has been confirmed at this time.
• There is no licensed vaccine available at this time.
.
A man infected with H7N9 bird flu receives treatment at an
intensive care unit in a hospital in Kaifeng, Henan province, on
Sunday.( Li Bo / Xinhua )

3. CASE UPDATES
• The National Health and Family Planning Commission continues to
notify WHO as there are are additional laboratory-confirmed cases of
human infection with influenza A(H7N9) virus.
• Cases have been confirmed in the following provinces and
municipalities: Shanghai, Beijing Jiangsu, Anhui, Henan and Zhejiang.
All locations are in Eastern and Northern China.
• The age of confirmed cases ranges from 4-87 years old.
• Cases presented with respiratory tract infection with progression to
severe pneumonia and breathing difficulties. More than 1,000 close
contacts of the identified cases are being closely monitored.
• Two confirmed cases have been associated with possible family
clusters. Close contacts of confirmed cases and health care workers
caring for cases have been monitored for infection. So far, among the
contacts who have been tested by polymerase chain reaction, none
has been shown to have infection.
SITUATION
Chinese Centers for Disease Control – H7N9 Update GISAID H7N9 virus sequencing Global Concerns Regarding Novel Influenza A (H7N9) Virus Infections
Centers for Disease Control and Prevention – Travelers’ Health World Health Organization Global Alert and Response Virology Down Under
Chinese Centers for Disease Control and Prevention H7N9 Information WHO H7N9 Risk Assessment
As of 15 April 2013 there have been a total of 64
confirmed cases and 14 deaths.
On 15 April, Beijing Municipal Health Bureau reported that a four-year-old boy,
who was tested positive for H7N9 flu virus, was asymptomatic.

4. SITUATION
VIRUS CHARACTERIZATION
• This is the first time human infection with this influenza
subtype, avian influenza A(H7N9) virus, has been detected.
• The sequences of the first three viruses were posted to GISAID
by China and are publicly available.
ANTIVIRAL DRUGS: So far, all three viruses seem to be
susceptible to the influenza antiviral drugs oseltamivir and
zanamivir, but they are resistant to the amantanes
VACCINE: There is no licensed H7N9 vaccine currently available,
but pharmaceutical manufacturers are currently using synthetic
biology techniques to develop a candidate vaccine strain.
The schematic above (provided by CDC) shows the structure of an influenza virus particle.
There are two major proteins found on the virus surface, hemagglutinin (that is the ”H” when the
virus type is designated) and neuraminidase (the “N”)
GENETIC CHARACTERISTICS
•The novel H7N9 viruses have genetic characteristics that are of
concern.
•The hemagglutinin (HA) sequence data suggest that these H7N9
viruses are a low-pathogenic avian influenza A virus and that
infection of wild birds and domestic poultry would therefore result
in asymptomatic or mild avian disease, potentially leading to a
“silent” widespread epizootic in China and neighboring countries.
• If H7N9 virus infection is primarily zoonotic, as reports currently
suggest, transmission is expected to occur through exposure to
clinically normal but infected poultry, in contrast to HPAI H5N1 virus
infection, which typically causes rapid death in infected chickens.
•The gene sequences also indicate that these viruses may be better
adapted than other avian influenza viruses to infecting mammals.
•Ongoing surveillance is crucial to assessing the emergence and
prevalence of H7N9 viruses resistant to available antivirals.

5. REPONSE ACTIVITIES
CHINESE GOVERNMENT ACTIVITIES
• Chinese government notifies the World Health Organization of
the emergence of an A(H7N9)
• Chinese health authorities are conducting investigations to learn
the source of the infections with this virus
• Chinese scientists first sequence the viral genome and identified
the origin of this new virus.
• The Chinese government has instituted enhanced surveillance,
strengthened laboratory utilization, and training of health care
professionals for detection, reporting, and treatment.
• All influenza network laboratories in the 31 provincial regions on
China's mainland are now capable of testing for the H7N9 bird
flu virus
US GOVERNMENT ACTIVITIES
5 April:
• CDC holds a telebriefing on H7N9 Influenza Cases
• CDC issues a Health Advisory, Human Infections with Novel
Influenza A (H7N9).
8 April:
• The US Centers for Disease Control and Prevention (CDC)
activates its Emergency Operations Center (EOC) in Atlanta at
Level 2 to support the response to the H7N9 influenza
outbreak in China, CDC officials said in an e-mailed statement
today.
• CDC post a Travel Notice about avian influenza A (H7N9) on
www.cdc.gov/travel
11 April:
• China provides US CDC with virus sample for vaccine
development

6. NUMBER OF DEATHS / NUMBER OF CONFIRMED CASES
NO EVIDENCE OF H7N9 TRANSMISSION FROM
PERSON-TO-PERSON1,2,3
However, this is still a future possibility:
• Every time the virus encounters and infects a new
human host, it has the opportunity to mutate.2
• The haemagglutinin (H) surface protein on the virus
has shown mutations that precede a change in
binding preference from bird to human cells.2,4
• A PB2 protein substitution is also indicative of
mammalian adaptation of the virus4
ALL CONFIRMED CASES AND DEATHS WITHIN CHINA1
• Cases in 29 prefectures/districts across 6 provinces
Cases Type Most Recent Total1
Deaths 14
Laboratory-Confirmed
Cases
64
Sources: 1. China CDC 2. www.Nature.com/news 3. South China Morning Post 4. www.NEJM.org
Note: All case and death totals are as of 8pm EST, April 14, 2013
H7N9 HAS NEVER BEFORE BEEN DETECTED IN
HUMANS4
• Rapid diagnostic tests are currently unavailable4
• All age groups expected to be susceptible4
Place1 Cases1 Deaths1 Place1 Cases1 Deaths1
Beijing 2 0 Zhejiang 16 2
Shanghai 24 9 Anhui 3 1
Jiangsu 17 2 Henan 2 0

7. NUMBER OF DEATHS / NUMBER OF CONFIRMED CASES
Total number of
confirmed human
cases A(H7N9)
60
Total number of
deaths attributed
A(H7N9)
13
Current Case
Fatality Rate
22%
Average time from
illness onset to first
confirmation of
H7N9 (days):
10 days
Average age of the
H7N9-confirmed
cases
59 years
Median age of the
H7N9 confirmed
cases
64 years
Modal age of the
H7N9 confirmed
cases
74 years
Average age of
deceased
62 years
Males 71% of the
cases 71%
of the
fatalities
Females 29%of the
cases 71%
of the
fatalities
SOURCE: Virology Down Under

8. 924
02
13
217
216
02
DISTRIBUTION OF CASES GEOGRAPHICALLY
Total number
of confirmed
cases
Total number
of deaths
Source: China CDC http://www.chinacdc.cn/en/research_5311/H7N9update/201304/t20130414_79862.html

9. RISK ASSESSMENT
GENERAL INFORMATION:
 At this time, there are still gaps in information and evidence available.
 Investigations into possible sources of infection and reservoirs of the virus are ongoing.
 This is the first time that human infection with influenza A(H7N9) virus has been identified and the first time that human infection with a low pathogenic
avian influenza A virus has been associated with a fatal outcome.
 For precautionary reasons, those working in or visiting China should avoid visiting live bird and animal markets and direct contact with bird and animal
feces, untreated bird feathers, and other animal and bird waste.
TWO RISK ASSESSMENTS HAVE BEEN PUBLISHED:
European Centre for Disease Prevention and Control (12 April 2013)
http://www.ecdc.europa.eu/en/publications/Publications/influenza-A(H7N9)-China-rapid-risk-assessment-4-april-2013.pdf
World Health Organization (13 April 2013):
http://www.who.int/influenza/human_animal_interface/influenza_h7n9/RiskAssessment_H7N9_13Apr13.pdf
• There is no evidence of sustained human-to-human transmission. However the two possible family clusters suggest that limited human-to-human
transmission may occur where there is close contact between cases and other individuals, as occurs in families and, potentially, healthcare
settings.
• At this time, there is no information to indicate international spread of this virus. However, it is possible that an infected person, who may or may not
have symptoms, could travel to another country. If the virus cannot sustain human-to-human transmission, as appears to be the current situation,
then extensive community spread is unlikely.
• WHO does not advise special screening at points of entry with regard to this event, nor does it recommend that any travel or trade restrictions be
applied.

10. RISK OF HUMAN TO HUMAN TRANSMISSION
 Insufficient evidence to determine risk of A(H7N9) human to
human transmission.
 Risk of healthcare-associated transmission when caring for
infected patients not yet determined
 Infective period for A(H7N9) cases not known but patients likely to
excrete the virus in body fluids
RISK OF FURTHER CASES IN CHINA
 Most human cases of H7N9 likely due to animal exposure
 Further cases are expected
RISK OF INTERNATIONAL SPREAD
 Risk of international spread via humans currently low
 As virus cannot sustain human-to-human transmission, extensive
spread unlikely regardless of infected travelers
 WHO does not advise special screening at points of entry with
regard to this event or any travel restrictions
 No cases have been reported outside of China
OTHER MODES OF TRANSMISSION
 No epidemiological evidence of transmission to humans through
the consumption of food
 Low or no risk of transmission through blood transfusion or
organ/tissue donations
 Importation through food and agricultural products from China
unlikely due to importation restrictions
 Risk of spread through migratory birds unknown
 Virus has not been detected in wild birds at this time
RISK ASSESSMENT
European Centre for Disease Prevention and Control (12 April 2013)
http://www.ecdc.europa.eu/en/publications/Publications/influenza-A(H7N9)-China-rapid-risk-assessment-4-april-2013.pdf
World Health Organization (13 April 2013):
http://www.who.int/influenza/human_animal_interface/influenza_h7n9/RiskAssessment_H7N9_13Apr13.pdf

11. AVIAN INFLUENZA
A(H7N9)
WHAT IS AVIAN INFLUENZA (AI)?
WHAT IS INFLUENZA A(H7N9)?
WHAT IS THE SOURCE OF INFLUENZA A(H7N9)?
SOURCE: OIE – Questions and Answers on Influenza A(H7N9)
PRESENT SITUATION IN CHINA
•To date, a total of 60 cases have been
laboratory confirmed with influenza
A(H7N9) virus in mainland China,
including 14 deaths.
•The China Animal Disease Control
Centre and the country’s animal health
services, including the OIE Reference
Laboratory in Harbin, are still
investigating animal sources and
possible reservoirs of the influenza
virus A(H7N9).
Chinese health workers collect bags of
dead chickens at the Huhai wholesale
market on April 5. China on high alert
over bird flu In Shanghai, more than
100,000 live birds have been killed in
the past week at live-poultry markets
across the city in an effort to contain
the problem - CNN
The first human cases of type A
influenza virus of the strain H7N9.
was found in March 13, 2013. This
strain of virus usually infects birds,
and the report was followed by
reinforced surveillance in bird
populations in China.
The virus has been found in a pigeon
in a market in Shanghai. It is not yet
known how persons became
infected. The possibility of animal-
to-human transmission is being
investigated, as is the possibility of
person-to-person transmission.
Wild birds can normally carry avian
influenza viruses in their respiratory
or intestinal tracts but they do not
commonly get sick. They have
historically been reservoirs of
influenza viruses
Avian influenza (AI) is an
infectious viral disease of
birds (especially wild water
fowl such as ducks and
geese), often causing no
apparent signs of illness. AI
viruses can sometimes
spread to domestic poultry
and cause large-scale
outbreaks of serious disease.
Outbreaks of AI in poultry often raise
global public health concerns due to
their effect on poultry populations,
their potential to cause serious
disease in people, and their pandemic
potential.
At this time there is no evidence of
ongoing human-to-human
transmission.
Influenza A H7N9 viruses are a group of
influenza viruses that normally circulate
among birds. The influenza A(H7N9) virus is
one subgroup among the larger group of H7
viruses. Although some H7 viruses (H7N2,
H7N3 and H7N7) have occasionally been
found to infect humans, no human
infections with H7N9 viruses have been
reported until recent reports from China.
Influenza - or, as it is often known, flu - is
a large family of different viruses (more
than 70 major types), some of which
affect humans and many of which affect
other animals, especially birds.

12. AVIAN INFLUENZA
A(H7N9)
HOW IS INFLUENZA A(H7N9) TRANSMITTED AND
SPREAD AMONG BIRDS?
WHAT ARE THE REPORTING REQUIREMENTS FOR
INFLUENZA A(H7N9)?
HAVE WILD BIRDS BEEN IDENTIFIED AS A CARRIER
OF THE INFLUENZA A(H7N9) VIRUS?
Map of outbreak
locations. SOURCE:
OIE
Thus far, most patients with
this infection have had
severe pneumonia.
Symptoms include fever,
cough and shortness of
breath. However,
information is still limited
about the full spectrum of
disease that infection with
influenza A(H7N9) virus
might cause.
OIE Terrestrial Animal Health
Code reporting guidelines
Confirmed Case: A patient with novel
influenza A (H7N9) virus infection that is
confirmed by CDC’s Influenza Laboratory or a
CDC certified public health laboratory using
methods agreed upon by CDC and CSTE.
Probable Case: A patient with illness
compatible with influenza for whom
laboratory diagnostic testing is positive for
influenza A, negative for H1, negative for
H1pdm09, and negative for H3 by real-time
reverse transcriptase polymerase chain
reaction (RT-PCR), and therefore
unsubtypeable.
An investigation by Chinese authorities is ongoing.
H7N9 viruses have been detected in poultry in the
same area where human infections have occurred.
Many of the human cases of H7N9 are reported to
have had contact with poultry. However some cases
reportedly have not had such contact. Close contacts
of confirmed H7N9 patients are being followed to
see if any human-to-human spread of H7N9 might
have occurred.
All the patients had preexisting medical conditions,
and two had a history of direct contact with poultry.
Since April 4, it has been
reported that H7N9 viruses
similar to those isolated from
the three patients described
here have been isolated from
pigeons and chickens,
indicating that the novel H7N9
viruses might currently be
circulating in poultry.
All AI viruses can be transmitted
among birds through direct
contact with secretions from
infected birds, especially feces or
through contaminated feed,
water, equipment, and human
clothing.
Several factors can contribute to
the spread of all AI viruses
including: the movements of
people and goods, marketing
practices (live bird markets),
farming practices and the
presence of the viruses in
migratory wild birds.
We do not yet know enough about these
infections to determine whether there is a
significant risk of community spread. This
possibility is the subject of epidemiological
investigations that are now taking place.
Does this influenza virus pose a pandemic
threat?
Any animal influenza virus that develops the
ability to infect people is a theoretical risk to
cause a pandemic. However, whether the
influenza A(H7N9) virus could actually cause a
pandemic is unknown. Other animal influenza
viruses that have been found to occasionally
infect people have not gone on to cause a
pandemic.

13. ECONOMIC IMPACTS
CURRENT SITUATION
• China exports 1821.9 Hundred Million dollars of goods per month.
• China produces 12.1 million metric tons of broiler meat.
• SARS caused year-over-year growth to fall to 7.9% from 10.8% in Q1 2003--
H7N9 may cause a similar drop.
TRADE BANS
• Vietnam has banned Chinese poultry imports.
• Shanghai’s, Huhai’s, Hangzhou’s, Nanjin’s, and several other poultry
markets have been closed.
• More bans may proliferate.
TRAVEL
• No travel bans are in place.
• Japanese airports are on alert for arriving travelers from China who exhibit
flu-like symptoms.
FOOD SECURITY
• Chicken meat is a popular source of protein among poor workers.
• In order to decrease the risk of H7N9 spread many birds were slaughtered
and will continue to be slaughtered. This could lead to food shortages and
a lack of protein, especially for the poor. Consumers are also avoiding
poultry and egg, despite authorities assuring that it is safe to eat if
properly cooked.
MARKET REACTION
• Soybeans and poultry shares are down on the Chinese market, but
pharmaceutical stocks are up, as well as the sales of medicinal herbs.
Overall the Shanghai index is down .7%, the Hang Seng index 2.7%, and
Bloomberg US-China Equity Index 1.8% due to fears of reduced economic
growth The market has reacted similarly to travel companies, hotels,
educational services, retail, and consumer staples due to beliefs that
people will avoid congregating and traveling.
• Sales of chicken are down, while sales of masks and hand sanitizer are up.
http://www.thepoultrysite.com/
http://www.grains.org/index.php/2012-04-30-15-22-26/4162-h7n9-affects-chinese-
poultry-market
http://www.chinaeconomicreview.com/big-bad-bird
http://www.guardian.co.uk/world/2013/apr/05/bird-flu-shanghai-poultry-market-cull
RAMIFICATIONS: If H7N9 continues to spread or simply generates
large amount of China’s recovery from the current global economic
situation could be retarded.
MITIGATION: The WHO’s measured response to the disease has
prevented market panic or intense travel fears. Continued
consideration of economic ramifications before issuing alerts will help
to minimize the amount of economic losses incurred.

14. OVERVIEW
What is H7N9 virus? The virus appears to be a reassortment of three avian
influenza viruses.
How does H7N9 flu spread? Thus far, there is no evidence of human-to-
human transmission. Some affected patient had exposures to poultry before
falling ill. There is concern that H7N9 does not cause severe illness in birds and
hence can potentially spread undetected from poultry to sporadic human
cases.
What are the symptoms? Predominant presenting symptoms have been
severe respiratory tract infections which progressed to pneumonia.
SCREENING
KEY POINTS
H7N9 is a new avian flu virus.
Rare but serious human cases have occurred
in China. So far, there is no evidence of
human-to-human transmission.
References: (picture) www.abcnew.com, www.upmc-biosecurity.org, www.uptodate.com,
http://emergency.cdc.gov/HAN/han00344.asp, http://www.cdc.gov/flu/avianflu/guidance-
labtesting.htm
Who should be tested ? Patients with flu symptoms and the following
exposure criteria:
1. Recent travel to countries with human H7N9 cases, especially if there
was close contact with animals (e.g. wild birds, poultry or pigs) or
where H7N9 viruses are known to be circulating in animals. Thus far,
China is the only country with recent reported human cases.
2. Recent contact with confirmed human H7N9 cases
Information on incubation period is incomplete but other avian
influenza had incubation period ranging 3-9 days.
Use Standard Precautions plus Droplet, Contact,
and Airborne Precautions, including eye protection
until more is known about the transmission
characteristics.
Commercial rapid influenza diagnostic tests may not detect avian or variant A
viruses. Hence a negative test does not exclude H7N9 infection.
Send a nasopharyngeal swab or aspirate placed in viral transport medium to
state or local health department. Currently, all confirmatory testing for H7N9
will be done by CDC.
TREATMENT
INFECTION CONTROL
Do not base treatment decision solely on the result of a negative rapid
influenza diagnostic test result.
For patients in following categories, start empiric treatment with oral
oseltamivir or inhaled zanamivir as soon as possible without waiting for
laboratory confirmation:
1.Patients hospitalized with suspected influenza, including H7N9 cases
2.High risk persons (age <5 or ≥65, certain underlying medical
conditions)
Antiviral treatment is most effective if started as soon as possible after
the onset of influenza illness. But treatment in moderate, severe, or
progressive disease that began after 48 hours may still have some
benefit.
DIAGNOSTIC TESTS
FACT SHEET: AVIAN INFLUENZA A (H7N9) VIRUS
SCREENING PATIENTS RETURNING FROM CHINA

15. FACT SHEET: AVIAN INFLUENZA A (H7N9) VIRUS
TIPS FOR THOSE VISITING CHINA
OVERVIEW
What is H7N9 flu? It is a contagious disease in humans and other animals that
can sometimes lead to serious illness and death.
How does H7N9 flu spread? An animal with H7N9 flu can give it to another
animal or human through feces, saliva, or nasal secretions. For now, there is
no evidence of human to human transmission.
What are the symptoms? Some of the following: fever, cough, sore throat,
runny nose, body aches, headaches, chills, fatigue.
PREVENTION
KEY POINTS
H7N9 is a new bird flu virus.
Rare but serious human cases have occurred
in China. So far, there is no evidence of
human-to-human transmission.
References: (picture) http://www.ottawacitizen.com
http://www.cdc.gov/flu/avianflu/h7n9-virus.htm,
http://www.who.int/csr/don/2013_04_10/en/
http://wwwnc.cdc.gov/travel/notices/watch/avian-flu-h7n9-china.htm
Do not touch birds or other animals.
Do not touch animals whether they are alive or dead.
Avoid live bird or poultry markets.
Avoid other markets or farms with animals (wet markets).
Eat food that is fully cooked.
Eat meat and poultry that is fully cooked (not pink) and served hot.
Eat hard-cooked eggs (not runny).
Don’t eat or drink dishes that include blood from any animal.
Don’t eat food from street vendors.
Practice hygiene and cleanliness:
–Wash your hands often.
–If soap and water aren’t available, clean
your hands with hand sanitizer containing
at least 60% alcohol.
– Don’t touch your eyes, nose, or mouth. If you need to touch your face,
make sure your hands are clean.
– Cover your mouth and nose with a tissue or your sleeve (not your
hands) when coughing or sneezing.
– Try to avoid close contact, such as kissing, hugging or sharing eating
utensils or cups, with people who are sick.
IF YOU BECOME ILL….
See a doctor if you become sick during or after travel to China.
‒ See a doctor right away if you become sick with fever, coughing, or
shortness of breath.
‒ If you get sick while you are still in China, visit the US Department of State
website to find a list of local doctors and hospitals. Many foreign hospitals
and clinics are accredited by the Joint Commission International. A list of
accredited facilities is available at their website
(www.jointcommissioninternational.org).
‒ Delay your travel home until after you have recovered or your doctor says
it is ok to travel.
‒ If you get sick with fever, coughing, or shortness of breath after you return
to the United States, be sure to tell your doctor about your recent travel to
China.