Editor’s Note: Dr. James Ireland is an internist/nephrologist on Oahu and an Assistant Clinical Professor of Medicine at the John A. Burns School of Medicine. He is the former director of the Honolulu Emergency Services Department. In “The Health Beat,” Ireland will address public health issues that are relevant to Hawaii, including health policy and access to healthcare, emerging diseases and the financial impact of chronic diseases. Watch for it every couple of weeks.

At least nine people have contracted an apparent novel influenza virus called H7N9 in Shanghai and Anhui Provence, China with three deaths and five people in critical condition.

Concerned officials in China report the “mortality of influenza A (H7N9) is very high.” Advances in technology and social media have provided for a steady stream of information updated literally by the hour, and Hawaii as an international tourist destination has a major stake in keeping up with developments.

A bulletin from the Chinese National Health and Planning Commission on March 31 confirmed the initial three infections and four more were reported yesterday. Doctors and healthcare workers there were advised to be “vigilant.” Two additional patients were identified today.

This influenza A virus, which had not previously been found in humans, is a type of Avian influenza and called H7N9. The naming of influenza A viruses is based on two proteins found on the surface of the virus: Hemagglutinin (H) and Neuraminidase (N). There are 17 different H types (1-17) and nine different N types (1-9). The H7N9 seems to be a new Avian flu virus, and is different than the previously described H5N1 Avian influenza virus.

Influenza has a peculiar ability to infect other animal species besides humans including pigs, bats, ducks and chickens. Not all viruses can do this. While uncommon, certain strains of flu can pass between, for instance, the chicken to the human and vice versa. When flocks of chickens or ducks have been infected with the feared H5N1 Avian influenza in China and other parts of Asia, the governments there order the immediate slaughter and incineration of the birds, which can number in the millions.

Another unusual and significant event that happens in nature with influenza is when a host animal, such as a pig, is infected with two strains of influenza at the same time. The genetic material that makes each strain unique is coded in segments, and these can be exchanged between flu viruses when they infect a host animal at the same time. This is one of the ways new strains are “born” through a process called “reassortment.” New strains of the flu are of particular concern because of their “newness,” people have not yet formed protective antibodies and are thus more susceptible to serious infection. Analysis is currently underway to determine the origin of H7N9, although a reassortment event is suspected.

Information dissemination about emerging flu viruses has been greatly facilitated by sites such as the University of Minnesota’s Center for Infectious Disease Research & Policy (CIDRAP) and the interactive site FluTrackers.com. This site was founded in 2006 as a place where “a bunch of people who wanted to talk about flu in a serious way” could share information, said Sharon Sanders, who founded FluTrackers. It has since expanded with twitter and Facebook The website has a wide variety of participants including scientists, physicians, health care consumers, journalists and others with a common interest in advancing the understanding of influenza. Typing in “H7N9” into the site’s search box brings up discussions, news releases and even genetic sequence analysis of the new flu strain.

Advances in DNA analysis and sharing have also permitted the rapid analysis of this new virus. A website hosted by the Global Initiative on Sharing All Influenza Data, or GISAID, allows influenza DNA sequence information to be posted and analyzed by other scientists around the world. Because China conducted DNA sequencing of genes from the H7N9 virus and shared this information on GISAID, comparisons could be made immediately to other known flu viruses. This helps predict not only the origin of the virus, but also the potential for a human pandemic.

Sophisticated computer modeling can also help predict the behavior of infectious diseases such as the flu. In 2012, Ruben Juanes and his group published their findings on “contagion dynamics” and which American airports would be more likely to spread an infectious disease. While JFK airport in New York was number one, and Los Angeles International (LAX) was second, Honolulu International Airport was a surprising third.

The importance of Hawaii as an international tourist destination and the potential for travelers to import foreign illnesses has not gone unnoticed by healthcare planners here. Hawaii has a statewide influenza surveillance program where participating doctors and healthcare centers can send nasal swabs for influenza testing and typing. This program was extended to the Honolulu International Airport in 2005 and international travelers who arrive ill can be swabbed for influenza.

Pandemic planning has also been one of the priorities of the Healthcare Association of Hawaii and the Hawaii Disaster Medical Assistance Team, or DMAT. This group is made up of healthcare workers and others from around the state who would potentially mobilize in the event of a pandemic to support hospitals and patients. They have even conducted “pandemic scenarios with the Hawaii State Department of Health and the Centers for Disease Control at Honolulu International Airport,” said Toby Clairmont, the Director of Emergency Services for the Healthcare Assoication of Hawaii.

In these exercises, their team quarantines and treats a large number of travelers with simulated influenza. They also have anti-viral medications such as Tamiflu in their cache.