At the frontier of the global battle against emerging infections: surveillance and management of avian influenza A(H7N9) in Guangdong Province, China

Background Guangdong, which stands at the frontier of emerging infections, has developed an innovative system approach to this threat. The province of 110 million inhabitants, a major hub for domestic and international trade, includes mega-cities side-by-side with small-scale agricultural areas in a region from which recent strains of influenza and other respiratory viruses have emerged. Guangdong residents consume chicken and purchase it at live poultry markets, which can accelerate the emergence of influenza strains and transmission to humans. We describe Guangdong's approach to surveillance and public health emergency response. # Methods We use H7N9 as a case study to illustrate how Guangdong's system functions. # Results Guangdong's approach includes five core elements -- real-time surveillance, risk assessment, rapid response, active and accurate intervention, and multilateral communication. This requires partnerships among governmental agencies at all levels as well as healthcare professionals and residents. Risk management, for instance, involves not only provincial and local Centers for Disease Control, other government agencies, hospitals and clinics, and wholesale and live poultry markets. The implementation of Guangdong's risk management strategy depends, in part, on available resources and existing capacities. Guangzhou and a majority of Guangdong Province implement "control risk" level strategies. However, the city of Shenzhen (as well as neighboring Hong Kong), implement "eliminate risk." level strategies. # Conclusions Effective disease surveillance requires vertical and horizontal coordination among public health agencies. Similarly, disease prevention and control efforts also require partnerships with other governmental agencies at all levels, as well as with healthcare professionals and civil society. Guangdong Province has developed an approach for surveillance and control of H7N9 that may represent a robust and potentially scalable model for China and other nations.