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Paradigm Shift Intervention Monitoring
WHO On Guangdong H7N9 Cluster In Baiyun - 29M
A 5 year old girl from Guangzhou City, Guangdong Province who became ill on 14 January. She was admitted to hospital on 15 January. She is currently in a stable condition.
The above comments from the January 14 and 20 WHO H7N9 bird flu updates confirm the 11 day gap in disease onset dates between the father (29M) and daughter (5F) cases in the familial cluster in the Baijun District of Guangzhou City, (see map) as seen the Guangdong Province Ministry of Health reports. The WHO report also notes that the daughter was hospitalized one day after disease onset, which was associated with a mild clinical presentation and antiviral treatment led to a subsequent discharge.
Although the father / daughter relationship was widely reported in Chinese media prior to the January 20 WHO update, the update failed to note the relationship. Consequently, the familial cluster was largely not reported in English language summaries by CIDRAP and ProMED, which rely on blogger reports to keep tallies of confirmed cases. This absence of cluster reporting is also true for the three recent clusters in Guangdong (Huai and Sanjiaozhen) and Hunan (Jiangyong), which were confirmed in the past few days.
The failure of the health agencies in China as well as WHO to report these clusters is remarkable. WHO notes that there is no sustained transmission, although China does not include mild cases in their surveillance unless the cases are contacts of H7N9 confirmed cases, and WHO fails to provide the most basic information, such as the relationship between conformed cases.
China undoubtedly knows that the mild cases are largely contacts, because China doesn’t routinely test mild cases that are not contacts. Similarly, the relationship between confirmed cases is undoubtable included in IHR reports, but WHO withholds that information from the public updates.
The lack of transparency on clusters, coupled with the dearth of sequences from these clusters seriously increases pandemic concerns.
This obfuscation on the clusters and sequences remains hazardous to the world's health.