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WHO On Hunan H7N9 Cluster In Jiangyong - 38M & 8F
Recombinomics Commentary 01:45
February 5, 2014

A 38-year-old male from Yongzhou City, Hunan Province with onset of symptoms on 24 January 2014. He was admitted to hospital on 30 January and is currently in a critical condition. The patient has a history of exposure to a live poultry market.

A 8 year-old girl from Yongzhou City, Hunan Province, who became ill on 30 January and was admitted to hospital on 31 January. She is currently in a serious condition. The patient has a history of exposure to a live poultry market.

The above comments from the February 3 and February 4 WHO H7N9 bird flu update describe a cluster that matches the pattern seen in human to human transmission among contacts, who typically are family members (and for the recent cases the family members are children). 

The adult index case is diagnosed as critical or severe (if not dead), with a gap between disease onset and hospital admission.  Severe cases with poultry exposure are the most common cases tested. For the above case there was a 6 day gap between disease onset and hospitalization.

Contacts develop symptoms well after the index case because transmission happens when the viral load in the index case increases.  Contacts of confirmed or suspect cases are monitored and hospitalized 0-1 days after disease onset.  These cases are typically described as mild or stable, and recover due to early hospitalization and treatment.  The above case was hospitalized a day after disease onset.  Although the WHO update cites a serious condition, the initial report on the case was stable.

Both of these cases were from Jiangyong County in Yongzhou City, (see map) strongly suggesting they are linked and will be cited as a familial cluster, as has happened for the Guangdong clusters in Baijun (29M father and 5F daughter), Sanjiaozhen (37M father and 2F daughter) and Huai (5M & 4F cousins living together, relationship to 28M unknown)

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