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Paradigm Shift Intervention Monitoring
Guangdong Huaiji H7N9 Cluster Grows To Seven
Case 2 Lin, male, 62 years old, home unemployed, now living Huaiji County, Zhaoqing City, February 6 confirmed cases of human infection of H7N9 avian influenza, the patient's condition is currently stable, treated at a local hospital sentinel.
The above translation from the February 7 H7N9 bird flu update from Guangdong describes two more cases (48M & 62M) in Huaiji County in Zhaoqing City, increasing the geographical cluster to seven. Moreover, the clinical status of stable raises concerns that these are additional milder cases that were hospitalized and H7N9 tested because they are contacts of one or more of the five previously confirmed cases.
The initial cluster (28M & 5M) created a pattern seen in multiple geographic cluster in southern China involving milder cases in children who were linked to a more severe adult case. This pattern was first seen last month in Baiyun, Guangdong involving a father (29M) and daughter (5F). More recently there were similar clusters in Jiangyong, Hunan involving a father (38M) and daughter (8F), Sanjiaozhen, Guangdong involving a father (37M) and daughter (2F), and Hengxian, Guangxi involving a mother (41F) and son (5M).
The cluster in Huaiji County initially involved an adult (28M) and child (5M). the confirmation of a second child (4F) was followed by media reports noting that the two children were cousins and lived in the same house. The reports were silent on the relationship to the adult (all three were in Huai Town). Two more cases were recently announced which included another critical adult (42M) and a mild child (5F). The two cases cited above increase the cluster to seven.
WHO updates on the first five include disease onset dates, as listed below. The two adults are in critical condition, while the three children are mild or stable. The stable designation of the two most recent cases described above (48M & 62M), raises concerns that these cases are contacts of one or more of the earlier confirmed cases.
Information on the relationships between these seven H7N9 cases in Huaiji would be useful.
January 24 (28M) critical
January 26 (4F) mild
January 27 (42M) critical
January 29 (5M) stable
January 30 (5F) mild