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Paradigm Shift Intervention Monitoring
Guangdong Huaiji H7N9 Cluster Grows To Eight
The above translation from the Guangdong H7N9 bird flu update of February 9 describes the eighth confirmed case from Huaiji County in Zhaoqing City. This is the fourth adolescent case and all have been characterized as “mild” or “stable,” raising concerns that they are linked to more severe adult cases. China’s H7N9 surveillance targets severe hospitalized cases, and milder cases are identified in contacts of confirmed cases.
Currently, only 2 of the 8 cases have been cited as being related (cousins, 5M & 4F, who live in the same home). Both were characterized as mild and one (4F) was discharged yesterday. The other (5M) was hospitalized on day 0, once again suggesting he was a contact of a confirmed case, since there are literally millions of mild flu cases in China at tis time, but hospitalization and H7N9 testing of mild cases is largely limited to contacts of confirmed cases.
The cluster of cases has raised serious concerns. Guangdong typically announces new H7N9 cases at 10 AM local time. The announcement of the 6th and 7th cases (48M & 62M) was delayed and announced at an evening press conference which warned there would be additional cases, and the latest case (11M) is the first announced case since the evening conference call.
One of the recent cases, 48M, has the same surname (Lee) as the other adolescent case (5F), raising concerns of another familial cluster. However, both cases were characterized as mild or stable. Only two of the adult cases (28M and 42M), where characterized as critical, and most index cases are characterized as critical or severe.
Thus, although the large cluster of reported confirmed H7N9 cases in Huaiji is expected to increase in the near term, details on the relationships between the eight announced cases (see list below) and those under investigation, are far from clear.
Detail on these relationships, and release of sequences from the growing cluster, would be useful.
Disease onset, age/gender, status
January 24 (28M) critical
January 26 (4F) mild/discharged
January 27 (42M) critical
January 29 (5M) stable
January 30 (5F) mild
???????? (48M) stable
???????? (62M) stable
???????? (11M) stable