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WHO On Hunan H7N9 Shuangfeng Cluster
Recombinomics Commentary 21:15
February 17, 2014

A 21 years old woman from Loudi City, Hunan Province, who became ill on 30 January and was admitted to hospital on 1 February and then transferred to another hospital on 2 February. She is currently in a critical condition. The patient has a history of exposure to live poultry.

A 23 year-old man from Loudi City, Hunan Province, who became ill on 8 February and was admitted to hospital on 9 February. He is currently in a severe condition. The patient has a history of exposure to live poultry.

The above description of a cluster in Shuangfeng in Loudi City, in Hunan Province (see map) includes an index case (21F in red as described in the February 10 WHO H7N9 bird flu update) as well as a subsequent case (23M in blue as described in the February 14 update).  Although the WHO descriptions do not include a relationship between the cases, the deputy of the Loudi CDC has indicated that they are wife and husband.  Moreover the WHO also does not cite the large gap in disease onset dates (9 days) which strongly suggests the wife infected her husband.  The history of poultry exposure is likely linked to the poultry linked to the wife rather than a poultry source for the husband’s infection.

Although WHO is given IHR documentation for these family clusters, which undoubtable include close relationships such as a parent / child, cousins living in the same home, or husband and wife, yet none of these relationships were noted in WHO updates, such as the two listed above.  Instead the updates leave the false impression that the contacts are infected by poultry, even though the cluster members have glaring gaps in disease onset dates.

These misleading updates of clusters involving known family members who are contacts of index cases raises concerns that additional geographic clusters are also due to additional human to human transmission, in spite of the WHO descriptions which omit the relationships between cluster members and instead focuses on poultry links.

Two recent exports (in Guangxi and Malaysia) increase those concerns because WHO does not cite a poultry link for the two index cases or the son of the index case in the Guangxi cluster, which includes onward transmission.

Details on relationships between H7N9 confirmed members in geographical clusters would be useful, since most of the recent H7N9 cases in southern China form such clusters.

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