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Suspect Shanghai H7N9 Familial Cluster
Recombinomics Commentary 03:00
April 1, 2013

The 87-year-old's two sons have gone to hospital with similar symptoms.
According to Shanghai No. 5 People's Hospital, the three members of the Li family were admitted between February 14 and 24 for symptoms including a high fever and coughing. All three were diagnosed as having pneumonia. The 69-year-old son recovered and was discharged but the 55-year-old died from severe pneumonia and respiratory failure in late February. The father died of multi-organ failure.

The above comments describe family members of the first confirmed case (87M, A/Shanghai/1/2012) who developed pneumonia.  The confirmed case, as well as one of his sons, died.  The cluster raises concerns that H7N9 is transmitting human to human (H2H) which is not being identified with current testing procedures.  It is likely that all three were H7N9 infected.  The sequence for A/Shanghai/1/2013 was more diverse than A/Shanghai/2/2013 and Anhui/1/2013, but all three had PB2 E627K as well as the 15 BP deletion in N9, signaling human adaptation.

Disease onset dates for the sons would be useful.  H7 has also been identified in horses, supporting mammalian transmission, and other human cases have been associated with symptomatic contacts.  Serological studies had also signaled human transmission, although prior clusters have been mild.  The only prior fatal H7 case (H7N7 in Netherlands in in 2003) had PB2 E627K, which was present in all three 2013 confirmed H7N9 cases, which were severe or fatal.

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