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Nanjing Jiangsu H7N9 Critical Case
Recombinomics Commentary 12:00
April 2, 2013

A new case of bird flu was reported in China’s eastern Jiangsu province on Tuesday after a member of staff at a Nanjing hospital leaked a patient’s diagnosis on a Chinese social networking site.
The Weibo user named “phoenix”, whose Weibo profile says he’s an administrative director at Nanjing Drum Tower Hospital, posted a photo of what appears to be a patient’s diagnosis on Tuesday.

The diagnosis said that a 45-year-old Jiangsu woman, who worked as a poultry butcher at a local market, had fallen ill with a fever and a cough sometime in March. Her condition worsened on March 24 when she was sent to intensive care. On March 30, doctors confirmed that the patient was infected with H7N9 avian influenza and she was quarantined.

The above comments describe a new H9N7 case, which is in Nanjing adjacent to Chuzhou City in Anhui (see map).  Thus, the first 4 cases fall into two geographic cluster, two near Nanjing and two in Shanghai.  However, local media describe multiple new cases in Shanghai in addition to the two confirmed cases in Shanghai and the two symptomatic contacts (69M and 55M) of one of the confirmed case (87M).  The disease onset dates signal human to human transmission (H2H) in the cluster.

H2H is also supported by the presence of H7 Q226L in Shanghai (A/Shanghai/2/2013) and Chuzhou City (A/Anhui/1/2013).  Both of these sequences, as well as the confirmed cluster case (A/Shanghai/1/2013, also have a 15 BP deletion in N9 as well as PB2 E627K.

More information on the Nanjing and Shanghai cases would be useful.

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