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Paradigm Shift Intervention Monitoring
H7N9 Confirmed Cases
Patients with a mulberry, female, 48 years old, Suqian Shuyang engaged in sheet metal processing
Patients Shen, male, 83 years old, Suzhou Wujiang District
Patients Zhang, female, 32 years old, Changzhou, now lives in Wuxi city, unemployed
The above translation describes 4 lab confirmed H7N9 cases in Jiangsu Province (see map). Only the case (45F) was described previously. No poultry contact is cited for the other three cases. All four cases had disease onset dates between March 19 and 21 and all were hospitalized between March 27 and March 30.
The four cases increase the number of lab confirmed case in China to 7. Most or all of these cases were severe and at least two were fatal. However, media reports describe a Shanghai cluster as well as multiple additional lab confirmed cases in Shanghai.
This explosion of H7N9 cases in Shanghai and adjacent provinces (Jiangsu and Anhui) are likely linked to a novel subclade which has a PB2 E627K, N9 with a 15 BP deletion, and a subset also have H7 Q226L (never reported in natural H5N1 bird flu).
Only the first three have been cited by WHO.
The large number of cases and the presence of key genetic markers associated with human adaptation raise serious pandemic concerns.