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Paradigm Shift Intervention Monitoring
Causes CDC Activation of Emergency Operations Center
The EOC was activated at level 2, the second of three levels. Level 1, the highest, signals an agency-wide response.
The above activation of the CDC EOC is not a surprise. Although WHO and the CDC have claimed there was no human to human (H2H) transmission of H7N9, the first confirmed case represented by A/Shanghai/1/2013 was part of a familial cluster (both sons had severe pneumonia and one, 55M, died) as well as a geographic cluster (the second confirmed case, A/Shanghai/2/2013, lived in the same area, Minghang District, and was treated at the same hospital, Fifth Peoples Hospital). Media reports cited a significantly larger cluster.
Moreover, the birds at live markets in the area (see map) were H7N9 positive and also had a key receptor binding domain change, Q226L raising the possibility that the birds were infected by humans.
The key change, however, was the presence of PB2 E617K in all three human sequences, and absence in all three avian sequences.
Moreover, the case fatality rate is at 90%, although many mild cases have not been tested.
Therefore, the activation was expected.