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H7N9 Minhang Familial Cluster of Three Confirmed?
Recombinomics Commentary 23:30
April 16, 2013

On April 15, the City Health and Family Planning Commission, then the national CDC letter informed case samples submitted to the national CDC Shanghai Fifth People's Hospital in late March, detected four cases of human infection with the H7N9 avian influenza virus-positive cases. Isolated from samples of which 2 cases of human infection with the H7N9 avian influenza virus, 2 cases of convalescent serum antibody titers were more than four times higher.

The above translation matches previously reported suspect / PCR confirmed H7N9 bird flu cases linked to the Fifth People’s Hospital in the Minhang District (see map).  The two suspect cases were the sons (55M and 69M) of those first confirmed case (87M represented by A/Shanghai/1/2013).  Like their father, both had severe pneumonia and the younger son died.  However, in contrast to their father, they tested negative for H7N9.  All three family members were admitted between March 14 and 24, and the father developed symptoms on March 19 suggesting he was infected by one or both sons.  This human to human (H2H) transmission is also supported by the absence of any travel by the father from his residence in the 2 weeks prior to disease onset.

Since both sons were hospitalized with severe pneumonia, it is likely that serum samples were collected at admission, as well as times closer to discharge or death, allowing for a greater than four fold increase in H7 antibody titer, confirming H7N9.

Thus, it appears that the familial cluster has been lab confirmed and this familial cluster accounts for one of the newly announced deaths (55M) and discharge (69M).  The two PCR confirmed cases match those described in additional media reports which cited additional lab confirmed cases at the Fifth people Hospital, which included fatal and discharged cases.  These four confirmed cases are represented in the updated map.

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