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H7N9 Minhang Confirmed Cluster Grows To Six
Recombinomics Commentary 08:30
April 17, 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 increases the number of confirmed cases at Fifth Peoples Hospital in the Minhang District to six, which includes two recovered cases.  The two cases confirmed by serum H7 titers is almost certainly the two sons (55M and 69M) of the first confirmed case (87M represented by A/Shanghai/1/2013).  The other prior confirmed case (27M represented by A/Shanghai/2/2013, like the 3 member familial cluster also lived in the Minhang District and died at the Fifth People’s Hospital.  His family
threatened to sue the hospital because they thought the fatal case was infected by one of the three family members. 

However, the A/Shanghai/1/2013 sequence did not match the A/Shanghai/2/2013 sequences,  but the above confirmation indicates at least two additional H7N9 cases were treated at the hospital where at least one additional case died (the official total for confirmed cases is four fatalities and two discharges, consistent with media reports describing the additional cases).  Moreover, the hospital compensated the family (130,000 yaun), adding credibility to their claim of a nosocomial H7N9 bird flu infection, which would represent additional H2H transmission.

The delayed confirmation of these cases raises concerns that H2H transmission is common, which is supported by recent comments by the Ministry of Agriculture, which noted that the 39 confirmed avian cases were identified by testing 47,801 samples.  This low frequency and the presence of Q226L in the sequences from bird samples from live markets in or near the Minhang District (see map) raises the possibility that these birds sequences were linked to transmission from humans to birds (which was also associated with a reversion to wild type at position 627 because all three avian sequences from the region are wild type, while all four humans sequences have E627K).

The presence of E627K in all four human sequences also supports widespread H2H transmission,  The latest update increases the number io confirmed human cases to 78, but only four sets of sequences have been released.  Similarly, only 3 of the 39 H7N9 bird sequences have been released.  An update of sequences from humans and birds would address the failure of the bird PB2 sequences to match the human sequences.

The presence of 6 confirmed H7N9 cases at the Fifth Peoples Hospital in the Minhang District in Shanghai raises serious pandemic concerns, especially since most or all cases are likely due to H2H transmission

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