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H7N9 Minhang Familial Cluster Confirmed
Recombinomics Commentary 21:00
April 17, 2013

The elder son, who has recovered from the disease, was previously confirmed to have contracted the virus, the Chinese National Health and Family Planning Commission said on Wednesday at a media briefing.

However, the results of a test on the younger son were not available.

The above comments confirmed the Minhang familial cluster, which was first reported on March 7,  At that time it was known that three family members (87M, 69M, 55M) had been admitted to the Fifth Peoples Hospital in the Minhang District of Shanghai (see map) between March 14 and March 24 with severe pneumonia and the father (87M) and youngest son (55M) had died.  Officials noted that they had tested negative for the novel coronavirus (nCoV) and common flu serotypes (H1N1pdm09, H3N2, H5N1) and that the pneumonia was due to weather changes.  A microblogger posted that they had died from influenza, and the blogger was arrested and fined for spreading false rumors.

However, on March 31 the confirmation of three cases of H7N9 bird flu was announced, including two from Shanghai.  One of the Shanghai case’s age and gender (87M) matched the father in the cluster and subsequent reports indicated all three family members, as well as the second confirmed cases in Shanghai (27M) lived in the Minhang District and all four were treated on the same floor of the Fifth Peoples Hospital. 

Both confirmed cases had died amd the family of the second case threatened to file suit against the hospital base on a nocosomal infection due to one of more of the symptomatic family members.  Sequences from the father, A/Shanghai/1/2013, and second confirmed case A/Shanghai/2/2013 were distinct and did not support the infection of the second case by one of the family members, but media reports indicated additional lab confirmed H7N9 cases were being treated at the same hospital at the same time, supporting a nocosomal infection, which was supported further by payment of 130,000 yaun to the family from the hospital.

Yesterday the Chinese National Health and Family Planning Commission held a press conference to announce the retroactive confirmation of four additional cases at the Fifth Peoples Hospital.  Two were confirmed by a more than 4 fold increase in H7 antibodies, while the other two were confirmed by PCR, consistent with earlier media reports.

However, WHO subsequently tweet denials of confirmation because the serological test was unreliable and additional testing would be required, which is the likely reason why the above comments only cited confirmation of the older surviving son.  This confirmation established a H7N9 familial cluster, but there is little doubt that the son who died was also H7N9 infected, as supported by severe pneumonia symptoms and the serological test.

Moreover, the time gap between the hospitalization of one or both sons on March 14 and the disease onset in the father on March 19 indicated the source of the infection of the father, who had not left his residence in then two weeks prior to disease onset, was one or both sons, defining human to human (H2H) transmission.

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