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H7N9 Cluster In Fuzhou Fujian Province  Grows
Recombinomics Commentary 10:30
May 5, 2013

Patients Wie, male, 69 years old, Fuzhou, Fuqing City, Town farmers. April 29 patients palpitations, chest tightness reasons unknown origin "to stay at the Fujian Provincial Hospital April 30 after cardiac surgery, recurring fever accompanied by cough, lung infection after anti-infective therapy is still progress. May 2 sample and send Fuzhou Center for Disease Control detection, re-examination by the Fujian Provincial Center for Disease Control in the afternoon of May 4, report the cases of specimens of human infection of H7N9 avian influenza virus nucleic acid positive. In the evening of May 4, the provincial-level expert group based on the clinical performance, results of laboratory tests and epidemiological data, the diagnosis of human infection of H7N9 avian influenza confirmed cases. At present, the case is under active treatment. After investigation, as of the close contacts of the cases of 9, to take timely measures of medical observation, were not unusual.

Up to now, the province reported a total of four cases of human infection with the H7N9 avian influenza confirmed cases were in active treatment and no deaths. Distribution of cases (n = 3) in Fuzhou, Longyan (1) two municipalities and districts in three counties (cities, districts).

The above translation describes a new H7N9 bird flu case in Fuqing City, Fuzhou, Fujian Province, which is near two other recent cases (see map), one that was also in Fuqing City, and the other in Cangshan District, Fuzhou (click on map markers for detail).  These cases, as well as the fourth case in Fujian Province, mark the leading southern spread of H7N9 (see map)..

Although the reporting of cases has slowed markedly in the past week, this change appears to be largely linked to testing / reporting.  H7 was confirmed in poultry in Guangdong province, leading to extensive culling, but the announcement of the confirmation of H7N9 has been delayed.  There have also been rumors that reporting of cases has been limited to two per day, and reports of spread have been banned or discouraged.  Instead, emphasis has been placed on cases discharged and the absence of cases after culling.

However, the number of poultry sequences with PB2 sequences with mammalian adaptation markers at position 627 or 701 remains at 0% (0/5), while the number of PB2 human sequences with E627K or D701N remains at 100% (10/10).  Moreover, the 10 human PB2 sequence from 8 patients is heavily weighted toward E627K (7 of 8 cases) signaling clonal expansion in humans, supported by identity in sequences from cases linked to Jiangsu Province, but not each other (A/Hangzhou/1/2013 and A/Jiangsu/01/2013).  Thus, the role of H7N9 in poultry in any of the recent human cases remains to be demonstrated by sequence matches.

The H7N9 reporting delays and anomalies continue to increase pandemic concerns.

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