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H7N9 Case Confirmed in Shaoxing Zhejiang
Recombinomics Commentary 19:00
October 15, 2013

patients Liu XX, male, aged 35, a company employee, now living in Shaoxing County. October 8 in Shaoxing County township first diagnosed, Shaoxing, now a hospital for treatment.

the patient's condition has been severe, there has been coma, edema, pulmonary symptoms of low blood oxygen saturation. According to the history and CT changes, etc., the patient's condition and February this year he was first discovered in Shanghai Minhang H7N9 cases are very similar.

through to the family learned that the patient engaged in painting, copying aspects of the work, often outside the sketch.

The above translation describes the first confirmed H7N9 case in the 2013/2014 flu season in the northern hemisphere.  The vast majority of prior cases were confirmed in the winter/spring of 2013 and most cases were in northern China, including the first cases in the Minhang District in Shanghai in February.  As noted above the symptoms in the current case matches those observed in cases in the spring, when the largest number of confirmed cases was identified in Zhejiang province.

This case, in Shaoxing, is also in Zhejiang province, although the source of the infection is far from clear, since there is no occupational exposure.

The most recent case prior to the current case, was in Guangdong province.  The full sequence, A/Guangdong/1/2013, was recently released by the Guangdong CDC.  Although the N9 sequence was identical to earlier cases and the H7 was closely related, the Guangdong sequence represented a reassortant which contained four internal gene segments (PB2, PB1, NP, NS) which were most closely related to H9N2 genes from southern China (in contrast to the earlier cases which had H9N2 internal genes closely related to sequences from northern China).

Moreover, recently releases H7N9 sequences from Hunan province (A/Changsha/1/2013 and A/Changsha/2/2013) from cases from last spring have gene segments closely related to the earlier cases, including H7 Q226L.  However, the PB2 sequences from these two cases do not have adaptive changes which were seen in all prior PB2 sequences from patient (which was dominated by E627K).  The two Hunan sequences exactly match avian PB2 sequences at the protein level, signal additional diversity in human H7N9 sequences.

Although, H7N9 cases in the fall have been expected, the confirmation of the first cases increases concerns that many additional cases will follow in the near term.

Release of sequences from the latest case would be useful.

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