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Another H7N9 Dongguan Case Raises Concerns
Recombinomics Commentary 15:00
November 5, 2013

Patient is an approximately 3 years, 5 months boy, Sichuan Suining people living in Changping Town, Dongguan. Patients currently treated in isolation, Dongguan City People's Hospital, he had no fever, symptoms of mild, stable condition.

The above translation describes the most recent confirmed H7N9 case (3M) in China.  He is the third confirmed H7N9 bird flu case this season, but he is near an August case, which was also in Dongguan City in Guangdong Province (see map).  The two earlier cases this season were in Zhejiang province, near Shanghai in northern China (see map).

Full sequences have been released from patients in each geographic region.  The earlier sequence from Dongguan, A/Guangdong/1/2013, had H7 and N9 sequences similar to the vast majority of cases from the spring (most of which were from northern China in and around Shanghai).  However, the sequences for four of the internal gene segments (PB2, PB1, NP, NS) match H9N2 avian sequences from southern China (in and around Hong Kong), in contrast to the cases from northern China, which match H9N2 avian sequences from northern China (in and around Shanghai) as seen in A/Zhejiang/22/2013 and A/Zhejiang/DTID-ZJU10/2013 from the same case (35M).

Thus, the reporting of a second case in Dongguan since August, 2013 raises concerns that two distinct H7N9 lineages are circulating in China at the present time.  Moreover, the detection (via routine surveillance) of the most recent case in a child who did not have a fever and had mild symptoms, raises concerns that the number of H7N9 cases, especially in children may be much higher than the reported cases.  Moreover, initial reports have not cited a poultry link for the latest case.

More information on poultry exposure and the sequences from this case would be useful.

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