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Hong Kong H7N9 Case(s) Raise Concerns
Recombinomics Commentary 23:30
December 2, 2013

The 36-year-old patient is in a critical condition in Queen Mary Hospital, Pok Fu Lam, with severe pneumonia and breathing with the help of an artificial lung.

The live-in helper works for a couple with two children, and all four were said to have minor flu symptoms and were under observation in quarantine at Princess Margaret Hospital.

Health officials are looking for a second person who accompanied the helper to Shenzhen on November 17.

The helper developed flu symptoms four days later. She was first treated at Tuen Mun Hospital, but was transferred to Queen Mary last Wednesday.

Ko said two earlier tests for the virus came back negative, but a third test last night confirmed she had contracted H7N9.

The above comments describe the first confirmed H7N9 bird flu case (36F) in Hong Kong.  The live-in helper had traveled to Shenzhen (see map) to buy a chicken.  She developed flu symptoms, but tested negative twice.  However, after her condition worsened (including breathing difficulties) she was hospitalized and tested positive for H7N9.

The case raised concerns since she tested negative twice and it is unclear if milder cases will be detected.  The four contacts in the home have mild symptoms, while status of the person who also traveled to Shenzhen is currently unknown.

This is the third H7N9 case originating in Huizhou in Guangdong province since August (collected Aug 10).  A full set of sequences, A/Guangdong/1/2013, was released for the first case (51F).  Although the external gene segments (H7, N9, MP) and NP were  closely related to the cases from the spring (largely centered around Shanghai), the internal gene segments (PB2, PB1, PA, NS) were most closely related to H9N2 sequences found in southern China (largely Hong Kong).

Sequences from a more recent case (3M), which was also from Guangdong Province (Dongguan) have not been released.  However, the Hong Kong case also traveled to Guangdong Province (Shenzhen) raising the possibility that all three cases have a similar constellation of genes which is distinct from the sequences from northern China.

The second case was also linked to symptomatic family members, but they tested negative for H7N9.  The initial negative tests for the current case raise concerns that mild H7N9 cases, including contacts, will also test negative.

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