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Another Hong Kong ex-Shenzhen H7N9 Case
Recombinomics Commentary 18:00
December 6, 2013

The patient, with underlying medical condition, lives in Shenzhen. He was admitted to a hospital in Shenzhen for management of his chronic illness from November 13 to 29.

On December 3, he arrived in Hong Kong with his three family members via Shenzhen Bay Port Border Control Point (SBP BCP) and subsequently took a taxi there in the afternoon to the Accident and Emergency Department (AED) of Tuen Mun Hospital (TMH) where he was admitted for further management of his chronic illness on the same day.

The patient had no fever upon admission. However, he developed fever this morning and was put under isolation immediately. His nasopharyngeal swab was tested positive for the avian influenza A(H7N9) virus upon laboratory testing by the Public Health Laboratory Services Branch of the CHP today.

The patient will be transferred to Princess Margaret Hospital for isolation. His current condition is stable.

The above translation, from the Government of Hong Kong press release provides detail on the second confirmed H7N9 case (80M) at the Tuen Mun hospital (see zoomed map), which had a travel history in Shenzhen.  This second case raises concerns that there is a significant number of unreported cases in Shenzhen.

The Guangdong CDC has promptly released a full sequence, A/Hong Kong/5942/2013, from the first case (36F), which has much in common with the sequence, A/Guangdong/1/2013 (GD/1), from August case (51F - see map).  Both sequences are easily distinguished from the H7N9 cases last spring, which had internal H9N2 gene segments related to avian sequences circulating in northern China.  The recent cases had four internal genes (PB2, PB1, NP, NS) which were related to H9N2 sequences circulating in southern China (Guangdong and Hong Kong) and both sequences also had H7 T131A, which also distinguishes the southern H7 sequences from the spring sequences.

However, the recent Hong Kong sequence was novel due to the relatedness of three of these gene segments (PB1, PA, NP) to H9N2 lineages that were distinct from GD/1, which can be used to determine the relatedness of the two Hong Kong sequences to each other.

Rapid release of the latest H7N9 sequences would again be useful.

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