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Hangzhou and Hong Kong H7N9 Clusters Raise Concerns
Recombinomics Commentary 14:00
December 7, 2013

Inform the PRC Zhejiang Provincial Health Department on December 6, 1 new cases of human infection in Zhejiang Province H7N9 avian flu cases . At risk patients, male, 30 years old. On December 5 confirmed, first affiliated hospital of Zhejiang University School of medicine now.
This reporter learned that, the infection H7N9 avian flu virus risk, was in a hospital of Zhejiang University last Wednesday the 57 confirmed Mr Chang's son-in-law.

The above translation describes the two most recent H7N9 bird flu confirmed cases (57M and 30M) in Hangzhou in Zhejiang Province (see map).  WHO has not yet acknowledge these two cases in northern China or the two recent cases in Hong Kong (36M and 80M) who were both treated in Tuen Mun Hospital (see map).

These two sets of clusters raise serious human to human transmission issues.  Sequences from one of the four above cases, A/Hong Kong/5942/2013, have been released, which are novel and distinct from spring H7N9 cases due to the presence of 5 of the 8 gene segments (PB2, PB1, PA, NP, NS) which are most closely related to H9N2 sequences circulating in southern China (largely from Hong Kong).  Two independent labs have released sequences from an October case, 35M, in Zhejiang, A/Zhejiang/22/2013 and A/Zhejiang/DTID-ZJU10/2013, which  are closely related to H7N9 cases from the spring.

Thus, although H7N9 constellations in northern China and southern China are readily distinguished from each other, the presence of familial and hospital clusters raises serious human transmission concerns. 

Release of sequences from the two cases from Hangzhou, as well as the most recent case in Hong Kong, would be useful.

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