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Fenggang H7N9 Case Raises Transmission Concerns
Recombinomics Commentary 16:00
December 15, 2013

After preliminary investigation, the patient started on December 6 with fever, headache and fatigue and discomfort, did not improve after the self-medication, he worked in a local clinic, Fenggang town, the 11th to Fenggang hospital treatment, 13 patients with dyspnea was progressively increased transferred to ICU treatment.

The above translation describes the most recent H7N9 confirmed case in China.  This case (39M) is also in Guangdong Province who lives in Fenggang town in Dongguan (see map).  The above claim that he “worked in a local clinic” in Fenggang town raises concerns that he was infected by another case.  H7N9 was recently confirmed in two wet markets in the Longgang district which are 7-8 miles south of Fenggang town. 

The index case in Hong Kong (36F) had handled live poultry in the Longgang district (also depicted in map).  In contrast, the second case in Hong Kong (80M), lived about 20 miles west of the Longgang district.  He did not have contact with live poultry, and developed symptoms 3 days after admission Tuen Mun Hospital (see map), where the index case was also treated and hospitalized.

The sequence from the index case, A/Hong Kong/5942/2013, was promptly released.  It had acquired internal genes that had been circulate\ng in H9N2 poultry in southern China, which were easily distinguished from cases
(A/Zhejiang/22/2013 and A/Zhejiang/DTID-ZJU10/2013) in northern China (in the spring and fall), which had internal genes related to H9N2 circulating in northern China.  Moreover, the August sequence from southern China, A/Guangdong/1/2013 had fewer southern H9N2 genes and was easily distinguished from the Hong Kong sequence.

The sequence from the second Hong Kong case has not been released.  If he was infected by nosocomial transmission linked to the first case at Tuen Mun, the two sets of sequences should be virtually identical.  Similarly, these sequences should also be closely related to sequences from live markets in the Longgang district.  These sequences, which are from samples collected more recently, also have not been released.

The release of sequences from the second Hong Kong case, the positive samples in the Longgang district, and the most recently case, should be released immediately.

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