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H5N1 Fatality in Fujian Province

Recombinomics Commentary

December 29, 2005

The woman, a factory worker in Sanming, a city in coastal Fujian province, fell ill on Dec. 6 and died on Dec. 21, the official Xinhua News Agency said, citing the Health Ministry. It said lab tests confirmed her infection according to World Health Organization standards.

The above comments describing a fatal H5N1 infection in Fujian Province raise a number of concerns regarding the number of human H5N1 cases in China.  Like the last human case, in Jianxi, China, the patient is in an area that has not reported H5N1 activity this year.  Moreover, the reports on this case give no indication of how a factory worker would have been exposed to H5N1 poultry.  The confirmed case also adds yet a another province in China where there has been an H5N1 confirmed case.

However, it is unlikely that this is the first H5N1 human case in Fujian Province.  In the beginning of 2003 a Hong Kong family visited Fujian Province.  The daughter died in Fujian Province with bird flu symptoms and her father and brother returned to Hong Kong.  The Z+ genotype of H5N1 was isolated from each (A/Hong Kong/212/03(H5N1), A/Hong Kong/213/03(H5N1)) and the father died.  The recovered H5N1 had the S227N polymorphisms associated with increased binding of the human receptor found on cells of the upper respiratory tract, raising concerns of more efficient human-to-human transmission.  Since the latest case has no announced link to poultry, human-to-human transmission remains a concern.

This concern is enhanced by data from Hunan Province where a confirmed and suspected H5N1 cases were reported.  Although H5N1 was not isolated directly from the patients, H5N1 from a family chicken was related to H5N1 from Fujian Province.

Considerable evidence exists for H5N1 in Fujian Province.  This year a ProMed report detailed geese dying in Fujian Province.  Although the birds were not tested for H5N1, the clinical symptoms, including falling over and a twisted neck, matched symptoms of H5N1 infections.  Replacement of stocks with birds from nearby provinces produced the same outcome, suggesting H5N1 was widespread in the Fujian Province region..

The publication of H5N1 in Qinghai Lake bar headed geese also contained H5N1 sequences from Fujian (A/Duck/Fujian/1734/05(H5N1)), Hunan, Yunnan, and Guangdong Provinces, indication H5N1 is circulating in these provinces this year. Although there had been no OIE reports at that time and there still have been no reports for any of these provinces except Hunan.

The above data suggest H5N1 is widespread in China in birds and probably humans.  Human cases have now been reported for Anhui, Hunan, Guangxi, Liaoning, Jianxi, and Fujian Provinces, suggesting many versions of H5N1 in China can cause human infections and the number of such infections

In addition, sequence analysis links polymorphisms in 1997 Hong Kong outbreak, the cases linked to Fujian Province in 2003, tree sparrow sequences in Henan, poultry sequences in Hubei, and wild bird sequences from Qinghai Lake (China), Chany Lake (Russia), and Erhel Lake (Mongolia) demonstrating recombination and evolution of H5N1 strains lethal to birds and humans.

Sequences on the isolates from birds and humans would be useful in mapping the evolution of H5N1 in China in 2005.


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