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Interpetation H7N9 person to person transmission in Binhu district of Wuxi City, Jiangsu province (Qi et al 2013)

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  • Interpetation H7N9 person to person transmission in Binhu district of Wuxi City, Jiangsu province (Qi et al 2013)

    Qi X, Qian Y, Bao C, et al. 2013 Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation. BMJ 2013;347:f4752 doi.org/10.1136/bmj.f4752 (Published 6 August 2013) open access

    Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation | BMJ
    http://www.bmj.com/content/347/bmj.f4752


    http://www.bmj.com/highwire/filestre...df/0/bmj.f4752

    Clip

    The index patient was a retired man aged 60 with a history of
    hypertension for more than 10 years. He developed a fever,
    cough, and shortness of breath on 8 March 2013 and was
    admitted to a Chinese hospital (hospital A) on March 11 with
    a left upper lobe inflammation. Initial blood routine testing
    identified no abnormality, except for increased hypersensitive
    C reactive protein (28.5 mg/L). He was treated with
    azithromycin and piperacillin-sulbactam. Because of progressive
    respiratory distress, persistent hyperpyrexia, and hypoxemia,
    he was transferred to the hospital’s intensive care unit in the
    afternoon of 15 March with a diagnosis of viral pneumonitis
    and type I acute respiratory distress syndrome. He was again
    transferred to another tertiary hospital’s (hospital B) intensive
    care unit because of deterioration on 18 March and began to
    treatment with oseltamivir the next day. He did not develop
    diarrhoea during the course of the disease. He died of
    disseminated intravascular coagulation and multi-organ failure
    on 4 May.

    The index patient’s daughter, an unemployed woman aged 32,
    was otherwise healthy without any underlying illnesses. She
    provided bedside care for her father until he was admitted to
    the second hospital’s intensive care unit. She developed fever
    with body temperature 39.6°C and cough on 21 March. On 24
    March, she was admitted to the pneumology department of the
    same hospital (hospital B) with pneumonia in the left upper
    lobe. Initial testing showed leucocytopenia (2.0×109/L),
    lymphopenia (0.7×109/L), and slight hypoxia. She was treated
    with antibiotics (azithromycin and piperacillin-sulbactam).
    Oseltamivir (75 mg twice a day) was administered on 24 March.
    She was transferred to intensive care on 28 March because of
    persistent hyperpyrexia, respiratory failure, and acute respiratory
    distress syndrome. Although treated with mechanical ventilation,
    broad spectrum antibiotics, oseltamivir, immunological therapy,
    and fluid resuscitation, she died of multi-organ failure and
    cardiac arrest on 24 April. Table A in appendix 1 summarises
    the clinical characteristics of the two patients.

    see supplements:
    http://www.bmj.com/highwire/filestre...unct_files/0**

    Web Extra

    Extra material supplied by the author

    Files in this Data Supplement:
    Data Supplement - Appendix 1: Supplementary tables and definitions of cases and close contacts
    Data Supplement - Appendix 2: Phylogenetic trees for eight gene segments
    Web Extra | BMJ
    http://www.bmj.com/content/suppl/201.../bmj.f4752.DC1

    Full genome sequences of
    the viruses were deposited in GenBank (accession number:
    KF034916-KF034923 for the father (index case),
    KF034908-KF034915 for the daughter, and
    KF150605-KF150612 for the environment).

    Most likely Flu tracker cases #7 and #119:


    #7 - Woman, 32, onset date March 21 - hospitalized March 28 - Binhu district of Wuxi City, Jiangsu province Death Note
    (probable hospital transmission while caring for father, A/Wuxi/1/2013**)

    FluTrackers - View Single Post - China - 4 cases of H7N9 + some suspected cases hospitalized? - Jiangsu province - Updated April 4, 2013
    http://www.flutrackers.com/forum/sho...0&postcount=15
    and
    http://www.flutrackers.com/forum/sho...04&postcount=1

    #119 - Man, 60, Binhu District Jiangsu province
    (Index Father of FT case #7 !,A/Wuxi/2/2013**)

    http://www.flutrackers.com/forum/sho...04&postcount=1


    Also see:
    First probable person to person transmission of new bird flu virus in China | BMJ Editorial
    http://www.bmj.com/press-releases/20...lu-virus-china


    H/T Tetano ( Yesterday 04:55 PM)
    BMJ: First probable person to person transmission of new bird flu virus in China - H7N9 - FluTrackers
    http://www.flutrackers.com/forum/sho...d.php?t=209752
    and
    CIDRAP (RSS)
    Study reports person-to-person spread of H7N9 in family | CIDRAP
    http://www.cidrap.umn.edu/news-persp...ad-h7n9-family

  • #2
    Re: Interpetation H7N9 person to person transmission in Binhu district of Wuxi City, Jiangsu province (Qi et al 2013)

    I have updated our case list to reflect this confirmed cluster.

    It was mentioned in the WHO news conference of April 19, but there were no details given at that time.

    http://www.flutrackers.com/forum/sho...04&postcount=1

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