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Nosocomial transmission of avian influenza A (H7N9) virus in China: epidemiological investigation

tetano

Editor, Senior Moderator
Previous reports of person to person transmissions have all occurred in family clusters, suggesting that either common exposures or genetic susceptibility might contribute to the infection.

The study describes two patients who shared the same ward in a district hospital in Zhejiang Province, China in February 2015.
The first (index) case was a 49 year old man who became ill after buying two chickens from a live poultry market for the wedding ceremony of his elder daughter. He developed a fever, cough, and sore throat and was admitted to a district hospital on 18 February.
He was diagnosed with H7N9 virus on 24 February and was admitted to a specialist hospital ward with intensive care facilities. He died of multi-organ failure on 20 April.
The second case, a 57 year old man with a history of chronic lung disease (COPD), developed flu-like symptoms after staying on the same ward of the district hospital as the index case for five days (18 to 23 February).
He was diagnosed with H7N9 virus on 25 February and died of respiratory failure on 2 March.
A total of 38 close contacts of both cases, including family members and health workers, were tested for the virus.
Two samples taken from the chickens purchased by the index patient as well as five of 11 samples from the live poultry market he visited were positive for H7N9 virus.
The second patient had no history of poultry exposure for 15 days prior to his illness. Samples from his home, from chickens raised by his neighbours, and a local chicken farm were all negative for H7N9 virus.
Yet the genetic sequence of H7N9 virus from the second patient was nearly identical to that from the index patient, and genetically similar to the virus samples taken from the live poultry market visited by the index patient.


...


http://medicalxpress.com/news/2015-11-evidence-probable-transmission-bird-flu.html
 
Nosocomial transmission of avian influenza A (H7N9) virus in China: epidemiological investigation

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h5765 (Published 19 November 2015)Cite this as: BMJ 2015;351:h5765

  • Chun-Fu Fang, director1,
  • Mai-Juan Ma, epidemiologist2,
  • Bing-Dong Zhan, epidemiologist1,
  • Shi-Ming Lai, deputy director1,
  • Yi Hu, virologist2,
  • Xiao-Xian Yang, molecular biologist2,
  • Jing Li, virologist2,
  • Guo-Ping Cao, epidemiologist1,
  • Jing-Jing Zhou, molecular biologist2,
  • Jian-Min Zhang, public health officer1,
  • Shuang-Qing Wang, public health officer1,
  • Xiao-Long Hu, public health officer1,
  • Yin-Jun Li, public health officer2,
  • Xiao-Xiao Wang, epidemiologist3,
  • Wei Cheng, epidemiologist3,
  • Hong-Wu Yao, molecular biologist2,
  • Xin-Lou Li, molecular biologist2,
  • Huai-Ming Yi, epidemiologist4,
  • Wei-Dong Xu, doctor5,
  • Jia-Fu Jiang, epidemiologist2,
  • Gregory C Gray, professor6,
  • Li-Qun Fang, epidemiologist2,
  • En-Fu Chen, epidemiologist3,
  • Wu-Chun Cao, professor2
  • 1Quzhou Center for Disease Control and Prevention, Quzhou, China
  • 2State Key Laboratory of Pathogen and Security, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
  • 3Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
  • 4Changshan County Center for Disease Control and Prevention, Changshan, China
  • 5Kecheng District People’s Hospital, Quzhou
  • 6Division of Infectious Diseases, Global Health Institute, & Nicholas School of the Environment, Duke University, Duke University Medical Center, Durham, NC, USA
  • Accepted 13 October 2015
Abstract

Study question Can avian influenza A (H7N9) virus be transmitted between unrelated individuals in a hospital setting?

Methods An epidemiological investigation looked at two patients who shared a hospital ward in February 2015, in Quzhou, Zhejiang Province, China. Samples from the patients, close contacts, and local environments were examined by real time reverse transcriptase (rRT) polymerase chain reaction (PCR) and viral culture. Haemagglutination inhibition and microneutralisation assays were used to detect specific antibodies to the viruses. Primary outcomes were clinical data, infection source tracing, phylogenetic tree analysis, and serological results.

Study answer and limitations A 49 year old man (index patient) became ill seven days after visiting a live poultry market. A 57 year old man (second patient), with a history of chronic obstructive pulmonary disease, developed influenza-like symptoms after sharing the same hospital ward as the index patient for five days. The second patient had not visited any poultry markets nor had any contact with poultry or birds within 15 days before the onset of illness. H7N9 virus was identified in the two patients, who both later died. Genome sequences of the virus isolated from both patients were nearly identical, and genetically similar to the virus isolated from the live poultry market. No specific antibodies were detected among 38 close contacts. Transmission between the patients remains unclear, owing to the lack of samples collected from their shared hospital ward. Although several environmental swabs were positive for H7N9 by rRT-PCR, no virus was cultured. Owing to delayed diagnosis and frequent hospital transfers, no serum samples were collected from the patients, and antibodies to H7N9 viruses could not be tested.

What this study adds Nosocomial H7N9 transmission might be possible between two unrelated individuals. Surveillance on patients with influenza-like illness in hospitals as well as chickens in live poultry markets should be enhanced to monitor transmissibility and pathogenicity of the virus.

http://www.bmj.com/content/351/bmj.h5765
 
H7N9 Nosocomial cluster in Quzhou I believe are these cases!

#614 - Male, 49, hospitalized in Hangzhou, Zhejiang province [Kecheng]
#628 - Male, 57, Changshan county, Zhejiang province [Changshan County is a county under the jurisdiction of Quzhou

FluTrackers H7N9 human case list link

If I'm not mistaken the strain designations isolates were publically available in June 2015 with both human strains being 100% identical but having collection date disparities.

Follow up:

A/Quzhou/2/2015 (odd Collection date 23-Apr-15)
A/Quzhou/1/2015 (odd collection date 25-Apr-15)
A/chicken/Quzhou/2/2015 [Feces 24-Feb-15)

http://www.fludb.org/brc/influenza_s...in_display.spg
 
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