Wednesday, February 15, 2017

Yunnan: 2nd Imported H7N9 Case (Mother of Last Week's Case)


With the upfront caveat that a family cluster does not necessarily imply human-to-human (H-2-H) transmission (both could have a shared poultry exposure) - we always are alert to cases where a close contact of a known case falls ill.
Last week, in Yunnan Province Reports Their 1st H7N9 Case (Imported), we saw a report on the death of 3 year old girl, whose family had visited Jiangxi Province over the New Year's holiday. 

While the official report on February 9th stated that `all close contacts did not appear abnormal', what was not disclosed was that the child's mother had been symptomatic for several days, and was placed in isolation on the 8th. 
She apparently tested negative for H7N9 upon admission, but later tested positive.  Her illness rapidly progressed and she died on the 14th.
As we’ve discussed before, when it comes to proving  H-2-H transmission of an emerging virus, the bar is set pretty high. When there are other, equally plausible explanations (e.g. shared environmental exposures), then H-2-H cannot be assumed.

Hopefully we'll get a more detailed epidemiological review out of the WHO on these cases, but for now local authorities are denying H-2-H transmission.

Yunnan Province confirmed a second case of imported H7N9 cases

[Index: 01510047-20170215-6818] Release Date: 2017-02-15

Yunnan Provincial Health and Family Planning Commission February 15 briefing in Health and Family Planning Commission from one case to return from Jiangxi and Yunnan severe cases detected H7N9 virus nucleic acid positive. According to the national, provincial expert consultation, clinical manifestations, laboratory tests and epidemiological investigation, confirmed imported cases of H7N9, Yunnan Province confirmed a second case of imported cases of H7N9, the first cases of imported cases Department of H7N9 cases mother-daughter relationship, have a common history of contact with live birds.

Patients with Yang XX, female, 23 years old, on January 21 a three Jiangxi New Year, there is history of exposure to live poultry, February 4 back to Kunming, a fever, self fatigue, self-medication, and no relief, because his daughter confirmed human cases of H7N9 infection, as close contacts on February 8 at 1:00 am the provincial emergency center car into a negative pressure isolation treatment hospital for infectious diseases in Yunnan Province. Admission detect H7N9 negative, after admission, the disease progresses rapidly, after repeated testing, identified as H7N9 avian influenza virus nucleic acid positive.

After the outbreak, the provincial government of Yunnan leadership made important instructions required to treat the patient, the Ministry of Health and Family Planning Commission set up rescue work group, all-out mobilization of the province of experts rescue work, and invited experts from the three countries, Beijing, Guangdong, made a special trip Yunnan to participate in treatment. By the national, provincial experts to rescue invalid, in at 20:03 on February 14 minutes Death.
At present, the rest of the close contacts no abnormality occurred, the situation of human to human transmission was not found.

According to the CDC in Yunnan province outside environmental monitoring samples, at present, I have not found in the environment outside the province H7N9 virus.

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