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Commentary
Huaiji H7N9 Geographic Cluster Of Familial
Clusters
Recombinomics Commentary 23:00
February 10, 2014
A 4 year-old girl from Zhaoqing City, Guangdong Province, who became ill on 26 January and was admitted to hospital on 3 February. She is currently in a mild condition. The patient has a history of exposure to live poultry.
A 5-year old boy from Zhaoqing City, Guangdong Province, who became ill on 29 January and admitted to hospital on the same day. He is in a stable condition. The patient has a history of exposure to a live poultry market.
Li Family
A 48 years old man from Zhaoqing City, Guangdong Province, who became ill on 28 January. He was admitted to hospital on 30 January and then transferred to a hospital in Guangzhou City on 5 February 2014. He is currently in a severe condition. The patient has a history of exposure to live poultry.
A 5 year-old girl from Zhaoqing City, Guangdong Province, who became ill on 30 January and was admitted to hospital on the same day. She currently has a mild illness. The patient has a history of exposure to live poultry.
Liang Family
A 42 year-old man from Zhaoqing City, Guangdong Province, who became ill on 27 January and was admitted to hospital on 28 January and transferred to another hospital on 4 February. He is currently in a critical condition. The patient has a history of exposure to live poultry.
Yijun, male, 11 years old, student, now living Huaiji County, Zhaoqing City, February 8 confirmed cases of human infection of H7N9 avian influenza, the patient's condition is currently stable, treated at a local hospital sentinel.
The WHO February 10 H7N9 birdflu update provides additional information on the Huaiji cluster, which has grown to 8. The WHO update provides additional information on clinical presentation and disease onset dates, which strongly suggest the cluster includes at least three sets of familial clusters. The geographic clusters include four children, and all four are in these three clusters. Neither the WHO updates (in red above) nor the Guangdong Ministry of Health (GD MoH) reports (in blue above) cite the familial relationships, but the withholding of this information has become standard in this outbreak.
Although WHO did acknowledge the contact in a family cluster in Guangxi (which was also acknowledged by the GX MoH), that cluster represented H7N9 export since the index case worked in GD Province (Zhongshan) and developed symptoms prior to returning to Hengxian, Nanning in GX Province where she was H7N9 confirmed. Her son developed symptoms after she returned signaling human to human (H2H) transmission, as well as onward transmission of exported H7N9, which is a serious development.
The more common H2H transmission within families located in a given region is not cited in the agency updates, and are identified in local media reports in many instances, as well as well defined patterns involving cases which share a surname. Since most married women keep their family name and children are given the husband's family name, the surname matches are most useful when the cluster involves a father / child relationship. Thus, in the three person cluster in Xiaoshan in Zhejiang the father and daughter shared the same family name (Yu) which was distinct from the wife’s name (Wang).
For father / child clusters the surnames were shared. The Hunan cluster in Jiangyong, Yongzhou, the father (38M) and daughter (8F) shared the Yang family name, which was also true for GD clusters. In Baiyun in Guangzhou the father (29M) and daughter (2F) share the family name of Pan. In Sanjiaozhen, Zhongshan the father (37M) and daughter (2M) share the family name of Liang.
However, in Guangxi, the mother’s (41F) name is Li, while her son (5M) is Gan.
The relationships for all of the above clusters were cited in Chinese media reports and only the GX relationship was cited in agency reports (GX MoH and WHO).
However, for the Huaiji cluster only the two cousins (5M & 4F) who live in the same home are cited as contacts in media reports. They share the family name of Oi (see pairings above) which is machine translated as “European”. However, family names are shared in two additional sets, which include an adult as the index case, followed by a child (who has a milder clinical presentation). One set (48M & 5F) share the family name of Li (machine translated as Lee), while the other family name of Liang (machine translated as Yijun) is shared by another set (42M & 11M).
Thus, the eight person cluster in Huaiji is really of geographic cluster that contains three family clusters of two members each, which may also have contacts with each other. This concentration of family clusters with disease onset dates over a relative short time frame (about a week) raises concerns that H2H transmission is far more common than indicated in agency reports, which withhold these relationships.
More information on contact within and between families would be useful in the above clusters as well as other clusters which involve contacts which do not have the father / child relationship, as seen in the Huaiji clusters grouped above.
Disease onset, age/gender, status, family name
January 24 (28M) critical
Kong
January 26
(4F)
mild/discharged Oi
January 27
(42M)
critical
Liang
January 28
(48M)
severe
Li
January 29
(5M)
stable
Oi
January 30
(5F)
mild
Li
February 1
(62M) severe
Lin
???????? (11M) stable
Liang
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