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Commentary
Shanghai H7N9
Familial Cluster Chronology Supports H2H
Recombinomics
Commentary 23:00
April 1, 2013
According to Shanghai No. 5 People's Hospital, the three members of the Li family were admitted between February 14 and 24 for symptoms including a high fever and coughing. All three were diagnosed as having pneumonia. The 69-year-old son recovered and was discharged but the 55-year-old died from severe pneumonia and respiratory failure in late February. The father died of multi-organ failure.
The above comments (in red) indicate that the confirmed case (87M) in the above cluster has no exposure to birds or people outside of his house. Media reports and the April 1 WHO update indicate disease onset was February 19. This one or both of his sons (see blue above) were hospitalized prior to his disease onset, strongly suggesting that one or both were the source of his infection. Both sons had similar systems and one (55M) died (as did the father, 87M).
These dates and contacts signal human to human transmission in this family, as expected from the sequences from the three confirmed cases, which include the 87M. All three have PB2 E627K as well as a 15 BP deletion in N9. Two of the confirmed cases, A/Shanghai/2/2013 and A/Anhui/1/2013 were most closely related to each other and had the receptor binding domain change Q226L, (added to all three H5s in transmiison studies) which would likely increase human to human (H2H) transmission. The age and collection dates for the two male confirmed cases (87M and 27M) were withheld. However samples as usually number chronologically, so it is likely that A/Shanghai/1/2013 is from the 87M, since his disease onset was more than a week earlier than the unrelated case (27M).
Regardless of the assignment, the above bird flu H7N9 cluster strongly suggests that all three family members were infected and one or both sons infected their father.
Although WHO maintains there is no evidence of H2H based on confirmed cases, the above cluster has disease onset dates that support H2H transmission, as expected due to the genetic changes in these sequences.
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