Multiple H7N2 Familial Clusters in England
Recombinomics Commentary
May 31, 2007
"A COUPLE struck down by bird flu said today they thought they were going to die. Lauren Gedman and her partner Mark Kinder, from Sutton Heath, St Helens, caught the same disease which hit north Wales earlier this month.
Ms Gedman was taken to Whiston hospital after complaining of headaches, nausea, and fever.Mr Kinder fell ill shortly afterwards and spent four days in hospital.
The couple said they had still not fully recovered and have launched legal action against the Cheshire market at the centre of the outbreak. Today they described how a trip to buy three chickens and 10 khaki ducklings for their allotment ended in disaster.
The couple visited Frank R Marshall & Co at Chelford market in Macclesfield on May 7. A week later Ms Gedman fell violently ill and was initially told by doctors that she had a water-based infection.
She was eventually taken to hospital, unable to walk or drive, where medics confirmed she had contracted a strain of bird flu. Mr Kinder fell ill later, and recorded a temperature of 39 degrees. He is still complaining of sneezing after completing his medication.
Ther above comments describe another familial cluster of H7N2 in England. In this cluster, both members tested positive. The disease onset dates raise the possibility of human-to-human transmission, and suggest the transmission chain in Wales for confirmed or suspect cases may be significantly longer.
In the above case in north west England, the index case developed symptoms on or about May 14, a week after purchasing birds at the market linked to the outbreak in Wales. Her partner developed symptoms later, possibly after the index case hospitalized, raising the possibility that the index case infected her partner.
The same sequence of events may have happened in Wales. Both owners of the farm with the H7N2 infected birds developed symptoms, but tested negative when the birds were tested. That cluster may have involved human-to-human transmission within the family, as well as to the three neighbors who either tested positive of had symptoms. That cluster of three may have been linked to the health care worker with symptoms at a nearby hospital.
Thus, the transmission chain my have gone from the index case to the partner, followed by transmission to the neighbor(s), followed by transmission to the health care worker. Moreover, in recent days the number of suspect cases has increased to 13, so the remaining 5 patients may represent more human-to-human transmission since the birds in Wales have been culled, and there is no firm evidence that anyone other than the owners had close contact with the 15 birds.
Although several examples of human-to-human transmission within and between the three familial cluster plus the health care worker and the five un-identified cases, official reports continue to discount the likelihood of such transmission.
More information on direct linkage to poultry and the relationship of the additional five cases to the earlier suspect cases would be useful.
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