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Online Discussion: Tracking new emerging diseases and the next pandemic

Evidence For Sustained H7N9 Human Transmission

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tango View Drop Down
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    Posted: May 01 2013 at 9:28pm
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: May 01 2013 at 9:35pm
Here's the story: 

Evidence For Sustained H7N9 Human Transmission
Recombinomics Commentary 03:15
April 30, 2013

The Zhejiang Provincial Center for Disease Control and Prevention has released full sequences from two H7N9 bird flu cases, A/Zhejiang/1/2013 (37M) and A/Zhejiang/2/2013 (64M), and they are to be commended for the rapid release of these important sequences.  The age, gender, and collection dates suggest these sequences originated from the cases that generated A/Hangzhou/1/2013 (by the Hangzhou Center for Disease Control and Prevention) and A/Zhejiang/DTID-ZJU01/2013 (by the State Key Laboratory of Diagnosis and Treatment of Infectious Diseases at Zhejiang University).  The recent sequences confirmed that the earlier case (37M) had H7 L226I and PB2 E627K, while the second case (64M) had H7 Q226L and PB2 D701N, all of which are mammalian adaptation markers.  Both of these cases were fatal and detail was provided in the recent Lancet paper  These sequences were from Patient #1 and Patient #3, respectively (see map).

The recently released avian sequences had Q226L, which had not been reported previously in H7  (or H5).  However, Q226L has become common in avian H9N2 sequences and the close relationship of the six H7N9 internal genes to H9N2 sequences suggests these internal genes were compatible with Q226L in avian hosts.  However, the PB2 changes (E627K and D701N) have not been identified in any of the recent H7N9 sequences from live markets in and around Shanghai, and some have speculated that these mammalian adaptations happened in the human cases.  However, the presence of E627K in six of the seven human cases, and the absence in any of the avian cases does not support the repeated acquisition E627K in each human case.  The presence of L226I, another mammalian adaptation, in the two sequences from the earlier case (who has been described as 39M, 38M, and 37M) raises serious questions about a recent avian source, since this adaptation has not been reported in any of the avian sequences.

Moreover, the recently released  H7 sequence from a Jiangsu case (45M), A/Jiangsu/01/2013, also has L226I, and the H7 sequence is identical to A/Hangzhou/1/2013 and A/Zhejiang/1/2013.  Although the PB2 sequence from A/Jiangsu/01/2013 has not been released, N9 and MP sequences are public and both sequences exactly match A/Hangzhou/1/2013.  The H7 and N9 sequences have synonymous changes (A1215C and T409C, respectively), which are also not present in other human or avian sequences, strongly supporting clonal expansion.

However, there is no reported contact between the two cases.  The earlier case is a chef who lived in Jiande, Hangzhou, but worked in Taicang, Jiangsu, while the second case was from the Jiangning District of Nanjing, Jiangsu, which is not near Taicang (see map).  The identity in the three sequences from cases without contact with each other strongly supports sustained human to human transmission, which is also supported by the presence of PB2 E627K in 6 of the 7 human cases (and absence in all five if the avian PB2 sequences).

This sustained transmission contradicts WHO statements, which rely on testing of upper respiratory tract samples, which have produced frequent false negatives.  In contrast to the negative data cited by WHO, the exact matches in the two cases above provides clear evidence for sustained human transmission.  Release of a full set of sequences from the Jiangsu case would be useful (and quite doable since the sequences from the first three gene segments were from an egg isolate).

The WHO claims of no evidence of H2H transmission, and the failure to address the identities in the human H7N9, continue to raise serious pandemic concerns.

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MelodyAtHome View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote MelodyAtHome Quote  Post ReplyReply Direct Link To This Post Posted: May 01 2013 at 9:56pm
Albert, so what does this mean for us? What do you think? Who do you believe? I'm with FluMom what she said in another post...about when to Sit In Place.
I'm thinking after we hear about our first case in the states? or 1st case in our state? What are you doing? Thanks.
 
Melody
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 1NiceGuy Quote  Post ReplyReply Direct Link To This Post Posted: May 01 2013 at 10:34pm
Influenza is a virus, not an chemical weapon. what I mean is that it's not as lethal as say a nerve agent.
Wash your hands often, don't touch your face, even wear a N95 mask. Avoid crowds and confined spaces... elevators, vehicles.... and use common sense.
If you respect the H7N9 virus you won't need to fear it.


"Chance favors the prepared mind."
Louis Pasteur

-- Louis Pasteur
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: May 02 2013 at 7:10am
Hi Melody, I don't believe we have "sustained" h2h at the moment, so I wouldn't base much off dr. niman's commentary regarding that claim.  However, we do have a lot of limited h2h happening and the virus is close to achieving sustained h2h.  So for the time being, all is good and we're still in a holding pattern - watch and see mode. 

If it does reach the U.S. and achieve efficient transmission, then we will prepare big time - and fast. I'll let you know my suggestions when/if the time comes, but for right now, we're okay.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote MelodyAtHome Quote  Post ReplyReply Direct Link To This Post Posted: May 02 2013 at 8:43am
Thank you Albert, I'll be here watching :)
Melody
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cyndi26 Quote  Post ReplyReply Direct Link To This Post Posted: May 02 2013 at 11:57am
Albert, thank so much for keeping us all updated will keep a watch and wait to c whats next  Thx again
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: May 02 2013 at 12:15pm
I'm not seeing sustained H2H either. The clusters so far are small indicating that it's developed only limited human transmissibility at best at this point, and I think if Niman's suggesting otherwise he's being premature. It appears to be dead ending in the clusters we're seeing.
People seem to be ready to lock the doors as soon as it leaves Asia. Don't be too quick to SIP as most people's resources wouldn't last much more than one wave, and the first one is not usually the one to worry about. You might burn through your preps while it's still finding it's feet, and then be no better off than the non-preppers if it comes back as a fully H2H virus, maybe in the fall. It's getting used to us right now, and while it does seem to be mutating faster than other influenzas it's still not a fully human virus. Yet. Don't SIP until you have good reason to - timing is key to make it through with what you've put aside.
"Buy it cheap. Stack it deep"
"Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote FluMom Quote  Post ReplyReply Direct Link To This Post Posted: May 02 2013 at 8:52pm
I agree to wait and see about SIP but that is why I am here on this site. When we all pretty much agree it is time to SIP I will do so. My son may hate me but oh well!
Always Be Prepared
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: May 03 2013 at 9:25am
You got it Cyndi, my pleasure.   We'll all watch this thing together and get it figured out. 

Best,

Albert
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