Thanks to Laurie Garrett and Greg Folkers for tweeting about this article in Chinese Medical Journal: A Suspected Person-to-person Transmission of Avian Influenza A (H7N9) Case in Ward. Excerpt:
Since throat swab specimens obtained from three adult Chinese patients were confirmed as an avian-origin influenza A (H7N9) virus by local Centers for Disease Control and Prevention (CDC) in 2013, many confirmed cases have been reported in Mainland of China. Although family and hospital clusters with confirmed or suspected avian H7N9 virus infection were previously reported and person-to-person transmission was put forward, human infection of H7N9 appears to be associated with exposure to infected live poultry or contaminated environments and no clear evidence has proved that it could transmit from person to person. Here, we report a case confirmed with H7N9 after intimately contact with his H7N9 ward mate, it may be the first case infected between ward mates in a ward, so we report it here.
Case Report
The index case, a 66-year-old male with hypertension and type II diabetes for more than 10 years, was admitted to the respiratory department for cough and expectoration with 3 days, aggravation with bloody sputum with 1 day on December 17, 2016. He was transferred to the nephrology department for elevated serum creatinine and hypourocrinia the next day (December 18).
The symptom of cough and expectoration was exacerbated, developed with dyspnea, dizzy, pink foam sputum, and descend transcutaneous oxygen saturation in the 3rd day (December 19), and was transferred to intensive care unit soon. Laboratory investigation of the throat swabs showed that he was positive for H7N9 by real-time polymerase chain reaction (RT-PCR). X-rays showed bilateral pneumonia and high-density patchiness in the left lung [December 19, [Figure 1]a. He died of persistent hyperpyrexia, respiratory failure, and acute respiratory distress syndrome at last although treated with mechanical ventilation, broad-spectrum antibiotics, oseltamivir, and immunological therapy.
The index patient had visited a live-poultry market (LPM) to buy food every day within 10 days before his illness onset and had no direct contact with live poultry in the market.
Case 2 (index case's ward mate), a 62-year-old male with no underlying disease, was admitted to the nephrology department and diagnosed as nephrotic syndrome due to edema of lower extremity for 1 month and palpebral edema for 3 days on December 16, treated with hormone drug.
Case 2 had an intimate contact with the index case on December 18; he and the index case stayed in the same room in the nephrology ward for approximately 20 h, developed a throat sore and cough on December 21. RT-PCR analysis of throat swabs from the patient tested positive for novel avian H7N9 nucleic acid (the same method and reagent as the index case). X-rays showed bilateral pneumonia [December 25, [Figure 1]b.
His condition remained stable and symptoms were improved. He was discharged after sputum samples tested negative for H7N9 by RT-PCR 10 days later. He had no history of exposure to live poultry or LPM before the illness onset.
