Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation
Identifieur interne : 001953 ( Istex/Corpus ); précédent : 001952; suivant : 001954Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation
Auteurs : Xian Qi ; Yan-Hua Qian ; Chang-Jun Bao ; Xi-Ling Guo ; Lun-Biao Cui ; Fen-Yang Tang ; Hong Ji ; Yong Huang ; Pei-Quan Cai ; Bing Lu ; Ke Xu ; Chao Shi ; Feng-Cai Zhu ; Ming-Hao Zhou ; Hua WangSource :
- BMJ : British Medical Journal [ 0959-8138 ] ; 2013.
English descriptors
- Teeft :
- April, Assay, August, Avian, Avian influenza, Bedside care, Care unit, Chain reaction, Clinical characteristics, Clinical data, Cloacal swabs, Convenience stores, Conventional care, Disease control, Distress syndrome, Eastern china, Engl, Environmental samples, Faecal samples, Family cluster, Fatal case, Field investigation, First report, Genome, Genome sequence, Genomic segments, Haemagglutination, Haemagglutination inhibition antibodies, Haemagglutination inhibition assay, Haemagglutination inhibition assays, Healthcare workers, Household members, Human infection, Human infections, Index case, Index patient, Infection, Influenza, Influenza virus, Influenza viruses, Intensive care, Intensive care unit, Jiangsu, Jiangsu province, Jiangsu province center, Laboratory testing, Life technologies, Novel influenza, Novel virus, Oral secretions, Persistent hyperpyrexia, Person transmission, Phylogenetic, Phylogenetic trees, Positive results, Poultry market, Poultry markets, Probable transmissibility, Range days, Real time, Reprint, Residential district, Respiratory failure, Sample collection, Second patient, Serum samples, Subclinical infections, Unprotected exposure, Viral, Viral genes, Viral genomes, Virological data, Virus, Virus infection, Wang, World health organization, Zhou.
Abstract
Objective To determine whether the novel avian influenza H7N9 virus can transmit from person to person and its efficiency. Design Epidemiological investigations conducted after a family cluster of two patients with avian H7N9 in March 2013. Setting Wuxi, Eastern China. Participants Two patients, their close contacts, and relevant environments. Samples from the patients and environments were collected and tested by real time reverse transcriptase-polymerase chain reaction (rRT-PCR), viral culture, and haemagglutination inhibition assay. Any contacts who became ill had samples tested for avian H7N9 by rRT-PCR. Paired serum samples were obtained from contacts for serological testing by haemagglutination inhibition assays. Main outcomes measures Clinical data, history of exposure before the onset of illnesses, and results of laboratory testing of pathogens and further analysis of sequences and phylogenetic tree to isolated strains. Results The index patient became ill five to six days after his last exposure to poultry. The second patient, his daughter aged 32, who provided unprotected bedside care in the hospital, had no known exposure to poultry. She developed symptoms six days after her last contact with her father. Two strains were isolated successfully from the two patients. Genome sequence and analyses of phylogenetic trees showed that both viruses were almost genetically identical. Forty three close contacts of both patients were identified. One had mild illness but had negative results for avian H7N9 by rRT-PCR. All 43 close contacts tested negative for haemagglutination inhibition antibodies specific for avian H7N9. Conclusions The infection of the daughter probably resulted from contact with her father (the index patient) during unprotected exposure, suggesting that in this cluster the virus was able to transmit from person to person. The transmissibility was limited and non-sustainable.
Url:
DOI: 10.1136/bmj.f4752
Links to Exploration step
ISTEX:6B2611F6A10E51F50CA8A396C08A901243AA4BD7Le document en format XML
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zmh@jscdc.cn</mods:affiliation></affiliation></author><author><name sortKey="Bao, Chang Jun" sort="Bao, Chang Jun" uniqKey="Bao C" first="Chang-Jun" last="Bao">Chang-Jun Bao</name><affiliation><mods:affiliation>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation></author><author><name sortKey="Guo, Xi Ling" sort="Guo, Xi Ling" uniqKey="Guo X" first="Xi-Ling" last="Guo">Xi-Ling Guo</name><affiliation><mods:affiliation>Key Lab of Enteric Pathogenic Microbiology (Ministry of Health), Institute of pathogenic microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation></author><author><name sortKey="Cui, Lun Biao" sort="Cui, Lun Biao" uniqKey="Cui L" first="Lun-Biao" last="Cui">Lun-Biao Cui</name><affiliation><mods:affiliation>Key Lab of Enteric Pathogenic Microbiology (Ministry of Health), Institute of pathogenic microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation></author><author><name sortKey="Tang, Fen Yang" sort="Tang, Fen Yang" uniqKey="Tang F" first="Fen-Yang" last="Tang">Fen-Yang Tang</name><affiliation><mods:affiliation>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation></author><author><name sortKey="Ji, Hong" sort="Ji, Hong" uniqKey="Ji H" first="Hong" last="Ji">Hong Ji</name><affiliation><mods:affiliation>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation></author><author><name sortKey="Huang, Yong" sort="Huang, Yong" uniqKey="Huang Y" first="Yong" last="Huang">Yong Huang</name><affiliation><mods:affiliation>Chinese Field Epidemiology Training Program, Beijing, China</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation></author><author><name sortKey="Cai, Pei Quan" sort="Cai, Pei Quan" uniqKey="Cai P" first="Pei-Quan" last="Cai">Pei-Quan Cai</name><affiliation><mods:affiliation>Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China 214023</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation></author><author><name sortKey="Lu, Bing" sort="Lu, Bing" uniqKey="Lu B" first="Bing" last="Lu">Bing Lu</name><affiliation><mods:affiliation>Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, Jiangsu, China 214023</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation></author><author><name sortKey="Xu, Ke" sort="Xu, Ke" uniqKey="Xu K" first="Ke" last="Xu">Ke Xu</name><affiliation><mods:affiliation>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation></author><author><name sortKey="Shi, Chao" sort="Shi, Chao" uniqKey="Shi C" first="Chao" last="Shi">Chao Shi</name><affiliation><mods:affiliation>Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, Jiangsu, China 214023</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation></author><author><name sortKey="Zhu, Feng Cai" sort="Zhu, Feng Cai" uniqKey="Zhu F" first="Feng-Cai" last="Zhu">Feng-Cai Zhu</name><affiliation><mods:affiliation>Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation></author><author><name sortKey="Zhou, Ming Hao" sort="Zhou, Ming Hao" uniqKey="Zhou M" first="Ming-Hao" last="Zhou">Ming-Hao Zhou</name><affiliation><mods:affiliation>Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation></author><author><name sortKey="Wang, Hua" sort="Wang, Hua" uniqKey="Wang H" first="Hua" last="Wang">Hua Wang</name><affiliation><mods:affiliation>Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</mods:affiliation></affiliation><affiliation><mods:affiliation>Health Department of Jiangsu Province, Nanjing, Jiangsu, China 210008</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: zmh@jscdc.cn</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">BMJ : British Medical Journal</title><title level="j" type="abbrev">BMJ</title><idno type="ISSN">0959-8138</idno><idno type="eISSN">1756-1833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2013">2013</date><biblScope unit="volume">347</biblScope></imprint><idno type="ISSN">0959-8138</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0959-8138</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>April</term><term>Assay</term><term>August</term><term>Avian</term><term>Avian influenza</term><term>Bedside care</term><term>Care unit</term><term>Chain reaction</term><term>Clinical characteristics</term><term>Clinical data</term><term>Cloacal swabs</term><term>Convenience stores</term><term>Conventional care</term><term>Disease control</term><term>Distress syndrome</term><term>Eastern china</term><term>Engl</term><term>Environmental samples</term><term>Faecal samples</term><term>Family cluster</term><term>Fatal case</term><term>Field investigation</term><term>First report</term><term>Genome</term><term>Genome sequence</term><term>Genomic segments</term><term>Haemagglutination</term><term>Haemagglutination inhibition antibodies</term><term>Haemagglutination inhibition assay</term><term>Haemagglutination inhibition assays</term><term>Healthcare workers</term><term>Household members</term><term>Human infection</term><term>Human infections</term><term>Index case</term><term>Index patient</term><term>Infection</term><term>Influenza</term><term>Influenza virus</term><term>Influenza viruses</term><term>Intensive care</term><term>Intensive care unit</term><term>Jiangsu</term><term>Jiangsu province</term><term>Jiangsu province center</term><term>Laboratory testing</term><term>Life technologies</term><term>Novel influenza</term><term>Novel virus</term><term>Oral secretions</term><term>Persistent hyperpyrexia</term><term>Person transmission</term><term>Phylogenetic</term><term>Phylogenetic trees</term><term>Positive results</term><term>Poultry market</term><term>Poultry markets</term><term>Probable transmissibility</term><term>Range days</term><term>Real time</term><term>Reprint</term><term>Residential district</term><term>Respiratory failure</term><term>Sample collection</term><term>Second patient</term><term>Serum samples</term><term>Subclinical infections</term><term>Unprotected exposure</term><term>Viral</term><term>Viral genes</term><term>Viral genomes</term><term>Virological data</term><term>Virus</term><term>Virus infection</term><term>Wang</term><term>World health organization</term><term>Zhou</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objective To determine whether the novel avian influenza H7N9 virus can transmit from person to person and its efficiency. Design Epidemiological investigations conducted after a family cluster of two patients with avian H7N9 in March 2013. Setting Wuxi, Eastern China. Participants Two patients, their close contacts, and relevant environments. Samples from the patients and environments were collected and tested by real time reverse transcriptase-polymerase chain reaction (rRT-PCR), viral culture, and haemagglutination inhibition assay. Any contacts who became ill had samples tested for avian H7N9 by rRT-PCR. Paired serum samples were obtained from contacts for serological testing by haemagglutination inhibition assays. Main outcomes measures Clinical data, history of exposure before the onset of illnesses, and results of laboratory testing of pathogens and further analysis of sequences and phylogenetic tree to isolated strains. Results The index patient became ill five to six days after his last exposure to poultry. The second patient, his daughter aged 32, who provided unprotected bedside care in the hospital, had no known exposure to poultry. She developed symptoms six days after her last contact with her father. Two strains were isolated successfully from the two patients. Genome sequence and analyses of phylogenetic trees showed that both viruses were almost genetically identical. Forty three close contacts of both patients were identified. One had mild illness but had negative results for avian H7N9 by rRT-PCR. All 43 close contacts tested negative for haemagglutination inhibition antibodies specific for avian H7N9. Conclusions The infection of the daughter probably resulted from contact with her father (the index patient) during unprotected exposure, suggesting that in this cluster the virus was able to transmit from person to person. 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swabs</json:string><json:string>haemagglutination inhibition assay</json:string><json:string>fatal case</json:string><json:string>real time</json:string><json:string>haemagglutination inhibition assays</json:string><json:string>genomic segments</json:string><json:string>persistent hyperpyrexia</json:string><json:string>intensive care unit</json:string><json:string>genome sequence</json:string><json:string>care unit</json:string><json:string>chain reaction</json:string><json:string>clinical characteristics</json:string><json:string>jiangsu province center</json:string><json:string>range days</json:string><json:string>positive results</json:string><json:string>viral genes</json:string><json:string>phylogenetic trees</json:string><json:string>oral secretions</json:string><json:string>poultry market</json:string><json:string>clinical data</json:string><json:string>faecal samples</json:string><json:string>viral genomes</json:string><json:string>influenza viruses</json:string><json:string>first report</json:string><json:string>probable transmissibility</json:string><json:string>virological data</json:string><json:string>field investigation</json:string><json:string>household members</json:string><json:string>world health organization</json:string><json:string>subclinical infections</json:string><json:string>sample collection</json:string><json:string>infection</json:string></teeft></keywords><author><json:item><name>Xian Qi</name><affiliations><json:string>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item><json:item><name>Yan-Hua Qian</name><affiliations><json:string>Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, Jiangsu, China 214023</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item><json:item><name>Chang-Jun Bao</name><affiliations><json:string>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item><json:item><name>Xi-Ling Guo</name><affiliations><json:string>Key Lab of Enteric Pathogenic Microbiology (Ministry of Health), Institute of pathogenic microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item><json:item><name>Lun-Biao Cui</name><affiliations><json:string>Key Lab of Enteric Pathogenic Microbiology (Ministry of Health), Institute of pathogenic microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item><json:item><name>Fen-Yang Tang</name><affiliations><json:string>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item><json:item><name>Hong Ji</name><affiliations><json:string>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item><json:item><name>Yong Huang</name><affiliations><json:string>Chinese Field Epidemiology Training Program, Beijing, China</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item><json:item><name>Pei-Quan Cai</name><affiliations><json:string>Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China 214023</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item><json:item><name>Bing Lu</name><affiliations><json:string>Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, Jiangsu, China 214023</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item><json:item><name>Ke Xu</name><affiliations><json:string>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item><json:item><name>Chao Shi</name><affiliations><json:string>Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, Jiangsu, China 214023</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item><json:item><name>Feng-Cai Zhu</name><affiliations><json:string>Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item><json:item><name>Ming-Hao Zhou</name><affiliations><json:string>Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</json:string><json:string>E-mail: zmh@jscdc.cn</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item><json:item><name>Hua Wang</name><affiliations><json:string>Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</json:string><json:string>Health Department of Jiangsu Province, Nanjing, Jiangsu, China 210008</json:string><json:string>E-mail: zmh@jscdc.cn</json:string><json:string>E-mail: zmh@jscdc.cn</json:string></affiliations></json:item></author><articleId><json:string>qixi013783</json:string></articleId><arkIstex>ark:/67375/NVC-2M2K7P27-R</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Objective To determine whether the novel avian influenza H7N9 virus can transmit from person to person and its efficiency. Design Epidemiological investigations conducted after a family cluster of two patients with avian H7N9 in March 2013. Setting Wuxi, Eastern China. Participants Two patients, their close contacts, and relevant environments. Samples from the patients and environments were collected and tested by real time reverse transcriptase-polymerase chain reaction (rRT-PCR), viral culture, and haemagglutination inhibition assay. Any contacts who became ill had samples tested for avian H7N9 by rRT-PCR. Paired serum samples were obtained from contacts for serological testing by haemagglutination inhibition assays. Main outcomes measures Clinical data, history of exposure before the onset of illnesses, and results of laboratory testing of pathogens and further analysis of sequences and phylogenetic tree to isolated strains. Results The index patient became ill five to six days after his last exposure to poultry. The second patient, his daughter aged 32, who provided unprotected bedside care in the hospital, had no known exposure to poultry. She developed symptoms six days after her last contact with her father. Two strains were isolated successfully from the two patients. Genome sequence and analyses of phylogenetic trees showed that both viruses were almost genetically identical. Forty three close contacts of both patients were identified. One had mild illness but had negative results for avian H7N9 by rRT-PCR. All 43 close contacts tested negative for haemagglutination inhibition antibodies specific for avian H7N9. Conclusions The infection of the daughter probably resulted from contact with her father (the index patient) during unprotected exposure, suggesting that in this cluster the virus was able to transmit from person to person. The transmissibility was limited and non-sustainable.</abstract><qualityIndicators><score>10</score><pdfWordCount>5080</pdfWordCount><pdfCharCount>32713</pdfCharCount><pdfVersion>1.4</pdfVersion><pdfPageCount>8</pdfPageCount><pdfPageSize>595.276 x 841.89 pts (A4)</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>280</abstractWordCount><abstractCharCount>1926</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation</title><pmid><json:string>23920350</json:string></pmid><genre><json:string>research-article</json:string></genre><host><title>BMJ : British Medical Journal</title><language><json:string>unknown</json:string></language><issn><json:string>0959-8138</json:string></issn><eissn><json:string>1756-1833</json:string></eissn><publisherId><json:string>bmj</json:string></publisherId><volume>347</volume><genre><json:string>journal</json:string></genre></host><namedEntities><unitex><date><json:string>2013</json:string><json:string>2003</json:string></date><geogName></geogName><orgName><json:string>China, February</json:string><json:string>RESEARCH Results The</json:string><json:string>RESEARCH Weaknesses</json:string><json:string>Jiangsu Provincial Center for Disease Control and Prevention</json:string><json:string>Department of Acute Infectious Disease Control and Prevention</json:string><json:string>Wuxi People’s Hospital Affiliated</json:string><json:string>Johns Hopkins University</json:string><json:string>Laboratory Procedures</json:string><json:string>Life Technologies</json:string><json:string>RESEARCH Table Table</json:string><json:string>Ministry of Health</json:string><json:string>Case Western Reserve University</json:string><json:string>Sci China Life Sci</json:string><json:string>Jiangsu Province Center for Disease Control and Prevention</json:string><json:string>Nanjing Medical University</json:string><json:string>RESEARCH Figure Timeline</json:string><json:string>Jiangsu Province Key Medical Talent Foundation</json:string><json:string>Health Department of Jiangsu Province, Nanjing, Jiangsu, China</json:string><json:string>National Emergent Public Health Events Act</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Hong Ji</json:string><json:string>Preliminary</json:string><json:string>Johanna Lam</json:string><json:string>Universal</json:string></persName><placeName><json:string>San Diego</json:string><json:string>Carlsbad</json:string><json:string>Beijing</json:string><json:string>Taiwan</json:string><json:string>Madison</json:string><json:string>China</json:string><json:string>Shanghai</json:string><json:string>USA</json:string><json:string>CA</json:string><json:string>WI</json:string><json:string>Cleveland</json:string><json:string>Nanjing</json:string><json:string>OH</json:string><json:string>Netherlands</json:string></placeName><ref_url><json:string>http://www.bmj.com/content/</json:string><json:string>http://www.bmj.com/subscribe</json:string><json:string>http://bmj.com/video</json:string><json:string>http://creativecommons.org/licenses/by-nc/</json:string><json:string>http://www.bmj.com/permissions</json:string></ref_url><ref_bibl><json:string>World Health Organization, 2013</json:string><json:string>March 2013</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/NVC-2M2K7P27-R</json:string></ark><categories><wos></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - clinical medicine</json:string><json:string>3 - general & internal medicine</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - General Medicine</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string></inist></categories><publicationDate>2013</publicationDate><copyrightDate>2013</copyrightDate><doi><json:string>10.1136/bmj.f4752</json:string></doi><id>6B2611F6A10E51F50CA8A396C08A901243AA4BD7</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-2M2K7P27-R/fulltext.pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-2M2K7P27-R/bundle.zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/ark:/67375/NVC-2M2K7P27-R/fulltext.tei"><teiHeader><fileDesc><titleStmt><title level="a">Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher scheme="https://publisher-list.data.istex.fr">British Medical Journal Publishing Group</publisher><availability status="free"><p>Open Access</p></availability><date>2013</date></publicationStmt><notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation</title><author xml:id="author-0000"><persName><forename type="first">Xian</forename><surname>Qi</surname></persName><email>zmh@jscdc.cn</email><note type="biography">viriologist</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>viriologist</affiliation><affiliation>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Yan-Hua</forename><surname>Qian</surname></persName><email>zmh@jscdc.cn</email><note type="biography">epidemiologist</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>epidemiologist</affiliation><affiliation>Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, Jiangsu, China 214023</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Chang-Jun</forename><surname>Bao</surname></persName><email>zmh@jscdc.cn</email><note type="biography">epidemiologist</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>epidemiologist</affiliation><affiliation>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Xi-Ling</forename><surname>Guo</surname></persName><email>zmh@jscdc.cn</email><note type="biography">microbiologist</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>microbiologist</affiliation><affiliation>Key Lab of Enteric Pathogenic Microbiology (Ministry of Health), Institute of pathogenic microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Lun-Biao</forename><surname>Cui</surname></persName><email>zmh@jscdc.cn</email><note type="biography">molecular biologist</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>molecular biologist</affiliation><affiliation>Key Lab of Enteric Pathogenic Microbiology (Ministry of Health), Institute of pathogenic microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Fen-Yang</forename><surname>Tang</surname></persName><email>zmh@jscdc.cn</email><note type="biography">public health officer</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>public health officer</affiliation><affiliation>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation></author><author xml:id="author-0006"><persName><forename type="first">Hong</forename><surname>Ji</surname></persName><email>zmh@jscdc.cn</email><note type="biography">public health officer</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>public health officer</affiliation><affiliation>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation></author><author xml:id="author-0007"><persName><forename type="first">Yong</forename><surname>Huang</surname></persName><email>zmh@jscdc.cn</email><note type="biography">trainee of CFETP</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>trainee of CFETP</affiliation><affiliation>Chinese Field Epidemiology Training Program, Beijing, China</affiliation></author><author xml:id="author-0008"><persName><forename type="first">Pei-Quan</forename><surname>Cai</surname></persName><email>zmh@jscdc.cn</email><note type="biography">respiratory physician</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>respiratory physician</affiliation><affiliation>Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China 214023</affiliation></author><author xml:id="author-0009"><persName><forename type="first">Bing</forename><surname>Lu</surname></persName><email>zmh@jscdc.cn</email><note type="biography">deputy director</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>deputy director</affiliation><affiliation>Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, Jiangsu, China 214023</affiliation></author><author xml:id="author-0010"><persName><forename type="first">Ke</forename><surname>Xu</surname></persName><email>zmh@jscdc.cn</email><note type="biography">public health officer</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>public health officer</affiliation><affiliation>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation></author><author xml:id="author-0011"><persName><forename type="first">Chao</forename><surname>Shi</surname></persName><email>zmh@jscdc.cn</email><note type="biography">public health officer</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>public health officer</affiliation><affiliation>Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, Jiangsu, China 214023</affiliation></author><author xml:id="author-0012"><persName><forename type="first">Feng-Cai</forename><surname>Zhu</surname></persName><email>zmh@jscdc.cn</email><note type="biography">professor</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>professor</affiliation><affiliation>Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation></author><author xml:id="author-0013" corresp="yes"><persName><forename type="first">Ming-Hao</forename><surname>Zhou</surname></persName><email>zmh@jscdc.cn</email><email>zmh@jscdc.cn</email><note type="biography">director</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>director</affiliation><affiliation>Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation></author><author xml:id="author-0014" corresp="yes"><persName><forename type="first">Hua</forename><surname>Wang</surname></persName><email>zmh@jscdc.cn</email><email>zmh@jscdc.cn</email><note type="biography">epidemiologist and deputy director-general</note><note type="correspondence"><p>Correspondence to: M H Zhou</p></note><affiliation>epidemiologist and deputy director-general</affiliation><affiliation>Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation><affiliation>Health Department of Jiangsu Province, Nanjing, Jiangsu, China 210008</affiliation></author><idno type="istex">6B2611F6A10E51F50CA8A396C08A901243AA4BD7</idno><idno type="ark">ark:/67375/NVC-2M2K7P27-R</idno><idno type="DOI">10.1136/bmj.f4752</idno><idno type="href">bmj-347-bmj-f4752.pdf</idno><idno type="article-id">qixi013783</idno><idno type="local">bmj;347/aug06_2/f4752</idno></analytic><monogr><title level="j">BMJ : British Medical Journal</title><title level="j" type="abbrev">BMJ</title><idno type="pISSN">0959-8138</idno><idno type="eISSN">1756-1833</idno><idno type="publisher-id">bmj</idno><idno type="PublisherID-hwp">bmj</idno><idno type="PublisherID-nlm-ta">BMJ</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2013"></date><biblScope unit="volume">347</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2013</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Objective To determine whether the novel avian influenza H7N9 virus can transmit from person to person and its efficiency. Design Epidemiological investigations conducted after a family cluster of two patients with avian H7N9 in March 2013. Setting Wuxi, Eastern China. Participants Two patients, their close contacts, and relevant environments. Samples from the patients and environments were collected and tested by real time reverse transcriptase-polymerase chain reaction (rRT-PCR), viral culture, and haemagglutination inhibition assay. Any contacts who became ill had samples tested for avian H7N9 by rRT-PCR. Paired serum samples were obtained from contacts for serological testing by haemagglutination inhibition assays. Main outcomes measures Clinical data, history of exposure before the onset of illnesses, and results of laboratory testing of pathogens and further analysis of sequences and phylogenetic tree to isolated strains. Results The index patient became ill five to six days after his last exposure to poultry. The second patient, his daughter aged 32, who provided unprotected bedside care in the hospital, had no known exposure to poultry. She developed symptoms six days after her last contact with her father. Two strains were isolated successfully from the two patients. Genome sequence and analyses of phylogenetic trees showed that both viruses were almost genetically identical. Forty three close contacts of both patients were identified. One had mild illness but had negative results for avian H7N9 by rRT-PCR. All 43 close contacts tested negative for haemagglutination inhibition antibodies specific for avian H7N9. Conclusions The infection of the daughter probably resulted from contact with her father (the index patient) during unprotected exposure, suggesting that in this cluster the virus was able to transmit from person to person. The transmissibility was limited and non-sustainable.</p></abstract></profileDesc><revisionDesc><change when="2013">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-2M2K7P27-R/fulltext.txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">bmj</journal-id><journal-id journal-id-type="nlm-ta">BMJ</journal-id><journal-id journal-id-type="publisher-id">bmj</journal-id><journal-title>BMJ : British Medical Journal</journal-title><issn pub-type="epub">1756-1833</issn><publisher><publisher-name>British Medical Journal Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">qixi013783</article-id><article-id pub-id-type="doi">10.1136/bmj.f4752</article-id><article-id pub-id-type="other">bmj;347/aug06_2/f4752</article-id><article-id pub-id-type="other">bmj;bmj.f4752</article-id><article-id pub-id-type="other">aug06_2</article-id><article-id pub-id-type="other">bmj.f4752</article-id><article-id pub-id-type="other">bmj.f4752</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="no"><name><surname>Qi</surname><given-names>Xian</given-names></name><role>viriologist</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Qian</surname><given-names>Yan-Hua</given-names></name><role>epidemiologist</role><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Bao</surname><given-names>Chang-Jun</given-names></name><role>epidemiologist</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Guo</surname><given-names>Xi-Ling</given-names></name><role>microbiologist</role><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Cui</surname><given-names>Lun-Biao</given-names></name><role>molecular biologist</role><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Tang</surname><given-names>Fen-Yang</given-names></name><role>public health officer</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Ji</surname><given-names>Hong</given-names></name><role>public health officer</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Huang</surname><given-names>Yong</given-names></name><role>trainee of CFETP</role><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Cai</surname><given-names>Pei-Quan</given-names></name><role>respiratory physician</role><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Lu</surname><given-names>Bing</given-names></name><role>deputy director</role><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Xu</surname><given-names>Ke</given-names></name><role>public health officer</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Shi</surname><given-names>Chao</given-names></name><role>public health officer</role><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Zhu</surname><given-names>Feng-Cai</given-names></name><role>professor</role><xref ref-type="aff" rid="aff6">6</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Zhou</surname><given-names>Ming-Hao</given-names></name><role>director</role><xref ref-type="aff" rid="aff6">6</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Wang</surname><given-names>Hua</given-names></name><role>epidemiologist and deputy director-general</role><xref ref-type="aff" rid="aff6">6</xref><xref ref-type="aff" rid="aff7">7</xref></contrib><aff id="aff1"><label>1</label>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</aff><aff id="aff2"><label>2</label>Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, Jiangsu, China 214023</aff><aff id="aff3"><label>3</label>Key Lab of Enteric Pathogenic Microbiology (Ministry of Health), Institute of pathogenic microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</aff><aff id="aff4"><label>4</label>Chinese Field Epidemiology Training Program, Beijing, China</aff><aff id="aff5"><label>5</label>Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China 214023</aff><aff id="aff6"><label>6</label>Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</aff><aff id="aff7"><label>7</label>Health Department of Jiangsu Province, Nanjing, Jiangsu, China 210008</aff></contrib-group><author-notes><corresp>Correspondence to: M H Zhou <email>zmh@jscdc.cn</email> and H Wang <email>hua@jscdc.cn</email></corresp></author-notes><pub-date pub-type="collection"><year>2013</year></pub-date><pub-date pub-type="epub-original"><year>2013</year></pub-date><volume>347</volume><volume-id pub-id-type="other">347</volume-id><volume-id pub-id-type="other">347</volume-id><elocation-id>f4752</elocation-id><history><date date-type="accepted"><day>24</day><month>July</month><year>2013</year></date></history><permissions><copyright-statement>© Qi et al 2013</copyright-statement><copyright-year>2013</copyright-year><copyright-holder>Qi et al</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><p>This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: <ext-link xlink:href="http://creativecommons.org/licenses/by-nc/3.0/" ext-link-type="uri">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>.</p></license></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-347-bmj-f4752.pdf"></self-uri><abstract><p><bold>Objective</bold> To determine whether the novel avian influenza H7N9 virus can transmit from person to person and its efficiency.</p><p><bold>Design</bold> Epidemiological investigations conducted after a family cluster of two patients with avian H7N9 in March 2013.</p><p><bold>Setting</bold> Wuxi, Eastern China.</p><p><bold>Participants</bold> Two patients, their close contacts, and relevant environments. Samples from the patients and environments were collected and tested by real time reverse transcriptase-polymerase chain reaction (rRT-PCR), viral culture, and haemagglutination inhibition assay. Any contacts who became ill had samples tested for avian H7N9 by rRT-PCR. Paired serum samples were obtained from contacts for serological testing by haemagglutination inhibition assays.</p><p><bold>Main outcomes measures</bold> Clinical data, history of exposure before the onset of illnesses, and results of laboratory testing of pathogens and further analysis of sequences and phylogenetic tree to isolated strains.</p><p><bold>Results</bold> The index patient became ill five to six days after his last exposure to poultry. The second patient, his daughter aged 32, who provided unprotected bedside care in the hospital, had no known exposure to poultry. She developed symptoms six days after her last contact with her father. Two strains were isolated successfully from the two patients. Genome sequence and analyses of phylogenetic trees showed that both viruses were almost genetically identical. Forty three close contacts of both patients were identified. One had mild illness but had negative results for avian H7N9 by rRT-PCR. All 43 close contacts tested negative for haemagglutination inhibition antibodies specific for avian H7N9.</p><p><bold>Conclusions</bold> The infection of the daughter probably resulted from contact with her father (the index patient) during unprotected exposure, suggesting that in this cluster the virus was able to transmit from person to person. The transmissibility was limited and non-sustainable.</p></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation</title></titleInfo><name type="personal"><namePart type="given">Xian</namePart><namePart type="family">Qi</namePart><affiliation>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>viriologist</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Yan-Hua</namePart><namePart type="family">Qian</namePart><affiliation>Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, Jiangsu, China 214023</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>epidemiologist</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Chang-Jun</namePart><namePart type="family">Bao</namePart><affiliation>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>epidemiologist</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Xi-Ling</namePart><namePart type="family">Guo</namePart><affiliation>Key Lab of Enteric Pathogenic Microbiology (Ministry of Health), Institute of pathogenic microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>microbiologist</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lun-Biao</namePart><namePart type="family">Cui</namePart><affiliation>Key Lab of Enteric Pathogenic Microbiology (Ministry of Health), Institute of pathogenic microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>molecular biologist</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Fen-Yang</namePart><namePart type="family">Tang</namePart><affiliation>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>public health officer</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Hong</namePart><namePart type="family">Ji</namePart><affiliation>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>public health officer</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Yong</namePart><namePart type="family">Huang</namePart><affiliation>Chinese Field Epidemiology Training Program, Beijing, China</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>trainee of CFETP</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Pei-Quan</namePart><namePart type="family">Cai</namePart><affiliation>Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China 214023</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>respiratory physician</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Bing</namePart><namePart type="family">Lu</namePart><affiliation>Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, Jiangsu, China 214023</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>deputy director</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ke</namePart><namePart type="family">Xu</namePart><affiliation>Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>public health officer</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Chao</namePart><namePart type="family">Shi</namePart><affiliation>Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, Jiangsu, China 214023</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>public health officer</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Feng-Cai</namePart><namePart type="family">Zhu</namePart><affiliation>Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>professor</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">Ming-Hao</namePart><namePart type="family">Zhou</namePart><affiliation>Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>director</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">Hua</namePart><namePart type="family">Wang</namePart><affiliation>Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009</affiliation><affiliation>Health Department of Jiangsu Province, Nanjing, Jiangsu, China 210008</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><affiliation>E-mail: zmh@jscdc.cn</affiliation><description>Correspondence to: M H Zhou</description><description>epidemiologist and deputy director-general</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>British Medical Journal Publishing Group</publisher><dateIssued encoding="w3cdtf">2013</dateIssued><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract>Objective To determine whether the novel avian influenza H7N9 virus can transmit from person to person and its efficiency. Design Epidemiological investigations conducted after a family cluster of two patients with avian H7N9 in March 2013. Setting Wuxi, Eastern China. Participants Two patients, their close contacts, and relevant environments. Samples from the patients and environments were collected and tested by real time reverse transcriptase-polymerase chain reaction (rRT-PCR), viral culture, and haemagglutination inhibition assay. Any contacts who became ill had samples tested for avian H7N9 by rRT-PCR. Paired serum samples were obtained from contacts for serological testing by haemagglutination inhibition assays. Main outcomes measures Clinical data, history of exposure before the onset of illnesses, and results of laboratory testing of pathogens and further analysis of sequences and phylogenetic tree to isolated strains. Results The index patient became ill five to six days after his last exposure to poultry. The second patient, his daughter aged 32, who provided unprotected bedside care in the hospital, had no known exposure to poultry. She developed symptoms six days after her last contact with her father. Two strains were isolated successfully from the two patients. Genome sequence and analyses of phylogenetic trees showed that both viruses were almost genetically identical. Forty three close contacts of both patients were identified. One had mild illness but had negative results for avian H7N9 by rRT-PCR. All 43 close contacts tested negative for haemagglutination inhibition antibodies specific for avian H7N9. Conclusions The infection of the daughter probably resulted from contact with her father (the index patient) during unprotected exposure, suggesting that in this cluster the virus was able to transmit from person to person. The transmissibility was limited and non-sustainable.</abstract><relatedItem type="host"><titleInfo><title>BMJ : British Medical Journal</title></titleInfo><titleInfo type="abbreviated"><title>BMJ</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><identifier type="ISSN">0959-8138</identifier><identifier type="eISSN">1756-1833</identifier><identifier type="PublisherID">bmj</identifier><identifier type="PublisherID-hwp">bmj</identifier><identifier type="PublisherID-nlm-ta">BMJ</identifier><part><date>2013</date><detail type="volume"><caption>vol.</caption><number>347</number></detail></part></relatedItem><identifier type="istex">6B2611F6A10E51F50CA8A396C08A901243AA4BD7</identifier><identifier type="ark">ark:/67375/NVC-2M2K7P27-R</identifier><identifier type="DOI">10.1136/bmj.f4752</identifier><identifier type="href">bmj-347-bmj-f4752.pdf</identifier><identifier type="ArticleID">qixi013783</identifier><identifier type="local">bmj;347/aug06_2/f4752</identifier><accessCondition type="use and reproduction" contentType="open-access">This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. 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