Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation

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.

Timeline of family cluster of two patients with novel avian influenza A (H7N9) virus infection in Eastern China, 2013. Strain isolation used Madin-Darby canine kidney cell culture (rRT-PCR=real time reverse transcriptase-polymerase chain reaction; HI=haemagglutination inhibition)