title: A study of family clustering in two young girls with novel avian influenza A (H7N9) in Dongyang, Zhejiang Province, in 2014.
abstract: BACKGROUND
  The avian influenza A H7N9 virus, previously unknown in humans, has infected humans in many areas of China since February 2013. Here we report on a clustering case of H7N9 in two little girls in one family in Dongyang city, Jinhua area, Zhejiang Province.
  
  
  OBJECTIVE
  To determine (1) whether the infections were due to person-to-person transmission or to co-exposure to poultry and (2) the prevalence of this novel H7N9 virus in Dongyang inferred by this family clustering case.
  
  
  METHODS
  Samples were collected from patients and environment. We undertook detailed epidemiological investigations and laboratory work. Phylogenetic analyses were done based on the sequenced genomes. The concentration of cytokines and chemokines in the serum was detected by cytometric bead array analyses.
  
  
  RESULTS
  A mixture of H7 and H9 was detected from the environmental sample. The three H7N9 viruses shared one infection source. The index patient who had significantly higher levels of IL-4, IL-8 and IL-10 suffered severe infection.
  
  
  CONCLUSIONS
  Based on a comparison with previous isolations of the virus in 2013, H7N9 has evolved different lineages through recombination with local H9N2 viruses. Determining whether it was human-to-human transmission or exposure to the same live poultry, since both patients had identical exposure histories, was ambiguous. The results from the cytokine analyses agreed with the conclusion that H7N9 severity is associated with a higher level of cytokines/chemokines. Long term influenza surveillance remains essential to allow for early warning of potential transmission events.
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: HaiYan
authors.initials: H
authors.lastname: Mao
authors.affiliation: Dongyang Center for Disease Control and Prevention, Dongyang, Zhejiang, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Guo
authors.affiliation: Jinhua Center for Disease Control and Prevention, Jinhua, Zhejiang, China.
authors.forename: FengYing
authors.initials: F
authors.lastname: Wang
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: XiuYu
authors.initials: X
authors.lastname: Lou
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: XinYing
authors.initials: X
authors.lastname: Wang
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Li
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: SheLan
authors.initials: S
authors.lastname: Liu
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: ShuWen
authors.initials: S
authors.lastname: Qin
authors.affiliation: Dongyang Center for Disease Control and Prevention, Dongyang, Zhejiang, China.
authors.forename: JunChao
authors.initials: J
authors.lastname: Wei
authors.affiliation: Jinhua Center for Disease Control and Prevention, Jinhua, Zhejiang, China.
authors.forename: ZhiFeng
authors.initials: Z
authors.lastname: Pang
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: ZhiPing
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China. Electronic address: yjzhang@cdc.zj.cn.
authors.forename: YanJun
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000818:Animals; D002648:Child; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D016207:Cytokines / Q000097:blood; D004783:Environmental Microbiology; D005192:Family Health; D005260:Female; D006801:Humans; D007223:Infant; D064766:Influenza A Virus, H7N9 Subtype / Q000145:classification* / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000276:immunology / Q000473:pathology / Q000821:virology*; D008297:Male; D008969:Molecular Sequence Data; D010802:Phylogeny; D012367:RNA, Viral / Q000235:genetics; D017422:Sequence Analysis, DNA
chemical_list: D016207:Cytokines; D012367:RNA, Viral
keywords: Avian influenza; Cytokine; Family cluster; H7N9; Phylogenetic