title: Living poultry markets in rural area: Human infection with H7N9 virus re-emerges in Zhejiang Province, China, in winter 2014.
abstract: BACKGROUND
  Avian influenza A H7N9 virus, previously undetected in humans, has caused infections in many areas in China since February 2013. Here we report the re-emergence of a case of H7N9 in rural Jiaxing city, Zhejiang Province, in the winter of 2014.
  
  
  OBJECTIVE
  To understand (1) the clinical syndrome, epidemiological and virological characteristics of this case; (2) the importance of controlling live poultry markets (LPMs) in rural areas.
  
  
  METHODS
  There is one patient and 16 contacts, including 4 family members living in the same household, and 12 medical personnel. Pharyngeal swabs and serum samples were collected from the patient and her contacts. Environment samples were also obtained from the local LPMs. We conducted detailed clinical and epidemiological investigations and laboratory work, including viral RNA extraction, RT-PCR detection and sequencing. Characteristic and phylogenetic analyses were performed using the obtained sequences.
  
  
  RESULTS
  H7N9s were detected in environmental samples collected in LPMs in Jiaxing, Zhejiang. Unknown mutations were discovered in amino acids in the sample from the patient. The strain from the patient was in a clade different from isolates obtained in 2013 in phylogenetic trees of HA, NA and PB2.
  
  
  CONCLUSIONS
  A severe case of H7N9 was identified in early winter, 2014. Epidemiological and clinical tests were consistent with patterns reported previously, while laboratory findings showed the virus to be different. Live poultry markets in rural Zhejiang Province are in need of closer supervision and enhanced management.
authors: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors: Yi
authors: Y
authors: Sun
authors: Jiaxing Center for Disease Control and Prevention, Dongyang, Zhejiang, China.
authors: Henghui
authors: H
authors: Wang
authors: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors: Xiuyu
authors: X
authors: Lou
authors: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors: Haiyan
authors: H
authors: Mao
authors: Jiaxing Center for Disease Control and Prevention, Dongyang, Zhejiang, China.
authors: Yong
authors: Y
authors: Yan
authors: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors: Enfu
authors: E
authors: Chen
authors: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors: Xinying
authors: X
authors: Wang
authors: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors: Zhen
authors: Z
authors: Li
authors: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors: Jian
authors: J
authors: Gao
authors: Jiaxing Center for Disease Control and Prevention, Dongyang, Zhejiang, China.
authors: Xiaofei
authors: X
authors: Fu
authors: Jiaxing Center for Disease Control and Prevention, Dongyang, Zhejiang, China.
authors: Zhongwen
authors: Z
authors: Chen
authors: Center for Infection & Immunity, Department of Medical Microbiology & Parasitology, School of Basic Medical Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, China.
authors: Youjun
authors: Y
authors: Feng
authors: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors: Zhiping
authors: Z
authors: Chen
authors: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China; Center for Infection & Immunity, Department of Medical Microbiology & Parasitology, School of Basic Medical Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, China. Electronic address: yjzhang@cdc.zj.cn.
authors: Yanjun
authors: Y
authors: Zhang
mesh_terms: D000818:Animals; D002681:China / Q000453:epidemiology; D021821:Communicable Diseases, Emerging; D005260:Female; D005814:Genes, Viral; D049674:History, 21st Century; D006801:Humans; D064766:Influenza A Virus, H7N9 Subtype / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D005585:Influenza in Birds / Q000453:epidemiology; D007251:Influenza, Human / Q000453:epidemiology* / Q000266:history / Q000821:virology*; D008875:Middle Aged; D010802:Phylogeny; D011159:Population Surveillance; D011200:Poultry; D012424:Rural Population; D012621:Seasons
keywords: Avian influenza; H7N9; Live poultry market; Rural area