H7N9 antibodies develop 21-days after viral load falls...

Lin and colleagues recently described in Clinical Infectious Diseases, the detection of anti-H7N9 antibodies in the first exported (from mainland China) human case of H7N9.

The 53-year old male case in Taiwan (described previously) harboured a virus that was not fully susceptible to oseltamivir/zanamivir/peramivir 6-days after initiation of oseltamivir. 

This resistance was associated with high viral load in nasopharyngeal and sputum (not spilling over into serum specimens) and slow clearance of virus. 

Whether the virus already had these mutations or developed them in the patient during treatment, could not be determined but both types of viral sequences could be detected in samples using 2nd generation next-generation sequencing techniques.

The patient developed antibodies to H7N9 after 2-weeks, when viral shedding was dropping.

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Three hospital workers test negative.

Despite contact, and some confusion over whether they were or were not wearing personal protective equipment, they are H7N9 negative. So the upper respiratory tract infections (UTRIs; acute signs and symptoms including headache, perhaps a temperature, runny nose, sneezing, cough etc) they manifested after being in contact are due to another virus. Might be interesting to know which one(s). 

Presumably Taiwan already screens for whatever it is as part of a standard "respiratory virus panel". Thanks to ClaireW for the link.

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H7N9 transported outside mainland China.

The first case of H7N9, has been reported reported in Taiwan marking its first known departure from the borders of mainland China. It seems that the 53-year old businessman imported it from somewhere on the mainland - he visited Suchou city in Jiangsu province, traveling out via Shanghai. He reportedly did not have any live birds or poultry.

There is now a risk of new cases emerging from close/regular/healthcare worker (HCW) contacts (n=138) he had (also also those during travel although he was pre-symptomatic and possibly not shedding), in the 3 three days he spent in Taiwan before showing signs of illness and at the medical facilities where he visited and was eventually admitted. If human-to-human transmission can happen, this will be the first chance to see it spread under the auspices of a different government. Four HCWs have cleared the suspected 7-day incubation period without symptoms while 3 HCWs have "developed" upper respiratory infections.

The patient did not seem to respond to Tamiflu but his infection was well advanced and beyond the recommended 48-hour commencement time (Tamiflu was started 16.04.13, about a week after first symptoms). His condition on 20.04.13 required intubation to manage respiratory failure.

The only upside to this "release" is that we may see and hear about some prospective testing which is sorely needed. Thanks to ClaireW and Jason Gale for the heads up.

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Hepatitis B rears its tiny ugly head in the Taiwan case.

Apparently the 53M was also hepatitis B (HepB) positive as were 2/3 cases described in detail in the recent NEJM manuscript (see H7N9 page). 

Is there an association between HepB virus/viral disease and H7N9 or are these co-detections just coincidence due to high prevalence of HepB infection in China (suggested here)?

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