H7N9 Project

Fictional_Zambia_Scenario21.docx

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Fictional Zambia Scenario

In mid-December, a cluster of 7 cases of a severe flu-like illness was identified in a rural village in Zambia. The index case was a 12-year-old child who died at home on the 4th day of the illness. The other cases include the girl’s mother, a younger brother, and 4 classmates at the small school at the edge of the village. Each of the secondary cases was exposed to the index case and developed symptoms of influenza within 2–5 days of exposure. Presenting symptoms for all cases included fever over 101 ͦ F, dry cough, sore throat, headache, and myalgia. All of the affected individuals sought care at the village health center and were attended by a community health worker (CHW). The CHW became concerned about the brother of the index case on the sixth day of illness when the child developed hemoptysis and increasing respiratory distress. He was referred to Mtendere Mission Hospital in the Southern Providence of Zambia near the border with Zimbabwe, where he subsequently died a week later.

Viral cultures from the boy’s nasopharynx were submitted to CIDRZ laboratory in Lusaka, Zambia at the time of admission. Samples were forwarded to the National Institute for Communicable Diseases (NICD) in South Africa as well as the Centers for Disease Control and Prevention (CDC) in the United States. Both laboratories isolated an influenza A (H7N9) strain similar to the Chinese strain of H7N9 originally isolated in August 2013.

The remaining 5 cases have recovered significantly since being diagnosed. The average duration of most symptoms for the survivors was approximately 8 days; however, profound fatigue persisted beyond 2 weeks. Neither of these cases required a referral for hospitalization, thus viral cultures were not submitted.

Investigation of potential sources of the infection suggested a possible link to imported chickens. The father of the index case had purchased several birds from a Chinese vendor using a micro loan a few weeks prior to the outbreak. The index case was responsible for cleaning the chicken coup outside the family’s home. The girl’s mother and brother had no history of exposure to the chicken coup. The other children at school also denied history of exposure to chickens. The family’s flock has been destroyed by government authorities because of the possible association of the index case and chickens. Laboratory officials are now reporting influenza A (H7N9) virus in at least one chicken. Confirmatory studies are underway.