Clusters of human infections with avian Influenza A(H7N9) virus in China, March 2013 to June 2015

Bo Liu, Fiona P Havers, Lei Zhou, Haojie Zhong, Xianjun Wang, Shenghua Mao, Hai Li, Ruiqi Ren, Nijuan Xiang, Yuelong Shu, Suizan Zhou, Fuqiang Liu, Enfu Chen, Yanping Zhang, Marc-Alain Widdowson, Qun Li, Zijian Feng

Research output: Contribution to journalA1: Web of Science-articlepeer-review


Multiple clusters of human infections with novel avian influenza A(H7N9) virus have occurred since the virus was first identified in spring 2013. However, in many situations it is unclear whether these clusters result from person-to-person transmission or exposure to a common infectious source. We analyzed the possibility of person-to-person transmission in each cluster and developed a framework to assess the likelihood that person-to-person transmission had occurred. We described 21 clusters with 22 infected contact cases that were identified by the Chinese Center for Disease Control and Prevention from March 2013 through June 2015. Based on detailed epidemiological information and the timing of the contact case patients' exposures to infected persons and to poultry during their potential incubation period, we graded the likelihood of person-to-person transmission as probable, possible, or unlikely. We found that person-to-person transmission probably occurred 12 times and possibly occurred 4 times; it was unlikely in 6 clusters. Probable nosocomial transmission is likely to have occurred in 2 clusters. Limited person-to-person transmission is likely to have occurred on multiple occasions since the H7N9 virus was first identified. However, these transmission events represented a small fraction of all identified cases of H7N9 human infection, and sustained person-to-person transmission was not documented.

Original languageEnglish
JournalJournal of Infectious Diseases
Issue numbersuppl_4
Pages (from-to)S548-S554
Publication statusPublished - 2017


  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Animals
  • Child
  • Child, Preschool
  • China/epidemiology
  • Cluster Analysis
  • Cross Infection
  • Female
  • Humans
  • Influenza A Virus, H7N9 Subtype/isolation & purification
  • Influenza in Birds/epidemiology
  • Influenza, Human/epidemiology
  • Male
  • Middle Aged
  • Poultry/virology
  • Young Adult


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