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Hebei Province, China, January 2, 2021

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Hebei Province, China, January 2, 2021 China CDC Weekly Notes from the Field Two Reemergent Cases of COVID-19 — Hebei Province, China, January 2, 2021 Shunxiang Qi1,&; Xiang Zhao2,&; Peter Hao3; Nankun Liu3; George F. Gao3; Yang Song2; Wenbo Xu2,#; Qi Li1,# On January 2, 2021, 2 cases of coronavirus disease when traveling to Shijiazhuang City to see his daughter 2019 (COVID-19) were identified in 2 cities of Hebei at a children’s hospital or on December 28 when Province, and genomic sequencing suggested that the attending an agricultural conference without wearing a cases likely resulted from the same origin. The first case mask. Based on the full investigation of Patient B’s (Patient A) was identified as positive at 12∶18 in epidemiological history, 137 close contacts have been Shijiazhuang City, the capital of Hebei Province, and preliminarily identified. the second case (Patient B) was identified as positive at On January 4, the sequences of the COVID-19 21∶00 in Xingtai City. samples from Patients A (Shijiazhuang) and B Patient A is a 61-year-old female residing in a rural (Xingtai) were obtained using Illumina Miseq and village in Gaocheng District of Shijiazhuang City and Illumina Nextseq550 platform, respectively (Sequence had a history of hypertension and multiple mild ID: 512 and 519). Compared with the Wuhan cerebral infarctions. Patient A experienced discomfort reference sequence (EPI_ISL_ 402119) (1–2), the in her pharynx starting around 21∶30 on January 1, Shijiazhuang strain had 21 nucleotide variation sites 2021 and general malaise and fever around 04∶00 on and the Xingtai strain had 22 nucleotide variation sites. January 2. At 05∶00, she took a taxi accompanied by The Xingtai strain shared the 21 nucleotide variation her husband and eldest son (all wearing masks) to a sites presented by the Shijiazhuang strain and also hospital for treatment and was sent to the fever clinic presented an additional unique variation. The 2 strains for testing. Her temperature measured 38.6 ℃ and she both contained the 7 single nucleotide polymorphisms tested positive at 12∶18. At 17∶50, she was transferred (SNPs) that defined L-lineage European branch I by a negative pressure ambulance to a designated (C241T, C3037T, C14408T, A23403G, G28881A, hospital in Shijiazhuang for isolation and treatment. G28882A, and G28883C) (Figure 1). Furthermore, In the two weeks prior to her diagnosis, Patient A the 2 sequences shared an additional 14 unique had a history of staying at home, visiting family, and nucleotide variation sites (T2392C, C6354T, attending religious gatherings in the village with T7075C, C10747T, A11794G, C15342T, C15360T, sporadic mask wearing. However, on December 28, G15666A, C16733T, C21727T, T22020C, she attended a wedding in the village at a restaurant C25416T, C27213T, and C29835T) and were both with roughly 250 people in attendance. Of these 250 identified as belonging to B.1.1.123 Pangolin lineage people, several were known to be traveling from Xi’an (3), which suggested that the Shijiazhuang and Xingtai City of Shaanxi Province and Beijing Municipality. strains had the same transmission route. However, the Patient B is a 34-year-old male residing in Nangong Xingtai strain had an additional variation site City, a county-level city of Xingtai City. At 14:00 on T23227C. The sequencing results indicated that the January 1, he recorded a self-tested temperature of genomic characteristics of the Hebei strains differed 38.1 ℃ and drove to the fever clinic of Nangong City from recent strains detected in several COVID-19 for a COVID-19 test at his own expense. His results epidemics in China (4–6) and were unrelated to recent were found to be positive at 21∶00 on January 2, and variants discovered in the United Kingdom. he was immediately isolated via ambulance and placed After accessing the public database GISAID and under medical observation. He was retested by Xingtai GenBank, 3 Russian strains detected in July were CDC and confirmed to be COVID-19 positive. found to share the 10 variation sites with the 2 Hebei In the two weeks prior to his diagnosis, Patient B strains (GISAID IDs: EPI_ISL_596266, EPI_ISL_ had a history of performing work-related tasks, staying 569792, and EPI_ISL_569793). Despite relatively few at home, and meeting guests without going to high- shared variation sites, the 3 unique sites detected from risk areas. He was possibly exposed on December 25 the Russian strains were only seen in the Hebei strains Chinese Center for Disease Control and Prevention CCDC Weekly / Vol. 3 / No. 2 25 China CDC Weekly LNDL-WY-0722-Y_S11/Dalian_strain 100 LNDL-XY-0722-Y_S10/Dalian_strain LNDL-SFL-0722-Y_S9/Dalian_strain L-Lineage European Branch I/Lineage B.1.1 LNDL-BHQ-0722-Y_S12/Dalian_strain 71 Shulan_02/Shulan_strain 88 Shulan_03/Shulan_strain HLJ-0418-32-T/Heilongjiang_strain EPI_ISL_413997|hCoV-19/Switzerland/GE3895/2020|Europe/Switzerland| HLJ-0418-36-Y/Heilongjiang_strain EPI_ISL_420877|hCoV-19/Australia/VIC-CBA3/2020|Oceania/Australia| nCoVBeijing_IVDC-002_06_2020/Beijing_Xinfadi_strain 19 nCoVBeijing_IVDC-003_06_2020/Beijing_Xinfadi_strain 62 nCoVBeijing_IVDC-001_06_2020/Beijing_Xinfadi_strain EPI_ISL_420129|hCoV-19/Spain/Valencia45/2020|Europe/Spain| EPI_ISL_419656|hCoV-19/Austria/CeMM0003/2020|Europe/Austria| EPI_ISL_416730|hCoV-19/England/SHEF-BFCB1/2020|Europe/England| EPI_ISL_418366|hCoV-19/Canada/ON_PHL3350/2020|North-America/Canada| EPI_ISL_417525|hCoV-19/Taiwan/CGMH-CGU-12/2020|Asia/Taiwan| 30 EPI_ISL_419559|hCoV-19/USA/FL_5125/2020|North-America/USA| L-Lineage European Branch/Lineage B.1 76 EPI_ISL_420555|hCoV-19/India/c32/2020|Asia/India| hCoV-19/England/MILK-9E05B3/2020|EPI_ISL_601443|2020-09-20 hCoV-19/England/CAMC-BBC4C0/2020|EPI_ISL_724145|2020-11-21 100 76 hCoV-19/England/ALDP-C5842F/2020|EPI_ISL_736160|2020-12-13 54 82 NC20SCU2740-1/Shanghai_strain_(December) XJ1-0715-Y_S27/Urumchi_strain XJ3-0716-Y_S29/Urumchi_strain 77 XJ2-0715-Y_S28/Urumchi_strain 56 XJ-THT-1-0715-Y_S25/Urumchi_strain 77 100 512/Shijiazhuang strain/Hebei Province/Jan, 2021 519/Xingtai strain/Hebei Province/Jan, 2021 L-Lineage/Lineage B 85 hCoV-19/Russia/OMS-ORINFI-8945S/2020|EPI_ISL_569792|2020-07-23 48 hCoV-19/Russia/OMS-ORINFI-9295S/2020|EPI_ISL_569793|2020-07-25 2 43 hCoV-19/Russia/NVS-RII-MH1137S/2020|EPI_ISL_596266|2020-07-30 hCoV-19/Russia/SPE-RII-MH1628S/2020|EPI_ISL_596301|2020-09-07 100 RM947-YS/Manzhouli_strain 92 RM948-Y/Manzhouli_strain EPI_ISL_422623|hCoV-19/Netherlands/NA_314/2020|Europe/Netherlands| 100 hCoV-19/South_Africa/NHLS-UCT-GS-0676/2020|EPI_ISL_700510|2020-10-19 hCoV-19/South_Africa/NHLS-UCT-GS-1349/2020|EPI_ISL_700531|2020-11-06 ( L-Lineage European Branch II.1 HLJ-0418-1-1/Heilongjiang_strain America Branch 44 EPI_ISL_422463|hCoV-19/USA/WI-GMF-00588/2020|North-America/USA| EPI_ISL_424202|hCoV-19/USA/WA-UW-1651/2020|North-America/USA| 79 hCoV-19/Canada/ON-S171/2020|EPI_ISL_586371|2020-03-24 16 TJ138/Tianjin_strain 22 EPI_ISL_422430|hCoV-19/Singapore/37/2020|Asia/Singapore| ) EPI_ISL_417693|hCoV-19/Iceland/25/2020|Europe/Iceland| /Lineage B.1 EPI_ISL_418349|hCoV-19/Canada/ON_PHL3650/2020|North-America/Canada| 13 EPI_ISL_418926|hCoV-19/USA/WA-UW359/2020|North-America/USA| 10 EPI_ISL_420791|hCoV-19/USA/NH_0004/2020|North-America/USA| EPI_ISL_421636|hCoV-19/Australia/NSWID930/2020|Oceania/Australia| EPI_ISL_420150|hCoV-19/Norway/2084/2020|Europe/Norway| EPI_ISL_420081|hCoV-19/Russia/StPetersburg-RII3997/2020|Europe/Russia| EPI_ISL_424964|hCoV-19/USA/NY-NYUMC157/2020|North-America/USA| EPI_ISL_420238|hCoV-19/England/SHEF-C051C/2020|Europe/England| EPI_ISL_424912|hCoV-19/USA/MA_9889/2020|North-America/USA| 58 EPI_ISL_420324|hCoV-19/Belgium/DVBJ-030468/2020|Europe/Belgium| EPI_ISL_414626|hCoV-19/France/HF1684/2020|Europe/France| 33 EPI_ISL_418390|hCoV-19/Finland/13M33/2020|Europe/Finland| L-Lineage European Branch II.3 27 EPI_ISL_422703|hCoV-19/Netherlands/NA_168/2020|Europe/Netherlands| EPI_ISL_418219|hCoV-19/France/B1623/2020|Europe/France| 8 38 EPI_ISL_424963|hCoV-19/USA/NY-NYUMC156/2020|North-America/USA| EPI_ISL_419660|hCoV-19/Austria/CeMM0007/2020|Europe/Austria| 52 EPI_ISL_419296|hCoV-19/Japan/P1/2020|Asia/Japan| EPI_ISL_417018|hCoV-19/Belgium/ULG-6670/2020|Europe/Belgium| 93 S2-20201026/KS-first/Kashgar_strain 52 hCoV-19/Bangladesh/BCSIR-NILMRC-220/2020|EPI_ISL_483710| 97 hCoV-19/India/HR-TF20/2020|EPI_ISL_508497| EPI_ISL_415156|hCoV-19/Belgium/SH-03014/2020|Europe/Belgium| EPI_ISL_418355|hCoV-19/Canada/ON_PHLU8150/2020|North-America/Canada| 53 EPI_ISL_420623|hCoV-19/France/ARA13095/2020|Europe/France| EPI_ISL_416731|hCoV-19/England/SHEF-BFCC0/2020|Europe/England| EPI_ISL_420010|hCoV-19/Australia/VIC319/2020|Oceania/Australia| EPI_ISL_424616|hCoV-19/Iceland/596/2020|Europe/Iceland| 73 EPI_ISL_417530|hCoV-19/Luxembourg/LNS2128808/2020|Europe/Luxembourg| 88 EPI_ISL_414624|hCoV-19/France/N1620/2020|Europe/France| EPI_ISL_412973|hCoV-19/Italy/CDG1/2020|Europe/Italy| EPI_ISL_420080|hCoV-19/Russia/StPetersburg-RII3992/2020|Europe/Russia| hCoV-19/Myanmar/NIH-4385/2020|EPI_ISL_434709| 7 YJ20201109-4525/Shanghai_strain_(November) 60 EPI_ISL_419553|hCoV-19/USA/RI_0520/2020|North-America/USA| EPI_ISL_406862|hCoV-19/Germany/BavPat1/2020|Europe/Germany| EPI_ISL_406036|hCoV-19/USA/CA2/2020|North-America/USA| 45 EPI_ISL_424366|hCoV-19/Turkey/ERAGEM-001/2020|Europe/Turkey| 11 EPI_ISL_417444|hCoV-19/Pakistan/Gilgit1/2020|Asia/Pakistan| hCoV-19/Myanmar/MMC_137/2020|EPI_ISL_512844| 28 52 EPI_ISL_420799|hCoV-19/Korea/BA-ACH_2604/2020|Asia/Korea| 41 EPI_ISL_420222|hCoV-19/England/SHEF-C02F7/2020|Europe/England| 59 EPI_ISL_417732|hCoV-19/Iceland/94/2020|Europe/Iceland|
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