The first avian influenza A (H7N9) viral infection in humans in Zhejiang Province, China: a death report

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• 作者：Enfu Chen (1)
  Fenjuan Wang (2)
  Huakun Lv (1)
  Yanjun Zhang (1)
  Hua Ding (3)
  Shelan Liu (1)
  Jian Cai (1)
  Li Xie (3)
  Xiaoping Xu (4)
  Chengliang Chai (1)
  Haiyan Mao (1)
  Jimin Sun (1)
  Junfen Lin (1)
  Zhao Yu (1)
  Lianhong Li (1)
  Zhiping Chen (1)
  Shichang Xia (1)
  
• 关键词：avian influenza A (H7N9) virus ; epidemiology ; contacts ; person ; to ; person transmission
• 刊名：Frontiers of Medicine
• 出版年：2013
• 出版时间：September 2013
• 年：2013
• 卷：7
• 期：3
• 页码：333-344
• 全文大小：967KB
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• 作者单位：Enfu Chen (1)
  Fenjuan Wang (2)
  Huakun Lv (1)
  Yanjun Zhang (1)
  Hua Ding (3)
  Shelan Liu (1)
  Jian Cai (1)
  Li Xie (3)
  Xiaoping Xu (4)
  Chengliang Chai (1)
  Haiyan Mao (1)
  Jimin Sun (1)
  Junfen Lin (1)
  Zhao Yu (1)
  Lianhong Li (1)
  Zhiping Chen (1)
  Shichang Xia (1)
  
  1. Department of Infectious Diseases, Zhejiang Center for Disease Control and Prevention, Hangzhou, 310051, China
  2. Department of Infectious Diseases, Xiaoshan District Center for Disease Control and Prevention, Hangzhou, 311201, China
  3. Department of Infectious Diseases, Hangzhou Center for Disease Control and Prevention, Hangzhou, 310021, China
  4. Department of Infectious Diseases, Jiande Center for Disease Control and Prevention, Hangzhou, 311600, China
  

文摘

This study reports the first death caused by a novel avian influenza A (H7N9) virus in Zhejiang Province, China. The patient had chronic hepatitis B and history of exposure to poultry. The patient initially complained of diarrhea and influenza-like symptoms on March 7 and 14 respectively. The disease progressed to severe pneumonia, sustained hypoxia, and coagulation abnormalities. The patient died on March 27 because of respiratory failure, multiple organ failure, and disseminated intravascular coagulation without oseltamivir treatment. This H7N9 virus from Zhejiang is highly similar to isolates obtained from Shanghai, Jiangsu, Anhui, etc. Analysis of hemagglutinin, neuramidinase, and matrix genes indicated that the isolates share the same avian origin, have low virulence, and are sensitive to oseltamivir, but are resistant to adamantine. Only the isolate that caused the fatality exhibited substitution of Q226I in the HA gene, which indicates a potentially enhanced human affinity. The secondary transmission rate was 1.6% (2/125). Only two health workers presented with influenza-like symptoms, and they subsequently tested negative for H7N9 RNA. In conclusion, underlying disease, late diagnosis, and untimely antiviral treatment are possible high-risk factors for infections and death caused by the lowpathogenicity avian influenza A (H7N9). Person-to-person transmission of the H7N9 virus was not detected among close contacts, but such transmission should be investigated in the future. Expanding and enhancing surveillance will help in the early discovery and diagnosis of suspected cases, which will reduce the number of severe cases and deaths.