Frontiers of Medicine

, Volume 7, Issue 3, pp 333–344 | Cite as

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

  • Enfu Chen
  • Fenjuan Wang
  • Huakun Lv
  • Yanjun Zhang
  • Hua Ding
  • Shelan Liu
  • Jian Cai
  • Li Xie
  • Xiaoping Xu
  • Chengliang Chai
  • Haiyan Mao
  • Jimin Sun
  • Junfen Lin
  • Zhao Yu
  • Lianhong Li
  • Zhiping Chen
  • Shichang Xia
Research Article

Abstract

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.

Keywords

avian influenza A (H7N9) virus epidemiology contacts person-to-person transmission 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Uyeki TM, Cox NJ. Global concerns regarding novel influenza A (H7N9) virus infections. N Engl J Med 2013; 368(20): 1862–1864PubMedCrossRefGoogle Scholar
  2. 2.
    Gao R, Cao B, Hu Y, Feng Z, Wang D, Hu W, Chen J, Jie Z, Qiu H, Xu K, Xu X, Lu H, Zhu W, Gao Z, Xiang N, Shen Y, He Z, Gu Y, Zhang Z, Yang Y, Zhao X, Zhou L, Li X, Zou S, Zhang Y, Li X, Yang L, Guo J, Dong J, Li Q, Dong L, Zhu Y, Bai T, Wang S, Hao P, Yang W, Zhang Y, Han J, Yu H, Li D, Gao GF, Wu G, Wang Y, Yuan Z, Shu Y. Human infection with a novel avian-origin influenza A (H7N9) virus. N Engl J Med 2013; 368(20): 1888–1897PubMedCrossRefGoogle Scholar
  3. 3.
    World Health Organization. Interim WHO surveillance recommendations for human infection with avian influenza A (H7N9) virus. http://www.who.int/influenza/human_animal_interface/influenza_h7n9/InterimSurveillanceRecH7N9_10May13.pdf (Accessed on May 31, 2013)
  4. 4.
    CDC of USA. Avian influenza A (H7N9) virus. http://www.cdc.gov/flu/avianflu/h7n9-virus.htm (Accessed on May 6, 2013)
  5. 5.
    World Health Organization. Number of confirmed human cases of avian influenza A (H7N9) reported to WHO. http://www.who.int/influenza/human_animal_interface/influenza_h7n9/06_Report-WebH7N9Number.pdf (Accessed on May 20, 2013)
  6. 6.
    National Health and Family Planning Commission (NHFPC). Diagnostic and treatment protocol for human infections with avian influenza A (H7N9). http://www.chinacdc.cn/en/research_5311/Guidelines/ (Accessed on May 28, 2013)
  7. 7.
    National Health and Family Planning Commission (NHFPC). Prevention and control protocol for human infections with avian influenza A (H7N9). http://www.chinacdc.cn/jkzt/crb/rgrgzbxqlg_5295/rgrglgyh/ (Accessed on May 20, 2013)
  8. 8.
    Pasick J, Pedersen J, Hernandez MS. Avian influenza in North America, 2009–2011. Avian Dis 2012; 56(4 Suppl): 845–848PubMedCrossRefGoogle Scholar
  9. 9.
    Hirst M, Astell CR, Griffith M, Coughlin SM, Moksa M, Zeng T, Smailus DE, Holt RA, Jones S, Marra MA, Petric M, Krajden M, Lawrence D, Mak A, Chow R, Skowronski DM, Tweed SA, Goh S, Brunham RC, Robinson J, Bowes V, Sojonky K, Byrne SK, Li Y, Kobasa D, Booth T, Paetzel M. Novel avian influenza H7N3 strain outbreak, British Columbia. Emerg Infect Dis 2004; 10(12): 2192–2195PubMedCrossRefGoogle Scholar
  10. 10.
    Nguyen-Van-Tam JS, Nair P, Acheson P, Baker A, Barker M, Bracebridge S, Croft J, Ellis J, Gelletlie R, Gent N, Ibbotson S, Joseph C, Mahgoub H, Monk P, Reghitt TW, Sundkvist T, Sellwood C, Simpson J, Smith J, Watson JM, Zambon M, Lightfoot N; Incident Response Team. Outbreak of low pathogenicity H7N3 avian influenza in UK, including associated case of human conjunctivitis. Euro Surveill 2006; 11(5): E060504.2PubMedGoogle Scholar
  11. 11.
    Arzey GG, Kirkland PD, Arzey KE, Frost M, Maywood P, Conaty S, Hurt AC, Deng YM, Iannello P, Barr I, Dwyer DE, Ratnamohan M, McPhie K, Selleck P. Influenza virus A (H10N7) in chickens and poultry abattoir workers, Australia. Emerg Infect Dis 2012; 18(5): 814–816PubMedCrossRefGoogle Scholar
  12. 12.
    Fouchier RA, Schneeberger PM, Rozendaal FW, Broekman JM, Kemink SA, Munster V, Kuiken T, Rimmelzwaan GF, Schutten M, Van Doornum GJ, Koch G, Bosman A, Koopmans M, Osterhaus AD. Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of acute respiratory distress syndrome. Proc Natl Acad Sci USA 2004; 101(5): 1356–1361PubMedCrossRefGoogle Scholar
  13. 13.
    Li Q, Zhou L, Zhou M, Chen Z, Li F, Wu H, Xiang N, Chen E, Tang F, Wang D, Meng L, Hong Z, Tu W, Cao Y, Li L, Ding F, Liu B, Wang M, Xie R, Gao R, Li X, Bai T, Zou S, He J, Hu J, Xu Y, Chai C, Wang S, Gao Y, Jin L, Zhang Y, Luo H, Yu H, Gao L, Pang X, Liu G, Shu Y, Yang W, Uyeki TM, Wang Y, Wu F, Feng Z. Preliminary report: epidemiology of the avian influenza A (H7N9) outbreak in China. N Engl J Med 2013 Apr 24. [Epub ahead of print]Google Scholar
  14. 14.
    Tweed SA, Skowronski DM, David ST, Larder A, Petric M, Lees W, Li Y, Katz J, Krajden M, Tellier R, Halpert C, Hirst M, Astell C, Lawrence D, Mak A. Human illness from avian influenza H7N3, British Columbia. Emerg Infect Dis 2004; 10(12): 2196–2199PubMedCrossRefGoogle Scholar
  15. 15.
    Robert M, Holle Rv, Setiawaty V, Pangesti KN, Sedyaningsih ER. Seroprevalence of avian influenza A/H5N1 among poultry farmers in rural Indonesia, 2007. Southeast Asian J Trop Med Public Health 2010; 41(5): 1095–1103PubMedGoogle Scholar
  16. 16.
    Wang H, Feng Z, Shu Y, Yu H, Zhou L, Zu R, Huai Y, Dong J, Bao C, Wen L, Wang H, Yang P, Zhao W, Dong L, Zhou M, Liao Q, Yang H, Wang M, Lu X, Shi Z, Wang W, Gu L, Zhu F, Li Q, Yin W, Yang W, Li D, Uyeki TM, Wang Y. Probable limited person-toperson transmission of highly pathogenic avian influenza A (H5N1) virus in China. Lancet 2008; 371(9622): 1427–1434PubMedCrossRefGoogle Scholar
  17. 17.
    Mounts AW, Kwong H, Izurieta HS, Ho Y, Au T, Lee M, Buxton Bridges C, Williams SW, Mak KH, Katz JM, Thompson WW, Cox NJ, Fukuda K. Case-control study of risk factors for avian influenza A (H5N1) disease, Hong Kong, 1997. J Infect Dis 1999; 180(2): 505–508PubMedCrossRefGoogle Scholar
  18. 18.
    Yu H, Feng Z, Zhang X, Xiang N, Huai Y, Zhou L, Li Z, Xu C, Luo H, He J, Guan X, Yuan Z, Li Y, Xu L, Hong R, Liu X, Zhou X, Yin W, Zhang S, Shu Y, Wang M, Wang Y, Lee CK, Uyeki TM, Yang W; Avian Influenza H5N1 Study Group. Human influenza A (H5N1) cases, urban areas of People’s Republic of China, 2005–2006. Emerg Infect Dis 2007; 13(7): 1061–1064PubMedCrossRefGoogle Scholar
  19. 19.
    Liu SL, Zhang ZR, Wang C, Dong Y, Cui LB, Yang XH, Sun Z, Wang J, Chen J, Huang RJ, Miao F, Ruan B, Xie L, He HX, Deng J. 2009 pandemic characteristics and controlling experiences of influenza H1N1 virus 1 year after the inception in Hangzhou, China. J Med Virol 2010; 82(12): 1985–1995PubMedCrossRefGoogle Scholar
  20. 20.
    World Health Organization. Cumulative number of confirmed human cases for avian influenza A (H5N1) reported to WHO, 2003–2013. http://www.who.int/influenza/human_animal_interface/EN_GIP_20130312CumulativeNumberH5N1cases.pdf (Accessed on April 6, 2013)
  21. 21.
    Ito T, Kawaoka Y. Host-range barrier of influenza A viruses. Vet Microbiol 2000; 74(1–2): 71–75PubMedCrossRefGoogle Scholar
  22. 22.
    Skehel JJ, Wiley DC. Receptor binding and membrane fusion in virus entry: the influenza hemagglutinin. Annu Rev Biochem 2000; 69(1): 531–569PubMedCrossRefGoogle Scholar

Copyright information

© Higher Education Press and Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • 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. 1.Department of Infectious DiseasesZhejiang Center for Disease Control and PreventionHangzhouChina
  2. 2.Department of Infectious DiseasesXiaoshan District Center for Disease Control and PreventionHangzhouChina
  3. 3.Department of Infectious DiseasesHangzhou Center for Disease Control and PreventionHangzhouChina
  4. 4.Department of Infectious DiseasesJiande Center for Disease Control and PreventionHangzhouChina

Personalised recommendations