Probable Hospital Cluster of H7N9 Influenza Infection

Farooqui, Amber; Liu, Weidong; Zeng, Tiansheng; Liu, Yisu; Zhang, Li; Khan, Adnan; Wu, Xiuming; Wu, Renhua; Wu, Suwu; Huang, Lusheng; Cai, Yingmu; Kelvin, Alyson A.; Paquette, Stéphane G.; Hu, Kezhao; Zheng, N S; Chen, Hongxia; Xu, Sheng; Lin, Chunnuan; Sun, Peng; Yao, Zhancheng; Wang, Jun; Ma, Huanjie; Zhu, Zengtai; Lin, Pengzhou; Chen, Weihong; Fang, Xibing; Bermejo-Martín, Jesús F.; Leόn, Alberto J.; Kelvin, David J.

doi:10.1056/nejmc1505359

Cited by 22 publications

(12 citation statements)

References 4 publications

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“…Among the well-described clusters of HPAI and LPAI avian influenza, it appears that the secondary cases were less severe than the index cases [9,11,12,43,44,45]. Similar to other research, the secondary deaths occurring in the H5N1 virus case clusters were markedly less severe than the index fatalities.…”

Section: Discussionsupporting

confidence: 77%

“…These viruses occur naturally among wild aquatic birds worldwide and can infect over 100 domestic sources of poultry as well as other birds and animal species [2,3,4,5,6,7]. Avian influenza viruses do not normally infect humans, but human infections may occur after contact with infected birds or their secretions or excretions, or through limited human-to-human transmission [8,9,10,11,12]. Given the significant global improvements in laboratory characterization and surveillance, additional novel avian viruses are likely to be identified.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Epidemiology of Human Fatal Infections with Novel, High (H5N6 and H5N1) and Low (H7N9 and H9N2) Pathogenicity Avian Influenza A Viruses

Zhang²,

Zhao

et al. 2017

IJERPH

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This study aimed to assess the mortality risks for human infection with high (HPAI) and low (LPAI) pathogenicity avian influenza viruses. The HPAI case fatality rate (CFR) was far higher than the LPAI CFR [66.0% (293/444) vs. 68.75% (11/16) vs. 40.4% (265/656) vs. 0.0% (0/18) in the cases with H5N1, H5N6, H7N9, and H9N2 viruses, respectively; p < 0.001]. Similarly, the CFR of the index cases was greater than the secondary cases with H5N1 [100% (43/43) vs. 43.3% (42/97), p < 0.001]. Old age [22.5 vs. 17 years for H5N1, p = 0.018; 61 vs. 49 years for H7H9, p < 0.001], concurrent diseases [18.8% (15/80) vs. 8.33% (9/108) for H5N1, p = 0.046; 58.6% (156/266) vs. 34.8% (135/388) for H7H9, p < 0.001], delayed confirmation [13 vs. 6 days for H5N1, p < 0.001; 10 vs. 8 days for H7N9, p = 0.011] in the fatalities and survivors, were risk factors for deaths. With regard to the H5N1 clusters, exposure to poultry [67.4% (29/43) vs. 45.2% (19/42), p = 0.039] was the higher risk for the primary than the secondary deaths. In conclusion, old age, comorbidities, delayed confirmation, along with poultry exposure are the major risks contributing to fatal outcomes in human HPAI and LPAI infections.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Comparative Epidemiology of Human Fatal Infections with Novel, High (H5N6 and H5N1) and Low (H7N9 and H9N2) Pathogenicity Avian Influenza A Viruses

Zhang²,

Zhao

et al. 2017

IJERPH

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“…12 However, there is no report of a confirmed hospital cluster of H7N9 infection except a possible or controversial hospital cluster in 2016. [13][14][15] This report confirmed that the virus infected case A through airborne transmission possibly in a shared hospital room. It suggested that early diagnosis as well as clinical isolation treatment is necessary for H7N9 patients, and rigorous use of PPE is necessary for close contacts as well.…”

Section: Discussionsupporting

confidence: 75%

A hospital cluster combined with a family cluster of avian influenza H7N9 infection in Anhui Province, China

Zhang

Zhao

Jin

et al. 2019

Journal of Infection

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H7N9 Avian influenza virus Hospital clusterFamily cluster Human-to-human transmission Air transmission s u m m a r y Objectives: To identify human-to-human transmission of H7N9 avian influenza virus, we investigated a hospital cluster combined with family cluster in this study. Methods: We obtained and analyzed clinical, epidemiological and virological data from the three patients. RT-PCR, viral culture and sequencing were conducted for determination of causative pathogen. Results: The index case presented developed pneumonia with fever after exposure to chicken in a poultry farm. Case A presented pneumonia with high fever on day 3 after she shared a hospital room with the index case. Case B, the father of the index case, presented pneumonia with high fever on day 15 after he took care of the index case. H7N9 virus circulated in the local farm to which the index case was exposed. Full genomic sequence of virus showed 99.8-100% identity shared between the index case and case A or case B. Compared to the earliest virus of Anhui, a total of 29 amino acid variation sites were observed in the 8 segments.Conclusions: A hospital cluster combined with family cluster of H7N9 avian influenza infection was identified. Air transmission resulted in the hospital cluster possibly. A poultry farm was the initially infectious source of the cluster.

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“…Avian influenza A viruses of the H7N9 subtype first infected humans in China in 2013 and have since resulted in 786 confirmed cases and 307 deaths (case-fatality risk 39%) as of May 2016 (Food and Agriculture Organization of the United Nations, 2016). Most infections are believed to result from direct exposure to poultry, but there is evidence that limited person-to-person spread has occurred (Farooqui et al, 2016; Qi et al, 2013). Although A(H7N9) is not yet capable of establishing sustained person-to-person transmission, these viruses are considered to have pandemic potential due to their ability to bind both avian and human-like receptors (α2,3 and α2,6-linked sialic acid, respectively) (Shi et al, 2013; Yang et al, 2013; Zhou et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

An influenza A virus (H7N9) anti-neuraminidase monoclonal antibody with prophylactic and therapeutic activity in vivo

et al. 2016

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Zoonotic A(H7N9) avian influenza viruses emerged in China in 2013 and continue to be a threat to human public health, having infected over 800 individuals with a mortality rate approaching 40%. Treatment options for people infected with A(H7N9) include the use of neuraminidase (NA) inhibitors. However, like other influenza viruses, A(H7N9) can become resistant to these drugs. The use of monoclonal antibodies is a rapidly developing strategy for controlling influenza virus infection. Here we generated a murine monoclonal antibody (3c10-3) directed against the NA of A(H7N9) and show that prophylactic systemic administration of 3c10-3 fully protected mice from lethal challenge with wild-type A/Anhui/1/2013 (H7N9). Further, post-infection treatment with a single systemic dose of 3c10-3 at either 24, 48 or 72 h post A(H7N9) challenge resulted in both dose- and time-dependent protection of up to 100% of mice, demonstrating therapeutic potential for 3c10-3. Epitope mapping revealed that 3c10-3 binds near the enzyme active site of NA, and functional characterization showed that 3c10-3 inhibits the enzyme activity of NA and restricts the cell-to-cell spread of the virus in cultured cells. Affinity analysis also revealed that 3c10-3 binds equally well to recombinant NA of wild-type A/Anhui/1/2013 and to a variant NA carrying a R289K mutation known to infer NAI resistance. These results suggest that 3c10-3 has the potential to be used as a therapeutic to treat A(H7N9) infections either as an alternative to, or in combination with, current NA antiviral inhibitors.

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Probable Hospital Cluster of H7N9 Influenza Infection

Cited by 22 publications

References 4 publications

Comparative Epidemiology of Human Fatal Infections with Novel, High (H5N6 and H5N1) and Low (H7N9 and H9N2) Pathogenicity Avian Influenza A Viruses

Comparative Epidemiology of Human Fatal Infections with Novel, High (H5N6 and H5N1) and Low (H7N9 and H9N2) Pathogenicity Avian Influenza A Viruses

A hospital cluster combined with a family cluster of avian influenza H7N9 infection in Anhui Province, China

An influenza A virus (H7N9) anti-neuraminidase monoclonal antibody with prophylactic and therapeutic activity in vivo

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