Clinical characteristics of hospitalized adult avian influenza A (H7N9) virus infections in Hunan province, 2013-2017_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YI Lishan ¹ ,  HU Chengping ¹ , ZHANG Hengjiao ² , LI Zaiqing ³ , YANG Xiangyong ⁴ , ZHOU Yongsheng ⁵ , LI Chiguan ⁶ , HE Xiqiang ⁷

1. Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008,P. R. China;
2. Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan 410005, P. R. China;
3. Department of Respiratory Medicine, Central Hospital of Shaoyang, Shaoyang, Hunan 422000, P. R. China;
4. Department of Respiratory Medicine, Central Hospital of Yongzhou, Yongzhou, Hunan 425000, P. R. China;
5. Department of Respiratory Medicine, Central Hospital of Loudi, Loudi, Hunan 422000, P. R. China;
6. Department of Respiratory Medicine, Chenzhou No.1 People’s Hospital, Chenzhou, Hunan 423000, P. R. China;
7. Intensive Care Unit, Central Hospital of Xiangtan, Xiangtan, Hunan 411100, P. R. China;

Corresponding author：

HU Chengping, Email: huchengp28@csu.edu.cn

Keywords：

Human infections with avian influenza A (H7N9) virus; H7N9; Avian influenza; Clinical characteristics; Antivirus

DOI：

10.7507/1671-6205.201801025

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ObjectiveTo analyze the clinical and epidemiological characteristics of hospitalized avian influenza A (H7N9) virus infections in Hunan province from 2013 to 2017, and provide evidences for control, diagnosis and treatment of this disease.MethodsNinety-one hospitalized patients were confirmed with H7N9 infection in Hunan. Excluding 2 patients less than 18 years old and 10 with missing data, 79 patients with H7N9 infection were analyzed.ResultsMost confirmed cases were affected in the second and fifth epidemic wave and number of patients in the fifth wave was more than the sum in prior 4 waves. Epidemiological characteristics, clinical symptoms and case fatality did not change significantly. Administration of antiviral drugs was more active in the fifth wave [from illness onset to antiviral drug: (6.3±2.4)d vs. (7.6±2.4)d, P=0.047]. Multiple logistic regression analysis showed that shock (OR=4.683, 95%CI 1.136–19.301, P=0.033) was the independent risk factor of H7N9 infections. There were no significant differences in case fatality among group oseltamivir, group oseltamivir+peramivir, and group peramivir.ConclusionsPatients with avian influenza A (H7N9) increased in the fifth wave but clinical characteristics changed little. Antiviral treatment should be more active. Shock is an independent risk factor of H7N9 infections. Oseltamivir-peramivir biotherapy can not reduce case fatality compared with oseltamivir or peramivir monotherapy.

Citation： YI Lishan, HU Chengping, ZHANG Hengjiao, LI Zaiqing, YANG Xiangyong, ZHOU Yongsheng, LI Chiguan, HE Xiqiang. Clinical characteristics of hospitalized adult avian influenza A (H7N9) virus infections in Hunan province, 2013-2017. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(4): 341-347. doi: 10.7507/1671-6205.201801025 Copy

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2.	世界卫生组织. 人感染甲型 H7N9 禽流感病毒——中国. (2018-06-13)[2018/6/13]. http://www.who.int/csr/don/20-april-2017-ah7n9-china/zh/.
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4.	Zhou L, Ren R, Yang L, et al. Sudden increase in human infection with avian influenza A (H7N9) virus in China, September-December 2016. Western Pac Surveill Response J, 2017, 8(1): 6-14.
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10.	华伟玉, 刘锋, 孙亚敏, 等. 一例儿童轻型人感染 H7N9 禽流感确诊病例调查. 国际病毒学杂志, 2015, 22(1): 62-64.
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12.	Wang C, Yu H, Horby PW, et al. Comparison of patients hospitalized with influenza A subtypes H7N9, H5N1, and 2009 pandemic H1N1. Clin Infect Dis, 2014, 58(8): 1095-1103.
13.	Yang ZF, Mok CK, Liu XQ, et al. Clinical, virological and immunological features from patients infected with re-emergent avian-origin human H7N9 influenza disease of varying severity in Guangdong province. PLoS One, 2015, 10(2): e117846.
14.	Wu W, Shi D, Fang D, et al. A new perspective on C-reactive protein in H7N9 infections. Int J Infect Dis, 2016, 44(C): 31-36.
15.	徐冲, 董丽霞, 曹洁. 降钙素原在社区获得性肺炎预后评估中的价值. 中国呼吸与危重监护杂志, 2017, 16(2): 117-121.
16.	Poddar B, Gurjar M, Singh S, et al. Reduction in procalcitonin level and outcome in critically ill children with severe sepsis/septic shock-A pilot study. J Crit Care, 2016, 36(2016): 230-233.
17.	Leung YH, To MK, Lam TS, et al. Epidemiology of human influenza A(H7N9) infection in Hong Kong. J Microbiol Immunol Infect, 2015, 2(50): 183-188.
18.	Cao B, Gao H, Zhou B, et al. Adjuvant corticosteroid treatment in adults with influenza A (H7N9) viral pneumonia. Crit Care Med, 2016, 44(6): e318-e328.
19.	Hu Y, Lu S, Song Z, et al. Association between adverse clinical outcome in human disease caused by novel influenza A H7N9 virus and sustained viral shedding and emergence of antiviral resistance. Lancet, 2013, 381(9885): 2273-2279.
20.	Smee DF, Hurst BL, Wong MH, et al. Combinations of oseltamivir and peramivir for the treatment of influenza A (H1N1) virus infections in cell culture and in mice. Antiviral Res, 2010, 88(1): 38-44.
21.	Zhang Y, Gao H, Liang W, et al. Efficacy of oseltamivir-peramivir combination therapy compared to oseltamivir monotherapy for Influenza A (H7N9) infection: a retrospective study. BMC Infect Dis, 2016, 16(1): 76-84.
22.	Pizzorno A, Abed Y, Rhéaume C, et al. Oseltamivir-zanamivir combination therapy is not superior to zanamivir monotherapy in mice infected with influenza A(H3N2) and A(H1N1)pdm09 viruses. Antiviral Res, 2014, 105(3): 54-58.

1. Gao R, Cao B, Hu Y, et al. Human infection with a novel avian-origin influenza A (H7N9) virus. N Engl J Med, 2013, 368(20): 1888-1897.
2. 世界卫生组织. 人感染甲型 H7N9 禽流感病毒——中国. (2018-06-13)[2018/6/13]. http://www.who.int/csr/don/20-april-2017-ah7n9-china/zh/.
3. Xiang NJ, Li XY, Ren RQ, et al. Assessing change in avian influenza A (H7N9) virus infections during the fourth epidemic -- China, September 2015-August 2016. Morb Mortal Wkly Rep, 2016, 65(49): 1390-1394.
4. Zhou L, Ren R, Yang L, et al. Sudden increase in human infection with avian influenza A (H7N9) virus in China, September-December 2016. Western Pac Surveill Response J, 2017, 8(1): 6-14.
5. 国家卫生和计划生育委员会. 人感染 H7N9 禽流感诊疗方案(2017 年第 1 版). 中国病毒病杂志, 2017, 7(1): 1-4.
6. Tan KX, Jacob SA, Chan KG, et al. An overview of the characteristics of the novel avian influenza A H7N9 virus in humans. Front Microbiol, 2015, 6(140): 140-151.
7. 刘国贤, 刘荣强, 王正良, 等. 一起家庭聚集性人感染 H7N9 禽流感事件调查. 实用预防医学, 2015, 22(7): 826-828.
8. 钟群, 高立冬, 陈伯中, 等. 一起家庭聚集性人感染 H7N9 禽流感疫情的流行病学调查. 实用预防医学, 2017, 24(9): 1140-1142.
9. Li Q, Zhou L, Zhou M, et al. Epidemiology of human infections with avian influenza A (H7N9) virus in China. N Engl J Med, 2014, 370(6): 520-532.
10. 华伟玉, 刘锋, 孙亚敏, 等. 一例儿童轻型人感染 H7N9 禽流感确诊病例调查. 国际病毒学杂志, 2015, 22(1): 62-64.
11. 曾玫, 朱燕凤, 葛艳玲, 等. 中国确诊的首例儿童 H7N9 禽流感. 中华儿科杂志, 2013, 51(9): 665-669.
12. Wang C, Yu H, Horby PW, et al. Comparison of patients hospitalized with influenza A subtypes H7N9, H5N1, and 2009 pandemic H1N1. Clin Infect Dis, 2014, 58(8): 1095-1103.
13. Yang ZF, Mok CK, Liu XQ, et al. Clinical, virological and immunological features from patients infected with re-emergent avian-origin human H7N9 influenza disease of varying severity in Guangdong province. PLoS One, 2015, 10(2): e117846.
14. Wu W, Shi D, Fang D, et al. A new perspective on C-reactive protein in H7N9 infections. Int J Infect Dis, 2016, 44(C): 31-36.
15. 徐冲, 董丽霞, 曹洁. 降钙素原在社区获得性肺炎预后评估中的价值. 中国呼吸与危重监护杂志, 2017, 16(2): 117-121.
16. Poddar B, Gurjar M, Singh S, et al. Reduction in procalcitonin level and outcome in critically ill children with severe sepsis/septic shock-A pilot study. J Crit Care, 2016, 36(2016): 230-233.
17. Leung YH, To MK, Lam TS, et al. Epidemiology of human influenza A(H7N9) infection in Hong Kong. J Microbiol Immunol Infect, 2015, 2(50): 183-188.
18. Cao B, Gao H, Zhou B, et al. Adjuvant corticosteroid treatment in adults with influenza A (H7N9) viral pneumonia. Crit Care Med, 2016, 44(6): e318-e328.
19. Hu Y, Lu S, Song Z, et al. Association between adverse clinical outcome in human disease caused by novel influenza A H7N9 virus and sustained viral shedding and emergence of antiviral resistance. Lancet, 2013, 381(9885): 2273-2279.
20. Smee DF, Hurst BL, Wong MH, et al. Combinations of oseltamivir and peramivir for the treatment of influenza A (H1N1) virus infections in cell culture and in mice. Antiviral Res, 2010, 88(1): 38-44.
21. Zhang Y, Gao H, Liang W, et al. Efficacy of oseltamivir-peramivir combination therapy compared to oseltamivir monotherapy for Influenza A (H7N9) infection: a retrospective study. BMC Infect Dis, 2016, 16(1): 76-84.
22. Pizzorno A, Abed Y, Rhéaume C, et al. Oseltamivir-zanamivir combination therapy is not superior to zanamivir monotherapy in mice infected with influenza A(H3N2) and A(H1N1)pdm09 viruses. Antiviral Res, 2014, 105(3): 54-58.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical characteristics of hospitalized adult avian influenza A (H7N9) virus infections in Hunan province, 2013-2017

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