Epidemiology of Human Infections with Avian Influenza A(H7N9) Virus in China
Epidemiology of Human Infections with Avian Influenza A(H7N9) Virus in China
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DOI：
10.1056/nejmoa1304617
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发表时间：
2014-02-06
影响因子：
158.5
通讯作者：
Feng, Zijian
中科院分区：
文献类型：
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作者：
Li, Qun;Zhou, Lei;Feng, Zijian
2013年2月至3月期间，中国发生了首例人感染H7N9禽流感病毒的病例。方法对2013年12月1日中国确诊的H7N9病例进行现场调查，分析其流行病学特征。如果通过实时逆转录酶-聚合酶链反应检测（RT-PCR）、病毒分离或血清学检测证实患者存在H7N9病毒，则认为该患者患有确诊病例。从确诊病例患者中获得人口统计学特征、暴露史和疾病时间表的信息。密切接触者被监测了7天的疾病症状。咽拭子从接触者中获得症状的发展，并通过实时RT-PCR. Results 139人确认H7N9病毒感染的存在进行了测试，中位年龄为61岁（范围，2至91），71%是男性，73%是城市居民。中国12个地区出现确诊病例。9人是家禽业工人，在有数据的131人中，82%有活动物接触史，包括鸡（82%）。共有137人（99%）住院，125人（90%）患有肺炎或呼吸衰竭，103人中有65人（63%）被送入重症监护室。共有47人（34%）在中位病程21天后在医院死亡，88人出院，2人仍在住院治疗，情况危急; 2名患者未入院。在四个家庭群中，不能排除H7N9病毒的人际传播。排除继发性病例的集群，2675例患者的密切接触者完成了监测期，其中28人（1%）呼吸道症状的发展，所有测试阴性H7N9病毒。结论大多数人确诊H7N9病毒感染严重下呼吸道疾病，流行病学无关，并有近期接触家禽的历史。2013年初，中国发现了第一例人感染H7N9禽流感病毒的病例。本报告描述了截至2013年12月1日139名确诊H7N9病毒感染者的发现。2013年2月至3月期间，中国东部发生了首例新型甲型流感（H7N9）病毒人感染病例，其特征为快速进展性肺炎、呼吸衰竭、急性呼吸窘迫综合征（ARDS）和致死性结局。(1)我们分析了来自现场调查的可用数据，以描述截至2013年12月1日向中国疾病预防控制中心（中国CDC）报告的实验室确诊的人感染甲型H7N9禽流感病毒病例的描述性流行病学特征。本文总结了病例调查和密切接触者追踪监测的流行病学结果。
BackgroundThe first identified cases of avian influenza A(H7N9) virus infection in humans occurred in China during February and March 2013. We analyzed data obtained from field investigations to describe the epidemiologic characteristics of H7N9 cases in China identified as of December 1, 2013.MethodsField investigations were conducted for each confirmed case of H7N9 virus infection. A patient was considered to have a confirmed case if the presence of the H7N9 virus was verified by means of real-time reverse-transcriptase-polymerase-chain-reaction assay (RT-PCR), viral isolation, or serologic testing. Information on demographic characteristics, exposure history, and illness timelines was obtained from patients with confirmed cases. Close contacts were monitored for 7 days for symptoms of illness. Throat swabs were obtained from contacts in whom symptoms developed and were tested for the presence of the H7N9 virus by means of real-time RT-PCR.ResultsAmong 139 persons with confirmed H7N9 virus infection, the median age was 61 years (range, 2 to 91), 71% were male, and 73% were urban residents. Confirmed cases occurred in 12 areas of China. Nine persons were poultry workers, and of 131 persons with available data, 82% had a history of exposure to live animals, including chickens (82%). A total of 137 persons (99%) were hospitalized, 125 (90%) had pneumonia or respiratory failure, and 65 of 103 with available data (63%) were admitted to an intensive care unit. A total of 47 persons (34%) died in the hospital after a median duration of illness of 21 days, 88 were discharged from the hospital, and 2 remain hospitalized in critical condition; 2 patients were not admitted to a hospital. In four family clusters, human-to-human transmission of H7N9 virus could not be ruled out. Excluding secondary cases in clusters, 2675 close contacts of case patients completed the monitoring period; respiratory symptoms developed in 28 of them (1%); all tested negative for H7N9 virus.ConclusionsMost persons with confirmed H7N9 virus infection had severe lower respiratory tract illness, were epidemiologically unrelated, and had a history of recent exposure to poultry. However, limited, nonsustained human-to-human H7N9 virus transmission could not be ruled out in four families.The first cases of human infection with the avian influenza A(H7N9) virus were identified in China in early 2013. This report describes findings for 139 persons with confirmed H7N9 virus infection through December 1, 2013. The first identified cases of human infection with a novel influenza A(H7N9) virus occurred in eastern China during February and March 2013 and were characterized by rapidly progressive pneumonia, respiratory failure, the acute respiratory distress syndrome (ARDS), and fatal outcomes.(1) We analyzed available data from field investigations to characterize the descriptive epidemiology of laboratory-confirmed cases of avian influenza A(H7N9) virus infection in humans that were reported to the Chinese Center for Disease Control and Prevention (China CDC) as of December 1, 2013. In this report, we summarize the epidemiologic findings of case investigations and follow-up monitoring of close contacts of ...