Avian influenza A (H5N1) in 10 patients in Vietnam.
Avian influenza A (H5N1) in 10 patients in Vietnam.
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DOI：
10.1056/nejmoa040419
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发表时间：
2004-03-18
影响因子：
158.5
通讯作者：
Farrar, J
中科院分区：
文献类型：
--
作者：
Hien, TT;Liem, NT;Farrar, J
背景：最近在亚洲禽类中爆发的甲型H5N1禽流感对经济和卫生产生了重大影响。2004年1月在越南发现人类感染该病毒。方法：报告2003年12月和2004年1月在越南胡志明市和河内医院就诊的10例甲型H5N1禽流感确诊病例的临床特征和初步流行病学调查结果。结果：所有10例病例均通过病毒培养或H5和N1特异性引物逆转录聚合酶链反应确诊为甲型H5N1流感。10例患者（平均年龄13.7岁）均无既往病史。其中9人有直接接触家禽的明确史（发病前中位数时间为3天）。所有患者均出现发热（体温38.5 ~ 40.0℃）、呼吸道症状和临床显著淋巴细胞减少（中位淋巴细胞计数为700 /立方毫米）。血小板中位数为75,500 /立方毫米。7名患者出现腹泻。所有患者胸片均有明显异常。没有明确的证据表明存在人际传播。8名患者死亡，1名患者已经康复，1名患者正在康复。结论：以发热、呼吸道症状和淋巴细胞减少为特征的甲型H5N1流感感染具有很高的死亡风险。虽然在所有10例病例中，感染似乎都是直接从受感染的家禽中获得的，但存在与人流感病毒基因重组和人际传播演变的可能性。因此，迫切需要在亚洲各地的家禽中控制甲型H5N1流感。
Background: Recent outbreaks of avian influenza A (H5N1) in poultry throughout Asia have had major economic and health repercussions. Human infections with this virus were identified in Vietnam in January 2004.Methods: We report the clinical features and preliminary epidemiologic findings among 10 patients with confirmed cases of avian influenza A (H5N1) who presented to hospitals in Ho Chi Minh City and Hanoi, Vietnam, in December 2003 and January 2004.Results: In all 10 cases, the diagnosis of influenza A (H5N1) was confirmed by means of viral culture or reverse transcriptase-polymerase chain reaction with primers specific for H5 and N1. None of the 10 patients (mean age, 13.7 years) had preexisting medical conditions. Nine of them had a clear history of direct contact with poultry (median time before onset of illness, three days). All patients presented with fever (temperature, 38.5 to 40.0degreesC), respiratory symptoms, and clinically significant lymphopenia (median lymphocyte count, 700 per cubic millimeter). The median platelet count was 75,500 per cubic millimeter. Seven patients had diarrhea. In all patients, there were marked abnormalities on chest radiography. There was no definitive evidence of human-to-human transmission. Eight patients died, one patient has recovered, and one is recovering.Conclusions: Influenza A (H5N1) infection, characterized by fever, respiratory symptoms, and lymphopenia, carries a high risk of death. Although in all 10 cases the infection appears to have been acquired directly from infected poultry, the potential exists for genetic reassortment with human influenzaviruses and the evolution of human-to-human transmission. Containment of influenza A (H5N1) in poultry throughout Asia is therefore urgently required.