Human Infection with a Novel Avian-Origin Influenza A (H7N9) Virus
Human Infection with a Novel Avian-Origin Influenza A (H7N9) Virus
复制标题
人类感染新型禽源甲型流感 (H7N9) 病毒。
DOI：
10.1056/nejmoa1304459
复制
发表时间：
2013-05-16
影响因子：
158.5
通讯作者：
Shu, Yuelong
中科院分区：
文献类型：
--
作者：
Gao, Rongbao;Cao, Bin;Shu, Yuelong
背景
H7亚型流感病毒感染家禽在世界各地都有发生，但以前没有观察到该亚型在亚洲被引入人类。2013年3月，中国上海或安徽的三名城市居民出现了快速进展的下呼吸道感染，并被发现感染了一种新型禽源性流感病毒A（H7N9）。
方法
我们从这些患者中获得并分析了临床、流行病学和病毒学数据。通过实时逆转录酶-聚合酶链反应试验、病毒培养和序列分析检测呼吸道标本中的流感病毒和其他呼吸道病毒。
结果
从所有三名患者的呼吸道标本中分离出一种新型禽源性流感病毒（H7N9），并鉴定为H7N9。测序分析表明，这三种病毒的所有基因都是禽源的，其中六个内部基因来自禽流感A（H9 N2）病毒。在A/Anhui/1/2013和A/Shanghai/2/2013病毒中发现血凝素（HA）基因210环处的Q226 L（H3编号）置换，但在A/Shanghai/1/2013病毒中未发现。在所有三种病毒的HA基因的150环处鉴定出T160 A突变。在所有三种病毒中均发现神经氨酸酶（NA）茎区的五个氨基酸缺失。所有三名患者均表现为发热、咳嗽和呼吸困难。其中两名患者有近期接触家禽的病史。胸片显示弥漫性阴影和实变。并发症包括急性呼吸窘迫综合征和多器官功能衰竭。三个病人都死了。
结论
在3名患者中，新型H7N9病毒与严重和致命的呼吸道疾病相关。（国家基础研究计划等资助）。
BACKGROUND
Infection of poultry with influenza A subtype H7 viruses occurs worldwide, but the introduction of this subtype to humans in Asia has not been observed previously. In March 2013, three urban residents of Shanghai or Anhui, China, presented with rapidly progressing lower respiratory tract infections and were found to be infected with a novel reassortant avian-origin influenza A (H7N9) virus.
METHODS
We obtained and analyzed clinical, epidemiologic, and virologic data from these patients. Respiratory specimens were tested for influenza and other respiratory viruses by means of real-time reverse-transcriptase-polymerase-chain-reaction assays, viral culturing, and sequence analyses.
RESULTS
A novel reassortant avian-origin influenza A (H7N9) virus was isolated from respiratory specimens obtained from all three patients and was identified as H7N9. Sequencing analyses revealed that all the genes from these three viruses were of avian origin, with six internal genes from avian influenza A (H9N2) viruses. Substitution Q226L (H3 numbering) at the 210-loop in the hemagglutinin (HA) gene was found in the A/Anhui/1/2013 and A/Shanghai/2/2013 virus but not in the A/Shanghai/1/2013 virus. A T160A mutation was identified at the 150-loop in the HA gene of all three viruses. A deletion of five amino acids in the neuraminidase (NA) stalk region was found in all three viruses. All three patients presented with fever, cough, and dyspnea. Two of the patients had a history of recent exposure to poultry. Chest radiography revealed diffuse opacities and consolidation. Complications included acute respiratory distress syndrome and multiorgan failure. All three patients died.
CONCLUSIONS
Novel reassortant H7N9 viruses were associated with severe and fatal respiratory disease in three patients. (Funded by the National Basic Research Program of China and others.).