Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation.
Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation.
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DOI：
10.1136/bmj.f4752
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发表时间：
2013-08-06
期刊：
影响因子：
--
通讯作者：
Wang H
中科院分区：
文献类型：
--
作者：
Qi X;Qian YH;Bao CJ;Guo XL;Cui LB;Tang FY;Ji H;Huang Y;Cai PQ;Lu B;Xu K;Shi C;Zhu FC;Zhou MH;Wang H
目的确定新型H7N9禽流感病毒是否能在人与人之间传播及其传播效率。2013年3月，在两名禽流感H7N9患者的家庭聚集性之后进行的流行病学调查。地点在中国东部的无锡。研究对象两例患者及其密切接触者和相关环境。采集患者和环境样本，采用真实的实时逆转录聚合酶链反应（rRT-PCR）、病毒培养和血凝抑制试验进行检测。任何患病的接触者都通过rRT-PCR检测了禽流感H7N9样本。从接触者中采集配对血清样本，通过血凝抑制试验进行血清学检测。主要结果测量临床数据、发病前的暴露史、病原体实验室检测结果以及对分离菌株的序列和系统发育树的进一步分析。结果该指示患者在最后一次接触家禽后5 - 6天发病。第二名患者是他32岁的女儿，她在医院提供无保护的床边护理，没有已知的家禽接触史。她在最后一次与父亲接触后六天出现症状。从2例患者中成功分离出2株菌株。基因组序列和系统发育树分析表明，这两种病毒在遗传上几乎相同。确定了两名患者的43名密切接触者。其中一人病情轻微，但经rRT-PCR检测，禽流感H7N9病毒检测结果为阴性。所有43名密切接触者的H7N9禽流感特异性血凝抑制抗体检测结果均为阴性。结论女儿的感染可能是由于在无保护的暴露期间与父亲（指示患者）接触，这表明在该集群中病毒能够在人与人之间传播。可传播性是有限的和不可持续的。
Objective To determine whether the novel avian influenza H7N9 virus can transmit from person to person and its efficiency. Design Epidemiological investigations conducted after a family cluster of two patients with avian H7N9 in March 2013. Setting Wuxi, Eastern China. Participants Two patients, their close contacts, and relevant environments. Samples from the patients and environments were collected and tested by real time reverse transcriptase-polymerase chain reaction (rRT-PCR), viral culture, and haemagglutination inhibition assay. Any contacts who became ill had samples tested for avian H7N9 by rRT-PCR. Paired serum samples were obtained from contacts for serological testing by haemagglutination inhibition assays. Main outcomes measures Clinical data, history of exposure before the onset of illnesses, and results of laboratory testing of pathogens and further analysis of sequences and phylogenetic tree to isolated strains. Results The index patient became ill five to six days after his last exposure to poultry. The second patient, his daughter aged 32, who provided unprotected bedside care in the hospital, had no known exposure to poultry. She developed symptoms six days after her last contact with her father. Two strains were isolated successfully from the two patients. Genome sequence and analyses of phylogenetic trees showed that both viruses were almost genetically identical. Forty three close contacts of both patients were identified. One had mild illness but had negative results for avian H7N9 by rRT-PCR. All 43 close contacts tested negative for haemagglutination inhibition antibodies specific for avian H7N9. Conclusions The infection of the daughter probably resulted from contact with her father (the index patient) during unprotected exposure, suggesting that in this cluster the virus was able to transmit from person to person. The transmissibility was limited and non-sustainable.
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