Nosocomial transmission of avian influenza A (H7N9) virus in China: epidemiological investigation
Nosocomial transmission of avian influenza A (H7N9) virus in China: epidemiological investigation
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DOI：
10.1136/bmj.h5765
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发表时间：
2015-11-19
影响因子：
105.7
通讯作者：
Cao, Wu-Chun
中科院分区：
文献类型：
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作者：
Fang, Chun-Fu;Ma, Mai-Juan;Cao, Wu-Chun
研究问题H7N9禽流感病毒是否可以在医院环境中的无关个体之间传播？方法对2015年2月在浙江省衢州市共用一个医院病房的两名患者进行流行病学调查。采用真实的实时逆转录聚合酶链反应（PCR）和病毒培养对患者、密切接触者和当地环境样本进行检测。血凝抑制和微量中和试验用于检测病毒的特异性抗体。主要结果是临床资料，感染源追踪，系统发育树分析，血清学结果。研究答案和局限性49岁的男子（索引病人）生病后7天参观活禽市场。一例57岁男性（第二例患者），有慢性阻塞性肺疾病病史，在与索引患者共用同一医院病房5天后出现流感样症状。第二名病人在发病前15天内没有去过任何家禽市场，也没有接触过家禽或鸟类。在这两名患者中发现了H7N9病毒，他们后来都死亡了。从这两名患者身上分离出的病毒的基因组序列几乎相同，并且与从活禽市场分离出的病毒在遗传上相似。38名密切接触者均未检出特异性抗体。由于缺乏从患者共用的医院病房收集的样本，患者之间的传播仍不清楚。尽管几份环境拭子经rRT-PCR检测为H7N9阳性，但未培养出病毒。由于延误诊断和频繁的医院转移，没有从患者中收集血清样本，无法检测H7N9病毒抗体。本研究补充的内容H7N9医院传播可能在两个无关的个体之间发生。应加强监察在医院出现流感样病症的病人及活家禽市场的鸡只，以监察病毒的传染性及致病性。
STUDY QUESTIONCan avian influenza A (H7N9) virus be transmitted between unrelated individuals in a hospital setting?METHODSAn epidemiological investigation looked at two patients who shared a hospital ward in February 2015, in Quzhou, Zhejiang Province, China. Samples from the patients, close contacts, and local environments were examined by real time reverse transcriptase (rRT) polymerase chain reaction (PCR) and viral culture. Haemagglutination inhibition and microneutralisation assays were used to detect specific antibodies to the viruses. Primary outcomes were clinical data, infection source tracing, phylogenetic tree analysis, and serological results.STUDY ANSWER AND LIMITATIONSA 49 year old man (index patient) became ill seven days after visiting a live poultry market. A 57 year old man (second patient), with a history of chronic obstructive pulmonary disease, developed influenza-like symptoms after sharing the same hospital ward as the index patient for five days. The second patient had not visited any poultry markets nor had any contact with poultry or birds within 15 days before the onset of illness. H7N9 virus was identified in the two patients, who both later died. Genome sequences of the virus isolated from both patients were nearly identical, and genetically similar to the virus isolated from the live poultry market. No specific antibodies were detected among 38 close contacts. Transmission between the patients remains unclear, owing to the lack of samples collected from their shared hospital ward. Although several environmental swabs were positive for H7N9 by rRT-PCR, no virus was cultured. Owing to delayed diagnosis and frequent hospital transfers, no serum samples were collected from the patients, and antibodies to H7N9 viruses could not be tested.WHAT THIS STUDY ADDSNosocomial H7N9 transmission might be possible between two unrelated individuals. Surveillance on patients with influenza-like illness in hospitals as well as chickens in live poultry markets should be enhanced to monitor transmissibility and pathogenicity of the virus.