Effect of #closure of live #poultry #markets in #China on #prevention and control of #human #infection with #H7N9 #avian #influenza: a case study of four cities in #Jiangsu Province (J Public Health Policy, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Public Health Policy. 2019 Sep 16. doi: 10.1057/s41271-019-00185-2. [Epub ahead of print]

Effect of closure of live poultry markets in China on prevention and control of human infection with H7N9 avian influenza: a case study of four cities in Jiangsu Province.

Ma J1, Yang N1, Gu H2, Bai L1, Sun J1, Gu S1, Gu J3.

Author information: 1 Center for Health Policy and Management Studies, School of Government, Nanjing University, Nanjing, 210093, China. 2 Center for Health Policy and Management Studies, School of Government, Nanjing University, Nanjing, 210093, China. ghai1008@nju.edu.cn. 3 Nanjing Foreign Language School Xianlin Campus, Nanjing, China.

 

Abstract

As of August 2017, China had encountered five seasonal epidemics of H7N9 avian influenza. To prevent people from contracting H7N9 avian influenza, most cities closed live poultry markets (LPMs) to cut off the source of H7N9 virus. The objective of this study is to assess the impact of LPMs closure on reducing zoonotic transmission of avian influenza A (H7N9) virus and to make specific recommendations on the duration of closing the LPMs. Results show that the closure of LPMs can effectively control the spread of H7N9 avian influenza and reduce the incidence of human infection with H7N9. If cases of H7N9 avian influenza continue to occur, LPMs should close for at least 3-4 weeks in susceptible areas to control the spread of infection.

KEYWORDS: Avian influenza; H7N9; Incidence; Live poultry market; Zoonotic transmission

PMID: 31527787 DOI: 10.1057/s41271-019-00185-2

Keywords: Avian Influenza; H7N9; Human; Poultry; Live Poultry Markets; Jiangsu; China.

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#Platelet count and #mortality of #H7N9 infected patients in #Guangdong, #China (Platelets., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Platelets. 2019 Sep 11:1-4. doi: 10.1080/09537104.2019.1665639. [Epub ahead of print]

Platelet count and mortality of H7N9 infected patients in Guangdong, China.

Chen Y1,2, Yang Y1, Cheng J2, Lu J1, Hu W2.

Author information: 1 School of Public Health, Sun Yat-sen University , Guangzhou , China. 2 School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology , Brisbane , Australia.

 

Abstract

Avian influenza A (H7N9) is a serve zoonosis with a high mortality rate. Timely and effective diagnosis and early warning is crucial for the clinical treatment of H7N9 patients. The previous studies indicated that thrombocytopenia was associated with the prognosis of influenza cases, but the related evidence of platelet change within the course of the disease remains largely insufficient. A total of 130 laboratory-confirmed H7N9 cases and their corresponding medical records from August 2013 to March 2015 were collected from 23 hospitals of 13 cities in Guangdong, China. The results indicated that there was a significant difference between the outcome of H7N9 cases and their average platelet count (PC) including maximum, minimum, range, admission and discharge/death of the PC value. Furthermore, we built a classification and regression tree (CART) model to predict the fatality rate which varied with average PC. There was a 7% chance for a mortality from H7N9 if PC was over 207.0 × 10^9/L, while there was a 46.3% chance of a mortality from H7N9 when PC was between 123.9 × 10^9/L and 207.0 × 10^9/L, and 81.3% chance of a mortality from H7N9 when PC was less than 123.9 × 10^9/L. This study demonstrates that using platelet count to predict the fatality of H7N9 is significant, and lower platelet counts of H7N9 patients were associated with higher risk of mortality of H7N9 patients, which may need to be taken into consideration when planning clinical treatment.

KEYWORDS: Avian influenza A (H7N9); CART; platelet count; predicting death

PMID: 31509040 DOI: 10.1080/09537104.2019.1665639

Keywords: Avian Influenza; H7N9; Human; China; Guangdong.

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Delayed #peak of #human #infections and ongoing #reassortment of #H7N9 #avian #influenza virus in the newly affected western #Chineses provinces during Wave Five (Int J Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Int J Infect Dis. 2019 Sep 6. pii: S1201-9712(19)30363-7. doi: 10.1016/j.ijid.2019.09.002. [Epub ahead of print]

Delayed peak of human infections and ongoing reassortment of H7N9 avian influenza virus in the newly affected western Chineses provinces during Wave Five.

Li J1, Chen C2, Wei J3, Huang H2, Peng Y2, Bi Y3, Liu Y4, Yang Y5.

Author information: 1 School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China. 2 Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, 518112, China. 3 Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, 518112, China; CAS Key Laboratory of Pathogenic Microbiology and Immunology, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Institute of Microbiology, Center for Influenza Research and Early-warning (CASCIRE), Chinese Academy of Sciences, Beijing, 100101, China. 4 Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, 518112, China; University of Chinese Academy of Sciences Medical School, Chinese Academy of Sciences, Beijing, 101408, China. Electronic address: yingxialiu@hotmail.com. 5 Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People’s Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, 518112, China; CAS Key Laboratory of Pathogenic Microbiology and Immunology, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Institute of Microbiology, Center for Influenza Research and Early-warning (CASCIRE), Chinese Academy of Sciences, Beijing, 100101, China. Electronic address: yyszth2018@163.com.

 

Abstract

OBJECTIVES:

Eight additional provinces in western China reported human infections for the first time during the fifth wave of human H7N9 infections. Our study aimed to analyze the epidemiological and virological characteristics of this outbreak.

METHODS:

The epidemiological data of H7N9 cases from the newly affected western Chinese provinces were collected and analyzed. Meanwhile, full-length genome sequences of H7N9 virus were downloaded from GenBank and GISAID databases, and phylogenetic, genotyping and genetic analyses were conducted.

RESULTS:

The peak of human infections in the newly affected western Chinese provinces was delayed by 4 months compared to the eastern China, and both low pathogenic (LP) and highly pathogenic (HP) H7N9 infected cases were found. The LP- and HP-H7N9 virus belonged to 10 different genotypes (including 4 new genotypes), of which G11 and G3 were the dominant genotypes, respectively. Almost all of these viruses originated from eastern and southern China, and were most possibly imported from neighboring provinces. Genetic characteristics of the circulating viruses were similar with the viruses from previously affected provinces during Wave Five.

CONCLUSION:

A delayed peak of human infections was observed in the newly affected western Chinese provinces, and reassortment has been ongoing since the introduction of H7N9 viruses. Our study highlights the importance of continued surveillance of the circulation and evolution of H7N9 virus in western China.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: H7N9; Reassortment; Wave Five; Western dissemination; avian influenza virus (AIV)

PMID: 31499209 DOI: 10.1016/j.ijid.2019.09.002

Keywords: Avian Influenza; H7N9; Human; China; Reassortant strain.

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Novel #reassortant #H7N2 originating from the #H7N9 highly pathogenic #avian #influenza viruses in #China, 2019 (J Infect., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Infect. 2019 Aug 29. pii: S0163-4453(19)30256-7. doi: 10.1016/j.jinf.2019.08.016. [Epub ahead of print]

Novel reassortant H7N2 originating from the H7N9 highly pathogenic avian influenza viruses in China, 2019.

Qiu Y1, Sun R2, Hou G2, Yu X2, Li Y2, Li J2, Zhang Q1, Zou F1, Liu H2, Jiang W3.

Author information: 1 Guangdong Key Laboratory of Animal Conservation and Resource Utilization, Guangdong Public Laboratory of Wild Animal Conservation and Utilization, Guangdong Institute of Applied Biological Resources, Guangzhou, China. 2 China Animal Health and Epidemiology Center, Qingdao, China. 3 China Animal Health and Epidemiology Center, Qingdao, China. Electronic address: civcul@163.com.

 

Abstract

In March 2013, the first human case of zoonotic H7N9 avian influenza virus (AIV) infection was reported in China. This virus has been circulating in domestic poultry in China while mutating to highly pathogenic AIV (HPAIV) since 2017, which caused human infections and poultry outbreaks. In 2019, a novel reassortant H7N2 HPAIV, A/chicken/China/SJZ1/2019(SJZ1), was isolated from H7-Re2-vaccinated layers. We analyzed the genetic, pathogenic, and antigenic characteristics of SJZ1. Analysis of the entire SJZ1 genomic sequence revealed that it comprised at least two different sources; the PB2, PB1, PA, HA (H7), M, and NS segments of SJZ1 were directly derived from H7N9 AIVs, whereas the NA (N2) and NP segments of SJZ1 were derived from H9N2 AIVs. Experimental infection revealed that SJZ1 was highly pathogenic in chickens but not in ducks. SJZ1 was shed from and replicated in chickens and ducks. Hemagglutination-inhibition assay and challenge test indicated that SJZ1 exhibited rapid antigenic drift and distinct antigenicity relative to the H7-Re2 vaccine strain, which provides poor protection for SJZ1. Our study reports the emergence of a new reassortant of H7N2 AIV with novel viral characteristics and warns of the challenge we still face to control the zoonotic H7N9 AIVs and their reassortants.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Antigenic drift; Chickens; Ducks; H7N2; H7N9; Pathogenicity

PMID: 31473272 DOI: 10.1016/j.jinf.2019.08.016

Keywords: Avian Influenza; H7N9; H7N2; H9N2; Reassortant Strain; Poultry; Vaccines; China.

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#Glucocorticoid #treatment of suspected organizing #pneumonia after #H7N9 #infection: A case report (Medicine (Baltimore), abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Medicine (Baltimore). 2019 Aug;98(34):e16839. doi: 10.1097/MD.0000000000016839.

Glucocorticoid treatment of suspected organizing pneumonia after H7N9 infection: A case report.

Liu H1, Li J1, Chen M1, Su J2.

Author information: 1 Department of Intensive Care Unit. 2 Department of Neurosurgery, Zhongshan City People’s Hospital, Zhongshan, China.

 

Abstract

RATIONALE:

H7N9 infection causes acute respiratory distress syndrome with high mortality. The use of glucocorticoids in the acute phase lessened inflammatory responses. Some case reports suggested that secondary organizing pneumonia (SOP) could occur at the recovery stage of the influenza virus infection, and the treatment with glucocorticoid was effective. However, the reports of organizing pneumonia after H7N9 infection are lacking. This study reported a patient with H7N9 virus infection who presented a suspected SOP during the recovery stage.

PATIENT CONCERN:

A 68-year-old woman who was diagnosed with H7N9 viral pneumonia. After standard antiviral treatment, venous-venous extracorporeal membranous oxygenation (VV-ECMO) and other supportive treatment, the antigen in the alveolar lavage fluid turned negative, and the shadow in the lung was partially absorbed. However, the imaging manifestations were deteriorated at 3 weeks after disease onset, presented as exudation and consolidation shadow distributed under the pleura and along the bronchial vascular bundles. The oxygenation could not be improved. Repeated sputum, alveolar lavage fluid, and blood pathogen examinations showed negative results. Broad-spectrum anti-infective treatment was ineffective. However, the autoantibodies (ANA, anti-SSA/Ro60, anti-SSA/Ro52) were detected.

DIAGNOSIS:

SOP was considered.

INTERVENTIONS:

Glucocorticoid treatment begun at week 4 from the disease onset. The regimen was methylprednisolone at an initial dose of 40 mg twice a day for 1 week, tapering within 70 days until total withdrawal.

OUTCOMES:

The oxygenation was rapidly improved after initiation of methylprednisolone. The shadow in the lung gradually resolved, and the patient was discharged after improvement of the disease condition. The clinical disease course, imaging findings, and treatment effects in the previous cases of SOP after influenza virus infection were similar to those in this case, suggesting the occurrence of SOP after H7N9 virus infection.

LESSONS:

Organizing pneumonia might occur during the recovery stage of influenza virus infection. When the clinical symptoms do not improve and the shadow in the lung shows no obvious absorption after elimination of the H7N9 influenza virus, or the clinical symptoms are aggravated again after improvement, the probability of transforming into the organizing pneumonia should be taken into consideration.

PMID: 31441857 DOI: 10.1097/MD.0000000000016839

Keywords: Avian Influenza; H7N9; Human; Corticosteroids; ARDS; ECMO; China; Organizing pneumonia.

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Efficacy of #clarithromycin against #H5N1 and #H7N9 #avian #influenza a virus #infection in cynomolgus monkeys (Antiviral Res., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Antiviral Res. 2019 Aug 14:104591. doi: 10.1016/j.antiviral.2019.104591. [Epub ahead of print]

Efficacy of clarithromycin against H5N1 and H7N9 avian influenza a virus infection in cynomolgus monkeys.

Arikata M1, Itoh Y2, Shichinohe S3, Nakayama M3, Ishigaki H3, Kinoshita T3, Le MQ4, Kawaoka Y5, Ogasawara K6, Shimizu T1.

Author information: 1 Department of Otorhinolaryngology, Shiga University of Medical Science, Japan. 2 Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Japan. Electronic address: yasushii@belle.shiga-med.ac.jp. 3 Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Japan. 4 National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam. 5 Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Tokyo, Japan; Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA. 6 Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Japan; Research Center for Animal Life Science, Shiga University of Medical Science, Otsu, Japan.

 

Abstract

Clarithromycin (CAM), a 14-membered ring macrolide, has anti-inflammatory and immunomodulatory actions and antiviral effects in seasonal influenza virus infection. We examined the prophylactic and therapeutic efficacy of CAM against H5N1 highly pathogenic and H7N9 low pathogenic avian influenza virus infections in cynomolgus monkeys. CAM suppressed H5N1 virus-induced severe signs of disease in the treated monkeys and inhibited virus propagation in tracheal samples and the production of inflammatory cytokines in the lungs of monkeys infected with H5N1 and H7N9 viruses. The prophylactic administration of CAM showed more suppressive effects on clinical signs of disease and viral titers than did therapeutic administration. Thus, since administration of CAM alone showed a tendency to ameliorate clinical sings and to reduce levels of inflammatory cytokines, the macrolides are expected to have effects in combination with the other antiviral drugs on the prophylactic and treatment of patients with severe avian influenza virus infection, which should be further investigated.

Copyright © 2019. Published by Elsevier B.V.

KEYWORDS: Avian influenza virus; Clarithromycin; Cynomolgus monkey; H5N1; H7N9

PMID: 31421167 DOI: 10.1016/j.antiviral.2019.104591

Keywords: Antivirals; Antibiotics; Clarithromycin; Avian Influenza; H5N1; H7N9; Animal models.

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#Factors associated with #fatality due to #avian #influenza A(#H7N9) #infection in #China (Clin Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Clin Infect Dis. 2019 Aug 16. pii: ciz779. doi: 10.1093/cid/ciz779. [Epub ahead of print]

Factors associated with fatality due to avian influenza A(H7N9) infection in China.

Zheng S1,2,3, Zou Q2,3, Wang X2,3, Bao J2,3, Yu F2,3, Guo F4, Liu P5, Shen Y6, Wang Y7, Yang S1, Wu W1, Sheng J1, Vijaykrishna D8,9, Gao H1,4, Chen Y1,2,3.

Author information: 1 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China. 2 Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, P.R. China. 3 Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China. 4 Department of Infectious Diseases, Shulan (Hangzhou) Hospital, Hangzhou, P.R. China. 5 Department of Infectious Diseases, The second hospital of Ningbo, Ningbo, P.R. China. 6 Department of Infectious and Immune Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, P.R. China. 7 Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, P.R. China. 8 Department of Microbiology, Biomedicine Discovery Institute, Monash University, Victoria, Australia. 9 World Health Organization Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.

 

Abstract

BACKGROUND:

The high case fatality rate of influenza A H7N9 infected patients has been a major clinical concern.

METHODS:

To identify the common causes of death due to H7N9 as well as identify risk factors associated with the high inpatient mortality, we retrospectively collected clinical treatment information from 350 hospitalized human cases of H7N9 virus in mainland China during 2013-2017, of which 109 (31.1%) had died, and systematically analysed the patient’s clinical characteristics and risk factors for death.

RESULTS:

The median age of infection was 57 years, whereas the median age of mortality was 61 years, significantly older than those survived. In contrast to previous studies, we found nosocomial infections, comprising Acinetobacter baumannii and Klebsiella most commonly associated with secondary bacterial infections, which was likely due to the high utilization of supportive therapies, including mechanical ventilation (52.6%), ECMO (14%), CRRT (19.1%), and artificial liver therapy (9.7%). Age, time from illness onset to antiviral therapy initiation and secondary bacterial infection were independent risk factors for death. Age >65, secondary bacterial infections, and initiation of neuraminidase inhibitors therapy after 5 days from symptom onset were associated with increased risk of death.

CONCLUSIONS:

Fatality among H7N9 virus infected patients occurred rapidly after hospital admission, especially among older patients, and was followed by severe hypoxemia and multisystem organ failure. Our results show that early neuraminidase-inhibitor therapy and reduction of secondary bacterial infections can help reduce mortality.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

KEYWORDS: H7N9; Influenza; Risk factors; zoonotic infection

PMID: 31418813 DOI: 10.1093/cid/ciz779

Keywords: Antivirals; Antibiotics; Avian Influenza; H7N9; Human; China; Klebsiella pneumoniae; Acinetobacter baumannii.

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