Human infection with avian influenza A H7N9 virus: an assessment of clinical severity
Identifieur interne : 001859 ( Main/Merge ); précédent : 001858; suivant : 001860Human infection with avian influenza A H7N9 virus: an assessment of clinical severity
Auteurs : HONGJIE YU [République populaire de Chine] ; Benjamin J. Cowling [Hong Kong] ; LUZHAO FENG [République populaire de Chine] ; Eric H. Y. Lau [Hong Kong] ; QIAOHONG LIAO [République populaire de Chine] ; Tim K. Tsang [Hong Kong] ; ZHIBIN PENG [République populaire de Chine] ; PENG WU [Hong Kong] ; FENGFENG LIU [République populaire de Chine] ; Vicky J. Fang [Hong Kong] ; HONGLONG ZHANG [République populaire de Chine] ; MING LI [République populaire de Chine] ; LINGJIA ZENG [République populaire de Chine] ; ZHEN XU [République populaire de Chine] ; ZHONGJIE LI [République populaire de Chine] ; HUIMING LUO [République populaire de Chine] ; QUN LI [République populaire de Chine] ; ZIJIAN FENG [République populaire de Chine] ; BIN CAO [République populaire de Chine] ; WEIZHONG YANG [République populaire de Chine] ; Joseph T. Wu [Hong Kong] ; YU WANG [République populaire de Chine] ; Gabriel M. Leung [Hong Kong]Source :
- Lancet : (British edition) [ 0140-6736 ] ; 2013.
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Abstract
Background Characterisation of the severity profile of human infections with influenza viruses of animal origin is a part of pandemic risk assessment, and an important part of the assessment of disease epidemiology. Our objective was to assess the clinical severity of human infections with avian influenza A H7N9 virus, which emerged in China in early 2013. Methods We obtained information about laboratory-confirmed cases of avian influenza A H7N9 virus infection reported as of May 28, 2013, from an integrated database built by the Chinese Center for Disease Control and Prevention. We estimated the risk of fatality, mechanical ventilation, and admission to the intensive care unit for patients who required hospital admission for medical reasons. We also used information about laboratory-confirmed cases detected through sentinel influenza-like illness surveillance to estimate the symptomatic case fatality risk. Findings Of 123 patients with laboratory-confirmed avian influenza A H7N9 virus infection who were admitted to hospital, 37 (30%) had died and 69 (56%) had recovered by May 28, 2013. After we accounted for incomplete data for 17 patients who were still in hospital, we estimated the fatality risk for all ages to be 36% (95% CI 26-45) on admission to hospital. Risks of mechanical ventilation or fatality (69%, 95% CI 60-77) and of admission to an intensive care unit, mechanical ventilation, or fatality (83%, 76-90) were high. With assumptions about coverage of the sentinel surveillance network and health-care-seeking behaviour for patients with influenza-like illness associated with influenza A H7N9 virus infection, and pro-rata extrapolation, we estimated that the symptomatic case fatality risk could be between 160 (63-460) and 2800 (1000-9400) per 100 000 symptomatic cases. Interpretation Human infections with avian influenza A H7N9 virus seem to be less serious than has been previously reported. Many mild cases might already have occurred. Continued vigilance and sustained intensive control efforts are needed to minimise the risk of human infection. Funding Chinese Ministry of Science and Technology; Research Fund for the Control of Infectious Disease; Hong Kong University Grants Committee; China-US Collaborative Program on Emerging and Re-emerging Infectious Diseases; Harvard Center for Communicable Disease Dynamics; US National Institute of Allergy and Infectious Disease; and the US National Institutes of Health.
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<author><name sortKey="Ming Li" sort="Ming Li" uniqKey="Ming Li" last="Ming Li">MING LI</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Human infection with avian influenza A H7N9 virus: an assessment of clinical severity</title>
<author><name sortKey="Hongjie Yu" sort="Hongjie Yu" uniqKey="Hongjie Yu" last="Hongjie Yu">HONGJIE YU</name>
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</affiliation>
</author>
<author><name sortKey="Luzhao Feng" sort="Luzhao Feng" uniqKey="Luzhao Feng" last="Luzhao Feng">LUZHAO FENG</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</s1>
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<country>République populaire de Chine</country>
<wicri:noRegion>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Lau, Eric H Y" sort="Lau, Eric H Y" uniqKey="Lau E" first="Eric H. Y." last="Lau">Eric H. Y. Lau</name>
<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong</s1>
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<country>Hong Kong</country>
<wicri:noRegion>Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Qiaohong Liao" sort="Qiaohong Liao" uniqKey="Qiaohong Liao" last="Qiaohong Liao">QIAOHONG LIAO</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</s1>
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<country>République populaire de Chine</country>
<wicri:noRegion>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Tsang, Tim K" sort="Tsang, Tim K" uniqKey="Tsang T" first="Tim K." last="Tsang">Tim K. Tsang</name>
<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong</s1>
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<country>Hong Kong</country>
<wicri:noRegion>Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Zhibin Peng" sort="Zhibin Peng" uniqKey="Zhibin Peng" last="Zhibin Peng">ZHIBIN PENG</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</s1>
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<country>République populaire de Chine</country>
<wicri:noRegion>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Peng Wu" sort="Peng Wu" uniqKey="Peng Wu" last="Peng Wu">PENG WU</name>
<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong</s1>
<s3>HKG</s3>
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</inist:fA14>
<country>Hong Kong</country>
<wicri:noRegion>Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Fengfeng Liu" sort="Fengfeng Liu" uniqKey="Fengfeng Liu" last="Fengfeng Liu">FENGFENG LIU</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</s1>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>7 aut.</sZ>
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<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
<wicri:noRegion>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Fang, Vicky J" sort="Fang, Vicky J" uniqKey="Fang V" first="Vicky J." last="Fang">Vicky J. Fang</name>
<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong</s1>
<s3>HKG</s3>
<sZ>2 aut.</sZ>
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</inist:fA14>
<country>Hong Kong</country>
<wicri:noRegion>Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Honglong Zhang" sort="Honglong Zhang" uniqKey="Honglong Zhang" last="Honglong Zhang">HONGLONG ZHANG</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</s1>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
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</inist:fA14>
<country>République populaire de Chine</country>
<wicri:noRegion>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Ming Li" sort="Ming Li" uniqKey="Ming Li" last="Ming Li">MING LI</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</s1>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
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<country>République populaire de Chine</country>
<wicri:noRegion>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Lingjia Zeng" sort="Lingjia Zeng" uniqKey="Lingjia Zeng" last="Lingjia Zeng">LINGJIA ZENG</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</s1>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
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<country>République populaire de Chine</country>
<wicri:noRegion>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Zhen Xu" sort="Zhen Xu" uniqKey="Zhen Xu" last="Zhen Xu">ZHEN XU</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</s1>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
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<country>République populaire de Chine</country>
<wicri:noRegion>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Zhongjie Li" sort="Zhongjie Li" uniqKey="Zhongjie Li" last="Zhongjie Li">ZHONGJIE LI</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</s1>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
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<country>République populaire de Chine</country>
<wicri:noRegion>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Huiming Luo" sort="Huiming Luo" uniqKey="Huiming Luo" last="Huiming Luo">HUIMING LUO</name>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>National Immunization Program</s1>
<s3>CHN</s3>
<sZ>16 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
<wicri:noRegion>National Immunization Program</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Qun Li" sort="Qun Li" uniqKey="Qun Li" last="Qun Li">QUN LI</name>
<affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Public Health Emergency Center</s1>
<s3>CHN</s3>
<sZ>17 aut.</sZ>
<sZ>18 aut.</sZ>
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<country>République populaire de Chine</country>
<wicri:noRegion>Public Health Emergency Center</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Zijian Feng" sort="Zijian Feng" uniqKey="Zijian Feng" last="Zijian Feng">ZIJIAN FENG</name>
<affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Public Health Emergency Center</s1>
<s3>CHN</s3>
<sZ>17 aut.</sZ>
<sZ>18 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
<wicri:noRegion>Public Health Emergency Center</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Bin Cao" sort="Bin Cao" uniqKey="Bin Cao" last="Bin Cao">BIN CAO</name>
<affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University</s1>
<s2>Beijing</s2>
<s3>CHN</s3>
<sZ>19 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
<placeName><settlement type="city">Pékin</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Weizhong Yang" sort="Weizhong Yang" uniqKey="Weizhong Yang" last="Weizhong Yang">WEIZHONG YANG</name>
<affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Office of the Director , Chinese Center for Disease Control and Prevention</s1>
<s2>Beijing</s2>
<s3>CHN</s3>
<sZ>20 aut.</sZ>
<sZ>22 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
<placeName><settlement type="city">Pékin</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Wu, Joseph T" sort="Wu, Joseph T" uniqKey="Wu J" first="Joseph T." last="Wu">Joseph T. Wu</name>
<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong</s1>
<s3>HKG</s3>
<sZ>2 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>21 aut.</sZ>
<sZ>23 aut.</sZ>
</inist:fA14>
<country>Hong Kong</country>
<wicri:noRegion>Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Yu Wang" sort="Yu Wang" uniqKey="Yu Wang" last="Yu Wang">YU WANG</name>
<affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Office of the Director , Chinese Center for Disease Control and Prevention</s1>
<s2>Beijing</s2>
<s3>CHN</s3>
<sZ>20 aut.</sZ>
<sZ>22 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
<placeName><settlement type="city">Pékin</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Leung, Gabriel M" sort="Leung, Gabriel M" uniqKey="Leung G" first="Gabriel M." last="Leung">Gabriel M. Leung</name>
<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong</s1>
<s3>HKG</s3>
<sZ>2 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>21 aut.</sZ>
<sZ>23 aut.</sZ>
</inist:fA14>
<country>Hong Kong</country>
<wicri:noRegion>Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series><title level="j" type="main">Lancet : (British edition)</title>
<title level="j" type="abbreviated">Lancet : (Br. ed.)</title>
<idno type="ISSN">0140-6736</idno>
<imprint><date when="2013">2013</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><title level="j" type="main">Lancet : (British edition)</title>
<title level="j" type="abbreviated">Lancet : (Br. ed.)</title>
<idno type="ISSN">0140-6736</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Avian influenza</term>
<term>Human</term>
<term>Infection</term>
<term>Influenza A virus</term>
<term>Medicine</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Infection</term>
<term>Homme</term>
<term>Virus grippal A</term>
<term>Grippe aviaire</term>
<term>Médecine</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term>
<term>Médecine</term>
</keywords>
</textClass>
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</teiHeader>
<front><div type="abstract" xml:lang="en">Background Characterisation of the severity profile of human infections with influenza viruses of animal origin is a part of pandemic risk assessment, and an important part of the assessment of disease epidemiology. Our objective was to assess the clinical severity of human infections with avian influenza A H7N9 virus, which emerged in China in early 2013. Methods We obtained information about laboratory-confirmed cases of avian influenza A H7N9 virus infection reported as of May 28, 2013, from an integrated database built by the Chinese Center for Disease Control and Prevention. We estimated the risk of fatality, mechanical ventilation, and admission to the intensive care unit for patients who required hospital admission for medical reasons. We also used information about laboratory-confirmed cases detected through sentinel influenza-like illness surveillance to estimate the symptomatic case fatality risk. Findings Of 123 patients with laboratory-confirmed avian influenza A H7N9 virus infection who were admitted to hospital, 37 (30%) had died and 69 (56%) had recovered by May 28, 2013. After we accounted for incomplete data for 17 patients who were still in hospital, we estimated the fatality risk for all ages to be 36% (95% CI 26-45) on admission to hospital. Risks of mechanical ventilation or fatality (69%, 95% CI 60-77) and of admission to an intensive care unit, mechanical ventilation, or fatality (83%, 76-90) were high. With assumptions about coverage of the sentinel surveillance network and health-care-seeking behaviour for patients with influenza-like illness associated with influenza A H7N9 virus infection, and pro-rata extrapolation, we estimated that the symptomatic case fatality risk could be between 160 (63-460) and 2800 (1000-9400) per 100 000 symptomatic cases. Interpretation Human infections with avian influenza A H7N9 virus seem to be less serious than has been previously reported. Many mild cases might already have occurred. Continued vigilance and sustained intensive control efforts are needed to minimise the risk of human infection. Funding Chinese Ministry of Science and Technology; Research Fund for the Control of Infectious Disease; Hong Kong University Grants Committee; China-US Collaborative Program on Emerging and Re-emerging Infectious Diseases; Harvard Center for Communicable Disease Dynamics; US National Institute of Allergy and Infectious Disease; and the US National Institutes of Health.</div>
</front>
</TEI>
<affiliations><list><country><li>Hong Kong</li>
<li>République populaire de Chine</li>
</country>
<settlement><li>Pékin</li>
</settlement>
</list>
<tree><country name="République populaire de Chine"><noRegion><name sortKey="Hongjie Yu" sort="Hongjie Yu" uniqKey="Hongjie Yu" last="Hongjie Yu">HONGJIE YU</name>
</noRegion>
<name sortKey="Bin Cao" sort="Bin Cao" uniqKey="Bin Cao" last="Bin Cao">BIN CAO</name>
<name sortKey="Fengfeng Liu" sort="Fengfeng Liu" uniqKey="Fengfeng Liu" last="Fengfeng Liu">FENGFENG LIU</name>
<name sortKey="Honglong Zhang" sort="Honglong Zhang" uniqKey="Honglong Zhang" last="Honglong Zhang">HONGLONG ZHANG</name>
<name sortKey="Huiming Luo" sort="Huiming Luo" uniqKey="Huiming Luo" last="Huiming Luo">HUIMING LUO</name>
<name sortKey="Lingjia Zeng" sort="Lingjia Zeng" uniqKey="Lingjia Zeng" last="Lingjia Zeng">LINGJIA ZENG</name>
<name sortKey="Luzhao Feng" sort="Luzhao Feng" uniqKey="Luzhao Feng" last="Luzhao Feng">LUZHAO FENG</name>
<name sortKey="Ming Li" sort="Ming Li" uniqKey="Ming Li" last="Ming Li">MING LI</name>
<name sortKey="Qiaohong Liao" sort="Qiaohong Liao" uniqKey="Qiaohong Liao" last="Qiaohong Liao">QIAOHONG LIAO</name>
<name sortKey="Qun Li" sort="Qun Li" uniqKey="Qun Li" last="Qun Li">QUN LI</name>
<name sortKey="Weizhong Yang" sort="Weizhong Yang" uniqKey="Weizhong Yang" last="Weizhong Yang">WEIZHONG YANG</name>
<name sortKey="Yu Wang" sort="Yu Wang" uniqKey="Yu Wang" last="Yu Wang">YU WANG</name>
<name sortKey="Zhen Xu" sort="Zhen Xu" uniqKey="Zhen Xu" last="Zhen Xu">ZHEN XU</name>
<name sortKey="Zhibin Peng" sort="Zhibin Peng" uniqKey="Zhibin Peng" last="Zhibin Peng">ZHIBIN PENG</name>
<name sortKey="Zhongjie Li" sort="Zhongjie Li" uniqKey="Zhongjie Li" last="Zhongjie Li">ZHONGJIE LI</name>
<name sortKey="Zijian Feng" sort="Zijian Feng" uniqKey="Zijian Feng" last="Zijian Feng">ZIJIAN FENG</name>
</country>
<country name="Hong Kong"><noRegion><name sortKey="Cowling, Benjamin J" sort="Cowling, Benjamin J" uniqKey="Cowling B" first="Benjamin J." last="Cowling">Benjamin J. Cowling</name>
</noRegion>
<name sortKey="Fang, Vicky J" sort="Fang, Vicky J" uniqKey="Fang V" first="Vicky J." last="Fang">Vicky J. Fang</name>
<name sortKey="Lau, Eric H Y" sort="Lau, Eric H Y" uniqKey="Lau E" first="Eric H. Y." last="Lau">Eric H. Y. Lau</name>
<name sortKey="Leung, Gabriel M" sort="Leung, Gabriel M" uniqKey="Leung G" first="Gabriel M." last="Leung">Gabriel M. Leung</name>
<name sortKey="Peng Wu" sort="Peng Wu" uniqKey="Peng Wu" last="Peng Wu">PENG WU</name>
<name sortKey="Tsang, Tim K" sort="Tsang, Tim K" uniqKey="Tsang T" first="Tim K." last="Tsang">Tim K. Tsang</name>
<name sortKey="Wu, Joseph T" sort="Wu, Joseph T" uniqKey="Wu J" first="Joseph T." last="Wu">Joseph T. Wu</name>
</country>
</tree>
</affiliations>
</record>
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