Human infections with the emerging avian influenza A H7N9 virus from wet market poultry: clinical analysis and characterisation of viral genome
Identifieur interne : 001B41 ( PascalFrancis/Curation ); précédent : 001B40; suivant : 001B42Human infections with the emerging avian influenza A H7N9 virus from wet market poultry: clinical analysis and characterisation of viral genome
Auteurs : YU CHEN [République populaire de Chine] ; WEIFENG LIANG [République populaire de Chine] ; SHIGUI YANG [République populaire de Chine] ; NANPING WU [République populaire de Chine] ; Hainv Gao [République populaire de Chine] ; JIFANG SHENG [République populaire de Chine] ; HANGPING YAO [République populaire de Chine] ; JIANER WO [République populaire de Chine] ; QIANG FANG [République populaire de Chine] ; DAWEI CUI [République populaire de Chine] ; YONGCHENG LI [République populaire de Chine] ; XING YAO [République populaire de Chine] ; YUNTAO ZHANG [République populaire de Chine] ; HAIBO WU [République populaire de Chine] ; SHUFA ZHENG [République populaire de Chine] ; HONGYAN DIAO [République populaire de Chine] ; SHICHANG XIA [République populaire de Chine] ; YANJUN ZHANG [République populaire de Chine] ; Kwok-Hung Chan [Hong Kong] ; Hoi-Wah Tsoi [République populaire de Chine, Hong Kong] ; Jade Lee-Lee Teng [Hong Kong] ; WENJUN SONG [Hong Kong] ; PUI WANG [Hong Kong] ; Siu-Ying Lau [Hong Kong] ; MIN ZHENG [Hong Kong] ; Jasper Fuk-Woo Chan [Hong Kong] ; Kelvin Kai-Wang To [Hong Kong] ; HONGLIN CHEN [République populaire de Chine, Hong Kong] ; LANJUAN LI [République populaire de Chine] ; Kwok-Yung Yuen [République populaire de Chine, Hong Kong]Source :
- Lancet : (British edition) [ 0140-6736 ] ; 2013.
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English descriptors
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Abstract
Background Human infection with avian influenza A H7N9 virus emerged in eastern China in February, 2013, and has been associated with exposure to poultry. We report the clinical and microbiological features of patients infected with influenza A H7N9 virus and compare genomic features of the human virus with those of the virus in market poultry in Zhejiang, China. Methods Between March 7 and April 8, 2013, we included hospital inpatients if they had new-onset respiratory symptoms, unexplained radiographic infiltrate, and laboratory-confirmed H7N9 virus infection. We recorded histories and results of haematological, biochemical, radiological, and microbiological investigations. We took throat and sputum samples, used RT-PCR to detect M, H7, and N9 genes, and cultured samples in Madin-Darby canine kidney cells. We tested for co-infections and monitored serum concentrations of six cytokines and chemokines.We collected cloacal swabs from 86 birds from epidemiologically linked wet markets and inoculated embryonated chicken eggs with the samples. We identified and subtyped isolates by RT-PCR sequencing. RNA extraction, complementary DNA synthesis, and PCR sequencing were done for one human and one chicken isolate. We characterised and phylogenetically analysed the eight gene segments of the viruses in the patient's and the chicken's isolates, and constructed phylogenetic trees of H, N, PB2, and NS genes. Findings We identified four patients (mean age 56 years), all of whom had contact with poultry 3-8 days before disease onset. They presented with fever and rapidly progressive pneumonia that did not respond to antibiotics. Patients were leucopenic and lymphopenic, and had impaired liver or renal function, substantially increased serum cytokine or chemokine concentrations, and disseminated intravascular coagulation with disease progression. Two patients died. Sputum specimens were more likely to test positive for the H7N9 virus than were samples from throat swabs. The viral isolate from the patient was closely similar to that from an epidemiologically linked market chicken. All viral gene segments were of avian origin. The H7 of the isolated viruses was closest to that of the H7N3 virus from domestic ducks in Zhejiang, whereas the N9 was closest to that of the wild bird H7N9 virus in South Korea. We noted Gln226Leu and Gly186Val substitutions in human virus H7 (associated with increased affinity for α-2,6-linked sialic acid receptors) and the PB2 Asp701Asn mutation (associated with mammalian adaptation). Ser31Asn mutation, which is associated with adamantane resistance, was noted in viral M2. Interpretation Cross species poultry-to-person transmission of this new reassortant H7N9 virus is associated with severe pneumonia and multiorgan dysfunction in human beings. Monitoring of the viral evolution and further study of disease pathogenesis will improve disease management, epidemic control, and pandemic preparedness. Funding Larry Chi-Kin Yung, National Key Program for Infectious Diseases of China.
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<author><name sortKey="Jianer Wo" sort="Jianer Wo" uniqKey="Jianer Wo" last="Jianer Wo">JIANER WO</name>
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<author><name sortKey="Qiang Fang" sort="Qiang Fang" uniqKey="Qiang Fang" last="Qiang Fang">QIANG FANG</name>
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<author><name sortKey="Dawei Cui" sort="Dawei Cui" uniqKey="Dawei Cui" last="Dawei Cui">DAWEI CUI</name>
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<author><name sortKey="Yongcheng Li" sort="Yongcheng Li" uniqKey="Yongcheng Li" last="Yongcheng Li">YONGCHENG LI</name>
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<author><name sortKey="Xing Yao" sort="Xing Yao" uniqKey="Xing Yao" last="Xing Yao">XING YAO</name>
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</author>
<author><name sortKey="Shufa Zheng" sort="Shufa Zheng" uniqKey="Shufa Zheng" last="Shufa Zheng">SHUFA ZHENG</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
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</affiliation>
</author>
<author><name sortKey="Hongyan Diao" sort="Hongyan Diao" uniqKey="Hongyan Diao" last="Hongyan Diao">HONGYAN DIAO</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
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<country>République populaire de Chine</country>
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<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
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<author><name sortKey="Shichang Xia" sort="Shichang Xia" uniqKey="Shichang Xia" last="Shichang Xia">SHICHANG XIA</name>
<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Zhejiang Provincial Center for Disease Control and Prevention</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
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<country>République populaire de Chine</country>
</affiliation>
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<author><name sortKey="Yanjun Zhang" sort="Yanjun Zhang" uniqKey="Yanjun Zhang" last="Yanjun Zhang">YANJUN ZHANG</name>
<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Zhejiang Provincial Center for Disease Control and Prevention</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
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<sZ>18 aut.</sZ>
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<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Chan, Kwok Hung" sort="Chan, Kwok Hung" uniqKey="Chan K" first="Kwok-Hung" last="Chan">Kwok-Hung Chan</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
<s3>HKG</s3>
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<author><name sortKey="Tsoi, Hoi Wah" sort="Tsoi, Hoi Wah" uniqKey="Tsoi H" first="Hoi-Wah" last="Tsoi">Hoi-Wah Tsoi</name>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
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<country>République populaire de Chine</country>
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<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
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</affiliation>
</author>
<author><name sortKey="Teng, Jade Lee Lee" sort="Teng, Jade Lee Lee" uniqKey="Teng J" first="Jade Lee-Lee" last="Teng">Jade Lee-Lee Teng</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
<s3>HKG</s3>
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<country>Hong Kong</country>
</affiliation>
</author>
<author><name sortKey="Wenjun Song" sort="Wenjun Song" uniqKey="Wenjun Song" last="Wenjun Song">WENJUN SONG</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
<s3>HKG</s3>
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<country>Hong Kong</country>
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<author><name sortKey="Pui Wang" sort="Pui Wang" uniqKey="Pui Wang" last="Pui Wang">PUI WANG</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
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<author><name sortKey="Lau, Siu Ying" sort="Lau, Siu Ying" uniqKey="Lau S" first="Siu-Ying" last="Lau">Siu-Ying Lau</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
<s3>HKG</s3>
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<country>Hong Kong</country>
</affiliation>
</author>
<author><name sortKey="Min Zheng" sort="Min Zheng" uniqKey="Min Zheng" last="Min Zheng">MIN ZHENG</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
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</author>
<author><name sortKey="Chan, Jasper Fuk Woo" sort="Chan, Jasper Fuk Woo" uniqKey="Chan J" first="Jasper Fuk-Woo" last="Chan">Jasper Fuk-Woo Chan</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
<s3>HKG</s3>
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</affiliation>
</author>
<author><name sortKey="To, Kelvin Kai Wang" sort="To, Kelvin Kai Wang" uniqKey="To K" first="Kelvin Kai-Wang" last="To">Kelvin Kai-Wang To</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
<s3>HKG</s3>
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<country>Hong Kong</country>
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</author>
<author><name sortKey="Honglin Chen" sort="Honglin Chen" uniqKey="Honglin Chen" last="Honglin Chen">HONGLIN CHEN</name>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
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<country>République populaire de Chine</country>
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<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
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<author><name sortKey="Lanjuan Li" sort="Lanjuan Li" uniqKey="Lanjuan Li" last="Lanjuan Li">LANJUAN LI</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
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<country>République populaire de Chine</country>
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<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
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<country>République populaire de Chine</country>
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</author>
<author><name sortKey="Yuen, Kwok Yung" sort="Yuen, Kwok Yung" uniqKey="Yuen K" first="Kwok-Yung" last="Yuen">Kwok-Yung Yuen</name>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
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<country>République populaire de Chine</country>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
<s3>HKG</s3>
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<sZ>27 aut.</sZ>
<sZ>28 aut.</sZ>
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<country>Hong Kong</country>
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</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">INIST</idno>
<idno type="inist">13-0193288</idno>
<date when="2013">2013</date>
<idno type="stanalyst">PASCAL 13-0193288 INIST</idno>
<idno type="RBID">Pascal:13-0193288</idno>
<idno type="wicri:Area/PascalFrancis/Corpus">000286</idno>
<idno type="wicri:Area/PascalFrancis/Curation">001B41</idno>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Human infections with the emerging avian influenza A H7N9 virus from wet market poultry: clinical analysis and characterisation of viral genome</title>
<author><name sortKey="Yu Chen" sort="Yu Chen" uniqKey="Yu Chen" last="Yu Chen">YU CHEN</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
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<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>29 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
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<sZ>29 aut.</sZ>
<sZ>30 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Weifeng Liang" sort="Weifeng Liang" uniqKey="Weifeng Liang" last="Weifeng Liang">WEIFENG LIANG</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
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<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>29 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
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<sZ>30 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Shigui Yang" sort="Shigui Yang" uniqKey="Shigui Yang" last="Shigui Yang">SHIGUI YANG</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
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<sZ>3 aut.</sZ>
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<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
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<sZ>29 aut.</sZ>
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<country>République populaire de Chine</country>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
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<sZ>1 aut.</sZ>
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<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Nanping Wu" sort="Nanping Wu" uniqKey="Nanping Wu" last="Nanping Wu">NANPING WU</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
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<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
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<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>11 aut.</sZ>
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<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>29 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
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<sZ>20 aut.</sZ>
<sZ>28 aut.</sZ>
<sZ>29 aut.</sZ>
<sZ>30 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Gao, Hainv" sort="Gao, Hainv" uniqKey="Gao H" first="Hainv" last="Gao">Hainv Gao</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
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<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>29 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
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<sZ>30 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Jifang Sheng" sort="Jifang Sheng" uniqKey="Jifang Sheng" last="Jifang Sheng">JIFANG SHENG</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
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<sZ>13 aut.</sZ>
<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>29 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
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<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
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<sZ>20 aut.</sZ>
<sZ>28 aut.</sZ>
<sZ>29 aut.</sZ>
<sZ>30 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Hangping Yao" sort="Hangping Yao" uniqKey="Hangping Yao" last="Hangping Yao">HANGPING YAO</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
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<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>11 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>29 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
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<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>28 aut.</sZ>
<sZ>29 aut.</sZ>
<sZ>30 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Jianer Wo" sort="Jianer Wo" uniqKey="Jianer Wo" last="Jianer Wo">JIANER WO</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
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<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>11 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>29 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>28 aut.</sZ>
<sZ>29 aut.</sZ>
<sZ>30 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Qiang Fang" sort="Qiang Fang" uniqKey="Qiang Fang" last="Qiang Fang">QIANG FANG</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
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<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>11 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>29 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Dawei Cui" sort="Dawei Cui" uniqKey="Dawei Cui" last="Dawei Cui">DAWEI CUI</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>7 aut.</sZ>
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<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>11 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>29 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Yongcheng Li" sort="Yongcheng Li" uniqKey="Yongcheng Li" last="Yongcheng Li">YONGCHENG LI</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>11 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>29 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Xing Yao" sort="Xing Yao" uniqKey="Xing Yao" last="Xing Yao">XING YAO</name>
<affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Huzhou Central Hospital</s1>
<s2>Huzhou</s2>
<s3>CHN</s3>
<sZ>12 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Yuntao Zhang" sort="Yuntao Zhang" uniqKey="Yuntao Zhang" last="Yuntao Zhang">YUNTAO ZHANG</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>11 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>29 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Xiaoshan People's Hospital</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>13 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Haibo Wu" sort="Haibo Wu" uniqKey="Haibo Wu" last="Haibo Wu">HAIBO WU</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>11 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>29 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Shufa Zheng" sort="Shufa Zheng" uniqKey="Shufa Zheng" last="Shufa Zheng">SHUFA ZHENG</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>11 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>29 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Hongyan Diao" sort="Hongyan Diao" uniqKey="Hongyan Diao" last="Hongyan Diao">HONGYAN DIAO</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>11 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>29 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>28 aut.</sZ>
<sZ>29 aut.</sZ>
<sZ>30 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Shichang Xia" sort="Shichang Xia" uniqKey="Shichang Xia" last="Shichang Xia">SHICHANG XIA</name>
<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Zhejiang Provincial Center for Disease Control and Prevention</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>17 aut.</sZ>
<sZ>18 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Yanjun Zhang" sort="Yanjun Zhang" uniqKey="Yanjun Zhang" last="Yanjun Zhang">YANJUN ZHANG</name>
<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Zhejiang Provincial Center for Disease Control and Prevention</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>17 aut.</sZ>
<sZ>18 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
</author>
<author><name sortKey="Chan, Kwok Hung" sort="Chan, Kwok Hung" uniqKey="Chan K" first="Kwok-Hung" last="Chan">Kwok-Hung Chan</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
<s3>HKG</s3>
<sZ>19 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
<sZ>22 aut.</sZ>
<sZ>23 aut.</sZ>
<sZ>24 aut.</sZ>
<sZ>25 aut.</sZ>
<sZ>26 aut.</sZ>
<sZ>27 aut.</sZ>
<sZ>28 aut.</sZ>
<sZ>30 aut.</sZ>
</inist:fA14>
<country>Hong Kong</country>
</affiliation>
</author>
<author><name sortKey="Tsoi, Hoi Wah" sort="Tsoi, Hoi Wah" uniqKey="Tsoi H" first="Hoi-Wah" last="Tsoi">Hoi-Wah Tsoi</name>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>28 aut.</sZ>
<sZ>29 aut.</sZ>
<sZ>30 aut.</sZ>
</inist:fA14>
<country>République populaire de Chine</country>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
<s3>HKG</s3>
<sZ>19 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
<sZ>22 aut.</sZ>
<sZ>23 aut.</sZ>
<sZ>24 aut.</sZ>
<sZ>25 aut.</sZ>
<sZ>26 aut.</sZ>
<sZ>27 aut.</sZ>
<sZ>28 aut.</sZ>
<sZ>30 aut.</sZ>
</inist:fA14>
<country>Hong Kong</country>
</affiliation>
</author>
<author><name sortKey="Teng, Jade Lee Lee" sort="Teng, Jade Lee Lee" uniqKey="Teng J" first="Jade Lee-Lee" last="Teng">Jade Lee-Lee Teng</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
<s3>HKG</s3>
<sZ>19 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
<sZ>22 aut.</sZ>
<sZ>23 aut.</sZ>
<sZ>24 aut.</sZ>
<sZ>25 aut.</sZ>
<sZ>26 aut.</sZ>
<sZ>27 aut.</sZ>
<sZ>28 aut.</sZ>
<sZ>30 aut.</sZ>
</inist:fA14>
<country>Hong Kong</country>
</affiliation>
</author>
<author><name sortKey="Wenjun Song" sort="Wenjun Song" uniqKey="Wenjun Song" last="Wenjun Song">WENJUN SONG</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
<s3>HKG</s3>
<sZ>19 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
<sZ>22 aut.</sZ>
<sZ>23 aut.</sZ>
<sZ>24 aut.</sZ>
<sZ>25 aut.</sZ>
<sZ>26 aut.</sZ>
<sZ>27 aut.</sZ>
<sZ>28 aut.</sZ>
<sZ>30 aut.</sZ>
</inist:fA14>
<country>Hong Kong</country>
</affiliation>
</author>
<author><name sortKey="Pui Wang" sort="Pui Wang" uniqKey="Pui Wang" last="Pui Wang">PUI WANG</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
<s3>HKG</s3>
<sZ>19 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
<sZ>22 aut.</sZ>
<sZ>23 aut.</sZ>
<sZ>24 aut.</sZ>
<sZ>25 aut.</sZ>
<sZ>26 aut.</sZ>
<sZ>27 aut.</sZ>
<sZ>28 aut.</sZ>
<sZ>30 aut.</sZ>
</inist:fA14>
<country>Hong Kong</country>
</affiliation>
</author>
<author><name sortKey="Lau, Siu Ying" sort="Lau, Siu Ying" uniqKey="Lau S" first="Siu-Ying" last="Lau">Siu-Ying Lau</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
<s3>HKG</s3>
<sZ>19 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
<sZ>22 aut.</sZ>
<sZ>23 aut.</sZ>
<sZ>24 aut.</sZ>
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<author><name sortKey="Chan, Jasper Fuk Woo" sort="Chan, Jasper Fuk Woo" uniqKey="Chan J" first="Jasper Fuk-Woo" last="Chan">Jasper Fuk-Woo Chan</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
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<author><name sortKey="To, Kelvin Kai Wang" sort="To, Kelvin Kai Wang" uniqKey="To K" first="Kelvin Kai-Wang" last="To">Kelvin Kai-Wang To</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
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<country>République populaire de Chine</country>
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<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
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<author><name sortKey="Lanjuan Li" sort="Lanjuan Li" uniqKey="Lanjuan Li" last="Lanjuan Li">LANJUAN LI</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
<s2>Hangzhou</s2>
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<author><name sortKey="Yuen, Kwok Yung" sort="Yuen, Kwok Yung" uniqKey="Yuen K" first="Kwok-Yung" last="Yuen">Kwok-Yung Yuen</name>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
<s2>Hangzhou</s2>
<s3>CHN</s3>
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<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong</s1>
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<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>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Avian influenza</term>
<term>Genome</term>
<term>Human</term>
<term>Humidity</term>
<term>Infection</term>
<term>Influenza A virus</term>
<term>Markets</term>
<term>Medicine</term>
<term>Poultry</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Infection</term>
<term>Homme</term>
<term>Virus grippal A</term>
<term>Grippe aviaire</term>
<term>Humidité</term>
<term>Marché</term>
<term>Volaille</term>
<term>Génome</term>
<term>Médecine</term>
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<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term>
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<front><div type="abstract" xml:lang="en">Background Human infection with avian influenza A H7N9 virus emerged in eastern China in February, 2013, and has been associated with exposure to poultry. We report the clinical and microbiological features of patients infected with influenza A H7N9 virus and compare genomic features of the human virus with those of the virus in market poultry in Zhejiang, China. Methods Between March 7 and April 8, 2013, we included hospital inpatients if they had new-onset respiratory symptoms, unexplained radiographic infiltrate, and laboratory-confirmed H7N9 virus infection. We recorded histories and results of haematological, biochemical, radiological, and microbiological investigations. We took throat and sputum samples, used RT-PCR to detect M, H7, and N9 genes, and cultured samples in Madin-Darby canine kidney cells. We tested for co-infections and monitored serum concentrations of six cytokines and chemokines.We collected cloacal swabs from 86 birds from epidemiologically linked wet markets and inoculated embryonated chicken eggs with the samples. We identified and subtyped isolates by RT-PCR sequencing. RNA extraction, complementary DNA synthesis, and PCR sequencing were done for one human and one chicken isolate. We characterised and phylogenetically analysed the eight gene segments of the viruses in the patient's and the chicken's isolates, and constructed phylogenetic trees of H, N, PB2, and NS genes. Findings We identified four patients (mean age 56 years), all of whom had contact with poultry 3-8 days before disease onset. They presented with fever and rapidly progressive pneumonia that did not respond to antibiotics. Patients were leucopenic and lymphopenic, and had impaired liver or renal function, substantially increased serum cytokine or chemokine concentrations, and disseminated intravascular coagulation with disease progression. Two patients died. Sputum specimens were more likely to test positive for the H7N9 virus than were samples from throat swabs. The viral isolate from the patient was closely similar to that from an epidemiologically linked market chicken. All viral gene segments were of avian origin. The H7 of the isolated viruses was closest to that of the H7N3 virus from domestic ducks in Zhejiang, whereas the N9 was closest to that of the wild bird H7N9 virus in South Korea. We noted Gln226Leu and Gly186Val substitutions in human virus H7 (associated with increased affinity for α-2,6-linked sialic acid receptors) and the PB2 Asp701Asn mutation (associated with mammalian adaptation). Ser31Asn mutation, which is associated with adamantane resistance, was noted in viral M2. Interpretation Cross species poultry-to-person transmission of this new reassortant H7N9 virus is associated with severe pneumonia and multiorgan dysfunction in human beings. Monitoring of the viral evolution and further study of disease pathogenesis will improve disease management, epidemic control, and pandemic preparedness. Funding Larry Chi-Kin Yung, National Key Program for Infectious Diseases of China.</div>
</front>
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<fA11 i1="01" i2="1"><s1>YU CHEN</s1>
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<fA11 i1="17" i2="1"><s1>SHICHANG XIA</s1>
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<fA11 i1="26" i2="1"><s1>CHAN (Jasper Fuk-Woo)</s1>
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<fA11 i1="27" i2="1"><s1>TO (Kelvin Kai-Wang)</s1>
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<fA14 i1="01"><s1>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University</s1>
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<fA14 i1="02"><s1>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases</s1>
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<fC01 i1="01" l="ENG"><s0>Background Human infection with avian influenza A H7N9 virus emerged in eastern China in February, 2013, and has been associated with exposure to poultry. We report the clinical and microbiological features of patients infected with influenza A H7N9 virus and compare genomic features of the human virus with those of the virus in market poultry in Zhejiang, China. Methods Between March 7 and April 8, 2013, we included hospital inpatients if they had new-onset respiratory symptoms, unexplained radiographic infiltrate, and laboratory-confirmed H7N9 virus infection. We recorded histories and results of haematological, biochemical, radiological, and microbiological investigations. We took throat and sputum samples, used RT-PCR to detect M, H7, and N9 genes, and cultured samples in Madin-Darby canine kidney cells. We tested for co-infections and monitored serum concentrations of six cytokines and chemokines.We collected cloacal swabs from 86 birds from epidemiologically linked wet markets and inoculated embryonated chicken eggs with the samples. We identified and subtyped isolates by RT-PCR sequencing. RNA extraction, complementary DNA synthesis, and PCR sequencing were done for one human and one chicken isolate. We characterised and phylogenetically analysed the eight gene segments of the viruses in the patient's and the chicken's isolates, and constructed phylogenetic trees of H, N, PB2, and NS genes. Findings We identified four patients (mean age 56 years), all of whom had contact with poultry 3-8 days before disease onset. They presented with fever and rapidly progressive pneumonia that did not respond to antibiotics. Patients were leucopenic and lymphopenic, and had impaired liver or renal function, substantially increased serum cytokine or chemokine concentrations, and disseminated intravascular coagulation with disease progression. Two patients died. Sputum specimens were more likely to test positive for the H7N9 virus than were samples from throat swabs. The viral isolate from the patient was closely similar to that from an epidemiologically linked market chicken. All viral gene segments were of avian origin. The H7 of the isolated viruses was closest to that of the H7N3 virus from domestic ducks in Zhejiang, whereas the N9 was closest to that of the wild bird H7N9 virus in South Korea. We noted Gln226Leu and Gly186Val substitutions in human virus H7 (associated with increased affinity for α-2,6-linked sialic acid receptors) and the PB2 Asp701Asn mutation (associated with mammalian adaptation). Ser31Asn mutation, which is associated with adamantane resistance, was noted in viral M2. Interpretation Cross species poultry-to-person transmission of this new reassortant H7N9 virus is associated with severe pneumonia and multiorgan dysfunction in human beings. Monitoring of the viral evolution and further study of disease pathogenesis will improve disease management, epidemic control, and pandemic preparedness. Funding Larry Chi-Kin Yung, National Key Program for Infectious Diseases of China.</s0>
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<s5>11</s5>
</fC03>
<fC03 i1="08" i2="X" l="ENG"><s0>Genome</s0>
<s5>11</s5>
</fC03>
<fC03 i1="08" i2="X" l="SPA"><s0>Genoma</s0>
<s5>11</s5>
</fC03>
<fC03 i1="09" i2="X" l="FRE"><s0>Médecine</s0>
<s5>12</s5>
</fC03>
<fC03 i1="09" i2="X" l="ENG"><s0>Medicine</s0>
<s5>12</s5>
</fC03>
<fC03 i1="09" i2="X" l="SPA"><s0>Medicina</s0>
<s5>12</s5>
</fC03>
<fC07 i1="01" i2="X" l="FRE"><s0>Influenzavirus A</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="01" i2="X" l="ENG"><s0>Influenzavirus A</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="01" i2="X" l="SPA"><s0>Influenzavirus A</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="02" i2="X" l="FRE"><s0>Orthomyxoviridae</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="02" i2="X" l="ENG"><s0>Orthomyxoviridae</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="02" i2="X" l="SPA"><s0>Orthomyxoviridae</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="03" i2="X" l="FRE"><s0>Virus</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="03" i2="X" l="ENG"><s0>Virus</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="03" i2="X" l="SPA"><s0>Virus</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="04" i2="X" l="FRE"><s0>Virose</s0>
</fC07>
<fC07 i1="04" i2="X" l="ENG"><s0>Viral disease</s0>
</fC07>
<fC07 i1="04" i2="X" l="SPA"><s0>Virosis</s0>
</fC07>
<fN21><s1>175</s1>
</fN21>
<fN44 i1="01"><s1>OTO</s1>
</fN44>
<fN82><s1>OTO</s1>
</fN82>
</pA>
</standard>
</inist>
</record>
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