title: Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of acute respiratory distress syndrome.
abstract: Highly pathogenic avian influenza A viruses of subtypes H5 and H7 are the causative agents of fowl plague in poultry. Influenza A viruses of subtype H5N1 also caused severe respiratory disease in humans in Hong Kong in 1997 and 2003, including at least seven fatal cases, posing a serious human pandemic threat. Between the end of February and the end of May 2003, a fowl plague outbreak occurred in The Netherlands. A highly pathogenic avian influenza A virus of subtype H7N7, closely related to low pathogenic virus isolates obtained from wild ducks, was isolated from chickens. The same virus was detected subsequently in 86 humans who handled affected poultry and in three of their family members. Of these 89 patients, 78 presented with conjunctivitis, 5 presented with conjunctivitis and influenza-like illness, 2 presented with influenza-like illness, and 4 did not fit the case definitions. Influenza-like illnesses were generally mild, but a fatal case of pneumonia in combination with acute respiratory distress syndrome occurred also. Most virus isolates obtained from humans, including probable secondary cases, had not accumulated significant mutations. However, the virus isolated from the fatal case displayed 14 amino acid substitutions, some of which may be associated with enhanced disease in this case. Because H7N7 viruses have caused disease in mammals, including horses, seals, and humans, on several occasions in the past, they may be unusual in their zoonotic potential and, thus, form a pandemic threat to humans.
authors.affiliation: Department of Virology and National Influenza Center, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands. r.fouchier@erasmusmc.nl
authors.forename: Ron A M
authors.initials: RA
authors.lastname: Fouchier
authors.forename: Peter M
authors.initials: PM
authors.lastname: Schneeberger
authors.forename: Frans W
authors.initials: FW
authors.lastname: Rozendaal
authors.forename: Jan M
authors.initials: JM
authors.lastname: Broekman
authors.forename: Stiena A G
authors.initials: SA
authors.lastname: Kemink
authors.forename: Vincent
authors.initials: V
authors.lastname: Munster
authors.forename: Thijs
authors.initials: T
authors.lastname: Kuiken
authors.forename: Guus F
authors.initials: GF
authors.lastname: Rimmelzwaan
authors.forename: Martin
authors.initials: M
authors.lastname: Schutten
authors.forename: Gerard J J
authors.initials: GJ
authors.lastname: Van Doornum
authors.forename: Guus
authors.initials: G
authors.lastname: Koch
authors.forename: Arnold
authors.initials: A
authors.lastname: Bosman
authors.forename: Marion
authors.initials: M
authors.lastname: Koopmans
authors.forename: Albert D M E
authors.initials: AD
authors.lastname: Osterhaus
mesh_terms: D000595:Amino Acid Sequence; D000818:Animals; D001717:Birds; D003231:Conjunctivitis / Q000209:etiology*; D004196:Disease Outbreaks; D017809:Fatal Outcome; D019267:Hemagglutinin Glycoproteins, Influenza Virus / Q000737:chemistry; D006801:Humans; D053126:Influenza A Virus, H7N7 Subtype; D009980:Influenza A virus / Q000145:classification / Q000302:isolation & purification*; D005585:Influenza in Birds / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009426:Netherlands / Q000453:epidemiology; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000473:pathology
chemical_list: D019267:Hemagglutinin Glycoproteins, Influenza Virus