title: The first avian influenza A (H7N9) viral infection in humans in Zhejiang Province, China: a death report.
abstract: This study reports the first death caused by a novel avian influenza A (H7N9) virus in Zhejiang Province, China. The patient had chronic hepatitis B and history of exposure to poultry. The patient initially complained of diarrhea and influenza-like symptoms on March 7 and 14 respectively. The disease progressed to severe pneumonia, sustained hypoxia, and coagulation abnormalities. The patient died on March 27 because of respiratory failure, multiple organ failure, and disseminated intravascular coagulation without oseltamivir treatment. This H7N9 virus from Zhejiang is highly similar to isolates obtained from Shanghai, Jiangsu, Anhui, etc. Analysis of hemagglutinin, neuramidinase, and matrix genes indicated that the isolates share the same avian origin, have low virulence, and are sensitive to oseltamivir, but are resistant to adamantine. Only the isolate that caused the fatality exhibited substitution of Q226I in the HA gene, which indicates a potentially enhanced human affinity. The secondary transmission rate was 1.6% (2/125). Only two health workers presented with influenza-like symptoms, and they subsequently tested negative for H7N9 RNA. In conclusion, underlying disease, late diagnosis, and untimely antiviral treatment are possible high-risk factors for infections and death caused by the lowpathogenicity avian influenza A (H7N9). Person-to-person transmission of the H7N9 virus was not detected among close contacts, but such transmission should be investigated in the future. Expanding and enhancing surveillance will help in the early discovery and diagnosis of suspected cases, which will reduce the number of severe cases and deaths.
authors.affiliation: Department of Infectious Diseases, Zhejiang Center for Disease Control and Prevention, Hangzhou, 310051, China.
authors.forename: Enfu
authors.initials: E
authors.lastname: Chen
authors.forename: Fenjuan
authors.initials: F
authors.lastname: Wang
authors.forename: Huakun
authors.initials: H
authors.lastname: Lv
authors.forename: Yanjun
authors.initials: Y
authors.lastname: Zhang
authors.forename: Hua
authors.initials: H
authors.lastname: Ding
authors.forename: Shelan
authors.initials: S
authors.lastname: Liu
authors.forename: Jian
authors.initials: J
authors.lastname: Cai
authors.forename: Li
authors.initials: L
authors.lastname: Xie
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Xu
authors.forename: Chengliang
authors.initials: C
authors.lastname: Chai
authors.forename: Haiyan
authors.initials: H
authors.lastname: Mao
authors.forename: Jimin
authors.initials: J
authors.lastname: Sun
authors.forename: Junfen
authors.initials: J
authors.lastname: Lin
authors.forename: Zhao
authors.initials: Z
authors.lastname: Yu
authors.forename: Lianhong
authors.initials: L
authors.lastname: Li
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Chen
authors.forename: Shichang
authors.initials: S
authors.lastname: Xia
mesh_terms: D000328:Adult; D000818:Animals; D002681:China / Q000453:epidemiology; D017809:Fatal Outcome; D006801:Humans; D064766:Influenza A Virus, H7N9 Subtype / Q000302:isolation & purification / Q000472:pathogenicity*; D007251:Influenza, Human / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy / Q000635:transmission / Q000821:virology*; D008297:Male; D011200:Poultry; D012128:Respiratory Distress Syndrome / Q000821:virology; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure