title: Epidemiological, clinical and viral characteristics of fatal cases of human avian influenza A (H7N9) virus in Zhejiang Province, China.
abstract: BACKGROUND
  The high mortality of avian influenza H7N9 in humans is a cause of great concern in China.
  
  
  METHODS
  We compared epidemiological, clinical and viral features of H7N9 influenza of 10 fatal cases and 30 survivors.
  
  
  RESULTS
  Increasing age (p = 0.021), smoking (p = 0.04), underlying medical background (p = 0.05) and chronic drug use (p = 0.042) had a strong relationship with death due to H7N9 infection. Serological inflammatory markers were higher in fatal cases compared to survivors. Acute respiratory distress syndrome (100%), respiratory failure (100%), co-infection with bacteria (60%), shock (50%) and congestive heart failure (50%) were the most common complications observed in fatal cases. The median time from onset of symptoms to antiviral therapy was 4.6 and 7.4 days in those who survived and those who died, respectively (p = 0.04). Viral HA, NA and MP nucleotide sequences of isolates from both study groups exhibited high molecular genetic homology.
  
  
  CONCLUSIONS
  Age along with a history of smoking, chronic lung disease, immuno-suppressive disorders, chronic drug use and delayed Oseltamivir treatment are risk factors which might contribute to fatal outcome in human H7N9 infection.
authors: Department of Infectious Diseases, Zhejiang Provincial Centre for Disease Control and Prevention, 630 Xincheng Road, Binjiang District, Hangzhou, Zhejiang 310051, China. Electronic address: liushelan20070429@126.com.
authors: Shelan
authors: S
authors: Liu
authors: Jimin
authors: J
authors: Sun
authors: Jian
authors: J
authors: Cai
authors: Ziping
authors: Z
authors: Miao
authors: Miaogui
authors: M
authors: Lu
authors: Shuwen
authors: S
authors: Qin
authors: Xiaoxiao
authors: X
authors: Wang
authors: Huakun
authors: H
authors: Lv
authors: Zhao
authors: Z
authors: Yu
authors: Said
authors: S
authors: Amer
authors: Chengliang
authors: C
authors: Chai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D004196:Disease Outbreaks; D005260:Female; D019267:Hemagglutinin Glycoproteins, Influenza Virus / Q000235:genetics; D006801:Humans; D007223:Infant; D064766:Influenza A Virus, H7N9 Subtype / Q000235:genetics / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D055815:Young Adult
chemical_list: D019267:Hemagglutinin Glycoproteins, Influenza Virus
keywords: Avian influenza A (H7N9) virus; Clinical symptoms; Epidemiology; Fatal outcome