title: Human infection with a novel, highly pathogenic avian influenza A (H5N6) virus: Virological and clinical findings.
abstract: OBJECTIVE
  Severe infection with avian influenza A (H5N6) virus in humans was identified first in 2014 in China. Before that, it was unknown or unclear if the disease or the pathogen affected people. This study illustrates the virological and clinical findings of a fatal H5N6 virus infection in a human patient.
  
  
  METHODS
  We obtained and analyzed the clinical, epidemiological, and virological data from the patient. Reverse transcription polymerase chain reaction (RT-PCR), viral culture, and sequencing were conducted for determination of the causative pathogen.
  
  
  RESULTS
  The patient, who presented with fever, severe pneumonia, leucopenia, and lymphopenia, developed septic shock and acute respiratory distress syndrome (ARDS), and died on day 10 after illness onset. A novel reassortant avian-origin influenza A (H5N6) virus was isolated from the throat swab or trachea aspirate of the patient. The virus was reassorted with the HA gene of clade 2.3.4.4 H5, the internal genes of clade 2.3.2.1 H5, and the NA gene of the H6N6 avian virus. The cleavage site of the HA gene contained multiple basic amino acids, indicating that the novel H5N6 virus was highly pathogenic in chicken.
  
  
  CONCLUSIONS
  A novel, highly pathogenic avian influenza H5N6 virus with a backbone of H5N1 virus acquired from the NA gene from the H6N6 virus has been identified. It caused human infection resulting in severe respiratory disease.
authors.affiliation: Sichuan Provincial Disease Control and Prevention, Chengdu 610041, China.
authors.forename: Ming
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authors.lastname: Pan
authors.affiliation: National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China.
authors.forename: Rongbao
authors.initials: R
authors.lastname: Gao
authors.affiliation: Sichuan Provincial Disease Control and Prevention, Chengdu 610041, China.
authors.forename: Qiang
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authors.affiliation: Nanchong City Disease Control and Prevention, Nanchong 637000, China.
authors.forename: Shunhe
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authors.lastname: Huang
authors.affiliation: Affiliated Hospital of Chuanbei Medical School, Nanchong 637000, China.
authors.forename: Zhonghui
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authors.lastname: Zhou
authors.affiliation: National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China.
authors.forename: Lei
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authors.lastname: Yang
authors.affiliation: National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China.
authors.forename: Xiaodan
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authors.lastname: Li
authors.affiliation: National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China.
authors.forename: Xiang
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authors.lastname: Zhao
authors.affiliation: National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Zou
authors.affiliation: Sichuan Provincial Disease Control and Prevention, Chengdu 610041, China.
authors.forename: Wenbin
authors.initials: W
authors.lastname: Tong
authors.affiliation: Sichuan Provincial Disease Control and Prevention, Chengdu 610041, China.
authors.forename: Suling
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authors.lastname: Mao
authors.affiliation: National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China.
authors.forename: Shumei
authors.initials: S
authors.lastname: Zou
authors.affiliation: National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Bo
authors.affiliation: Sichuan Provincial Disease Control and Prevention, Chengdu 610041, China.
authors.forename: Xiaoping
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authors.lastname: Zhu
authors.affiliation: Sichuan Provincial Disease Control and Prevention, Chengdu 610041, China.
authors.forename: Lei
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authors.lastname: Liu
authors.affiliation: Sichuan Provincial Disease Control and Prevention, Chengdu 610041, China.
authors.forename: Heng
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authors.affiliation: Nanchong City Disease Control and Prevention, Nanchong 637000, China.
authors.forename: Minghong
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authors.affiliation: Affiliated Hospital of Chuanbei Medical School, Nanchong 637000, China.
authors.forename: Daqing
authors.initials: D
authors.lastname: Wang
authors.affiliation: Affiliated Hospital of Chuanbei Medical School, Nanchong 637000, China.
authors.forename: Zumao
authors.initials: Z
authors.lastname: Li
authors.affiliation: Nanbu County Disease Control and Prevention, Nanchong 637300, China.
authors.forename: Wei
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authors.lastname: Zhao
authors.affiliation: Nanbu County Hospital, Nanchong 637300, China.
authors.forename: Maoli
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authors.affiliation: Dongba Center Hospital of Nanbu County, Nanchong 637300, China.
authors.forename: Yaqiang
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authors.lastname: Li
authors.affiliation: Sichuan Provincial Disease Control and Prevention, Chengdu 610041, China.
authors.forename: Tianshu
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authors.lastname: Li
authors.affiliation: Sichuan Provincial Disease Control and Prevention, Chengdu 610041, China.
authors.forename: Huiping
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authors.lastname: Yang
authors.affiliation: Sichuan Provincial Disease Control and Prevention, Chengdu 610041, China.
authors.forename: Jianan
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authors.affiliation: Sichuan Provincial Disease Control and Prevention, Chengdu 610041, China.
authors.forename: Lijun
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authors.lastname: Zhou
authors.affiliation: Sichuan Provincial Disease Control and Prevention, Chengdu 610041, China.
authors.forename: Xingyu
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authors.lastname: Zhou
authors.affiliation: Nanchong City Disease Control and Prevention, Nanchong 637000, China.
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authors.lastname: Tang
authors.affiliation: Department of Pathology, Beijing Renhe Hospital, Beijing 102600, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Song
authors.affiliation: National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China.
authors.forename: Tao
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authors.lastname: Chen
authors.affiliation: National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China.
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authors.lastname: Bai
authors.affiliation: National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China.
authors.forename: Jianfang
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authors.lastname: Zhou
authors.affiliation: National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China.
authors.forename: Dayan
authors.initials: D
authors.lastname: Wang
authors.affiliation: National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China.
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authors.lastname: Wu
authors.affiliation: National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China.
authors.forename: Dexin
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authors.lastname: Li
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Zijian
authors.initials: Z
authors.lastname: Feng
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: George F
authors.initials: GF
authors.lastname: Gao
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Sichuan Provincial Disease Control and Prevention, Chengdu 610041, China.
authors.forename: Shusen
authors.initials: S
authors.lastname: He
authors.affiliation: National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing 102206, China. Electronic address: yshu@cnic.org.cn.
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mesh_terms: D000818:Animals; D002681:China; D017809:Fatal Outcome; D006801:Humans; D009980:Influenza A virus / Q000235:genetics* / Q000472:pathogenicity*; D005585:Influenza in Birds / Q000821:virology; D007251:Influenza, Human / Q000175:diagnosis* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D011200:Poultry / Q000821:virology; D016865:Reassortant Viruses
keywords: Emerging infectious diseases; H5N6; Highly pathogenic avian influenza virus; Reassortment