title: A fatal yellow fever virus infection in China: description and lessons.
abstract: Yellow fever (YF) is a viral disease endemic to the tropical regions of Africa and South America. An outbreak of YF has been occurring in Angola, since the beginning of 2016. In March 2016, a 32-year-old Chinese man who returned from Angola was hospitalized and diagnosed with the first case of imported YF in China. Clinical observations, blood viral RNA detection, serological testing and treatments for the patient were performed daily. The virus was isolated in Vero cells, and the complete viral genome was sequenced and analyzed using the next-generation genomic sequencing platform. The patient presented with hemorrhagic fever, jaundice and oliguria at day 3 after onset, which rapidly progressed to multisystem organ failure with extremely elevated liver, pancreatic and myocardial enzymes. The patient died despite the intensive supportive treatments that were performed. A liver biopsy showed severe and multilobular necrosis. Viral RNA was detectable throughout the clinical course of the disease. Whole-genomic sequence analysis revealed that the virus belongs to the Angola71 genotype. Although the virus has been circulating in Angola for 45 years, only 14 amino-acid substitutions and no amino-acid changes were observed in the membrane and envelope proteins compared with the virus collected in 1971. The presence of this imported YF case in China indicated that with the increase in business travel among countries, YF outbreaks in Africa can lead to the international spread of the disease. The production and use of YF vaccines is, therefore, an urgent issue.
authors.affiliation: The National Clinical Key Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
authors.forename: Zhihai
authors.initials: Z
authors.lastname: Chen
authors.affiliation: National Health and Family Planning Commission of the People's Republic of China Key Laboratory for Medical Virology, Department of Viral Hemorrhagic Fever, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.affiliation: Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control (CDC), Beijing 100013, China.
authors.forename: Yanning
authors.initials: Y
authors.lastname: Lv
authors.affiliation: The National Clinical Key Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: National Health and Family Planning Commission of the People's Republic of China Key Laboratory for Medical Virology, Department of Viral Hemorrhagic Fever, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Jiandong
authors.initials: J
authors.lastname: Li
authors.affiliation: National Health and Family Planning Commission of the People's Republic of China Key Laboratory for Medical Virology, Department of Viral Hemorrhagic Fever, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: The National Clinical Key Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
authors.forename: Tian
authors.initials: T
authors.lastname: Di
authors.affiliation: National Health and Family Planning Commission of the People's Republic of China Key Laboratory for Medical Virology, Department of Viral Hemorrhagic Fever, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Shuo
authors.initials: S
authors.lastname: Zhang
authors.affiliation: The National Clinical Key Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
authors.forename: Jingyuan
authors.initials: J
authors.lastname: Liu
authors.affiliation: Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control (CDC), Beijing 100013, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.affiliation: National Health and Family Planning Commission of the People's Republic of China Key Laboratory for Medical Virology, Department of Viral Hemorrhagic Fever, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Qu
authors.affiliation: The National Clinical Key Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
authors.forename: Wenhao
authors.initials: W
authors.lastname: Hua
authors.affiliation: National Health and Family Planning Commission of the People's Republic of China Key Laboratory for Medical Virology, Department of Viral Hemorrhagic Fever, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Li
authors.affiliation: The National Clinical Key Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Wang
authors.affiliation: National Health and Family Planning Commission of the People's Republic of China Key Laboratory for Medical Virology, Department of Viral Hemorrhagic Fever, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Quanfu
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: The National Clinical Key Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
authors.forename: Yanli
authors.initials: Y
authors.lastname: Xu
authors.affiliation: The National Clinical Key Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
authors.forename: Rongmeng
authors.initials: R
authors.lastname: Jiang
authors.affiliation: National Health and Family Planning Commission of the People's Republic of China Key Laboratory for Medical Virology, Department of Viral Hemorrhagic Fever, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control (CDC), Beijing 100013, China.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Chen
authors.affiliation: National Health and Family Planning Commission of the People's Republic of China Key Laboratory for Medical Virology, Department of Viral Hemorrhagic Fever, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Shiwen
authors.initials: S
authors.lastname: Wang
authors.affiliation: Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control (CDC), Beijing 100013, China.
authors.forename: Xinghuo
authors.initials: X
authors.lastname: Pang
authors.affiliation: National Health and Family Planning Commission of the People's Republic of China Key Laboratory for Medical Virology, Department of Viral Hemorrhagic Fever, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Mifang
authors.initials: M
authors.lastname: Liang
authors.affiliation: National Health and Family Planning Commission of the People's Republic of China Key Laboratory for Medical Virology, Department of Viral Hemorrhagic Fever, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Xuejun
authors.initials: X
authors.lastname: Ma
authors.affiliation: The National Clinical Key Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
authors.forename: Xingwang
authors.initials: X
authors.lastname: Li
authors.affiliation: Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control (CDC), Beijing 100013, China.
authors.forename: Quanyi
authors.initials: Q
authors.lastname: Wang
authors.affiliation: The National Clinical Key Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
authors.forename: Fujie
authors.initials: F
authors.lastname: Zhang
authors.affiliation: National Health and Family Planning Commission of the People's Republic of China Key Laboratory for Medical Virology, Department of Viral Hemorrhagic Fever, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Dexin
authors.initials: D
authors.lastname: Li
mesh_terms: D000328:Adult; D000810:Angola / Q000453:epidemiology; D000818:Animals; D001483:Base Sequence; D002681:China; D002522:Chlorocebus aethiops; D004196:Disease Outbreaks; D017809:Fatal Outcome; D016679:Genome, Viral; D005838:Genotype; D006801:Humans; D008099:Liver / Q000473:pathology / Q000821:virology; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D009846:Oliguria; D012367:RNA, Viral / Q000097:blood; D017422:Sequence Analysis, DNA; D014195:Travel; D014709:Vero Cells; D015004:Yellow Fever / Q000175:diagnosis / Q000821:virology; D015005:Yellow fever virus / Q000235:genetics / Q000302:isolation & purification
chemical_list: D012367:RNA, Viral