A case report of avian influenza H7N9 killing a young doctor in Shanghai, China

BMC Infectious Diseases

Fan Wu³  Chwan-Chuen King²  Hong Zhang¹  Shenghua Mao³  Yaxu Zheng³  Zheng Teng³  Qichao Pan³  Jian Chen³  Jiayu Hu³  Xi Zhang³  Hao Pan³ 

[1]Department of Infectious Disease Control and Prevention, Pudong District Center for Disease Control and Prevention, No 3039, ZhangYang Road, Shanghai 200136, China

[2]College of Public Health, National Taiwan University, Taipei 100, Taiwan

[3]Department of Infectious Disease Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, No 1380, West Zhongshan Road, Shanghai 200336, China

关键词: Public health policies;    Preventive measures;    Healthcare workers;    Live-poultry market;    Avian influenza H7N9;   

Others  :  1230398
DOI  :  10.1186/s12879-015-0970-4

 received in 2014-11-24, accepted in 2015-05-29,  发布年份 2015

【 摘 要 】

Background

The novel avian influenza H7N9 virus has caused severe diseases in humans in eastern China since the spring of 2013. On January 18 ^th2014, a doctor working in the emergency department of a hospital in Shanghai died of H7N9 virus infection. To understand possible reasons to explain this world’s first fatal H7N9 case of a health care worker (HCW), we summarize the clinical presentation, epidemiological investigations, laboratory results, and prevention and control policies and make important recommendations to hospital-related workers.

Case presentation

The patient was a 31-year-old male Chinese surgeon who was obese and had a five-year history of hypertension and suspected diabetes. On January 11 ^th2014, he showed symptoms of an influenza-like illness. Four days later, his illness rapidly progressed with bilateral pulmonary infiltration, hypoxia and lymphopenia. On January 17th, the case had a high fever, productive cough, chest tightness and shortness of breath, so that he was administered with oseltamivir, glucocorticoid, immunoglobulin, and broad-spectrum antibiotic therapy. The case died in the early morning of next day after invasive ventilation. He had no contact with poultry nor had he visited live-poultry markets (LPMs), where positive rates of H7N9 were 14.6 % and 18.5 %. Before his illness, he cared for three febrile patients and had indirect contact with one severe pneumonia patient. Follow-up with 35 close contacts identified two HCWs who had worked also in emergency department but had not worn masks were anti-H7N9-positive. Viral sequence identity percentages between the patient and two LPM-H7N9 isolates were fewer than between the patient and another human case in shanghai in January of 2014.

Conclusions

Important reasons for the patient’s death might include late treatment with oseltamivir, and the infected H7N9 virus carrying both mammalian-adapted signature (HA-Q226L) and aerosol transmissibility (PB2-D701N). The LPM he passed every day was an unlikely source of his infection, but a contaminated environment, or an unidentified mild/asymptomatic H7N9 carrier were more probable. We advocate rigorous standard operating procedures for infection control practices in hospital settings and evaluations thereafter.

【 授权许可】

   
2015 Pan et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

【 参考文献 】

• [1]Gao R, Cao B, Hu Y, Feng Z, Wang D, Hu W, Chen J, Jie Z, Qiu H, Xu K, Xu X, Lu H, Zhu W, Gao Z, Xiang N, Shen Y, He Z, Gu Y, Zhang Z, Yang Y, Zhao X, Zhou L, Li X, Zou S, Zhang Y, Li X, Yang L, Guo J, Dong J, Li Q, Dong L, Zhu Y, Bai T, Wang S, Hao P, Yang W, Zhang Y, Han J, Yu H, Li D, Gao GF, Wu G, Wang Y, Yuan Z, Shu Y. Human infection with a novel avian-origin influenza A (H7N9) virus. N Engl J Med. 2013;368:1888–97.
• [2]Li Q, Zhou L, Zhou M, Chen Z, Li F, Wu H, Xiang N, Chen E, Tang F, Wang D, Meng L, Hong Z, Tu W, Cao Y, Li L, Ding F, Liu B, Wang M, Xie R, Gao R, Li X, Bai T, Zou S, He J, Hu J, Xu Y, Chai C, Wang S, Gao Y, Jin L, Zhang Y, Lou H, Yu H, He J, Li Q, Wang X, Gao L, Pang X, Liu G, Yan Y, Yuan H, Shu Y, Yang W, Wang Y, Wu F, Uyeki MT, Feng Z. Epidemiology of Human Infections with Avian Influenza A(H7N9) Virus in China. N Engl J Med. 2014;370:520–32.
• [3]Chen C, Lu FC. The guidelines for prevention and control of overweight and obesity in Chinese adults. Biomed Environ Sci. 2004; 17 Suppl:1-36.
• [4]World Health Organization: Real-time RT-PCR Protocol for the Detection of Avian Influenza A (H7N9) Virus. 2013. http://www.who.int/influenza/gisrs_laboratory/cnic_realtime_rt_pcr_protocol_a_h7n9.pdf?ua = 1. Accessed 8 Apr 2013.
• [5]World Health Organization: Serological detection of avian influenza A(H7N9) virus infections by modified horse red blood cells haemagglutination-inhibition assay. 2013. http://www.who.int/entity/influenza/gisrs_laboratory/cnic_serological_diagnosis_hai_a_h7n9_20131220.pdf?ua=1. Accessed 20 Dec 2013.
• [6]Hoang Vu MP, Nguyen CT, Nguyen Le KH, Nguyen TK, Le QM. Oseltamivir resistance among influenza viruses: surveillance in northern Viet Nam, 2009–2012. Western Pac Surveill Response J. 2013; 4:25-29.
• [7]Zhao B, Zhang X, Zhu W, Teng Z, Yu X, Gao Y, Wu D, Pei E, Yuan Z, Yang L, Wang D, Shu Y, Wu F. Novel Avian Influenza A(H7N9) Virus in Tree Sparrow, Shanghai, China, 2013. Emerg Infect Dis. 2014;20:850–3.
• [8]Herfst S, Schrauwen EJ, Linster M, Chutinimitkul S, Wit E, Munster VJ, Sorrell EM, Bestebroer TM, Burke DF, Smith DJ, Rimmelzwaan GF, Osterhaus ADME ,Fouchier RAM. Airborne transmission of influenza A/H5N1 virus between ferrets. Science. 2012;336:1534–41.
• [9]Imai M, Watanabe T, Hatta M, Das SC, Ozawa M, Shinya K, Zhong G, Hanson A, Katsura H, Watanabe S, Li C, Kawakami E, Yamada S, Kiso M, Suzuki Y, Maher EA, Neumann G, Kawaoka Y. Experimental adaptation of an influenza H5 HA confers respiratory droplet transmission to a reassortant H5 HA/H1N1 virus in ferrets. Nature. 2012;486:420–8.
• [10]Ren YY, Yin YY, Li WQ, Lin Y, Liu T, Wang S, Zhang SY, Li Z, Wang XJ, Bi ZQ. Risk factors associated with severe manifestations of 2009 pandemic influenza A (H1N1) infection in China: a case–control study. Virol J. 2013;10:149.
• [11]Critical care services and 2009 H1N1 influenza in Australia and New Zealand. N EnglJ Med. 2009; 361:1925-1934.
• [12]Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, Sugerman DE, Druckenmiller JK, Ritger KA, Chugh R, Jasuja S, Deutscher M, Chen S, Walker JD, Duchin JS, Lett S, Soliva S, Wells EV, Swerdlow D, Uyeki TM, Fiore AE, Olsen SJ, Fry AM, Bridges CB, Finelli L. Hospitalized Patients with 2009 H1N1 Influenza in the United States, April-June 2009. N Engl J Med. 2009;2009(361):1935–44.
• [13]Gao HN, Lu HZ, Cao B, Du B, Shang H, Gan JH, Lu SH, Yang YD, Fang Q, Shen YZ, Xi XM, Gu Q, Zhou XM, Qu HP, Yan Z, Li FM, Zhao W, Gao ZC, Wang GF, Ruan LX, Wang WH, Ye J, Cao HF, Li XW, Zhang WH, Fang XC, He J, Liang WF, Xie J, Zeng M, Wu X, Li J, Xia Q, Jin Z, Chen Q, Tang C, Zhang Z, Hou B, Feng Z, Sheng J, Zhong N, Li L. Clinical findings in 111 cases of influenza A (H7N9) virus infection. N Engl J Med. 2013;368:2277–85.
• [14]Ramos I, Bernal-Rubio D, Durham N, Belicha-Villanueva A, Lowen AC, Steel J, Fernandez-Sesma A. Effects of receptor binding specificity of avian influenza virus on the human innate immune response. J Virol. 2011;85:4421–31.
• [15]Tran TH, Nguyen TL, Nguyen TD, Luong TS, Pham PM, Nguyen vV, Pham TS, Vo CD, Le TQ, Ngo TT, Dao BK, Le PP, Nguyen TT, Hoang TL, Cao VT, Le TG, Nguyen DT, Le HN, Nguyen KT, Le HS, Le VT, Christiane D, Tran TT, Menno de J, Schultsz C, Cheng P, Lim W, Horby P, Farrar J. Avian influenza A (H5N1) in 10 patients in Vietnam. N Engl J Med. 2004;350:1179–88.
• [16]Zhu H, Wang D, Kelvin DJ, Li L, Zheng Z, Yoon SW, Wong SS, Farooqui A, Wang J, Banner D, Chen R, Zheng R, Zhou J, Zhang Y, Hong W, Dong W, Cai Q, Roehrl MH, Huang SS, Kelvin AA, Yao T, Zhou B, Chen X, Leung GM, Poon LL, Webster RG, Webby RJ, Peiris JS, Guan Y, Shu Y. Infectivity, transmission, and pathology of human-isolated H7N9 influenza virus in ferrets and pigs. Science. 2013;341:183–6.
• [17]Yu H, Wu JT, Cowling BJ, Liao Q, Fang VJ, Zhou S, Wu P, Zhou H, Lau EH, Guo D, Ni MY, Peng Z, Feng L, Jiang H, Luo H, Li Q, Feng Z, Wang Y, Yang W, Leung GM. Effect of closure of live poultry markets on poultry-to-person transmission of avian influenza A H7N9 virus: an ecological study. Lancet. 2014;383:541–8.
• [18]World Health Organization: Opening statement by Dr Keiji Fukuda, WHO's Assistant Director-General for Health Security. 2013. http://www.wpro.who.int/china/mediacentre/speeches/2013/20130424/en/. Accessed 24 Apr 2013.
• [19]Osterholm MT. Preparing for the next pandemic. N Engl J Med. 2005; 352:1839-1842.