Comparison between human infections caused by highly and low pathogenic H7N9 avian influenza viruses in Wave Five: Clinical and virological findings - 05/03/19

Doi : 10.1016/j.jinf.2019.01.005

Yang Yang ^a,^b,^{^{1
These authors contributed equally to this study.}}, Gary Wong ^c,^d,^{^{1
These authors contributed equally to this study.}}, Liuqing Yang ^a, Shuguang Tan ^b, Jianming Li ^a, Bing Bai ^e, Zhixiang Xu ^a, Hong Li ^f, Wen Xu ^f, Xiaonan Zhao ^f, Chuansong Quan ^g, Haixia Zheng ^a, William J. Liu ^g, Wenjun Liu ^b, Lei Liu ^a, Yingxia Liu ^a,^h,^⁎ , Yuhai Bi ^a,^b,^⁎ , George F. Gao ^a,^b,^g,^h,^⁎
^a Shenzhen Key Laboratory of Pathogen and Immunity, Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious Diseases, State Key Discipline of Infectious Disease, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen Third People's Hospital, Shenzhen 518112, China
^b CAS Key Laboratory of Pathogenic Microbiology and Immunology, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Institute of Microbiology, Center for Influenza Research and Early-Warning (CASCIRE), Chinese Academy of Sciences, Beijing 100101, China
^c Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai 200031, China
^d Département de microbiologie-infectiologie et d’immunologie, Université Laval, Québec City G1V 0A6, Canada
^e Department of Infectious Diseases and Shenzhen Key Lab for Endogenous Infection, Shenzhen Nanshan Hospital of Shenzhen University, Shenzhen 518000, China
^f Yunnan Center for Disease Control and Prevention, Kunming 650022, China
^g National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing 102206, China
^h University of Chinese Academy of Sciences Medical School, Chinese Academy of Sciences, Beijing 101408, China

^⁎Corresponding authors.

Abstract

Objective

The newly emerged highly pathogenic (HP) H7N9 avian influenza virus during Wave Five has caused 28 human infections, while differences in disease severity between low pathogenic (LP)- and HP-H7N9 human infections remain unclear.

Methods

Clinical data, concentrations of serum cytokines, dynamics of virus shedding and PaO₂/FiO₂ from patients infected with LP-H7N9 (n = 7, LP group) and HP-H7N9 (n = 5, HP group) viruses during Wave Five were compared. In addition, critical mutations associated with H7N9 virulence in mammal/human were analyzed.

Results

Lymphopenia, elevated aspartate aminotransferase, alanine aminotransferase, C-reactive protein and lactate dehydrogenase were common features, with higher incidences of leukopenia and thrombocytopenia in the LP group. The acute phase of both groups was accompanied with elevated cytokines associated with disease severity, including MIF, MCP-1 and IP-10. Diffuse exudation of the lungs and consolidation were observed from all patients. The dynamics of virus shedding and PaO₂/FiO₂ were similar between both groups. Notably, a higher prevalence of neuraminidase inhibitors (NAIs) resistance in the HP-H7N9 virus was found.

Conclusions

Our results indicate that this newly emerged HP-H7N9 virus caused similar disease severity in humans compared with LP-H7N9 virus, while higher case fatality rate and prevalence of NAI-resistance in human HP-H7N9 infections were of great concern.

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Keywords : H7N9, Avian influenza virus (AIV), Highly pathogenic (HP), Low pathogenic (LP), Clinical comparison, Neuraminidase inhibitors (NAIs) resistance, Wave Five

Plan

Introduction

Patients and methods

Data collection and analysis of clinical findings

Quantitative reverse transcription polymerase chain reaction

Cytokine and chemokine measurements

Quantification of hypoxia and lung injury

Statistical analysis

Results

Timeline and general features of LP- and HP-H7N9 infection in humans

Clinical comparison of LP- and HP-H7N9 infection in humans

Cytokines associated with disease severity

Viral loads and lung function during treatment

Viral factors associated with virulence

Discussion

Funding

Conflicts of interest

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Vol 78 - N° 3

P. 241-248 - mars 2019 Retour au numéro

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Comparison between human infections caused by highly and low pathogenic H7N9 avian influenza viruses in Wave Five: Clinical and virological findings - 05/03/19

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Methods

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Conclusions

Plan

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