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Article: Human infection with avian influenza A H7N9 virus: An assessment of clinical severity

TitleHuman infection with avian influenza A H7N9 virus: An assessment of clinical severity
Authors
Issue Date2013
PublisherThe Lancet Publishing Group. The Journal's web site is located at http://www.elsevier.com/locate/lancet
Citation
The Lancet, 2013, v. 382 n. 9887, p. 138-145 How to Cite?
AbstractBACKGROUND: Characterisation of the severity profile of human infections with influenza viruses of animal origin is a part of pandemic risk assessment, and an important part of the assessment of disease epidemiology. Our objective was to assess the clinical severity of human infections with avian influenza A H7N9 virus, which emerged in China in early 2013. METHODS: We obtained information about laboratory-confirmed cases of avian influenza A H7N9 virus infection reported as of May 28, 2013, from an integrated database built by the Chinese Center for Disease Control and Prevention. We estimated the risk of fatality, mechanical ventilation, and admission to the intensive care unit for patients who required hospital admission for medical reasons. We also used information about laboratory-confirmed cases detected through sentinel influenza-like illness surveillance to estimate the symptomatic case fatality risk. FINDINGS: Of 123 patients with laboratory-confirmed avian influenza A H7N9 virus infection who were admitted to hospital, 37 (30%) had died and 69 (56%) had recovered by May 28, 2013. After we accounted for incomplete data for 17 patients who were still in hospital, we estimated the fatality risk for all ages to be 36% (95% CI 26-45) on admission to hospital. Risks of mechanical ventilation or fatality (69%, 95% CI 60-77) and of admission to an intensive care unit, mechanical ventilation, or fatality (83%, 76-90) were high. With assumptions about coverage of the sentinel surveillance network and health-care-seeking behaviour for patients with influenza-like illness associated with influenza A H7N9 virus infection, and pro-rata extrapolation, we estimated that the symptomatic case fatality risk could be between 160 (63-460) and 2800 (1000-9400) per 100,000 symptomatic cases. INTERPRETATION: Human infections with avian influenza A H7N9 virus seem to be less serious than has been previously reported. Many mild cases might already have occurred. Continued vigilance and sustained intensive control efforts are needed to minimise the risk of human infection. FUNDING: Chinese Ministry of Science and Technology; Research Fund for the Control of Infectious Disease; Hong Kong University Grants Committee; China-US Collaborative Program on Emerging and Re-emerging Infectious Diseases; Harvard Center for Communicable Disease Dynamics; US National Institute of Allergy and Infectious Disease; and the US National Institutes of Health.
Persistent Identifierhttp://hdl.handle.net/10722/184821
ISSN
2015 Impact Factor: 44.002
2015 SCImago Journal Rankings: 14.638
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorYu, HJen_US
dc.contributor.authorCowling, BJen_US
dc.contributor.authorFeng, LZen_US
dc.contributor.authorLau, EHYen_US
dc.contributor.authorLiao, QHen_US
dc.contributor.authorTsang, KLen_US
dc.contributor.authorPeng, ZBen_US
dc.contributor.authorWu, Pen_US
dc.contributor.authorLiu, FFen_US
dc.contributor.authorFang, Jen_US
dc.contributor.authorZhang, HLen_US
dc.contributor.authorLi, Men_US
dc.contributor.authorZeng, LJen_US
dc.contributor.authorXu, Zen_US
dc.contributor.authorLi, ZJen_US
dc.contributor.authorLuo, HMen_US
dc.contributor.authorLi, Qen_US
dc.contributor.authorFeng, ZJen_US
dc.contributor.authorCao, Ben_US
dc.contributor.authorYang, WZen_US
dc.contributor.authorWu, JTKen_US
dc.contributor.authorWang, Yen_US
dc.contributor.authorLeung, GMen_US
dc.date.accessioned2013-07-15T10:10:27Z-
dc.date.available2013-07-15T10:10:27Z-
dc.date.issued2013en_US
dc.identifier.citationThe Lancet, 2013, v. 382 n. 9887, p. 138-145en_US
dc.identifier.issn0140-6736-
dc.identifier.urihttp://hdl.handle.net/10722/184821-
dc.description.abstractBACKGROUND: Characterisation of the severity profile of human infections with influenza viruses of animal origin is a part of pandemic risk assessment, and an important part of the assessment of disease epidemiology. Our objective was to assess the clinical severity of human infections with avian influenza A H7N9 virus, which emerged in China in early 2013. METHODS: We obtained information about laboratory-confirmed cases of avian influenza A H7N9 virus infection reported as of May 28, 2013, from an integrated database built by the Chinese Center for Disease Control and Prevention. We estimated the risk of fatality, mechanical ventilation, and admission to the intensive care unit for patients who required hospital admission for medical reasons. We also used information about laboratory-confirmed cases detected through sentinel influenza-like illness surveillance to estimate the symptomatic case fatality risk. FINDINGS: Of 123 patients with laboratory-confirmed avian influenza A H7N9 virus infection who were admitted to hospital, 37 (30%) had died and 69 (56%) had recovered by May 28, 2013. After we accounted for incomplete data for 17 patients who were still in hospital, we estimated the fatality risk for all ages to be 36% (95% CI 26-45) on admission to hospital. Risks of mechanical ventilation or fatality (69%, 95% CI 60-77) and of admission to an intensive care unit, mechanical ventilation, or fatality (83%, 76-90) were high. With assumptions about coverage of the sentinel surveillance network and health-care-seeking behaviour for patients with influenza-like illness associated with influenza A H7N9 virus infection, and pro-rata extrapolation, we estimated that the symptomatic case fatality risk could be between 160 (63-460) and 2800 (1000-9400) per 100,000 symptomatic cases. INTERPRETATION: Human infections with avian influenza A H7N9 virus seem to be less serious than has been previously reported. Many mild cases might already have occurred. Continued vigilance and sustained intensive control efforts are needed to minimise the risk of human infection. FUNDING: Chinese Ministry of Science and Technology; Research Fund for the Control of Infectious Disease; Hong Kong University Grants Committee; China-US Collaborative Program on Emerging and Re-emerging Infectious Diseases; Harvard Center for Communicable Disease Dynamics; US National Institute of Allergy and Infectious Disease; and the US National Institutes of Health.-
dc.languageengen_US
dc.publisherThe Lancet Publishing Group. The Journal's web site is located at http://www.elsevier.com/locate/lancet-
dc.relation.ispartofThe Lanceten_US
dc.rightsNOTICE: this is the author’s version of a work that was accepted for publication in The Lancet. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in The Lancet, [VOL 382, ISSUE 9887, 2013] DOI 10.1016/S0140-6736(13)61207-6-
dc.subject.meshDisease Outbreaks-
dc.subject.meshInfluenza A virus-
dc.subject.meshInfluenza in Birds - mortality - transmission-
dc.subject.meshInfluenza, Human - mortality-
dc.subject.meshRespiration, Artificial - statistics and numerical data-
dc.titleHuman infection with avian influenza A H7N9 virus: An assessment of clinical severityen_US
dc.typeArticleen_US
dc.identifier.emailCowling, BJ: bcowling@hku.hken_US
dc.identifier.emailLau, EHY: ehylau@hku.hken_US
dc.identifier.emailTsang, KL: matklab@hku.hken_US
dc.identifier.emailWu, P: pengwu@hku.hken_US
dc.identifier.emailFang, J: vickyf@hku.hken_US
dc.identifier.emailWu, JTK: joewu@hku.hken_US
dc.identifier.emailLeung, GM: gmleung@hku.hken_US
dc.identifier.authorityCowling, BJ=rp01326en_US
dc.identifier.authorityLau, EHY=rp01349en_US
dc.identifier.authorityWu, JTK=rp00517en_US
dc.identifier.authorityLeung, GM=rp00460en_US
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/S0140-6736(13)61207-6-
dc.identifier.pmid23803487-
dc.identifier.pmcidPMC3801178-
dc.identifier.scopuseid_2-s2.0-84880307217-
dc.identifier.hkuros215925en_US
dc.identifier.volume382-
dc.identifier.issue9887-
dc.identifier.spage138-
dc.identifier.epage145-
dc.identifier.isiWOS:000322115300029-
dc.publisher.placeUnited Kingdom-

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