Summer Buzz

Polyxeni Potter

Author affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Clinical Findings for Early Human Cases of Influenza A(H7N9) Virus Infection, Shanghai, China

Shuihua Lu¹

, Yufang Zheng¹, Tao Li¹, Yunwen Hu¹, Xinian Liu, Xiuhong Xi, Qingguo Chen, Qingle Wang, Ye Cao, Yanbing Wang, Lijun Zhou, Douglas Lowrie, and Jing Bao

Author affiliations: Shanghai Public Health Clinical Center, Shanghai, China (S. Lu, Y. Zheng, T. Li, Y. Hu, X. Liu, X. Xi, Q. Chen, Q. Wang, Y. Cao, Y. Wang, L. Zhou, D. Lowrie); Henry M Jackson Foundation–Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (J. Bao)

Abstract

A novel strain of influenza A(H7N9) virus has emerged in China and is causing mild to severe clinical symptoms in infected humans. Some case-patients have died. To further knowledge of this virus, we report the characteristics and clinical histories of 4 early case-patients.

Avian influenza A(H7N9) virus normally circulates among birds; however, human infections with this virus were confirmed in China on March 31, 2013 (1,2). To help identify the best treatment strategies for influenza A(H7N9) virus infection, we summarized the clinical characteristics and outcomes for the first 4 patients who were transferred to Shanghai Public Health Clinical Center (SHPHCC) for treatment of influenza A(H7N9) virus infection. For each case, infection was confirmed by the Shanghai Municipal Centers for Disease Control and Prevention.

Case Reports

Clinical features of the 4 case-patients are listed in Table 1. All case-patients were 58- to 73-year-old married men, farmers or retirees, and long-term residents of Shanghai (Fengxian, Baoshan, Songjiang, and Pudong districts, respectively). Case-patient 1 had a history of coronary heart disease and hepatic schistosomiasis; case-patient 2 had no history of chronic disease; case-patient 3 had a history of hypertension and gout; and case-patient 4 had a history of hypertension and repetitive cough for > 10 years during spring and autumn.

Case-patient 1 raised chickens at home. Case-patients 2–4 had no clear history of close contact with poultry; however, each had visited various farmers’ markets that sold live poultry. None of the patients raised pigeons or live in or near a heavily pigeon-infested area.
Before being transferred to SHPHCC on April 6, 2013 (patients 1 and 2) and April 7, 2013 (patients 3 and 4), the 4 patients had been treated in local hospitals; infection with influenza A(H7N9) virus had been confirmed by real-time reverse transcription PCR of nasopharyngeal swab samples before transfer. The case-patients had cough and fever and had been expectorating sputum for ≈6–7 days before admittance to SHPHCC. In addition, all had experienced cold-like symptoms and fatigue before influenza-like symptoms developed. Case-patient 4 had cough and fever for 18 and 10 days, respectively, before being transferred to SHPHCC; his case was the most serious of the 4, and the disease progressed rapidly after he was transferred to SHPHCC.