Nosocomial transmission of avian influenza A (H7N9) virus in China: epidemiological investigation

Abstract

Study question Can avian influenza A (H7N9) virus be transmitted between unrelated individuals in a hospital setting? Methods An epidemiological investigation looked at two patients who shared a hospital ward in February 2015, in Quzhou, Zhejiang Province, China. Samples from the patients, close contacts, and local environments were examined by real time reverse transcriptase (rRT) polymerase chain reaction (PCR) and viral culture. Haemagglutination inhibition and microneutralisation assays were used to detect specific antibodies to the viruses. Primary outcomes were clinical data, infection source tracing, phylogenetic tree analysis, and serological results. Study answer and limitations A 49 year old man (index patient) became ill seven days after visiting a live poultry market. A 57 year old man (second patient), with a history of chronic obstructive pulmonary disease, developed influenza-like symptoms after sharing the same hospital ward as the index patient for five days. The second patient had not visited any poultry markets nor had any contact with poultry or birds within 15 days before the onset of illness. H7N9 virus was identified in the two patients, who both later died. Genome sequences of the virus isolated from both patients were nearly identical, and genetically similar to the virus isolated from the live poultry market. No specific antibodies were detected among 38 close contacts. Transmission between the patients remains unclear, owing to the lack of samples collected from their shared hospital ward. Although several environmental swabs were positive for H7N9 by rRT-PCR, no virus was cultured. Owing to delayed diagnosis and frequent hospital transfers, no serum samples were collected from the patients, and antibodies to H7N9 viruses could not be tested. What this study adds Nosocomial H7N9 transmission might be possible between two unrelated individuals. Surveillance on patients with influenza-like illness in hospitals as well as chickens in live poultry markets should be enhanced to monitor transmissibility and pathogenicity of the virus. Funding, competing interests, data sharing Funding support from the Program of International Science and Technology Cooperation of China (2013DFA30800), Basic Work on Special Program for Science and Technology Research (2013FY114600), National Natural Science Foundation of China (81402730), Special Program for Prevention and Control of Infectious Diseases in China (2013ZX10004218), US National Institutes of Health (1R01-AI108993), Zhejiang Province Major Science and Technology Program (2014C03039), and Quzhou Science and Technology Program (20111084). The authors declare no other interests and have no additional data.

Comparative Epidemiology of Human Fatal Infections with Novel, High (H5N6 and H5N1) and Low (H7N9 and H9N2) Pathogenicity Avian Influenza A Viruses

“…There were several reasons for an important case ascertainment bias. On one hand, the secondary cases were detected, and the antiviral treatment began early through the healthcare surveillance system, and on the other, the index cases were biased toward older people with a higher number of underlying diseases [46]. In addition, the index cases generally had significantly higher levels of exposure to poultry, while the secondary cases subsequently became infected after providing care for the ill index patients or after spending prolonged periods of time with them.…”

Nosocomial transmission of influenza: A retrospective cross‐sectional study using next generation sequencing at a hospital in England (2012‐2014)

“…Previous applications of next generation sequencing of influenza have included elucidating zoonosis and describing transmission of seasonal and pandemic strains . In the context of nosocomial transmission, several studies have used next generation sequencing to assess differences between sequences of specific influenza genome segments (HA, NA and/or PB2) or to investigate small outbreaks . These results have highlighted the importance of multiple introductions of community strains.…”

Assessing Change in Avian Influenza A(H7N9) Virus Infections During the Fourth Epidemic — China, September 2015–August 2016

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