May 22, 2013DOI: 10.1056/NEJMoa1305584
Background
During
the spring of 2013, a novel avian-origin influenza A (H7N9) virus
emerged and spread among humans in China. Data were lacking on the
clinical characteristics of the infections caused by this virus.
Methods
Using
medical charts, we collected data on 111 patients with
laboratory-confirmed avian-origin influenza A (H7N9) infection through
May 10, 2013.
Results
Of
the 111 patients we studied, 76.6% were admitted to an intensive care
unit (ICU), and 27.0% died. The median age was 61 years, and 42.3% were
65 years of age or older; 31.5% were female. A total of 61.3% of the
patients had at least one underlying medical condition. Fever and cough
were the most common presenting symptoms. On admission, 108 patients
(97.3%) had findings consistent with pneumonia. Bilateral ground-glass
opacities and consolidation were the typical radiologic findings.
Lymphocytopenia was observed in 88.3% of patients, and thrombocytopenia
in 73.0%. Treatment with antiviral drugs was initiated in 108 patients
(97.3%) at a median of 7 days after the onset of illness. The median
times from the onset of illness and from the initiation of antiviral
therapy to a negative viral test result on real-time
reverse-transcriptase–polymerase-chain-reaction assay were 11 days
(interquartile range, 9 to 16) and 6 days (interquartile range, 4 to 7),
respectively. Multivariate analysis revealed that the presence of a
coexisting medical condition was the only independent risk factor for
the acute respiratory distress syndrome (ARDS) (odds ratio, 3.42; 95%
confidence interval, 1.21 to 9.70; P=0.02).
Conclusions
During
the evaluation period, the novel H7N9 virus caused severe illness,
including pneumonia and ARDS, with high rates of ICU admission and
death. (Funded by the National Natural Science Foundation of China and
others.)
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