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Clin Infect Dis. Comparison of patients hospitalized with influenza A H7N9, H5N1, and 2009 pandemic H1N1
[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]
Comparison of patients hospitalized with influenza A H7N9, H5N1, and 2009 pandemic H1N1
Chen Wang 15,16,17,18, Hongjie Yu*,1, Peter W. Horby*,2,3,4, Bin Cao*,5, Peng Wu*,6, Shigui Yang*,7,8, Hainv Gao*,7,8, Hui Li*,5, Tim K. Tsang*,6, Qiaohong Liao 1, Zhancheng Gao 9, Dennis K. M. Ip 6, Hongyu Jia 7,8, Hui Jiang 1, Bo Liu 5, Michael Y. Ni 6, Xiahong Dai 7,8, Fengfeng Liu 1, Nguyen Van Kinh 10, Nguyen Thanh Liem 11, Tran Tinh Hien 2,12, Yu Li 1, Juan Yang 1, Joseph T. Wu 6, Yaming Zheng 1, Gabriel M. Leung 6, Jeremy J. Farrar 2,3,4,13, Benjamin J. Cowling 6, Timothy M. Uyeki 14, and Lanjuan Li 7,8
Author Affiliations: <SUP>1</SUP>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China <SUP>2</SUP>Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programme, Vietnam <SUP>3</SUP>Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom <SUP>4</SUP>Singapore Infectious Disease Initiative, Singapore <SUP>5</SUP>Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China <SUP>6</SUP>Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China <SUP>7</SUP>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China <SUP>8</SUP>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China <SUP>9</SUP>Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China <SUP>10</SUP>National Hospital for Tropical Diseases, Hanoi, Vietnam <SUP>11</SUP>National Hospital for Pediatrics, Hanoi, Vietnam <SUP>12</SUP>Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam <SUP>13</SUP>ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom <SUP>14</SUP>Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA <SUP>15</SUP>Institute of Respiratory Medicine, Beijing Hospital, National Health and Family Planning Commission, Beijing, China <SUP>16</SUP>Department of Respiratory Medicine, Capital Medical University, Beijing, China <SUP>17</SUP>Beijing Institute of Respiratory Medicine, Beijing, China <SUP>18</SUP>Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
Corresponding author: Luanjuan Li: State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China, e-mail: ljli@zju.edu.cn
* These authors contributed equally to this work.
<CITE><ABBR>Clin Infect Dis.</ABBR> (2014) doi: 10.1093/cid/ciu053 </CITE>First published online: January 31, 2014 / This article is Open Access
Abstract
Background.
Influenza A(H7N9) viruses isolated from humans show features suggesting partial adaptation to mammals. To provide insights into the pathogenesis of H7N9 virus infection, we compared risk factors, clinical presentation, and progression of patients hospitalized with H7N9, H5N1, and influenza A (H1N1)pdm09 (pH1N1) virus infections.
Methods.
We compared individual-level data from patients hospitalized with infection by H7N9 (n=123), H5N1 (n= 119; 43 China, 76 Vietnam), and pH1N1 (n=3486) viruses. We assessed risk factors for hospitalization after adjustment for age and gender specific prevalence of risk factors in the general Chinese population.
Results.
The median age of patients with H7N9 virus infection was older than other patient groups (63 years; P <0.001) and a higher proportion was male (71%; P <0.02). After adjustment for age and gender, chronic heart disease was associated with an increased risk of hospitalization with H7N9 (relative risk 9.68; 95% CI 5.24-17.90). H7N9 patients had similar patterns of leukopenia, thrombocytopenia, and elevated alanine aminotransferase, creatinine kinase, C-reactive protein, and lactate dehydrogenase to those seen in H5N1 patients, which were all significantly different from pH1N1 patients (P<0.005). H7N9 patients had a longer duration of hospitalization than either H5N1 or pH1N1 patients (P<0.001), and the median time from onset to death was 18 days for H7N9 (P=0.002) versus 11 days for H5N1 and 15 days for pH1N1 (P=0.154).
Conclusions.
The identification of known risk factors for severe seasonal influenza and the more protracted clinical course compared to H5N1 suggests that host factors are an important contributor to H7N9 severity.
Received September 26, 2013. Accepted November 27, 2013.
? The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/ ), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
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Comparison of patients hospitalized with influenza A H7N9, H5N1, and 2009 pandemic H1N1
Chen Wang 15,16,17,18, Hongjie Yu*,1, Peter W. Horby*,2,3,4, Bin Cao*,5, Peng Wu*,6, Shigui Yang*,7,8, Hainv Gao*,7,8, Hui Li*,5, Tim K. Tsang*,6, Qiaohong Liao 1, Zhancheng Gao 9, Dennis K. M. Ip 6, Hongyu Jia 7,8, Hui Jiang 1, Bo Liu 5, Michael Y. Ni 6, Xiahong Dai 7,8, Fengfeng Liu 1, Nguyen Van Kinh 10, Nguyen Thanh Liem 11, Tran Tinh Hien 2,12, Yu Li 1, Juan Yang 1, Joseph T. Wu 6, Yaming Zheng 1, Gabriel M. Leung 6, Jeremy J. Farrar 2,3,4,13, Benjamin J. Cowling 6, Timothy M. Uyeki 14, and Lanjuan Li 7,8
Author Affiliations: <SUP>1</SUP>Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China <SUP>2</SUP>Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programme, Vietnam <SUP>3</SUP>Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom <SUP>4</SUP>Singapore Infectious Disease Initiative, Singapore <SUP>5</SUP>Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China <SUP>6</SUP>Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China <SUP>7</SUP>Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China <SUP>8</SUP>State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China <SUP>9</SUP>Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China <SUP>10</SUP>National Hospital for Tropical Diseases, Hanoi, Vietnam <SUP>11</SUP>National Hospital for Pediatrics, Hanoi, Vietnam <SUP>12</SUP>Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam <SUP>13</SUP>ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom <SUP>14</SUP>Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA <SUP>15</SUP>Institute of Respiratory Medicine, Beijing Hospital, National Health and Family Planning Commission, Beijing, China <SUP>16</SUP>Department of Respiratory Medicine, Capital Medical University, Beijing, China <SUP>17</SUP>Beijing Institute of Respiratory Medicine, Beijing, China <SUP>18</SUP>Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
Corresponding author: Luanjuan Li: State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China, e-mail: ljli@zju.edu.cn
* These authors contributed equally to this work.
<CITE><ABBR>Clin Infect Dis.</ABBR> (2014) doi: 10.1093/cid/ciu053 </CITE>First published online: January 31, 2014 / This article is Open Access
Abstract
Background.
Influenza A(H7N9) viruses isolated from humans show features suggesting partial adaptation to mammals. To provide insights into the pathogenesis of H7N9 virus infection, we compared risk factors, clinical presentation, and progression of patients hospitalized with H7N9, H5N1, and influenza A (H1N1)pdm09 (pH1N1) virus infections.
Methods.
We compared individual-level data from patients hospitalized with infection by H7N9 (n=123), H5N1 (n= 119; 43 China, 76 Vietnam), and pH1N1 (n=3486) viruses. We assessed risk factors for hospitalization after adjustment for age and gender specific prevalence of risk factors in the general Chinese population.
Results.
The median age of patients with H7N9 virus infection was older than other patient groups (63 years; P <0.001) and a higher proportion was male (71%; P <0.02). After adjustment for age and gender, chronic heart disease was associated with an increased risk of hospitalization with H7N9 (relative risk 9.68; 95% CI 5.24-17.90). H7N9 patients had similar patterns of leukopenia, thrombocytopenia, and elevated alanine aminotransferase, creatinine kinase, C-reactive protein, and lactate dehydrogenase to those seen in H5N1 patients, which were all significantly different from pH1N1 patients (P<0.005). H7N9 patients had a longer duration of hospitalization than either H5N1 or pH1N1 patients (P<0.001), and the median time from onset to death was 18 days for H7N9 (P=0.002) versus 11 days for H5N1 and 15 days for pH1N1 (P=0.154).
Conclusions.
The identification of known risk factors for severe seasonal influenza and the more protracted clinical course compared to H5N1 suggests that host factors are an important contributor to H7N9 severity.
Received September 26, 2013. Accepted November 27, 2013.
? The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/ ), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
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