China: Report indicates H7N9 deceased mostly male smokers?

[Catbird]

Machine translation of original article:

"H7N9 deceased mostly male smokers
April 7, 2013

H7N9 deceased mostly male smokers

Newspaper roundup Zhejiang Online reported: said Leung Wai Fung, deputy director of the Zhejiang University unicameral Infectious Diseases, a major feature of H7N9 deaths: men, smoking men.

Leung Wai Fung said, on the limited information available, he made a statistics, including six confirmed cases of death, then Shanghai and his son died of pneumonia in patients with infection also counted eight people, seven of the patients who died were male.

Why more male patients died? Leung Wai Fung analysis, the virus because "hobby" lung cells, through the analysis of the patient's life history, smoking is a keyword One example smoking two decades, and one case of 1949. Smoking patients with lung function in patients with poor may be susceptible to the virus.

Leung Wai Fung pointed out that this infection has a very strange phenomenon, early patient seems to not feel anything, but seven to eleven days condition suddenly worsened, the majority of patients with respiratory failure, viral invasions major parts of the lungs, lung oxygenation poor, it follows that poor heart and lung capacity, and multiple organ failure.

Zheda a hospital intensive care unit main Renfang Jiang said that the three infected people in Zhejiang, diagnosed when it is already critically ill patients. The event of respiratory failure, illness speed deterioration that using a breathing machine, the results are not good. He described the virus to play a "blitzkrieg". However, he believed that the virus is a self-limiting disease, Just 度过危险期, hope of survival is very large. "

 

[JimO]

Re: China: Report indicates H7N9 deceased mostly male smokers

Re: China: Report indicates H7N9 deceased mostly male smokers

For one, there is a higher percentage of men than women in China, and second, smoking is widespread in China. So, this conclusion might not represent a statistical anomaly.

 

[Laidback Al]

Re: China: Report indicates H7N9 deceased mostly male smokers

Re: China: Report indicates H7N9 deceased mostly male smokers

For one, there is a higher percentage of men than women in China, and second, smoking is widespread in China. So, this conclusion might not represent a statistical anomaly.

Jim is right. The sample of cases is too small to assess whether or not smoking is a necessary condition for death from infection from H7N9. It is more likely simply a confounding factor.
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[Emily]

Re: China: Report indicates H7N9 deceased mostly male smokers?

Research suggests that smoking status in young men can play a significant role in epidemic influenza severity and/or spread.

http://europepmc.org/abstract/MED/7121513/reload=2;jsessionid=KxlmZPIS7lHs9FUKivzv.6

Cigarette smoking as a risk factor for epidemic a(h1n1) influenza in young men.
(PMID:7121513)
Kark JD, Lebiush M, Rannon L
The New England Journal of Medicine [1982, 307(17):1042-1046]
Type: Journal Article
Abstract Highlight Terms Highlight biological terms.
Diseases(1)
We studied an outbreak of A(H1N1) influenza in an Israeli military unit of 336 healthy young men to determine the relation of cigarette smoking to the incidence of clinically apparent influenza and to the influenza-antibody response. Of 168 smokers, 68.5 per cent had influenza, as compared with 47.2 per cent of nonsmokers (P less than 0.0001). Influenza was also more severe in the smokers; 50.6 per cent of the smokers lost work days or required bed rest, or both, as compared with 30.1 per cent of the nonsmokers. The proportion of all influenza in smokers that was attributable to smoking was 31.2 per cent (95 per cent confidence intervals, 16.5 to 43.1 per cent). For severe influenza, the attributable risk in the smokers was 40.6 per cent (95 per cent confidence intervals, 21.6 to 54.8 per cent). A quarter of all severe morbidity from influenza in the overall study population was attributable to smoking. Antibody levels to A/USSR/90/77(H1N1) antigen were higher in smokers but not markedly so. We conclude that smoking is a major determinant of morbidity in epidemic influenza and may contribute substantially to incapacitation in outbreaks in populations that smoke heavily.

http://aje.oxfordjournals.org/content/90/5/390.short

J. F. FINKLEA,
S. H. SANDIFER,
and D. D. SMITH

CIGARETTE SMOKING AND EPIDEMIC INFLUENZA, Am. J. Epidemiol. (1969) 90(5): 390-399

Abstract

Finklea, J. F. (ERB, DHER, NAPCA, 411 West Chapel Hill St., Durham, N. C. 27701), S. H. Sandifer and D. D. Smith. Cigarette smoking and epidemic influenza. Amer. J. Epid., 90: 390?399.?The effect of cigarette smoking upon epidemic influenza was studied prospectively among 1, 811 male college students. A severe epidemic in late 1968 was identified by virus isolation from throat washings and by hemagglutination inhibition (HI) testing of paired sera from patients as A2/ Hong Kong/68 influenza. Questionnaires revealed that clinical influenza incidence among those who daily smoked 21 or more cigarettes was 21% higher than that of non-smokers. Illness among ex-cigarette smokers, pipe and cigar smokers was only slightly greater than non-smokers while influenza incidence among smokers of 1 to 20 cigarettes daily was intermediate between non-smokers and heavy cigarette smokers. Neither the length of illness nor the ratio of those sick with influenza to those sick-in-bed with influenza significantly differed over smoking categories. Pre and post-epidemic serum HI antibody assays suggested that a post-epidemic titer of ≥1:40 was diagnostic of infection with A2/Hong Kong/68 during the epidemic. Diagnostic post-epidemic HI antibody titers among those who were clinically ill were equally common in all smoking categories but diagnostic HI titers among those who remained clinically well were significantly more common among cigarette smokers suggesting more frequent subclinical illness.

This makes me wonder about how big a role cigarette promotion among troops played in fueling the 1918 pandemic:

http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2008.152983

??Everywhere the Soldier Will Be??: Wartime Tobacco
Promotion in the US Military
Elizabeth A. Smith, PhD, and Ruth E. Malone, RN, PhD
[snip]
Tobacco companies have
targeted US military personnel14
since World War I.15 Cigarettes
had been regarded as a
physical and moral hazard,16 but by
1918, previously anticigarette organizations
and the military were
giving them to troops.

 

[Shannon Bennett]

Re: China: Report indicates H7N9 deceased mostly male smokers?

I actually have no problem believing that smoking plays a role in susceptability. The sample size is small but, there does seem to be a slight anomaly already in the age of the infected. I also wonder if the pollution is playing a role. In any case diminished lung function cannot be a good thing.

 

[Emily]

Re: China: Report indicates H7N9 deceased mostly male smokers?

Environmental tobacco smoke, wood smoke and diesel exhaust are pollutants that have research indicating they worsen respiratory infections.

Translating Basic Research Into Clinical Practice | January 2013
The Influence of Cigarette Smoking on Viral Infections: Translating Bench Science to Impact COPD Pathogenesis and Acute Exacerbations of COPD Clinically
Carla M. T. Bauer, PhD; Mathieu C. Morissette, PhD; Martin R. St?mpfli, PhD
Author and Funding Information

From the Pharma Research and Early Development (Dr Bauer), Inflammation Discovery and Translational Area, Hoffmann-La Roche Inc, Nutley, NJ; and Departments of Pathology and Molecular Medicine and Medicine (Drs Morissette and St?mpfli), McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada.

Correspondence to: Martin R. St?mpfli, PhD, Departments of Pathology and Molecular Medicine and Medicine, McMaster Immunology Research Centre, McMaster University, Michael DeGroote Centre for Learning and Discovery, Room 4080, 1280 Main St W, Hamilton, ON, L8S 4K2, Canada;

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013; 143(1):196-206. doi:10.1378/chest.12-0930
[snip]
Mounting evidence suggests that cigarette smoke profoundly affects the immune system, compromising the host?s ability to mount appropriate immune and inflammatory responses against microbial agents. This review highlights recent advances in our understanding of the impact of cigarette smoke on type 1 interferon and IL-1 signaling cascades. The immune defects caused by cigarette smoke on these two key pathways contribute to the seemingly contradictory nature of cigarette smoke as both a damaging and a proinflammatory factor as well as an immunosuppressive factor....

A history of second hand smoke exposure: are we asking the right questions

Lower ambient PM2.5 from rural wood smoke was associated with less reported children's respiratory illnesses, including influenza

Diesel exhaust enhanced susceptibility to influenza infection is associated with decreased surfactant protein expression.