A novel avian influenza A (H7N9) virus was discovered in February 2013 in China and has resulted in more than 100 comfirmed human infections including 26 fatal cases as of May 2, 2013. The situation raises many urgent...A novel avian influenza A (H7N9) virus was discovered in February 2013 in China and has resulted in more than 100 comfirmed human infections including 26 fatal cases as of May 2, 2013. The situation raises many urgent questions and global public health concerns. In this study, epidemiologic characteristics of infected human cases in Jiangsu province were analyzed and risk assessment was undertaken based on the information available. Briefly, it is highly unlikely that a pandemic of human infection with avian influenza A (H7N9) virus will happen in Jiangsu Province in the near future. In the end, some measures are recommended to prevent the situation from becoming worse.展开更多
Currently, three predominant subtypes of influenza virus are prevalent in pig populations worldwide: H1N1, H3N2, and H1N2. European avian-like H1N1 viruses, which were initially detected in European pig populations in...Currently, three predominant subtypes of influenza virus are prevalent in pig populations worldwide: H1N1, H3N2, and H1N2. European avian-like H1N1 viruses, which were initially detected in European pig populations in 1979, have been circulating in pigs in eastern China since 2007. In this study, six influenza A viruses were isolated from 60 swine lung samples collected from January to April 2011 in eastern China. Based on whole genome sequencing, molecular characteristics of two isolates were determined. Phylogenetic analysis showed the eight genes of the two isolates were closely related to those of the avian-like H1N1 viruses circulating in pig populations, especially similar to those found in China. Four potential glycosylation sites were observed at positions 13, 26, 198, 277 in the HA1 proteins of the two isolates. Due to the presence of a stop codon at codon 12, the isolates contained truncated PB1-F2 proteins. In this study, the isolates contained 591Q, 627E and 701N in the polymerase subunit PB2, which had been shown to be determinants of virulence and host adaptation. The isolates also had a D rather than E at position 92 of the NS1, a marker of mammalian adaptation. Both isolates contained the GPKV motif at the PDZ ligand domain of the 3' end of the NS1, a characteristic marker of the European avian-like swine viruses since about 1999, which is distinct from those of avian, human and classical swine viruses. The M2 proteins of the isolates have the mutation (S31N), a characteristic marker of the European avian-like swine viruses since about 1987, which may confer resistance to amantadine and rimantadine antivirals. Our findings further emphasize the importance of surveillance on the genetic diversity of influenza A viruses in pigs, and raise more concerns about the occurrence of cross-species transmission events.展开更多
One influenza H3N2 virus, A/swine/Shandong/3/2005 (Sw/SD/3/2005), was isolated from pigs with respiratory disease on a farm in eastern China. Genetic analysis revealed that Sw/SD/3/2005 was a triple-reassortant virus ...One influenza H3N2 virus, A/swine/Shandong/3/2005 (Sw/SD/3/2005), was isolated from pigs with respiratory disease on a farm in eastern China. Genetic analysis revealed that Sw/SD/3/2005 was a triple-reassortant virus with a PB2 gene from human-like H1N1, NS from classical swine H1N1, and the remaining genes from human-like H3N2 virus. These findings further support the concept that swine can serve as reservoir or mixing vessels of influenza virus strains and maintain genetic and antigenic stability of viruses. Furthermore, we have successfully established a reverse genetics system based on eight plasmids and rescued Sw/SD/3/2005 through cell transfection. HI tests and RT-PCR confirmed that the rescued virus maintained the biological properties of the wild type Sw/SD/3/2005. The successful establishment of the reverse genetics system of Sw/SD/3/2005 will enable us to conduct extensive studies of the molecular evolution of H3N2 influenza viruses in swine.展开更多
The actual incidence of human H7N9 infection is supposed to be much higher than the documented laboratoryconfirmed cases.In this study,we estimated the number of the actual H7N9 cases in Jiangsu,China using a probabil...The actual incidence of human H7N9 infection is supposed to be much higher than the documented laboratoryconfirmed cases.In this study,we estimated the number of the actual H7N9 cases in Jiangsu,China using a probabilistic multiplier model.Then,disability adjusted life years(DALYs),direct and indirect economic loss caused by this disease were calculated and analyzed.Till September 2017,the estimated total number of H7N9 cases was 2952[median,90%probability range(PR):1487-22094],which was 11.8 times(5.9-88.4)as large as the reported number.The median morbidity was estimated to be 4(90%PR:2-29)per 100000 population.The total DALYs loss was 16548 years,and the total economic loss(direct and indirect)was estimated to be RMB 1044618758(US$16.7 M).The average economic loss for per case and for per year was RMB 353868(US$56440)and RMB 232137502(US$37.0 M),respectively.The actual burden of human H7N9 infections was much heavier than what was documented.Our study provided an approach to estimate actual burden of infectious diseases using laboratory-confirmation.展开更多
Influenza-like illness(ILI)is an acute respiratory infection caused by various pathogens.However,the epidemiologic characteristics of ILI pathogens in Jiangsu province are unclear.To better understand the ILI etiology...Influenza-like illness(ILI)is an acute respiratory infection caused by various pathogens.However,the epidemiologic characteristics of ILI pathogens in Jiangsu province are unclear.To better understand the ILI etiology,the characteristics of the pathogens from nasopharyngeal swab samples of patients with ILI collected from 2012 to 2016 in 6 hospitals in Jiangsu province were studied.The pathogens,including influenza virus,respiratory syncytial virus(RSV),rhinovirus(HRV),adenovirus(ADV),herpes simplex virus(HSV),human coronavirus(hCoV),Streptococcus pneumoniae and Haemophilus influenzae,were detected by real-time PCR.At least one pathogen was identified in 1334 of the patients(40.23%).Among viruses,HRV,influenza A virus(Flu A),ADV and RSV were the most frequently detected.ADV was the only pathogen that was distributed evenly in different years and regions(P>0.05).The etiological distribution varied in different age groups.Streptococcus pneumoniae was the most common pathogen in co-infections with a co-detection rate of 64.57%(319/494).The spectrum of etiologies could help to estimate disease burden and provide guidance for vaccination.展开更多
Background:H7N9 continues to cause human infections and remains a pandemic concern.Understanding the economic impacts of this novel disease is important for making decisions on health resource allocation,including inf...Background:H7N9 continues to cause human infections and remains a pandemic concern.Understanding the economic impacts of this novel disease is important for making decisions on health resource allocation,including infectious disease prevention and control investment.However,there are limited data on such impacts.Methods:Hospitalized laboratory-confirmed H7N9 patients or their families in Jiangsu Province of China were interviewed.Patients’direct medical costs of hospitalization were derived from their hospital bills.A generalized linear model was employed to estimate the mean direct medical costs of patients with different characteristics.Results:The mean direct cost of hospitalization for H7N9 was estimated to be¥71060(95%CI,48180–104820),i.e.,US$10996(95%CI,7455–16220),and was¥12060(US$1861),¥136120(US$21001)and¥218610(US$33728)for those who had mild or severe symptoms or who died,respectively.The principal components of the total fees differed among patients with different disease severity,although medication fees were always the largest contributors.Disease severity,proportion of reimbursement and family member monthly average income were identified as the key factors that contributed to a patient’s direct medical cost of hospitalization.Conclusions:The direct medical costs of hospitalized patients with H7N9 are significant,and far surpass the annual per capita income of Jiangsu Province,China.The influencing factors identified should be taken into account when developing related health insurance policies and making health resource allocation.Trial registration:Not applicable.This is a survey study with no health care intervention implemented on human participants.展开更多
Human infections with influenza H7 subtypes, such as H7N9, have raised concerns worldwide. Here, we report a human infection with a novel influenza A(H7N4) virus. A 68 years-old woman with cardiovascular and cholecyst...Human infections with influenza H7 subtypes, such as H7N9, have raised concerns worldwide. Here, we report a human infection with a novel influenza A(H7N4) virus. A 68 years-old woman with cardiovascular and cholecystic comorbidities developed rapidly progressed pneumonia with influenza-like-illness as initial symptom, recovered after 23 days-hospitalization including 8 days in ICU. Laboratory indicators for liver and blood coagulation dysfunction were observed. Oseltamivir phosphate, glucocorticoids and antibiotics were jointly implemented, with nasal catheterization of oxygen inhalation for this patient.We obtained the medical records and collected serial respiratory and blood specimens from her. We collected throat, cloacal and/or feces samples of poultry and wild birds from the patient's backyard, neighborhood, local live poultry markets(LPMs) and the nearest lake. All close contacts of the patient were followed up and sampled with throat swabs and sera. Influenza viruses and other respiratory pathogens were tested by real-time RT-PCR, viral culturing and/or sequencing for human respiratory and bird samples. Micro-neutralizing assay was performed for sera. A novel reassortant wild bird-origin H7N4 virus is identified from the patient and her backyard poultry(chickens and ducks) by sequencing, which is distinct from previously-reported avian H7N4 and H7N9 viruses. At least four folds increase of neutralizing antibodies to H7N4 was detected in her convalescent sera. No samples from close contacts, wild birds or other poultry were tested positive for H7N4 by real-time RT-PCR.展开更多
基金supported by the Jiangsu Province Health Development Project with Science and Education (No.ZX201109 and RC2011085)the Research Projects of Jiangsu Preventive Medicine (No.YZ201020)
文摘A novel avian influenza A (H7N9) virus was discovered in February 2013 in China and has resulted in more than 100 comfirmed human infections including 26 fatal cases as of May 2, 2013. The situation raises many urgent questions and global public health concerns. In this study, epidemiologic characteristics of infected human cases in Jiangsu province were analyzed and risk assessment was undertaken based on the information available. Briefly, it is highly unlikely that a pandemic of human infection with avian influenza A (H7N9) virus will happen in Jiangsu Province in the near future. In the end, some measures are recommended to prevent the situation from becoming worse.
基金Supported by the Natural Science Foundation of Jiangsu Province(BK2009434)the Innovation Platform for Public Health Emergency Preparedness and Response(NO.ZX201109)the Key Medical Talent Foundation of Jiangsu Province(RC2011084)
文摘Currently, three predominant subtypes of influenza virus are prevalent in pig populations worldwide: H1N1, H3N2, and H1N2. European avian-like H1N1 viruses, which were initially detected in European pig populations in 1979, have been circulating in pigs in eastern China since 2007. In this study, six influenza A viruses were isolated from 60 swine lung samples collected from January to April 2011 in eastern China. Based on whole genome sequencing, molecular characteristics of two isolates were determined. Phylogenetic analysis showed the eight genes of the two isolates were closely related to those of the avian-like H1N1 viruses circulating in pig populations, especially similar to those found in China. Four potential glycosylation sites were observed at positions 13, 26, 198, 277 in the HA1 proteins of the two isolates. Due to the presence of a stop codon at codon 12, the isolates contained truncated PB1-F2 proteins. In this study, the isolates contained 591Q, 627E and 701N in the polymerase subunit PB2, which had been shown to be determinants of virulence and host adaptation. The isolates also had a D rather than E at position 92 of the NS1, a marker of mammalian adaptation. Both isolates contained the GPKV motif at the PDZ ligand domain of the 3' end of the NS1, a characteristic marker of the European avian-like swine viruses since about 1999, which is distinct from those of avian, human and classical swine viruses. The M2 proteins of the isolates have the mutation (S31N), a characteristic marker of the European avian-like swine viruses since about 1987, which may confer resistance to amantadine and rimantadine antivirals. Our findings further emphasize the importance of surveillance on the genetic diversity of influenza A viruses in pigs, and raise more concerns about the occurrence of cross-species transmission events.
文摘One influenza H3N2 virus, A/swine/Shandong/3/2005 (Sw/SD/3/2005), was isolated from pigs with respiratory disease on a farm in eastern China. Genetic analysis revealed that Sw/SD/3/2005 was a triple-reassortant virus with a PB2 gene from human-like H1N1, NS from classical swine H1N1, and the remaining genes from human-like H3N2 virus. These findings further support the concept that swine can serve as reservoir or mixing vessels of influenza virus strains and maintain genetic and antigenic stability of viruses. Furthermore, we have successfully established a reverse genetics system based on eight plasmids and rescued Sw/SD/3/2005 through cell transfection. HI tests and RT-PCR confirmed that the rescued virus maintained the biological properties of the wild type Sw/SD/3/2005. The successful establishment of the reverse genetics system of Sw/SD/3/2005 will enable us to conduct extensive studies of the molecular evolution of H3N2 influenza viruses in swine.
基金supported by the Science&Technology Demonstration Project for Emerging Infectious Diseases Control and Prevention under Grant(BE2015714&BE2017749)supported by the Key Medical Discipline of Jiangsu Science&Technology Project under Grant(epidemiology,ZDXKA2016008)+1 种基金supported by the National Science and Technology Major Project under Grant(2015ZX09101044)the Jiangsu Provincial Medical Youth Talents under Grant(QNRC2016539)
文摘The actual incidence of human H7N9 infection is supposed to be much higher than the documented laboratoryconfirmed cases.In this study,we estimated the number of the actual H7N9 cases in Jiangsu,China using a probabilistic multiplier model.Then,disability adjusted life years(DALYs),direct and indirect economic loss caused by this disease were calculated and analyzed.Till September 2017,the estimated total number of H7N9 cases was 2952[median,90%probability range(PR):1487-22094],which was 11.8 times(5.9-88.4)as large as the reported number.The median morbidity was estimated to be 4(90%PR:2-29)per 100000 population.The total DALYs loss was 16548 years,and the total economic loss(direct and indirect)was estimated to be RMB 1044618758(US$16.7 M).The average economic loss for per case and for per year was RMB 353868(US$56440)and RMB 232137502(US$37.0 M),respectively.The actual burden of human H7N9 infections was much heavier than what was documented.Our study provided an approach to estimate actual burden of infectious diseases using laboratory-confirmation.
基金supported by the Jiangsu Provincial Major Science & Technology Demonstration Project (No.BE2017749)the Jiangsu Province Science & Technology Demonstration Project for Emerging Infectious Diseases Control and Prevention (No.BE2015714)
文摘Influenza-like illness(ILI)is an acute respiratory infection caused by various pathogens.However,the epidemiologic characteristics of ILI pathogens in Jiangsu province are unclear.To better understand the ILI etiology,the characteristics of the pathogens from nasopharyngeal swab samples of patients with ILI collected from 2012 to 2016 in 6 hospitals in Jiangsu province were studied.The pathogens,including influenza virus,respiratory syncytial virus(RSV),rhinovirus(HRV),adenovirus(ADV),herpes simplex virus(HSV),human coronavirus(hCoV),Streptococcus pneumoniae and Haemophilus influenzae,were detected by real-time PCR.At least one pathogen was identified in 1334 of the patients(40.23%).Among viruses,HRV,influenza A virus(Flu A),ADV and RSV were the most frequently detected.ADV was the only pathogen that was distributed evenly in different years and regions(P>0.05).The etiological distribution varied in different age groups.Streptococcus pneumoniae was the most common pathogen in co-infections with a co-detection rate of 64.57%(319/494).The spectrum of etiologies could help to estimate disease burden and provide guidance for vaccination.
基金X H,F T,X Q,M Z and C B were supported by Jiangsu Province Science&Technology Demonstration Project for Emerging Infectious Diseases Control and Prevention(grant number BE2015714)C.B.was supported by Natural Science Foundation of China(grant number 81373055)+2 种基金Jiangsu Province Science and Technology Support Pro-gram(social development,grant number BE2012769)the 10th Summit of Six Top Talents of Jiangsu Province(grant number WS-2013-061)Shanghai Municipal Commission of Science and Technology Program(14495810301).
文摘Background:H7N9 continues to cause human infections and remains a pandemic concern.Understanding the economic impacts of this novel disease is important for making decisions on health resource allocation,including infectious disease prevention and control investment.However,there are limited data on such impacts.Methods:Hospitalized laboratory-confirmed H7N9 patients or their families in Jiangsu Province of China were interviewed.Patients’direct medical costs of hospitalization were derived from their hospital bills.A generalized linear model was employed to estimate the mean direct medical costs of patients with different characteristics.Results:The mean direct cost of hospitalization for H7N9 was estimated to be¥71060(95%CI,48180–104820),i.e.,US$10996(95%CI,7455–16220),and was¥12060(US$1861),¥136120(US$21001)and¥218610(US$33728)for those who had mild or severe symptoms or who died,respectively.The principal components of the total fees differed among patients with different disease severity,although medication fees were always the largest contributors.Disease severity,proportion of reimbursement and family member monthly average income were identified as the key factors that contributed to a patient’s direct medical cost of hospitalization.Conclusions:The direct medical costs of hospitalized patients with H7N9 are significant,and far surpass the annual per capita income of Jiangsu Province,China.The influencing factors identified should be taken into account when developing related health insurance policies and making health resource allocation.Trial registration:Not applicable.This is a survey study with no health care intervention implemented on human participants.
基金supported by National Science and Technology Major Project of China (2015ZX09101044)Science & Technology Demonstration Project for Emerging Infectious Diseases Control and Prevention of Jiangsu Province, China (BE2015714 & BE2017749)Key Medical Discipline of Jiangsu Science & Technology Project of China (epidemiology,ZDXKA2016008)
文摘Human infections with influenza H7 subtypes, such as H7N9, have raised concerns worldwide. Here, we report a human infection with a novel influenza A(H7N4) virus. A 68 years-old woman with cardiovascular and cholecystic comorbidities developed rapidly progressed pneumonia with influenza-like-illness as initial symptom, recovered after 23 days-hospitalization including 8 days in ICU. Laboratory indicators for liver and blood coagulation dysfunction were observed. Oseltamivir phosphate, glucocorticoids and antibiotics were jointly implemented, with nasal catheterization of oxygen inhalation for this patient.We obtained the medical records and collected serial respiratory and blood specimens from her. We collected throat, cloacal and/or feces samples of poultry and wild birds from the patient's backyard, neighborhood, local live poultry markets(LPMs) and the nearest lake. All close contacts of the patient were followed up and sampled with throat swabs and sera. Influenza viruses and other respiratory pathogens were tested by real-time RT-PCR, viral culturing and/or sequencing for human respiratory and bird samples. Micro-neutralizing assay was performed for sera. A novel reassortant wild bird-origin H7N4 virus is identified from the patient and her backyard poultry(chickens and ducks) by sequencing, which is distinct from previously-reported avian H7N4 and H7N9 viruses. At least four folds increase of neutralizing antibodies to H7N4 was detected in her convalescent sera. No samples from close contacts, wild birds or other poultry were tested positive for H7N4 by real-time RT-PCR.
