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

by Zu-Qun Wu 1,†, Yi Zhang 2,†, Na Zhao 3,†, Zhao Yu 4, Hao Pan 5, Ta-Chien Chan 6, Zhi-Ruo Zhang 7,* and She-Lan Liu 4,*
1
Department of Respiratory Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
2
Department of Medicine, Jinxi Petrochemical Hospital, Huludao 125001, China
3
National Research Center for Wildlife Borne Diseases, Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
4
Department of Infectious Diseases and Key Lab of Vaccine against Hemorrhagic Fever with Renal Syndrome, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
5
Department of Infectious Diseases, Shanghai Municipal Centre for Disease Control and Prevention, Shanghai 200336, China
6
Center for Geographic Information Science, Research Centre for Humanities and Social Science, Academia Sinica, Taipei 115, Taiwan
7
School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
*
Authors to whom correspondence should be addressed.
Zu-Qun Wu, Yi Zhang and Na Zhao equally contributed to this work.
Academic Editor: Paul B. Tchounwou
Int. J. Environ. Res. Public Health 2017, 14(3), 263; https://doi.org/10.3390/ijerph14030263
Received: 18 January 2017 / Revised: 20 February 2017 / Accepted: 28 February 2017 / Published: 4 March 2017
(This article belongs to the Section Global Health)
This study aimed to assess the mortality risks for human infection with high (HPAI) and low (LPAI) pathogenicity avian influenza viruses. The HPAI case fatality rate (CFR) was far higher than the LPAI CFR [66.0% (293/444) vs. 68.75% (11/16) vs. 40.4% (265/656) vs. 0.0% (0/18) in the cases with H5N1, H5N6, H7N9, and H9N2 viruses, respectively; p < 0.001]. Similarly, the CFR of the index cases was greater than the secondary cases with H5N1 [100% (43/43) vs. 43.3% (42/97), p < 0.001]. Old age [22.5 vs. 17 years for H5N1, p = 0.018; 61 vs. 49 years for H7H9, p < 0.001], concurrent diseases [18.8% (15/80) vs. 8.33% (9/108) for H5N1, p = 0.046; 58.6% (156/266) vs. 34.8% (135/388) for H7H9, p < 0.001], delayed confirmation [13 vs. 6 days for H5N1, p < 0.001; 10 vs. 8 days for H7N9, p = 0.011] in the fatalities and survivors, were risk factors for deaths. With regard to the H5N1 clusters, exposure to poultry [67.4% (29/43) vs. 45.2% (19/42), p = 0.039] was the higher risk for the primary than the secondary deaths. In conclusion, old age, comorbidities, delayed confirmation, along with poultry exposure are the major risks contributing to fatal outcomes in human HPAI and LPAI infections. View Full-Text
Keywords: influenza virus; endemic infection; horizontal transmission; seasonal incidence influenza virus; endemic infection; horizontal transmission; seasonal incidence
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Wu, Z.-Q.; Zhang, Y.; Zhao, N.; Yu, Z.; Pan, H.; Chan, T.-C.; Zhang, Z.-R.; Liu, S.-L. Comparative Epidemiology of Human Fatal Infections with Novel, High (H5N6 and H5N1) and Low (H7N9 and H9N2) Pathogenicity Avian Influenza A Viruses. Int. J. Environ. Res. Public Health 2017, 14, 263.

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