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Objective To analyze and estimate the possibility of early control in Shanghai if COVID-19 had begun in Shanghai. Methods Comparison was made in the processes of early control between H7N9 avian influenza in Shanghai in 2013 and COVID-19 in Wuhan in 2019.The early incidence data of Korean COVID-19 was simulated and analyzed to predict whether the medical resources needed in Shanghai were available. Results If it had occurred in Shanghai, it would have taken 22 days from the first case to the government′s emergency response.It was estimated that there would have been 602-763 patients with cumulative onset and onset after incubation period.At least 500 beds of infectious diseases could have been allocated in Shanghai in case of emergency.Through adding beds and resources reallocation in the whole city, patients could have been fully admitted and treated. Conclusion If COVID-19 epidemic had occurred in Shanghai, it′s early control would have been possible though there might have difficulties.
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[Objective] To analyze and judge the possibility of early control in Shanghai if COVID-19 begins in Shanghai. [Methods] Compare the process of early control of H7N9 avian influenza in Shanghai in 2013 and Wuhan COVID-19 in 2019. The early incidence data of Korean COVID-19 was simulated and analyzed to predict whether the medical resources needed in Shanghai were available. [Results] (1) It would take 22 days from the first case to the government's emergency response in terms of Shanghai. (2) It is estimated that there would be 602-763 patients with cumulative onset and onset after incubation period. (3) At least 500 beds of infectious diseases can be allocated in Shanghai in case of emergency. Through adding beds and resources reallocation in the whole city, patients can be fully admitted and treated. [Conclusion] If COVID-19 epidemic occurs in Shanghai, early control is possible.
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Objective To explore the predictive value of neutrophil-to-lymphocyte ratio on the prognosis of H7N9 avian influenza.Methods A retrospective analysis was conducted on 28 H7N9 avian influenza patients (treatment group) at the First Affiliated Hospital of Soochow University from April 2013 to January 2016.Thirty healthy physical examiners in the same period were enrolled as the healthy control group.The 28 patients were followed up for half a year and divided into the improvement group (18 cases) and the death group (10 cases) according to the clinical prognosis.Inflammatory indicators including white blood cells (WBC),neutrophil (N),lymphocyte (L),monocytes (M),platelet (PLT),creatine kinase (CK),lactate dehydrogenase (LDH),high sensitive C reactive protein were collected at day 1,day 3 and week 1 of admission.Calculation of neutrophil-to-lymphocyte ratio (NLR),platelet-to-lymphocyte ratio (PLR),lymphocyte-to-monocyte ratio (LMR),△NLR3 (day 3 of admission NLR-on day 1 of admission NLR),△NLR7 (week 1 of admission NLR-day 3 of admission NLR) and so on calculating △PLR3,△PLR7,△LMR3,△LMR7.Differences of the above indicators between the improvement group and death group were compared.The measurement data with normal distribution were tested by t-test of two independent samples,and the count data with non-normal distribution were tested by Mann-Whitney U-test.Univariate and multivariate logistic regression analysis to explore the prognostic factors and the working characteristic curve of subjects was used to evaluate the predictive value of inflammatory response indexes for H7N9 avian influenza death.Results In the treatment group,the baseline WBC,L,N,PLT,the proportion of lymphocytes,neutrophils,monocytes,and NLR,PLR,and LMR were all statistically different compared with the healthy control group (all P ＜0.01).After treatment,day 3 NLR,△NLR3 in improvement group were both significantly decreased to 10.93 (15.71)and0.87 (-15.63),respectively when compared with death group (17.62[23.63] and 7.42[22.68],respectively) (Z =-2.16 and-2.014,respectively,both P＜0.05).Day 7 NLR,△NLR7 in improved group were 6.51 (13.23) and-0.37 (-12.38),respectively,which were both lower than those of death group (27.90 [25.64] and 11.54 [-26.22]) with statistically significant differences (Z =-2.444 and -2.111,respectively,both P ＜ 0.05).Multivariate logistic regression analysis indicates that △NLR3 is the main factor that affects the prognosis of the H7N9 infection (odds ratio [OR] =1.153,95％ confidence interval [CI]:1.052-1.263,P =0.002).Reciver operating characteristic curve analysis showed that the area under the curve was 0.733 (95 ％ CI:0.532-0.935,P =0.044).Based on the principle of Youden index,the cutoff value of △NLR3 to predict the death risk of H7N9 avian influenza was 5.453 with sensitivity of 0.700 and the specificity of 0.722.The mortality was higher when △NLR3 was higher than 5.453.Conclusions Dynamic monitoring NLR,especially △NLR3 may reflect the condition and prognosis of H7N9 infection,which is an independent predictor of death.
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Objective To analyze the epidemiological characteristics of human infection with H7N9 avian influenza in Guilin in recent years and to provide on-site data and data support for scientific pre-vention and control of the epidemic of H7N9 avian influenza infection. Methods A descriptive epidemio-logical method was used to collect the data about human infection with H7N9 avian influenza form three as-pects, which were human infection cases in 2017, environmental monitoring for H7N9 avian influenza virus and sentinel surveillance of influenza-like cases. The epidemiological characteristics of human infection with H7N9 avian influenza in Guilin in 2017 were analyzed. Chi-square test was used to compare the positive rates of H7N9 avian influenza virus in environmental specimens. Results A total of six cases of confirmed human H7N9 infection including three deaths were reported in Guilin city in 2017. These cases were from five counties and districts and all occurred in winter and spring. The patients were middle-aged and old men. Most of them were farmers and had a clear history of poultry exposure before the onset of infection. No human H7N9 infection was reported in close contacts or in influenza-like cases. Conclusions H7N9 avian influen-za infection in Guilin was characterized by high sporadicity, high incidence in winter and spring, and pre-dominantly middle-aged and elderly men. Avian exposure history was a high risk factor for human infection with H7N9 avian influenza virus. All of the studied cases were severe cases. No human-to-human transmis-sion was reported. Farmers, having a history of poultry slaughter, and underlying diseases were potential risks causing death. Live poultry markets were the main sources of infection, hence closing market could re-duce the detection rate of H7N9 avian influenza virus. Strengthen the management of live poultry market and poultry environmental monitoring, closing live poultry markets when viral detection was positive, and suspen-ding live poultry trading were effective measures to control the epidemic of H7N9 avian influenza infection and prevent transmission.
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Objective @#To evaluate the immune effects of inactivated H7N9 influenza vaccine.@*Methods @#We searched several common databases（The Cochrane Library,PubMed,China Biology Medicine disc,China National Knowledge Infrastructure,etc.）for research articles about immune effects of H7N9 influenza vaccine published from the time the database built to July 10th of 2018,using H7N9 and vaccine as keywords. After screening the articles according to the inclusion and exclusion criteria,we assessed the quality of the studies and then employed seroconversion rate（SCR）as an outcome indicator to analyze the immune effects of different doses and adjuvants.@*Results @#We recruited 5 articles on inactivated H7N9 influenza vaccine from 1 679 articles. The sample size was 2 579. The results of the meta-analysis showed that the rate difference（RD）values of SCR in each dose group after the first dose ranged from 1% to 10%,which indicated a poor protective effect;after the second dose of immunization,the RD values of SCR in the vaccines without adjuvants ranged from 13% to 19%,which was not effective enough;the RD values of SCR in the vaccines with adjuvants ranged from 62% to 69%,which met the licensing criteria for influenza vaccine;better results could be achieved when immunized with two doses of vaccines with adjuvants（ RR=1.19,95%CI：1.02-1.39）;vaccines with AS03 or MF59 at the lowest dose of 3.75 μg had the same immune effects as ones at a dose of 15 μg;vaccines with AS03（RD=89%,95%CI：85%-93%）were superior to those with MF59（RD=42%,95%CI：9%- 75%）.@*Conclusion @#Inactivated H7N9 influenza vaccines could achieve good immune effects when inoculated two doses with adjuvants,and the minimum effective dose was 3.75 μg.
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Short-term closing live poultry markets have been frequently adopted to control H7N9 epidemic.To evaluate the effect of short-term closing live poultry markets,we analyzed the data of environment surveillance of H7 by RT-PCR,and the human H7N9 cases in Zhongshan City from Feb 2014 to May 2017.RRx =The positive rate during the x-th week after closing / the positive rate of the week before closing days * 100％.Three rounds of short-term closing live poultry markets were administered.Round one:from Feb 10 to 23,2014,the neighboring cities didn't synchronize.The H7 positive rate increased since the trade recovered,and RR1 =0.40 (95％CI:0.28-0.59),RR3 =0.63 (95％CI:0.32-1.24),RR4 =0.83 (95％CI:0.48 -1.46).Two human cases were reported in May,2014.Round two:from Feb 19 to 28,2015,the neighboring cities synchronized as the province policy.The H7 positive rate maintained a level lower than 10％ since the trade recovered,and RR1 =0.15 (95％CI:0.07-0.34),RR2=0.21 (95％CI:0.10-0.41),RR3 =0.03 (95％CI:0.00-0.18),RR4 =0.10 (95％CI:0.04-0.27).No more human cases reported in that epidemic season.Round three:from Jan 8 to 21,2017,the neighboring cities didn't synchronize with Zhongshan City.The H7 positive rate had increased since the trade recovered,and RR1 =0.25 (95 ％ CI:0.09-0.68),RR3 =0.37 (95％CI:0.14-1.00),RR4 =1.07 (95％CI:0.54-2.11).Two human cases were reported in Feb,2017.Results indicated that,if the policy of closing live poultry markets was administered in single city,the environment pollution rate would rise shortly and the risk of human infection would increase once the trade recovered.However,if it was synchronously administered in all the cities in one region,the environment pollution rate could maintain at a low level and the risk of human infection would reduce enormously.
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Objective To study the willingness and influence factors related to "centralized slaughtering,fresh poultry listing and marketing" strategy,among the household chefs,and provide reference for government to adjust and optimize the strategy on avian influenza prevention.Methods According to the geographical characteristics and regional functions,6'monitoring stations' were selected from 12 residential districts of Guangzhou,respectively.Another 21 meat markets which selling live poultry,were selected in each station and 5 household chefs of each market were invited to attend a face to face interview.Basic information,personal cognitive,willingness and influencing factors to the policy were under study.Univariate and multivariate logistic regression methods were used.Results A total of 664 household chefs underwent the survey and results showed that the rate of support to the "centralized slaughtering,fresh poultry listing and marketing" strategy was 44.6％ (296/664).Results from the multi-factor logistic regression showed that those household chefs who were males (OR=1.618,95％ CI:1.156-2.264,P=0.005),having received higher education (OR=1.814,95％ CI:1.296-2.539,P=0.001),or believing that the existence of live poultry stalls was related to the transmission of avian influenza (OR=1.918,95％CI:1.341-2.743,P＜0.001) were factors at higher risk.These household chefs also intended to avoid the use of live poultry stalls (OR =1.666,95％CI:1.203-2.309,P=0.002) and accept the "centralized slaughtering,fresh poultry listing and marketing" strategy.Conclusion Detailed study on this subject and,setting up pilot project in some areas as well as prioritizing the education programs for household chefs seemed helpful to the implementation of the'freezing-fresh poultry'policy.
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Objective To study the willingness and influence factors related to "centralized slaughtering,fresh poultry listing and marketing" strategy,among the household chefs,and provide reference for government to adjust and optimize the strategy on avian influenza prevention.Methods According to the geographical characteristics and regional functions,6'monitoring stations' were selected from 12 residential districts of Guangzhou,respectively.Another 21 meat markets which selling live poultry,were selected in each station and 5 household chefs of each market were invited to attend a face to face interview.Basic information,personal cognitive,willingness and influencing factors to the policy were under study.Univariate and multivariate logistic regression methods were used.Results A total of 664 household chefs underwent the survey and results showed that the rate of support to the "centralized slaughtering,fresh poultry listing and marketing" strategy was 44.6％ (296/664).Results from the multi-factor logistic regression showed that those household chefs who were males (OR=1.618,95％ CI:1.156-2.264,P=0.005),having received higher education (OR=1.814,95％ CI:1.296-2.539,P=0.001),or believing that the existence of live poultry stalls was related to the transmission of avian influenza (OR=1.918,95％CI:1.341-2.743,P＜0.001) were factors at higher risk.These household chefs also intended to avoid the use of live poultry stalls (OR =1.666,95％CI:1.203-2.309,P=0.002) and accept the "centralized slaughtering,fresh poultry listing and marketing" strategy.Conclusion Detailed study on this subject and,setting up pilot project in some areas as well as prioritizing the education programs for household chefs seemed helpful to the implementation of the'freezing-fresh poultry'policy.
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Objective To summarize nursing care of 6 critically ill patients with human infections of avian influenza A H7N9 virus. Methods Totally 6 cases of human infection with H7N9 avian influenza in our hospital during December 2016 to February 2017 were treated, with nursing care including:careful nursing of medication, nutrition management, oxygen therapy, analgesic sedative care, delirium prevention, humane care and protective isolation. Results About 5 cases were discharged from the hospital and 1 case died. Conclusion The key nursing points include observation of anti-avian influenza virus efficacy and side effects, nutrition management, oxygen therapy and mechanical ventilation care, analgesic sedative care, delirium prevention, humane care, and preventive isolation, which are key to the successful treatment of critically ill patients with human infections of avian influenza A H7N9 virus.
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Objective: To identify the general public’s perceptions of the overall risk communication strategy carried out by Chinese public health agencies during the first wave of avian influenza A(H7N9) outbreak in humans in 2013. Methods: Participants were recruited from communities in Beijing, Lanzhou and Hangzhou, China in May and June 2013 by convenience sampling. Demographics and other relevant information were collected using a self-administered questionnaire. Focus group interviews were conducted using a set of nine pre-developed questions and a tested moderator guide. The interviews were audio recorded and were transcribed verbatim. The constant comparative method was used to identify trends and themes. Results: A total of nine focus group interviews, with 94 participants recruited from nine communities, were conducted. Most participants received H7N9 information via television and the Internet. A majority of the participants appreciated the transparency and timeliness of the information released by the government. They expressed a sense of trust in the recommended public health advice and followed most of them. The participants suggested that the government release more information about clinical treatment outcomes, have more specific health recommendations that are practical to their settings and expand the use of new media channels for risk communication. Conclusion: The public perceived the overall risk communication strategy by the Chinese public health agencies as effective, though the moderator had a governmental agency title that might have biased the results. There is a need to expand the use of social media for risk communication in the future.
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Objective To analyze the main clinical features of human infection with H7N9 avian influenza complicated by acute respiratory distress syndrome (ARDS).Methods A retrospective analysis of complete clinical data of 9 cases of human infection with H7N9 avian influenza complicated by ARDS admitted from March 2013 to December 2014 admitted to Department of Critical Care Medicine of the Affiliated Drum Tower Hospital of Nanjing University Medical School was conducted.Results Nine patients' mean age was (46.3±12.3) years, male accounting for 66.7% (6/9). The main clinical features: ① In the duration of acute phase, high fever, cough, hemoptysis sputum, reduction of white blood cell count (WBC) and platelet count (PLT), and myocardial enzyme elevation were the features of the disease. Chest CT showed pulmonary consolidation and ground-glass like shadows. ② On admission, all their oxygenation indexes (PaO2/FiO2) were less than 200 mmHg (1 mmHg = 0.133 kPa) of which 66.7% (6/9) was less than 100 mmHg, mean (98.9±62.8) mmHg; 55.6% (5/9) required invasive mechanical ventilatory support; 77.8% (7/9) combined with shock, and hemodynamic monitoring showed peripheral vascular resistance was decreased. ③ There were secondary bloodstream infection in 5 cases and lung infection in 4 cases, accounting for 77.8% (7/9). ④ In 22.2% (2/9) patients, the virus relapsed after the anti-virus therapy was stopped for 7 days, then immediately antiviral treatment was used again, it was still effective.Conclusion Human infection with H7N9 avian influenza complicated by ARDS has typical clinical symptoms, laboratory tests and imaging features, often associated with distributive shock, and at the late stage, secondary pulmonary or blood infection and the virus resurgence may occur.
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Objective To investigate the spatial distribution and growing trend of 438 human infection with the H7N9 avian influenza virus in mainland China,and to provide evidence for developing scientific prevention and control strategies.Methods 438 human infection with the avian influenza A (H7N9) cases from February 2013 to May 2014 in mainland China were studied and data collected to establish a database for the development of geographic information system.Trend surface analysis and spatial autocorrelation analysis were used to study the spatial distribution.Descriptive epidemiological method was utilized to analyze the demographic characteristic.Results From June 2013 to May 2014,cases had an overall national increase,but significantly decreasing in Shanghai.A trend surface was established for human infection with avian influenza A (H7N9) in the mainland of China,showing that the incidence was increasing obviously from north to south and the line slope declined from west to east.Distribution pattern of the cases varied within different time series and regional levels.The overall Moran' s I coefficient of the provincial level from February to May in 2013 and the coefficient of the city level from June 2013 to May 2014 were 0.144 718 and 0.117 468,respectively,with the differences statistically significant (P＜0.05).According to the analysis of the local autocorrelation and hot spot,northern Zhejiang and southern Guangdong showed high spatial clusters of human infection with avian influenza A(H7N9) (Z＞2.58).Conclusion From February 2013 to May 2014,the spatial correlation at the provincial level decreased.However,the spatial correlation and the numbers of hot spots at the city level were both increasing.Effective measures should be taken accordingly,following the distributive characteristics.
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In March 2013,human cases of infection with the H7N9 avian influenza virus were reported in Shanghai and other places of China.This article highlights the background of human infection with the H7N9 avian influenza virus,the biological characteristics,epidemiology and pathogenesis,the clinical features,prevention and treatment of H7N9 avian influenza.In all,Pediatricians need to be aware of H7N9 avian influenza.
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[Objective] To investigate and analyze the first case of human infection with highly pathogenic avian influenza virus ( H7N9) so as to provide scientific basis for control of avian influenza infec-tion in humans. [Methods] Epidemiological survey was carried out including the process of morbidity , possible infection source , transmission route and risk factors , etc.Strict observation was made on close con-tacts of the patient .Meanwhile the patient underwent clinical diagnosis , treatment and laboratory tests . [ Results] The patient was confirmed to be infected with highly pathogenic human avian influenza H 7N9 virus as ascertained by expert group of ministry of health ,and was cured and discharged .The patient had definate contact with live poultry , and using H7N9 pharyngeal swab through laboratory tests , avian influenza virus nucleic acid showed positivity results .No abnormalities were found in clinical manifestations in close contacts of the patient.By expanding surveillance on 160 cases of influenza-likeillness(ILI)and 858 cases of professional groups , the samples were not found to be H 7 N9 positive .However , on local live poultry market, two chicken pharyngeal swab specimens were detected to be H 7N9 positive.Positive chickens were from other provinces . [ Conclusion] History of live poultry exposure is believed to be the key risk fac-tors in infection with H7N9 virus.So far there has been no evidence of human-to-human transmission . There has not been subclinical infection or mild cases found in crowd .However ,there is the need to expand monitoring and epidemiological investigation so as to improve the understanding of the disease .