H5N6 influenza virus infection, the newest influenza

The most recent new emerging infection is the H5N6 inl uenza virus infection. This infection has just been reported from China in early May 2014. The disease is believed to be a cross species infection. All indexed cases are from China. Of interest, the H5N6 inl uenza virus is the primary virus for avian. The avian H5N6 inl uenza virus in avian population is a low virulent strain. However, the clinical manifestation in human seems severe. In this mini-review, the authors summarize and discuss on this new emerging inl uenza.

Development and Assessment of Two Highly Pathogenic Avian Influenza(HPAI) H5N6 Candidate Vaccine Viruses for Pandemic Preparedness

Objective In China, 24 cases of human infection with highly pathogenic avian influenza(HPAI) H5 N6 virus have been confirmed since the first confirmed case in 2014. Therefore, we developed and assessed two H5 N6 candidate vaccine viruses(CVVs).Methods In accordance with the World Health Organization(WHO) recommendations, we constructed two reassortant viruses using reverse genetics(RG) technology to match the two different epidemic H5 N6 viruses. We performed complete genome sequencing to determine the genetic stability. We assessed the growth ability of the studied viruses in MDCK cells and conducted a hemagglutination inhibition assay to analyze their antigenicity. Pathogenicity attenuation was also evaluated in vitro and in vivo.Results The results showed that no mutations occurred in hemagglutinin or neuraminidase, and both CVVs retained their original antigenicity. The replication capacity of the two CVVs reached a level similar to that of A/Puerto Rico/8/34 in MDCK cells. The two CVVs showed low pathogenicity in vitro and in vivo, which are in line with the WHO requirements for CVVs.Conclusion We obtained two genetically stable CVVs of HPAI H5N6 with high growth characteristics,which may aid in our preparedness for a potential H5N6 pandemic.

Case report for human infection with a highly pathogenic avian influenza A(H5N6) virus in Beijing, China 2019

Bird infections with highly pathogenic avian influenza A(H5N6) viruses have been identified since 2014. With very limited occasion, the virus could sporadically spilled over to infect humans. It has been recognized that all human infections were within southern region of China's Mainland until the case reported here in Beijing in Aug. 2019. This was the first human case infected with highly pathogenic avian influenza A(H5N6) virus in northern China. The infection was confirmed by real-time RT-PCR assay. The whole genome sequences were obtained from clinical sample. Genetic characteristics of the virus were identified similar to those of previous avian influenza A(H5N6) viruses, retaining the main features of the avian influenza virus.

Variation and evolution of NP genes of human avian H_5N_1 virus strains

In order to reveal variation and revolution of NP genes of human avian H5 N1 influenza virus strains, the NP gene of a human avian H5 N1 influenza virus strain in Guangdong was sequenced and the global NP genes of strains were retrieved. The sequences were analyzed by DNAStar 5.0, and the evolutionary speed was studied with reference to the epidemiological data. It was found that NP genes of 45 strains during 1997-2006 were homologically classified into three groups： strains in 1997-1998, strains in 2004-2005 and strains from 2003 to 2006. There were 35 substitutions in NPs in all strains accounting for a ratio of 7.03% （35/498）. An additional glycoprotein domain （NGT430-432） was found in NP genes in the strains of 2003-2006, the mutation of N370S in GD-01-06 resulted in occurrence of one more glycoprotein domain （NES368-370）. In the synonymous variation, Ks values in NP were 2.03 × 10^-5-2.55 × 10^-5 Nt/d and K. values in NP were 1.58 × 10^-6-3.10 × 10^-6 Nt/d. There didn＇t exist obviously selective pressure. An additional glycoprotein domain in every strain of 2003-2006 and one more in strain GD-01-06 might change the antigenicity of human avian H5 N1 influenza virus. The variation on human avian H5 N1 influenza strains occurred frequently in the natural world, which would result in high probability of human-human transmission along with the natural evolution of the virus.

Clinical characteristics of human infection with a novel avian-origin influenza A（H10N8） virus

Background Novel influenza A viruses of avian-origin may be the precursors of pandemic strains. This descriptive study aims to introduce a novel avian-origin influenza A （H10N8） virus which can infect humans and cause severe diseases. Methods Collecting clinical data of three cases of human infection with a novel reassortment avian influenza A （H10N8） virus in Nanchang, Jiangxi Province, China. Results Three cases of human infection with a new reassortment avian influenza A（H10N8） virus were described, of which two were fatal cases, and one was severe case. These cases presented with severe pneumonia that progressed to acute respiratory distress syndrome （ARDS） and intractable respiratory failure. Conclusion This novel reassortment avian influenza A （H10N8） virus in China resulted in fatal human infections, and should be added to concerns in clinical practice.

First outbreak of human infection with avian influenza A(H7N9) virus in Guangxi, China, 2016 to 2017

To the Editor: Since avian influenza A(H7N9) was first identified in Shanghai, China, in March 2013, there have been a total of five epidemics. These have amounted to 1564 laboratory-confirmed cases up to September 2017, with a fatality rate of about 40%.[1] In the fifth wave, 4.09% of cases (31/758) were infected with the highly pathogenic avian influenza (HPAI) A(H7N9). This indicated that the pathotype of the A(H7N9) had switched from low pathogenic avian influenza (LPAI) to HPAI.

H5N1 influenza viruses： outbreaks and biological properties

All known subtypes of influenza A viruses are maintained in wild waterfowl, the natural reservoir of these viruses. Influenza A viruses are isolated from a variety of animal species with varying morbidity and mortality rates. More importantly, influenza A viruses cause respiratory disease in humans with potentially fatal outcome. Local or global outbreaks in humans are typically characterized by excess hospitalizations and deaths. In 1997, highly pathogenic avian influenza viruses of the H5N1 subtype emerged in Hong Kong that transmitted to humans, resulting in the first documented cases of human death by avian influenza virus infection. A new outbreak started in July 2003 in poultry in Vietnam, Indonesia, and Thailand, and highly pathogenic avian H5N1 influenza viruses have since spread throughout Asia and into Europe and Africa. These viruses continue to infect humans with a high mortality rate and cause worldwide concern of a looming pandemic. Moreover, H5N1 virus outbreaks have had devastating effects on the poultry industries throughout Asia. Since H5N1 virus outbreaks appear to originate from Southern China, we here examine H5N1 influenza viruses in China, with an emphasis on their biological properties.

Human avian influenza A (H5N1) virus infection in China

Highly pathogenic influenza A (H5N1) virus causes a widespread poultry deaths worldwide. The first human H5N1 infected case was reported in Hong Kong Special Administrative Region of China in 1997. Since then, the virus re-emerged in 2003 and continues to infect people worldwide. Currently, over 400 human infections have been reported in more than 15 countries and mortality rate is greater than 60%. H5N1 viruses still pose a potential pandemic threat in the future because of the continuing global spread and evolution. Here, we summarize the epidemiological, clinical and virological characteristics of human H5N1 infection in China monitored and identified by our national surveillance systems.

New light shed on global epidemiology of avian influenza A H5N1 virus infection in humans,1997—2015

With the support by the National Natural Science Foundation of China,the research team led by Prof.Yu Hongjie(余宏杰)at the School of Public Health,Fudan University,Key Laboratory of Public Health Safety,Ministry of Education,and the Key Laboratory of Surveillance and Early Warning on Infectious Disease,Chinese Center for Disease Control and Prevention,has published the paper entitled“Global epi-

Economic burden and its associated factors of hospitalized patients infected with A (H7N9) virus: a retrospective study in Eastern China, 2013–2014

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.

Highlight the significance of genetic evolution of H5N1 avian flu

Agrowing concern has focused on the recent ,identification of influenza A H5N1 virus in Asia. Previously thought to infect only wild birds and poultry, H5N1 has now infected humans, cats, pigs, and other mammals in an ongoing outbreak, often with fatal results. According to a report from the World Health Organization （WHO）, 217 human H5N1 cases have been confirmed and 123 of them have been fatal as of May 19, 2006.1 But many questions remain unanswered, for example how the H5N1 virus could cross species barriers and acquire the ability to infect humans;

人感染H7N9禽流感引发的传染病学教学思考

人感染H7N9禽流感疫情引发教学者对传染病学教学的思考，分析当前传染病学教学面临的挑战：传染病疾病谱发生巨大变化，但教学课时有限；传染病发病率下降，而适宜的教学病例有限；医学生对传染病学学习存在畏惧心理；教学师资缺乏；公众对传染病防控要求越来越高等。由此提出以下应对策略：调整课程设置；注重教学病例积累，使用多媒体教学，利用专科医院的教学资源；教育学生学会自身防护；注重青年教师培养；强调学科特征及公共卫生的重要性；改进教学方法，提高教学效率。