Het nieuwe aviaire influenzavirus H7N9: een update

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Abstract

In China is eind maart 2013 besmetting met een nieuw griepvirus vastgesteld. Het gaat om influenza A (H7N9). Op 11 juni 2013 zijn er 133 pa tiënten met een bevestigde influenza-A (H7N9)besmetting door de Chinese autoriteiten gerapporteerd, van wie er 39 zijn overleden. Naast dit nieuwe H7N9-virus circuleert ook de aviaire H5N1-influenza nog steeds in Zuidoost-Azië. Met deze H5N1-influenza waren op 4 juni 2013 630 mensen besmet, van wie er 375 zijn overleden.1 Kliniek en transmissie Het ziektebeeld wordt gekenmerkt door een ernstig pulmonaal ziektebeeld. De patiënten krijgen hoge koorts en vaak een ernstige longontsteking. Het beeld kan overgaan in een Acute Respiratory Distress Syndrome (ARDS) en multi-orgaanfalen.2 De gemiddelde leeftijd van de patiënten is 69 jaar. Vaak heeft er blootstelling aan pluimvee plaatsgevonden. Alle tot nu toe gemelde patiënten komen uit China. De ziekte is ook vastgesteld bij een patiënt in Taiwan die kort tevoren in China was geweest. Ongeveer 20% van de bevestigde gevallen van influenza H7N9 overlijdt. Het gaat hier om een nieuw influenzavirus, ontstaan door een genetische mix van vier aviaire influenzavirussen.3 Mens-op-menstransmissie is alleen beschreven in situaties waarin mensen lange tijd dicht op elkaar leven en werken. In 2003 was er in Nederland een uitbraak van aviaire influenza (H7N7) onder pluimvee. Er waren toen 89 humane besmettingsgevallen, van wie één persoon is overleden.4 Meestal veroorzaken H7-influenzavirussen bij mensen milde klachten, zoals een conjunctivitis en griepachtige klachten. Wetenschappers vragen zich dan ook af waarom deze (voor dieren) laag-pathogene influenza nu in staat is mensen te besmetten en ziek te maken.5 Hoewel op dit moment nog niet is aangetoond of pluimvee daadwerkelijk mensen heeft besmet, is dit wel aannemelijk. Aanbevelingen voor bedrijfsartsen De reizigersadviezen voor China zijn niet gewijzigd. Omdat de bron van infectie nog onbekend is, dienen reizigers algemene hygiënemaatregelen in acht te nemen en contact met dieren en dierlijke afvalproducten te vermijden (www.lcr.nl). Op de website van het CDC staat een handig overzicht voor reizigers.6 Net als voorheen geldt dat artsen in Nederland alert moeten zijn wanneer mensen uit China terugkeren met een ernstige longontsteking.

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Most cited references 3

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Transmission of H7N7 avian influenza A virus to human beings during a large outbreak in commercial poultry farms in the Netherlands.

Marion Koopmans, Berry Wilbrink, Marina Conyn … (2004)

An outbreak of highly pathogenic avian influenza A virus subtype H7N7 started at the end of February, 2003, in commercial poultry farms in the Netherlands. Although the risk of transmission of these viruses to humans was initially thought to be low, an outbreak investigation was launched to assess the extent of transmission of influenza A virus subtype H7N7 from chickens to humans. All workers in poultry farms, poultry farmers, and their families were asked to report signs of conjunctivitis or influenza-like illness. People with complaints were tested for influenza virus type A subtype H7 (A/H7) infection and completed a health questionnaire about type of symptoms, duration of illness, and possible exposures to infected poultry. 453 people had health complaints--349 reported conjunctivitis, 90 had influenza-like illness, and 67 had other complaints. We detected A/H7 in conjunctival samples from 78 (26.4%) people with conjunctivitis only, in five (9.4%) with influenza-like illness and conjunctivitis, in two (5.4%) with influenza-like illness only, and in four (6%) who reported other symptoms. Most positive samples had been collected within 5 days of symptom onset. A/H7 infection was confirmed in three contacts (of 83 tested), one of whom developed influenza-like illness. Six people had influenza A/H3N2 infection. After 19 people had been diagnosed with the infection, all workers received mandatory influenza virus vaccination and prophylactic treatment with oseltamivir. More than half (56%) of A/H7 infections reported here arose before the vaccination and treatment programme. We noted an unexpectedly high number of transmissions of avian influenza A virus subtype H7N7 to people directly involved in handling infected poultry, and we noted evidence for person-to-person transmission. Our data emphasise the importance of adequate surveillance, outbreak preparedness, and pandemic planning.

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Environmental connections of novel avian-origin H7N9 influenza virus infection and virus adaptation to the human.

Xiaoying Pu, Haixia Xiao, G Zhao … (2013)

A novel H7N9 influenza A virus has been discovered as the causative identity of the emerging acute respiratory infection cases in Shanghai, China. This virus has also been identified in cases of infection in the neighboring area Hangzhou City in Zhejiang Province. In this study, epidemiologic, clinical, and virological data from three patients in Hangzhou who were confirmed to be infected by the novel H7N9 influenza A virus were collected and analyzed. Human respiratory specimens and chicken feces from a contacted free market were tested for influenza virus by real-time reverse transcription PCR (RT-PCR) and sequencing. The clinical features of the three cases were similar featured with high fever and severe respiratory symptoms; however, only one of the patients died. A certain degree of diversity was observed among the three Hangzhou viruses sequenced from human samples compared with other reported H7N9 influenza A viruses. The sequences of the novel avian-origin H7N9 influenza viruses from Hangzhou City contained important amino acid substitutions related to human adaptation. One of the Hangzhou viruses had gained a novel amino acid substitution (Q226I) in the receptor binding region of hemagglutinin. More importantly, the virus sequenced from the chicken feces had a 627E substitution in the PB2 protein instead of the mammalian-adapted 627K substitution that was found in the PB2 proteins from the Hangzhou viruses from the three patients. Therefore, the newly-emerging H7N9 virus might be under adaptation pressure that will help it "jump" from avian to human hosts. The significance of these substitutions needs further exploration, with both laboratory experiments and extensive field surveillance.

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Pandemic influenza viruses--hoping for the road not taken.

A Fauci, Jeffery K Taubenberger, David M. Morens (2013)

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Author and article information

Contributors

Jaap Maas: j.j.maas@amc.uva.nl

Journal

Journal ID (nlm-ta): Tijdschr Bedr Verzekeringsgeneeskd

Journal ID (iso-abbrev): Tijdschr Bedr Verzekeringsgeneeskd

Title: Tijdschrift Voor Bedrijfs- En Verzekeringsgeneeskunde

Publisher: Bohn Stafleu van Loghum (Houten )

ISSN (Print): 0929-600X

ISSN (Electronic): 1876-5858

Publication date (Electronic): 26 September 2013

Publication date (Print): 2013

Volume: 21

Issue: 7

Page: 324

Affiliations

[23 ]GRID grid.5650.6, ISNI 0000000404654431, Nederlands Centrum voor Beroepsziekten, Coronel Instituut, , AMC, ; Amsterdam, The Netherlands

[24 ]GRID grid.31147.30, ISNI 0000000122080118, RIVM, ; Bilthoven, The Netherlands

Article

Publisher ID: 150

DOI: 10.1007/s12498-013-0150-7

PMC ID: 7111878

SO-VID: 386dccfa-0532-474d-be43-e7dcbfc47115

License:

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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Keywords: h7n9,h5n1,griepvirus,china,update

Data availability:

Keywords: h7n9, h5n1, griepvirus, china, update

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