2013 年 3 月下旬,中国卫生部门报告了 3 例人类感染新型甲型流感(H7N9)病毒病例。[43]Gao R, Cao B, Hu Y, et al. Human infection with a novel avian-origin influenza A (H7N9) virus. N Engl J Med. 2013 May 16;368(20):1888-97.
https://www.nejm.org/doi/10.1056/NEJMoa1304459
http://www.ncbi.nlm.nih.gov/pubmed/23577628?tool=bestpractice.com
这是首次在人类中发现甲型(H7N9)病毒感染,也是低致病性禽流感(low-pathogenic avian influenza,LPAI)病毒感染首次在人类中引起严重疾病从而导致致命性结局。截至 2019 年 6 月,亚洲谱系甲型(H7N9)病毒对公众健康构成的当前风险较低;[47]World Health Organization. Avian influenza weekly update number 713: human infection with avian influenza A(H7N9) virus in China. Nov 2019 [internet publication].
https://www.who.int/docs/default-source/wpro---documents/emergency/surveillance/avian-influenza/ai-20191101.pdf?sfvrsn=30d65594_40
然而,该病毒的大流行潜力令人担忧。流感病毒不断变化,这种病毒有可能会不断演变,从而获得在人群中轻易且持续传播的能力,从而引起广泛的大流行。[48]Centers for Disease Control and Prevention. Asian lineage avian influenza A (H7N9) virus. Dec 2018 [internet publication].
https://www.cdc.gov/flu/avianflu/h7n9-virus.htm
[49]World Health Organization. Frequently asked questions on human infection caused by the avian influenza A(H7N9) virus. Feb 2014 [internet publication].
https://www.who.int/influenza/human_animal_interface/faq_H7N9/en/
[50]Uyeki TM, Katz JM, Jernigan DB. Novel influenza A viruses and pandemic threats. Lancet. 2017 Jun 3;389(10085):2172-4.
http://www.ncbi.nlm.nih.gov/pubmed/28589883?tool=bestpractice.com
[51]Wang X, Jiang H, Wu P, et al. Epidemiology of avian influenza A H7N9 virus in human beings across five epidemics in mainland China, 2013-17: an epidemiological study of laboratory-confirmed case series. Lancet Infect Dis. 2017 Aug;17(8):822-32.
http://www.ncbi.nlm.nih.gov/pubmed/28583578?tool=bestpractice.com
在 2013-2017 年期间,在中国观察到人类中出现了 5 次不同的亚洲谱系甲型(H7N9)病毒感染流行暴发。[2]World Health Organization. Human infection with avian influenza A(H7N9) virus - China. Feb 2017 [internet publication].
https://www.who.int/csr/don/27-february-2017-ah7n9-china/en/
在 2017 年 10 月至 2019 年 6 月期间,仅在 2018 年和 2019 年上半年报告了少量的散发性人类病例。在中国,人类感染甲型(H7N9)病毒大体上与季节性流感年度暴发同时或重叠发生,但在当年的其他时间有发现散发病例。[2]World Health Organization. Human infection with avian influenza A(H7N9) virus - China. Feb 2017 [internet publication].
https://www.who.int/csr/don/27-february-2017-ah7n9-china/en/
[42]European Centre for Disease Prevention and Control. Influenza A(H7N9) virus in China: implications for public health. Seventh update. Jul 2017 [internet publication].
https://www.ecdc.europa.eu/sites/portal/files/documents/2017-07-03-RRA-Disease-China_H7N9_0.pdf
[52]Kile JC, Ren R, Liu L, et al. Update: increase in human infections with novel Asian lineage avian influenza A(H7N9) viruses during the fifth epidemic - China, October 1, 2016-August 7, 2017. MMWR Morb Mortal Wkly Rep. 2017 Sep 8;66(35):928-32.
https://www.cdc.gov/mmwr/volumes/66/wr/mm6635a2.htm?s_cid=mm6635a2_e
http://www.ncbi.nlm.nih.gov/pubmed/28880856?tool=bestpractice.com
在 2013-2017 年期间,每年报告的病例数均增加,在第 5 次暴发(2016-2017 年)时达到峰值。从 2013 年 3 月至 2017 年 8 月,报告了 1557 例人类亚洲谱系甲型(H7N9)病毒感染病例,其中第 5 次暴发报告了 759 例。在 2013-2017 年期间,39% 的报告病例为致死性病例。[52]Kile JC, Ren R, Liu L, et al. Update: increase in human infections with novel Asian lineage avian influenza A(H7N9) viruses during the fifth epidemic - China, October 1, 2016-August 7, 2017. MMWR Morb Mortal Wkly Rep. 2017 Sep 8;66(35):928-32.
https://www.cdc.gov/mmwr/volumes/66/wr/mm6635a2.htm?s_cid=mm6635a2_e
http://www.ncbi.nlm.nih.gov/pubmed/28880856?tool=bestpractice.com
自第 5 次疫潮结束以来,报告的病例明显减少,2017 年 10 月至 2019 年 6 月期间仅报告了 4 例。[53]Food and Agriculture Organization of the United Nations. H7N9 situation update. Nov 2019 [internet publication].
http://www.fao.org/ag/againfo/programmes/en/empres/H7N9/situation_update.html
报告病例的减少与在鸟禽和环境中检测到的亚洲谱系甲型(H7N9)病毒减少有关。[53]Food and Agriculture Organization of the United Nations. H7N9 situation update. Nov 2019 [internet publication].
http://www.fao.org/ag/againfo/programmes/en/empres/H7N9/situation_update.html
关闭城区中活禽市场有助于减少人类暴露于甲型(H7N9)病毒和人畜共患病传播。[54]Yuan J, Lau EH, Li K, et al. Effect of live poultry market closure on avian influenza A(H7N9) virus activity in Guangzhou, China, 2014. Emerg Infect Dis. 2015 Oct;21(10):1784-93.
https://wwwnc.cdc.gov/eid/article/21/10/15-0623_article
http://www.ncbi.nlm.nih.gov/pubmed/26402310?tool=bestpractice.com
[55]Yu H, Wu JT, Cowling BJ, et al. Effect of closure of live poultry markets on poultry-to-person transmission of avian influenza A H7N9 virus: an ecological study. Lancet. 2014 Feb 8;383(9916):541-8.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946250/
http://www.ncbi.nlm.nih.gov/pubmed/24183056?tool=bestpractice.com
然而,据报告,关闭活禽市场导致家禽中的甲型(H7N9)病毒传播到了其他地区。[56]Li Y, Wang Y, Shen C, et al. Closure of live bird markets leads to the spread of H7N9 influenza in China. PLoS One. 2018 Dec 12;13(12):e0208884.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208884
http://www.ncbi.nlm.nih.gov/pubmed/30540847?tool=bestpractice.com
中国实施二价 H5-H7 家禽疫苗接种计划可能有助于大幅减少人类感染甲型(H7N9)病毒。[57]Wu J, Ke C, Lau EH, et al. Influenza H5/H7 virus vaccination in poultry and reduction of zoonotic infections, Guangdong Province, China, 2017-18. Emerg Infect Dis. 2019 Jan 17;25(1):116-8.
https://wwwnc.cdc.gov/eid/article/25/1/18-1259_article
http://www.ncbi.nlm.nih.gov/pubmed/30355435?tool=bestpractice.com
[58]Cheng W, Chong KC, Lau SY, et al. Comparison of avian influenza virus contamination in the environment before and after massive poultry H5/H7 vaccination in Zhejiang Province, China. Open Forum Infect Dis. 2019 Apr 24;6(6):ofz197.
https://academic.oup.com/ofid/article/6/6/ofz197/5478571
http://www.ncbi.nlm.nih.gov/pubmed/31198818?tool=bestpractice.com
人类中多数亚洲谱系甲型(H7N9)病毒感染发生在中国大陆东部,但中国西南和西北部省份也有病例报告。大型病例系列研究显示,所有经评估满足病例定义的患者都有近期前往中国大陆受累省份的旅行史。[2]World Health Organization. Human infection with avian influenza A(H7N9) virus - China. Feb 2017 [internet publication].
https://www.who.int/csr/don/27-february-2017-ah7n9-china/en/
[42]European Centre for Disease Prevention and Control. Influenza A(H7N9) virus in China: implications for public health. Seventh update. Jul 2017 [internet publication].
https://www.ecdc.europa.eu/sites/portal/files/documents/2017-07-03-RRA-Disease-China_H7N9_0.pdf
[59]Chang SY, Lin PH, Tsai JC, et al. The first case of H7N9 influenza in Taiwan. Lancet. 2013 May 11;381(9878):1621.
http://www.ncbi.nlm.nih.gov/pubmed/23639487?tool=bestpractice.com
[60]Ho PL, Sin WC, Chan JF, et al. Severe influenza A H7N9 pneumonia with rapid virological response to intravenous zanamivir. Eur Respir J. 2014 Aug;44(2):535-7.
https://erj.ersjournals.com/content/44/2/535.long
http://www.ncbi.nlm.nih.gov/pubmed/24696114?tool=bestpractice.com
中国境外也发现了亚洲谱系 A 型(H7N9) 病毒感染,其中 2014 年 2 月马来西亚报道了 1 例,[61]William T, Thevarajah B, Lee SF, et al. Avian influenza (H7N9) virus infection in Chinese tourist in Malaysia, 2014. Emerg Infect Dis. 2015 Jan;21(1):142-5.
https://wwwnc.cdc.gov/eid/article/21/1/14-1092_article
http://www.ncbi.nlm.nih.gov/pubmed/25531078?tool=bestpractice.com
2015 年加拿大报道了 2 例,[62]Skowronski DM, Chambers C, Gustafson R, et al. Avian influenza A(H7N9) virus infection in 2 travelers returning from China to Canada, January 2015. Emerg Infect Dis. 2016 Jan;22(1):71-4.
https://wwwnc.cdc.gov/eid/article/22/1/15-1330_article
http://www.ncbi.nlm.nih.gov/pubmed/26689320?tool=bestpractice.com
中国台湾在 2013-2017 年报告了 5 例。[42]European Centre for Disease Prevention and Control. Influenza A(H7N9) virus in China: implications for public health. Seventh update. Jul 2017 [internet publication].
https://www.ecdc.europa.eu/sites/portal/files/documents/2017-07-03-RRA-Disease-China_H7N9_0.pdf
所有这些病例都与旅行有关,且认为这些感染均发生在中国大陆。
2013 年 2 月至 2019 年 6 月期间,1568 例患者中有 616 例患者死亡(病死率为 39%)。[42]European Centre for Disease Prevention and Control. Influenza A(H7N9) virus in China: implications for public health. Seventh update. Jul 2017 [internet publication].
https://www.ecdc.europa.eu/sites/portal/files/documents/2017-07-03-RRA-Disease-China_H7N9_0.pdf
每一波感染的死亡比例都相似。第二波疾病严重程度数据显示,219 名接受医疗服务的患者中有 218 名需要住院,且 218 名住院患者中有 191 名 (87.6%) 患有严重呼吸系统并发症或危重症。[63]European Centre for Disease Prevention and Control. Rapid risk assessment: human infection with avian influenza A viruses, China. Feb 2014 [internet publication].
https://www.ecdc.europa.eu/en/publications-data/rapid-risk-assessment-human-infections-avian-influenza-viruses-china
对有症状病死风险的评估表明,亚洲谱系甲型 LPAI 禽流感(H7N9)病毒感染比甲型季节性流感(H1N1)pdm09 病毒感染更可能导致死亡,但是比甲型高致病性禽流感(highly pathogenic avian influenza,HPAI)(H5N1)病毒感染引起死亡的可能性更小。[64]Wang C, Yu H, Horby PW, et al. Comparison of patients hospitalized with influenza A subtypes H7N9, H5N1, and 2009 pandemic H1N1. Clin Infect Dis. 2014 Apr;58(8):1095-103.
https://academic.oup.com/cid/article/58/8/1095/356888
http://www.ncbi.nlm.nih.gov/pubmed/24488975?tool=bestpractice.com
在一项大型病例系列研究中,就诊患者平均年龄为 55.5 岁(范围 2-91 岁),男性感染发生率高于女性(男女比例为 2:1)。在受感染患者中观察到共病的发生率较高,[7]Li Q, Zhou L, Zhou M, et al. Epidemiology of human infections with avian influenza A(H7N9) virus in China. N Engl J Med. 2014 Feb 6;370(6):520-32.
https://www.nejm.org/doi/10.1056/NEJMoa1304617
http://www.ncbi.nlm.nih.gov/pubmed/23614499?tool=bestpractice.com
已将至少一种合并症确定为亚洲谱系甲型 LPAI (H7N9) 病毒感染的风险因素。[65]Xiang N, Li X, Ren R, et al. Assessing change in avian influenza A(H7N9) virus infections during the fourth epidemic - China, September 2015-August 2016. MMWR Morb Mortal Wkly Rep. 2016 Dec 16;65(49):1390-4.
https://www.cdc.gov/mmwr/volumes/65/wr/mm6549a2.htm
http://www.ncbi.nlm.nih.gov/pubmed/27977644?tool=bestpractice.com
然而,有并存疾病患者的死亡风险并不比没有基础慢性疾病患者的高。从 2013 年至 2017 年,新发病例数从主要为老年人转换为中年人,地点也从城区转移到城乡结合部和乡村地区;不过,住院患者的疾病严重程度无变化。[51]Wang X, Jiang H, Wu P, et al. Epidemiology of avian influenza A H7N9 virus in human beings across five epidemics in mainland China, 2013-17: an epidemiological study of laboratory-confirmed case series. Lancet Infect Dis. 2017 Aug;17(8):822-32.
http://www.ncbi.nlm.nih.gov/pubmed/28583578?tool=bestpractice.com
鸡禽似乎最易发生亚洲谱系甲型 LPAI(H7N9)病毒感染,但在其他家禽种类中也已检测到该病毒,包括鸭和鹌鹑。尽管猪会被感染,但未在人类感染亚洲谱系甲型 LPAI(H7N9)病毒的流行病学中发现与暴露于猪有关。[66]Xu L, Bao L, Deng W, et al. Rapid adaptation of avian H7N9 virus in pigs. Virology. 2014 Feb 14;452-453:231-6.
https://www.sciencedirect.com/science/article/pii/S0042682214000191
http://www.ncbi.nlm.nih.gov/pubmed/24606700?tool=bestpractice.com
[67]Zhou P, Hong M, Merrill MM, et al. Serological report of influenza A (H7N9) infections among pigs in Southern China. BMC Vet Res. 2014 Sep 2;10:203.
https://bmcvetres.biomedcentral.com/articles/10.1186/s12917-014-0203-x
http://www.ncbi.nlm.nih.gov/pubmed/25178684?tool=bestpractice.com
[68]Yum J, Park EH, Ku KB, et al. Low infectivity of a novel avian-origin H7N9 influenza virus in pigs. Arch Virol. 2014 Jun 7;159(10):2745-9.
http://www.ncbi.nlm.nih.gov/pubmed/24906526?tool=bestpractice.com
许多感染患者称接触过家禽或者到过售卖和/或宰杀活禽的市场。从患者身上分离的亚洲谱系甲型 LPAI(H7N9)病毒,和在流行病学相关市场中从活鸡身上获得的亚洲谱系甲型 LPAI(H7N9)病毒展现出遗传相似性。[5]Chen Y, Liang W, Yang S, et al. Human infections with the emerging avian influenza A H7N9 virus from wet market poultry: clinical analysis and characterisation of viral genome. Lancet. 2013 Jun 1;381(9881):1916-25.
http://www.ncbi.nlm.nih.gov/pubmed/23623390?tool=bestpractice.com
在活禽市场研究中,鸡和鸭在亚洲谱系甲型(H7N9) LPAI 阳性检测中占了大部分,但在鹌鹑和鸽子的样本中以及从相同市场获得的环境样本和水样中也检测到亚洲谱系甲型 (H7N9) LPAI 病毒 RNA。[69]Wang C, Wang J, Su W, et al. Relationship between domestic and wild birds in live poultry market and a novel human H7N9 virus in China. J Infect Dis. 2014 Jan 1;209(1):34-7.
https://academic.oup.com/jid/article/209/1/34/2193231
http://www.ncbi.nlm.nih.gov/pubmed/23990569?tool=bestpractice.com
经证实,鸣禽和小型陆生禽鸟易受亚洲谱系甲型 LPAI (H7N9) 病毒感染,但它们在动物到人传播中的作用尚不清楚。[70]Jones JC, Sonnberg S, Koçer ZA, et al. Possible role of songbirds and parakeets in transmission of influenza A(H7N9) virus to humans. Emerg Infect Dis. 2014 Mar;20(3):380-5.
https://wwwnc.cdc.gov/eid/article/20/3/13-1271_article
http://www.ncbi.nlm.nih.gov/pubmed/24572739?tool=bestpractice.com
中国和其他地区的候鸟中 ,LPAI 和 HPAI 亚洲谱系甲型(H7N9) 病毒感染的患病率仍不清楚。在上海一只健康的树麻雀身上检测到亚洲谱系甲型 LPAI (H7N9) 病毒,但在同一研究中测试的上海其他野生鸟类的 2000 多个样本中,未检测出该病毒。[71]Zhao B, Zhang X, Zhu W, et al. Novel avian influenza A(H7N9) virus in tree sparrow, Shanghai, China, 2013. Emerg Infect Dis. 2014 May;20(5):850-3.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012817/
http://www.ncbi.nlm.nih.gov/pubmed/24751370?tool=bestpractice.com
这表明需要监测非家禽鸟类感染情况,并且候鸟的感染或出口感染家禽,可能会使亚洲谱系甲型(H7N9) 病毒传播到中国以外地区。根据定义,高致病性亚洲谱系甲型(H7N9)病毒的出现表明,对鸟类的致病性增强,但对人类却不一定。人类暴露于患病和垂死的禽类后感染亚洲谱系甲型(H7N9)病毒,可能有助于提高对潜在升高风险的认识,从而促使尽早就医或诊断。亚洲谱系 HPAI 或 LPAI 甲型(H7N9)病毒感染者的疾病严重程度没有差异。[25]Zhou L, Tan Y, Kang M, et al. Preliminary epidemiology of human infections with highly pathogenic avian influenza A(H7N9) virus, China, 2017. Emerg Infect Dis. 2017 Aug;23(8):1355-9.
https://wwwnc.cdc.gov/eid/article/23/8/17-0640_article
http://www.ncbi.nlm.nih.gov/pubmed/28580900?tool=bestpractice.com
[72]Kang M, Lau EHY, Guan W, et al. Epidemiology of human infections with highly pathogenic avian influenza A(H7N9) virus in Guangdong, 2016 to 2017. Euro Surveill. 2017 Jul 6;22(27):30568.
https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2017.22.27.30568
http://www.ncbi.nlm.nih.gov/pubmed/28703705?tool=bestpractice.com
回顾性流行病学分析表明,至少有 75% 确诊为亚洲谱系甲型 LPAI (H7N9) 病毒感染的患者,最近接触过家禽。[73]Lee SS, Wong NS, Leung CC. Exposure to avian influenza H7N9 in farms and wet markets. Lancet. 2013 May 25;381(9880):1815.
http://www.ncbi.nlm.nih.gov/pubmed/23664058?tool=bestpractice.com
利用统计模型进行的一项生态学研究表明,有目的性的关闭家禽市场,有效限制了中国若干城市亚洲谱系甲型 LPAI (H7N9) 病毒感染在人类中暴发。[55]Yu H, Wu JT, Cowling BJ, et al. Effect of closure of live poultry markets on poultry-to-person transmission of avian influenza A H7N9 virus: an ecological study. Lancet. 2014 Feb 8;383(9916):541-8.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946250/
http://www.ncbi.nlm.nih.gov/pubmed/24183056?tool=bestpractice.com
与甲型 HPAI(H5N1)相比,许多亚洲谱系甲型 LPAI(H7N9)病毒感染发生在城市地区,与在“后院”饲养或屠宰家禽无关。亚洲谱系甲型 LPAI(H7N9)病毒感染不会引起家禽生病或死亡,从而引发“悄然的”动物源性传播。相比之下,近期出现的亚洲谱系甲型 HPAI(H7N9)病毒感染可导致家禽患病和死亡,类似于甲型 HPAI(H5N1)病毒感染。据联合国粮食及农业组织报告,从 2016 年 10 月至 2019 年 6 月,290 份鸟禽和环境样本的甲型(H7N9)病毒检测呈阳性,其中 44份(15%)确定为 HPAI,其余确定为 LPAI 病毒。[53]Food and Agriculture Organization of the United Nations. H7N9 situation update. Nov 2019 [internet publication].
http://www.fao.org/ag/againfo/programmes/en/empres/H7N9/situation_update.html
目前尚不清楚 HPAI 病毒是否会成为中国家禽中主要流行的亚洲谱系 A 型(H7N9) 病毒,但如果它变得盛行,将更容易检测到家禽中的疫情。
一项针对来自家禽中传播亚洲谱系甲型 LPAI (H7N9) 病毒地区的 396 名家禽工人的研究发现,396 名工人中有 25 名 (6%) 体内检测到了抗甲型(H7N9) 病毒抗体(血凝素抑制滴度≥80)。相比之下,接受测试的 1000 多个一般人群样本中,未检测到该抗体。[74]Yang S, Chen Y, Cui D, et al. Avian-origin influenza A(H7N9) infection in influenza A(H7N9)-affected areas of China: a serological study. J Infect Dis. 2014 Jan 15;209(2):265-9.
https://academic.oup.com/jid/article/209/2/265/827092
http://www.ncbi.nlm.nih.gov/pubmed/23935201?tool=bestpractice.com
其他回顾性研究显示,中国家禽工人的甲型(H7N9)病毒抗体血清阳性率较低,或者发病率和血清转化率较低。[75]Quan C, Wang Q, Zhang J, et al. Avian influenza A viruses among occupationally exposed populations, China, 2014-2016. Emerg Infect Dis. 2019 Dec;25(12):2215-2225.
http://www.ncbi.nlm.nih.gov/pubmed/31742536?tool=bestpractice.com
[76]Yang P, Ma C, Cui S, et al. Avian influenza A(H7N9) and (H5N1) infections among poultry and swine workers and the general population in Beijing, China, 2013-2015. Sci Rep. 2016 Sep 27;6:33877.
http://www.ncbi.nlm.nih.gov/pubmed/27670286?tool=bestpractice.com
[77]Ma MJ, Zhao T, Chen SH, et al. Avian influenza A virus infection among workers at live poultry markets, China, 2013-2016. Emerg Infect Dis. 2018 Jul;24(7):1246-1256.
http://www.ncbi.nlm.nih.gov/pubmed/29912708?tool=bestpractice.com
另一项回顾性研究未发现 2012 年 11 月之前中国东部家禽工人中甲型 (H7N9) 病毒感染的血清学证据。[78]Bai T, Zhou J, Shu Y. Serologic study for influenza A (H7N9) among high-risk groups in China. N Engl J Med. 2013 Jun 13;368(24):2339-40.
https://www.nejm.org/doi/10.1056/NEJMc1305865
http://www.ncbi.nlm.nih.gov/pubmed/23718151?tool=bestpractice.com
感染的实验模型发现,亚洲谱系禽源 LPAI 甲型(H7N9)病毒可以在雪貂、小鼠、猪和非人灵长类动物中复制。亚洲谱系甲型 LPAI(H7N9)病毒的飞沫传播确实发生了在雪貂实验模型中,但与甲型(H1N1)pdm09 病毒相比,在雪貂中的传播似乎不是那么有效。尽管有流行病学研究分析了人类感染与鸡群感染的关联,但亚洲谱系 LPAI 甲型(H7N9)病毒在鸡群中复制不佳,并且在实验模型中该病毒无法有效率地从感染鸡群传播至未感染鸡群(或雪貂)。亚洲谱系 LPAI 甲型(H7N9)病毒的遗传分析发现了与哺乳动物适应性相关的基因替代,但可能需要更多适应性来促进人与人之间的有效传播。
在中国已经发现被证实感染的病例群,但到目前为止,尚无证据表明亚洲谱系甲型(H7N9)病毒存在持续的人与人之间传播。[11]Zhou L, Chen E, Bao C, et al. Clusters of human infection and human-to-human transmission of avian influenza A(H7N9) virus, 2013-2017. Emerg Infect Dis. 2018 Feb 17;24(2):397-400.
https://wwwnc.cdc.gov/eid/article/24/2/17-1565_article
http://www.ncbi.nlm.nih.gov/pubmed/29165238?tool=bestpractice.com
[48]Centers for Disease Control and Prevention. Asian lineage avian influenza A (H7N9) virus. Dec 2018 [internet publication].
https://www.cdc.gov/flu/avianflu/h7n9-virus.htm
[79]World Health Organization. WHO risk assessment: human infections with avian influenza A(H7N9) virus. Feb 2014 [internet publication].
https://www.who.int/influenza/human_animal_interface/influenza_h7n9/140225_H7N9RA_for_web_20140306FM.pdf
据报道,一名医务工作者感染了致命性亚洲谱系 LPAI 甲型(H7N9)病毒,但未发现确定的感染源,并且没有与确诊病例的任何已知接触。[80]Pan H, Zhang X, Hu J, et al. A case report of avian influenza H7N9 killing a young doctor in Shanghai, China. BMC Infect Dis. 2015 Jun 23;15:237.
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-015-0970-4
http://www.ncbi.nlm.nih.gov/pubmed/26101082?tool=bestpractice.com
对于新型甲型流感病毒的人类感染,有可能出现院内传播(包括患者对医护人员和患者对患者的传播),并且亚洲谱系甲型LPAI (H7N9) 病毒已有此报道。[12]Farooqui A, Liu W, Zeng T, et al. Probable hospital cluster of H7N9 influenza infection. N Engl J Med. 2016 Feb 11;374(6):596-8.
https://www.nejm.org/doi/10.1056/NEJMc1505359
http://www.ncbi.nlm.nih.gov/pubmed/26863372?tool=bestpractice.com
[13]Fang CF, Ma MJ, Zhan BD, et al. Nosocomial transmission of avian influenza A (H7N9) virus in China: epidemiological investigation. BMJ. 2015 Nov 19;351:h5765.
https://www.bmj.com/content/351/bmj.h5765.long
http://www.ncbi.nlm.nih.gov/pubmed/26586515?tool=bestpractice.com
[14]Chen H, Liu S, Liu J, et al. Nosocomial co-transmission of avian influenza A(H7N9) and A(H1N1)pdm09 viruses between 2 patients with hematologic disorders. Emerg Infect Dis. 2016 Apr;22(4):598-607.
https://wwwnc.cdc.gov/eid/article/22/4/15-1561_article
http://www.ncbi.nlm.nih.gov/pubmed/26982379?tool=bestpractice.com
因此,对于任何疑似新型甲型流感病毒感染患者(包括亚洲谱系甲型 (H7N9) 病毒患者),应尽快实施特定的感染预防和控制措施(包括飞沫和空气传播预防措施),以防止与医疗相关的传播。
其他甲型禽流感病毒(如,H5、H6、H7、H9、H10 病毒)已致人类发病,严重程度从轻度疾病(例如结膜炎、简单的流感样症状)到致死性疾病。[16]Peiris M, Yuen KY, Leung CW, et al. Human infection with influenza H9N2. Lancet. 1999 Sep 11;354(9182):916-7.
http://www.ncbi.nlm.nih.gov/pubmed/10489954?tool=bestpractice.com
[17]Uyeki TM, Chong YH, Katz JM, et al. Lack of evidence for human-to-human transmission of avian influenza A (H9N2) viruses in Hong Kong, China 1999. Emerg Infect Dis. 2002 Feb;8(2):154-9.
https://wwwnc.cdc.gov/eid/article/8/2/01-0148_article
http://www.ncbi.nlm.nih.gov/pubmed/11897066?tool=bestpractice.com
[18]Avian influenza A/(H7N2) outbreak in the United Kingdom. Euro Surveill. 2007 May 31;12(5):E070531.2.
http://www.ncbi.nlm.nih.gov/pubmed/17868584?tool=bestpractice.com
[22]Tweed SA, Skowronski DM, David ST, et al. Human illness from avian influenza H7N3, British Columbia. Emerg Infect Dis. 2004 Dec;10(12):2196-9.
https://wwwnc.cdc.gov/eid/article/10/12/04-0961_article
http://www.ncbi.nlm.nih.gov/pubmed/15663860?tool=bestpractice.com
[81]World Health Organization. Antigenic and genetic characteristics of influenza A(H5N1) and influenza A(H9N2) viruses and candidate vaccine viruses developed for potential use in human vaccines - February 2010. Wkly Epidemiol Rec. 2010 Mar 12;85(11):100-7.
http://www.ncbi.nlm.nih.gov/pubmed/20229648?tool=bestpractice.com
[82]Butt KM, Smith GJ, Chen H, et al. Human infection with an avian H9N2 influenza A virus in Hong Kong in 2003. J Clin Microbiol. 2005 Nov;43(11):5760-7.
https://jcm.asm.org/content/43/11/5760.long
http://www.ncbi.nlm.nih.gov/pubmed/16272514?tool=bestpractice.com
[83]Bos ME, Te Beest DE, van Boven M, et al. High probability of avian influenza virus (H7N7) transmission from poultry to humans active in disease control on infected farms. J Infect Dis. 2010 May 1;201(9):1390-6.
https://academic.oup.com/jid/article/201/9/1390/877281
http://www.ncbi.nlm.nih.gov/pubmed/20331380?tool=bestpractice.com
[84]Koopmans M, Wilbrink B, Conyn M, et al. Transmission of H7N7 avian influenza A virus to human beings during a large outbreak in commercial poultry farms in the Netherlands. Lancet. 2004 Feb 21;363(9409):587-93.
http://www.ncbi.nlm.nih.gov/pubmed/14987882?tool=bestpractice.com
[85]Chow EJ, Davis CT, Abd Elal AI, et al. Update: influenza activity - United States and worldwide, May 20-October 13, 2018. MMWR Morb Mortal Wkly Rep. 2018 Oct 26;67(42):1178-85.
https://www.cdc.gov/mmwr/volumes/67/wr/mm6742a3.htm
http://www.ncbi.nlm.nih.gov/pubmed/30359347?tool=bestpractice.com
[86]Arzey GG, Kirkland PD, Arzey KE, et al. Influenza virus A (H10N7) in chickens and poultry abattoir workers, Australia. Emerg Infect Dis. 2012 May;18(5):814-6.
https://wwwnc.cdc.gov/eid/article/18/5/11-1852_article
http://www.ncbi.nlm.nih.gov/pubmed/22516302?tool=bestpractice.com
[87]Wei SH, Yang JR, Wu HS, et al. Human infection with avian influenza A H6N1 virus: an epidemiological analysis. Lancet Respir Med. 2013 Dec;1(10):771-8.
http://www.ncbi.nlm.nih.gov/pubmed/24461756?tool=bestpractice.com
[88]Public Health England. Avian influenza: guidance, data and analysis. Mar 2019 [internet publication].
https://www.gov.uk/government/collections/avian-influenza-guidance-data-and-analysis