Long-term clinical prognosis of human infections with avian influenza A(H7N9) viruses in China after hospitalization

Qianli Wang; Hui Jiang; Yun Xie; Tianchen Zhang; Shelan Liu; Shenggen Wu; Qianlai Sun; Shaoxia Song; Wei Wang; Xiaowei Deng; Lingshuang Ren; Tiantian Qin; Peter Horby; Timothy Uyeki; Hongjie Yu

doi:10.1016/j.eclinm.2020.100282

Long-term clinical prognosis of human infections with avian influenza A(H7N9) viruses in China after hospitalization

EClinicalMedicine. 2020 Feb 19:20:100282. doi: 10.1016/j.eclinm.2020.100282. eCollection 2020 Mar.

Authors

Qianli Wang¹, Hui Jiang^{2

3

4}, Yun Xie⁵, Tianchen Zhang⁵, Shelan Liu⁶, Shenggen Wu⁷, Qianlai Sun⁸, Shaoxia Song⁹, Wei Wang¹, Xiaowei Deng¹, Lingshuang Ren¹, Tiantian Qin¹⁰, Peter Horby¹¹, Timothy Uyeki¹², Hongjie Yu¹

Affiliations

¹ School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
² Chinese Center for Disease Control and Prevention, Beijing, China.
³ Beijing Chest Hospital, Capital Medical University, Beijing, China.
⁴ Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
⁵ Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, China.
⁶ Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
⁷ Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China.
⁸ Hunan Provincial Center for Disease Control and Prevention, Changsha, China.
⁹ Shandong Provincial Center for Disease Control and Prevention, Jinan, China.
¹⁰ Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
¹¹ Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom.
¹² Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Abstract

Background: Mainland China has experienced five epidemics of human cases of avian influenza A(H7N9) virus infection since 2013. We conducted a prospective study to assess long-term clinical, pulmonary function testing, and chest computed tomography (CT) imaging findings after patients were discharged from hospital.

Methods: A(H7N9) survivors in five provinces and one municipality underwent follow-up visits from August 2013 to September 2018, at three, six, and 12 months after illness onset, and a subset was also assessed at 18 and 64 months after onset. Thirteen patients were enrolled from the first A(H7N9) epidemic in 2013, 36 from the 2013-2014 second epidemic, and 12 from the 2016-2017 fifth epidemic. At each visit, A(H7N9) survivors received a medical examination, including the mMRC (modified Medical Research Council) dyspnea scale assessment, chest auscultation, pulmonary function testing and chest CT scans.

Findings: The median age of 61 A(H7N9) survivors was 50 years. The cumulative rate of pulmonary dysfunction was 38·5% and 78·2% for chest CT scan abnormalities at the end of follow-up. Restrictive ventilation dysfunction was common during follow-up. Mild dyspnea was documented at three to 12-month follow-up visits.

Interpretation: Patients who survived severe illness from A(H7N9) virus infection had evidence of persistent lung damage and long-term pulmonary dysfunction.

Funding: National Science Fund for Distinguished Young Scholars (grant number 81525023); Program of Shanghai Academic/Technology Research Leader (grant number 18XD1400300); National Science and Technology Major Project of China (grant numbers 2017ZX10103009-005, 2018ZX10201001-010).

Keywords: CT scan; CT, computed tomography; DLCO, diffusion capacity of carbon monoxide; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; Follow-up; GGO, ground-glass opacity; H7N9 subtype; ICU, intensive care unit; IQR, interquartile range; Prognosis; RT-PCR, reverse transcriptase polymerase chain reaction; Respiratory function tests; SD, standard deviation; SPSS, Statistical Package for Social Sciences; WHO, World Health Organization; mMRC, modified Medical Research Council.