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NEJM:我国发现新型人感染H7N9禽流感病毒

时间:2013-04-18 浏览次数:1228

关键词: H7N9禽流感病毒 人感染

 

复旦大学和中国疾病预防控制中心专家联手,在zui短时间内确定了一种可导致人肺炎的新型重配的H7N9病毒。4月12日,*医学期刊《新英格兰医学杂志》(NEJM)以“Human Infection with a Novel Avian-Origin Influenza A (H7N9) Virus”为题刊发了这一重大发现。

该论文的及时发表对我国乃至*科学家深入研究这种新病原特性,评价其对人类健康的威胁以及及时有效地制定出防控措施提供了可能,因而具有重大价值,这也是一篇临床与预防等领域的学者联手合作为中国及公共卫生作出重要贡献的论文。

2月底和3月初,上海市(复旦大学附属)第五人民医院呼吸科发现一例不明原因重症肺炎患者。接到这一病例标本,复旦大学上海医学院经过病原学筛查,未检出新型冠状病毒、SARS冠状病毒和人高致病性禽流感病毒(H5N1)。随即又采用多种策略扩基因片段并进行序列分析。后根据获得的核酸序列和反复的验证,提示此病毒可能是一种以H7N9新型流感病毒为基因骨架,同时含有多种流感基因片段的重配毒株,研究取得突破性进展。3月22日向中国疾控中心送检病例标本,实验结果得到中国CDC的复核和确认。

3月29日,中国疾控中心从标本中分离到H7N9禽流感病毒。3月30日,国家卫生计生委组织专家,zui终诊断为人感染H7N9禽流感确诊病例,3月31日正式通报发现的新亚型流感病毒,既往仅在禽间发现。

对于新发现的禽流感病毒,该论文认为,新的重配病毒的流行潜力不能低估,还会在什么时间,什么地点以及如何出现,仍没有科学的证据和解释。由于目前该病毒感染造成的高病死率,作者提出要加快针对新病毒疫苗和抗病毒药物的研发。zui重要的是,由于流感病毒非常容易突变,因此要对该病毒的进化行为密切关注,尤其要严密监测可能在人之间的传播。

相关专家认为,这是科学上的重大发现,显示自然界会不断有新病毒出现,与病毒及传染病的斗争将是长期的任务。此次病毒的及早发现,以科研实力证明我国自SARS以来应对新发突发传染病能力有显著提高。(生物谷Bioon.com)

 

Human Infection with a Novel Avian-Origin Influenza A (H7N9) Virus

Rongbao Gao,  Bin Cao,Yunwen Hu, Zijian Feng, Dayan Wang, Wanfu Hu, Jian Chen, Zhijun Jie, Haibo Qiu, Ke Xu, Xuewei Xu,Hongzhou Lu, Wenfei Zhu,Zhancheng Gao, Nijuan Xiang, Yinzhong Shen, Zebao He, Yong Gu, Zhiyong Zhang, Yi Yang, Xiang Zhao, Lei Zhou, Xiaodan Li, Shumei Zou, Ye Zhang, Xiyan Li, Lei Yang,Junfeng Guo, Jie Dong, Qun Li, Libo Dong, Yun Zhu, Tian Bai, Shiwen Wang, Pei Hao, Weizhong Yang, Yanping Zhang, Jun Han, Hongjie Yu, Dexin Li, George F. Gao,  Guizhen Wu,Yu Wang,  Zhenghong Yuan and Yuelong Shu.

Background:Infection of poultry with influenza A subtype H7 viruses occurs worldwide, but the introduction of this subtype to humans in Asia has not been observed previously. In March 2013, three urban residents of Shanghai or Anhui, China, presented with rapidly progressing lower respiratory tract infections and were found to be infected with a novel reassortant avian-origin influenza A (H7N9) virus.
Methods:We obtained and analyzed clinical, epidemiologic, and virologic data from these patients. Respiratory specimens were tested for influenza and other respiratory viruses by means of real-time reverse-transcriptase–polymerase-chain-reaction assays, viral culturing, and sequence analyses.
Results:A novel reassortant avian-origin influenza A (H7N9) virus was isolated from respiratory specimens obtained from all three patients and was identified as H7N9. Sequencing analyses revealed that all the genes from these three viruses were of avian origin, with six internal genes from avian influenza A (H9N2) viruses. Substitution Q226L (H3 numbering) at the 210-loop in the hemagglutinin (HA) gene was found in the A/Anhui/1/2013 and A/Shanghai/2/2013 virus but not in the A/Shanghai/1/2013 virus. A T160A mutation was identified at the 150-loop in the HA gene of all three viruses. A deletion of five amino acids in the neuraminidase (NA) stalk region was found in all three viruses. All three patients presented with fever, cough, and dyspnea. Two of the patients had a history of recent exposure to poultry. Chest radiography revealed diffuse opacities and consolidation. Complications included acute respiratory distress syndrome and multiorgan failure. All three patients died.
Conclusions:Novel reassortant H7N9 viruses were associated with severe and fatal respiratory disease in three patients. (Funded by the National Basic Research Program of China and others

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