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Multicenter Study
. 2018 May 5;217(11):1708-1717.
doi: 10.1093/infdis/jiy115.

Factors Associated With Prolonged Viral Shedding in Patients With Avian Influenza A(H7N9) Virus Infection

Yeming Wang  1   2   3 , Qiang Guo  4 , Zheng Yan  5 , Daming Zhou  6 , Wei Zhang  7 , Shujun Zhou  8 , Yu-Ping Li  9 , Jing Yuan  10 , Timothy M Uyeki  11 , Xinghua Shen  12 , Wenjuan Wu  13 , Hui Zhao  14 , Yun-Fu Wu  15 , Jia Shang  16 , Zhengguang He  17 , Yi Yang  18 , Hongsheng Zhao  19 , Yongqing Hong  20 , Zehua Zhang  21 , Min Wu  22 , Tiemin Wei  23 , Xilong Deng  24 , Yijun Deng  25 , Li-Hua Cai  26 , Weihua Lu  27 , Hongmei Shu  28 , Lin Zhang  29 , Hong Luo  30 , Y Ing Zhou  31 , Heng Weng  32 , Keyi Song  33 , Li Yao  34 , Mingguang Jiang  35 , Boliang Zhao  36 , Ruibin Chi  37 , Boqi Guo  38 , Lin Fu  39 , Long Yu  40 , Haiyan Min  41 , Pu Chen  42 , Shuifang Chen  43 , Liang Hong  44 , Wei Mao  45 , Xiaoping Huang  46 , Lijun Gu  47 , Hui Li  2   3 , Chen Wang  2   3   48 , Bin Cao  2   3 ; CAP-China Network
Affiliations
Multicenter Study

Factors Associated With Prolonged Viral Shedding in Patients With Avian Influenza A(H7N9) Virus Infection

Yeming Wang et al. J Infect Dis. .

Abstract

Background: Data are limited on the impact of neuraminidase inhibitor (NAI) treatment on avian influenza A(H7N9) virus RNA shedding.

Methods: In this multicenter, retrospective study, data were collected from adults hospitalized with A(H7N9) infection during 2013-2017 in China. We compared clinical features and A(H7N9) shedding among patients with different NAI doses and combination therapies and evaluated factors associated with A(H7N9) shedding, using Cox proportional hazards regression.

Results: Among 478 patients, the median age was 56 years, 71% were male, and 37% died. The median time from illness onset to NAI treatment initiation was 8 days (interquartile range [IQR], 6-10 days), and the median duration of A(H7N9) RNA detection from onset was 15.5 days (IQR, 12-20 days). A(H7N9) RNA shedding was shorter in survivors than in patients who died (P < .001). Corticosteroid administration (hazard ratio [HR], 0.62 [95% confidence interval {CI}, .50-.77]) and delayed NAI treatment (HR, 0.90 [95% CI, .91-.96]) were independent risk factors for prolonged A(H7N9) shedding. There was no significant difference in A(H7N9) shedding duration between NAI combination treatment and monotherapy (P = .65) or between standard-dose and double-dose oseltamivir treatment (P = .70).

Conclusions: Corticosteroid therapy and delayed NAI treatment were associated with prolonged A(H7N9) RNA shedding. NAI combination therapy and double-dose oseltamivir treatment were not associated with a reduced A(H7N9) shedding duration as compared to standard-dose oseltamivir.

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Figures

Figure 1.
Figure 1.
Flow diagram of hospitalized patients with confirmed avian influenza A(H7N9) virus infection included into this study.
Figure 2.
Figure 2.
Distribution of antiviral treatment (ARV) and proportion of patients with undetectable avian influenza A(H7N9) virus RNA by day after onset of symptom
Figure 3.
Figure 3.
A, Cumulative proportion of patients between patients who survived and those who died with detectable avian influenza A(H7N9) virus RNA, by day after onset of illness. B, Cumulative proportion of patients who started neuraminidase inhibitor (NAI) therapy <5 days versus ≥5 days after illness onset who had detectable A(H7N9) RNA, by day after onset of illness. C, Cumulative proportion of patients treated with oseltamivir versus oseltamivir and peramivir who had detectable A(H7N9) RNA, by day after onset of illness. D, Cumulative proportion of patients treated with oseltamivir (75 mg twice daily) versus oseltamivir (150 mg twice daily) with detectable A(H7N9) RNA, by day after onset of illness. CI, confidence interval.
Figure 4.
Figure 4.
Duration of avian influenza A(H7N9) virus RNA detection in relationship to time from illness onset to antiviral treatment initiation.
See this image and copyright information in PMC

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