Factors Associated With Prolonged Viral Shedding in Patients With Avian Influenza A(H7N9) Virus Infection
Open Access
- 10 April 2018
- journal article
- research article
- Published by Oxford University Press (OUP) in The Journal of Infectious Diseases
- Vol. 217 (11), 1708-1717
- https://doi.org/10.1093/infdis/jiy115
Abstract
Data are limited on the impact of neuraminidase inhibitor (NAI) treatment on avian influenza A(H7N9) virus RNA shedding. 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. 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). 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.Keywords
Funding Information
- National Science Fund for Distinguished Young Scholars (81425001/H0104)
- National Science and Technology Emergency Project (10600100000015001206)
- Ministry of Science and Technology (2015BAI12B11)
This publication has 41 references indexed in Scilit:
- Effect of double dose oseltamivir on clinical and virological outcomes in children and adults admitted to hospital with severe influenza: double blind randomised controlled trialBMJ, 2013
- Impact of Neuraminidase Inhibitor Treatment on Outcomes of Public Health Importance During the 2009-2010 Influenza A(H1N1) Pandemic: A Systematic Review and Meta-Analysis in Hospitalized PatientsThe Journal of Infectious Diseases, 2012
- The Exploration of Disease Pattern, Zheng, for Differentiation of Allergic Rhinitis in Traditional Chinese Medicine PracticeEvidence-Based Complementary and Alternative Medicine, 2012
- Treatment With Neuraminidase Inhibitors for Critically Ill Patients With Influenza A (H1N1)pdm09Clinical Infectious Diseases, 2012
- Antiviral Therapy and Outcomes of Patients with Pneumonia Caused by Influenza A Pandemic (H1N1) VirusPLOS ONE, 2012
- Efficacy of Oseltamivir-Zanamivir Combination Compared to Each Monotherapy for Seasonal Influenza: A Randomized Placebo-Controlled TrialPLoS Medicine, 2010
- Oseltamivir in Seasonal, Avian H5N1 and Pandemic 2009 A/H1N1 InfluenzaClinical Pharmacokinetics, 2010
- Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: a multicentre cohort studyThe Lancet Infectious Diseases, 2010
- Pharmacokinetics of oseltamivir: an oral antiviral for the treatment and prophylaxis of influenza in diverse populationsJournal of Antimicrobial Chemotherapy, 2010
- Antiviral Therapy and Outcomes of Influenza Requiring Hospitalization in Ontario, CanadaClinical Infectious Diseases, 2007