Human infection with a reassortment avian influenza A H3N8 virus: an epidemiological investigation study

Pengtao Bao, Yang Liu, Xiaoai Zhang, Hang Fan, Jie Zhao, Mi Mu, Haiyang Li, Yanhe Wang, Honghan Ge, Shuang Li, Xin Yang, Qianqian Cui, Rui Chen, Liang Gao, Zhihua Sun, Lizhen Gao, Shuang Qiu, Xuchun Liu, Peter W. Horby (), Xiubin Li (), Liqun Fang () and Wei Liu ()
Additional contact information
Pengtao Bao: The Eighth Medical Center of Chinese PLA General Hospital
Yang Liu: Zhumadian Central Hospital
Xiaoai Zhang: Beijing Institute of Microbiology and Epidemiology
Hang Fan: Beijing Institute of Microbiology and Epidemiology
Jie Zhao: Zhumadian Second People’s Hospital
Mi Mu: The Eighth Medical Center of Chinese PLA General Hospital
Haiyang Li: Shangcai Caizhou Hospital, Shangcai County
Yanhe Wang: Beijing Institute of Microbiology and Epidemiology
Honghan Ge: Beijing Institute of Microbiology and Epidemiology
Shuang Li: Beijing Institute of Microbiology and Epidemiology
Xin Yang: Beijing Institute of Microbiology and Epidemiology
Qianqian Cui: National Institutes for Food and Drug Control (NIFDC)
Rui Chen: Zhumadian Central Hospital
Liang Gao: Zhumadian Central Hospital
Zhihua Sun: Zhumadian Central Hospital
Lizhen Gao: Zhumadian Central Hospital
Shuang Qiu: Zhumadian Central Hospital
Xuchun Liu: Zhumadian Central Hospital
Peter W. Horby: University of Oxford
Xiubin Li: The Eighth Medical Center of Chinese PLA General Hospital
Liqun Fang: Beijing Institute of Microbiology and Epidemiology
Wei Liu: Beijing Institute of Microbiology and Epidemiology

Nature Communications, 2022, vol. 13, issue 1, 1-8

Abstract: Abstract A four-year-old boy developed recurrent fever and severe pneumonia in April, 2022. High-throughput sequencing revealed a reassortant avian influenza A-H3N8 virus (A/Henan/ZMD-22-2/2022(H3N8) with avian-origin HA and NA genes. The six internal genes were acquired from Eurasian lineage H9N2 viruses. Molecular substitutions analysis revealed the haemagglutin retained avian-like receptor binding specificity but that PB2 genes possessed sequence changes (E627K) associated with increased virulence and transmissibility in mammalian animal models. The patient developed respiratory failure, liver, renal, coagulation dysfunction and sepsis. Endotracheal intubation and extracorporeal membrane oxygenation were administered. H3N8 RNA was detected from nasopharyngeal swab of a dog, anal swab of a cat, and environmental samples collected in the patient’s house. The full-length HA sequences from the dog and cat were identical to the sequence from the patient. No influenza-like illness was developed and no H3N8 RNA was identified in family members. Serological testing revealed neutralizing antibody response against ZMD-22-2 virus in the patient and three family members. Our results suggest that a triple reassortant H3N8 caused severe human disease. There is some evidence of mammalian adaptation, possible via an intermediary mammalian species, but no evidence of person-to-person transmission. The potential threat from avian influenza viruses warrants continuous evaluation and mitigation.

Date: 2022
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DOI: 10.1038/s41467-022-34601-1

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