Monday, July 11, 2016

CJP Peds: Severe H5N6 Infection In An 11 Year Old Child


With just 15 documented human infections with avian H5N6 over the past couple of years (10 since December of 2015), we haven't seen a lot of detail on the progression, treatment, and outcome of cases.

What we do know is the reported fatality rate has been  high - perhaps on par with H5N1 - and that of the 15 known cases, two have involved children.

In April Hunan Province reported their first case (see China Reports 2nd H5N6 Case in A Week), that of an 11 year-old girl from Lusong district, Zhuzhou city.   

Her mother reportedly died several days earlier of unknown causes. 

We've a report, published this past week in the Chinese Journal Of Practical Pediatrics (h/t Biological100 at FluTrackers), providing us with details on that case. 

Despite the report's title, the WHO previously acknowledged a report on a 5 year-old infected in an update last January. 

Severe H5N6 avian influenza pneumonia:First child case in China

YAO Zhen-ya*, LU Xiu-lan, LUO Ru-ping, XIAO Zheng-hui
2016 Vol. 31 (7): 524-527 [Abstract]



To summarize and analyze the clinical characteristics, diagnostic and therapeutic measures for the first child case of severe H5N6 avian influenza pneumonia in China.


The clinical data of the first case of severe H5N6 avian influenza infection in China admitted in April 13, 2016 in Department of Emergency Center, Hunan Children’s Hospital were analyzed and summarized.
The case was an 11 years old girl, acute onset, was similar with early symptoms of common respiratory infection including high fever, fatigue, vomiting, but catarrhal symptoms was not obvious. Since fever of unknown origin, obvious weakness, vomiting and other suspected influenza symptoms,clinicians speculated “flu” or “bird flu” possibility considering her history of exposure to her mother died of unknown illness.
The girl was admitted to the Department of Infectious Isolation Ward and received oral oseltamivir treatment. On the 8th day of the course, the condition was aggravated, which showed large areas of dense shadow on chest X-ray film.The girl was diagnosed as acute respiratory distress syndrome(ARDS), and was transferred to the Intensive Care Unit for isolation and treatment.
Based on the reports of Hunan CDC and National CDC, the girl was confirmed to be a case of avian influenza A H5N6 virus infection case. The treatment started with oseltamivir and then peramivir antivirus treatmnet, nCPAP ventilation, synchronous glucocorticoid treatment, and the gradual weaning of noninvasive ventilator. The girl recovered and was tolerance without oxygen therapy, then discharged from hospital.


It is very important for clinicians to pay more attention to epidemiological history. Timely detection, early diagnosis are crucial to the treatment of avian influenza virus pneumonia and the effective treatment can get better prognosis.

While H5N6 infections are rare, sporadic, and we've no evidence of human-to-human spread, it remains very much a   virus worth watching.

For more background on this emerging avian flu threat, you may wish to revisit some of these blogs from last year:

H5N6: The Other HPAI H5 Threat
H5N6 Rising: Infecting Birds, Humans, & Even Cats
EID Journal: Influenza A(H5N6) Virus Reassortant, Southern China, 2014

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