Benefit of early initiation of neuraminidase inhibitor treatment to hospitalized patients with avian influenza A (H7N9) virus

Abstract

Background

The significance of early neuraminidase inhibitor (NAI) therapy for treating influenza A(H7N9) is currently unknown.

Methods

The duration of viral shedding was monitored by RT-PCR after patients with confirmed H7N9 infection were admitted to the First Affiliated Hospital, Zhejiang University during April 2013 to April 2017. Indices such as the length of hospitalization and mortality were collected, and the correlation between the time of administration of NAI and the severity of disease was systematically analyzed.

Results

160 patients with confirmed H7N9 infection were divided into three groups according to NAI starting time. 3 (15%) out of 20 patients for whom NAI was administered within 2 days died compared with 12 (23.1%) out of 52 patients who received treatment within 2–5 days and 33 (37.5%) out of 88 patients who were treated after 5 days (P<0.05). The median durations of viral shedding from NAI therapy initiation was 4.5 days (interquartile range (IQR): 3–9) for patients who took antiviral medication within 2 days, which was significantly different from that for patients who took medication within 2–5 days (7.5 days,IQR: 4.25–12.75) or after 5 days (7days, IQR: 5–10) (P<0.05). We found that the duration of viral shedding from NAI therapy was the shortest of 5.5 days in spring 2013 and the longest of 8.5 days in winter-spring 2016–17 (P<0.05), showing a prolonged trend.

Conclusions

Early NAI therapy within 2 days of illness shorten the duration of viral shedding and improve survival in patients with H7N9 viral infections.