Effectiveness of Neuraminidase Inhibitors to Prevent Mortality in Laboratory-Confirmed Avian Influenza A H7N9 Patients

Abstract Objectives Human infection with avian influenza virus A(H7N9) remains a big threat and has a great potential to cause a pandemic in the foreseeable future. Antiviral treatment using the neuraminidase inhibitors has been recommended to treat H7N9 patients as early as possible, while evidence-based research on its effectiveness for the specific H7N9 infection was lacking. Methods We reviewed data from all laboratory-confirmed avian influenza A H7N9 cases in Zhejiang province between 2013 and 2017 and fit time-dependent survival models to evaluate the effectiveness of neuraminidase inhibitors treatment as an intervention to reduce death risk. Results The result of our final model indicated that there is no significant association (Odds Ratio = 1.29, 95% Confidence Interval [0.78–2.15]) between time to neuraminidase inhibitors treatment and survivorship after controlling for both age and white cell count. Sensitivity analyses with multiple imputation for missing data concurred with the primary complete case analysis. Conclusions . We did not find an association between neuraminidase inhibitors treatment and survival benefit in H7N9 patients across various adjusted models and sensitivity analyses of missing data imputations.