{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T20:49:16Z","timestamp":1779137356781,"version":"3.51.4"},"reference-count":32,"publisher":"Proceedings of the National Academy of Sciences","issue":"5","content-domain":{"domain":["www.pnas.org"],"crossmark-restriction":true},"short-container-title":["Proc. Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[2004,2,3]]},"abstract":"<jats:p>Highly pathogenic avian influenza A viruses of subtypes H5 and H7 are the causative agents of fowl plague in poultry. Influenza A viruses of subtype H5N1 also caused severe respiratory disease in humans in Hong Kong in 1997 and 2003, including at least seven fatal cases, posing a serious human pandemic threat. Between the end of February and the end of May 2003, a fowl plague outbreak occurred in The Netherlands. A highly pathogenic avian influenza A virus of subtype H7N7, closely related to low pathogenic virus isolates obtained from wild ducks, was isolated from chickens. The same virus was detected subsequently in 86 humans who handled affected poultry and in three of their family members. Of these 89 patients, 78 presented with conjunctivitis, 5 presented with conjunctivitis and influenza-like illness, 2 presented with influenza-like illness, and 4 did not fit the case definitions. Influenza-like illnesses were generally mild, but a fatal case of pneumonia in combination with acute respiratory distress syndrome occurred also. Most virus isolates obtained from humans, including probable secondary cases, had not accumulated significant mutations. However, the virus isolated from the fatal case displayed 14 amino acid substitutions, some of which may be associated with enhanced disease in this case. Because H7N7 viruses have caused disease in mammals, including horses, seals, and humans, on several occasions in the past, they may be unusual in their zoonotic potential and, thus, form a pandemic threat to humans.<\/jats:p>","DOI":"10.1073\/pnas.0308352100","type":"journal-article","created":{"date-parts":[[2004,2,3]],"date-time":"2004-02-03T17:47:24Z","timestamp":1075830444000},"page":"1356-1361","update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":881,"title":["Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of acute respiratory distress syndrome"],"prefix":"10.1073","volume":"101","author":[{"given":"Ron A. M.","family":"Fouchier","sequence":"first","affiliation":[{"name":"Department of Virology and National Influenza Center, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands; Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL, Den Bosch, The Netherlands; Section of Notifiable and Exotic Viral Diseases, Central Institute for Animal Disease Control, P.O. Box 147, 8200 AC, Lelystad, The Netherlands; and Center for Infectious Disease Epidemiology and Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of..."}]},{"given":"Peter M.","family":"Schneeberger","sequence":"additional","affiliation":[{"name":"Department of Virology and National Influenza Center, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands; Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL, Den Bosch, The Netherlands; Section of Notifiable and Exotic Viral Diseases, Central Institute for Animal Disease Control, P.O. Box 147, 8200 AC, Lelystad, The Netherlands; and Center for Infectious Disease Epidemiology and Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of..."}]},{"given":"Frans W.","family":"Rozendaal","sequence":"additional","affiliation":[{"name":"Department of Virology and National Influenza Center, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands; Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL, Den Bosch, The Netherlands; Section of Notifiable and Exotic Viral Diseases, Central Institute for Animal Disease Control, P.O. Box 147, 8200 AC, Lelystad, The Netherlands; and Center for Infectious Disease Epidemiology and Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of..."}]},{"given":"Jan M.","family":"Broekman","sequence":"additional","affiliation":[{"name":"Department of Virology and National Influenza Center, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands; Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL, Den Bosch, The Netherlands; Section of Notifiable and Exotic Viral Diseases, Central Institute for Animal Disease Control, P.O. Box 147, 8200 AC, Lelystad, The Netherlands; and Center for Infectious Disease Epidemiology and Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of..."}]},{"given":"Stiena A. G.","family":"Kemink","sequence":"additional","affiliation":[{"name":"Department of Virology and National Influenza Center, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands; Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL, Den Bosch, The Netherlands; Section of Notifiable and Exotic Viral Diseases, Central Institute for Animal Disease Control, P.O. Box 147, 8200 AC, Lelystad, The Netherlands; and Center for Infectious Disease Epidemiology and Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of..."}]},{"given":"Vincent","family":"Munster","sequence":"additional","affiliation":[{"name":"Department of Virology and National Influenza Center, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands; Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL, Den Bosch, The Netherlands; Section of Notifiable and Exotic Viral Diseases, Central Institute for Animal Disease Control, P.O. Box 147, 8200 AC, Lelystad, The Netherlands; and Center for Infectious Disease Epidemiology and Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of..."}]},{"given":"Thijs","family":"Kuiken","sequence":"additional","affiliation":[{"name":"Department of Virology and National Influenza Center, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands; Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL, Den Bosch, The Netherlands; Section of Notifiable and Exotic Viral Diseases, Central Institute for Animal Disease Control, P.O. Box 147, 8200 AC, Lelystad, The Netherlands; and Center for Infectious Disease Epidemiology and Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of..."}]},{"given":"Guus F.","family":"Rimmelzwaan","sequence":"additional","affiliation":[{"name":"Department of Virology and National Influenza Center, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands; Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL, Den Bosch, The Netherlands; Section of Notifiable and Exotic Viral Diseases, Central Institute for Animal Disease Control, P.O. Box 147, 8200 AC, Lelystad, The Netherlands; and Center for Infectious Disease Epidemiology and Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of..."}]},{"given":"Martin","family":"Schutten","sequence":"additional","affiliation":[{"name":"Department of Virology and National Influenza Center, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands; Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL, Den Bosch, The Netherlands; Section of Notifiable and Exotic Viral Diseases, Central Institute for Animal Disease Control, P.O. Box 147, 8200 AC, Lelystad, The Netherlands; and Center for Infectious Disease Epidemiology and Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of..."}]},{"given":"Gerard J. J.","family":"van Doornum","sequence":"additional","affiliation":[{"name":"Department of Virology and National Influenza Center, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands; Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL, Den Bosch, The Netherlands; Section of Notifiable and Exotic Viral Diseases, Central Institute for Animal Disease Control, P.O. Box 147, 8200 AC, Lelystad, The Netherlands; and Center for Infectious Disease Epidemiology and Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of..."}]},{"given":"Guus","family":"Koch","sequence":"additional","affiliation":[{"name":"Department of Virology and National Influenza Center, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands; Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL, Den Bosch, The Netherlands; Section of Notifiable and Exotic Viral Diseases, Central Institute for Animal Disease Control, P.O. Box 147, 8200 AC, Lelystad, The Netherlands; and Center for Infectious Disease Epidemiology and Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of..."}]},{"given":"Arnold","family":"Bosman","sequence":"additional","affiliation":[{"name":"Department of Virology and National Influenza Center, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands; Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL, Den Bosch, The Netherlands; Section of Notifiable and Exotic Viral Diseases, Central Institute for Animal Disease Control, P.O. 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