Report Published on 3 Who Died From H7N9 Bird Flu

A report on three of the first patients in China to contract a new strain of bird flu paints a grim portrait of severe pneumonia, septic shock and other complications that damaged the brain, kidney and other organs. All three died.

Ray Young/European Pressphoto Agency

TAKING STEPS A clinic for H7N9 avian influenza at a hospital in Shanghai. Of the 31 people who have been reported stricken by H7N9, nine are dead, one has recovered and the rest are hospitalized.

So far, the disease has killed 10 people in China and has sickened more than 20 others in the last two months, and new cases are reported every day. The illness is caused by a virus called H7N9 that patients contract from birds but that does not seem to spread from person to person.

The new report, by a team of researchers from China, was published Thursday in The New England Journal of Medicine along with a commentary from American health officials, who said the disease "raises many urgent questions and global public health concerns."

During a telephone news briefing on Thursday, Nancy J. Cox, of the influenza division at the Centers for Disease Control and Prevention, said that several features of H7N9 were particularly troubling: it causes severe disease, it has genetic traits that help it infect mammals and humans probably have no resistance to it.

Because it does not seem to make birds sick, its presence in flocks may go unrecognized until people start to get sick. In addition, Dr. Cox said, it may be difficult to make an effective vaccine. Past efforts to produce vaccines against related viruses were unsuccessful.

Many questions about the virus remain. Researchers are not sure how deadly it is because they do not know how many people have been infected. The worst cases become obvious, but if some people have mild symptoms or none at all, many cases could go undetected.

Richard Webby, of the infectious diseases department at St. Jude Children's Research Hospital in Memphis, who was not involved in the report from China or the commentary, said in an interview that compared with other types of bird flu, H7N9 was the most worrisome he had seen because it seemed the most capable of infecting humans.

On Thursday, the C.D.C. received its first specimen of the virus from China. It was a sample from one of the patients described in the journal article, a 35-year-old woman from Anhui who died on April 9 after 19 days in the hospital. The sample consisted of a tiny bit of egg white in a vial, containing tens or possibly hundreds of millions of viruses, Michael Shaw, a flu expert at the C.D.C., said in an interview.

Dr. Shaw said scientists would immediately start growing more of the virus to share with other researchers, and would begin using it to develop diagnostic tests that could be used to look for the disease in travelers who returned from China with flulike symptoms, or in people who had been exposed to someone with the disease.

"Nothing's been seen in any country outside of China," Dr. Shaw said. "Everybody is looking very closely, especially Hong Kong and Vietnam, the neighboring countries. With air travel as extensive as it is now, if this is going to spread, it will spread pretty quickly. That's why we're relieved to see so far that it is localized, and not efficiently going from person to person."

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