美国新冠病毒疫情公共卫生应对和临床指南，招募翻译

   CDC currently recommends a cautious approach to the examination of PUIs. These patients should be asked to wear a surgical mask as soon as they are identified, and directed to a separate area, if possible, separated by at least 6 ft (2 m) from other persons. Patients should be evaluated in a private room with the door closed, ideally an airborne infection isolation room, if available. Health care personnel entering the room should use standard precautions, contact precautions, airborne precautions, and eye protection (e.g., goggles or a face shield).
   Clinicians should immediately notify the health care facility’s infection control personnel and local health department. The health department will determine whether the patient needs to be considered a PUI for 2019-nCoV and be tested for infection. If directed by the health department, to increase the likelihood of detecting 2019-nCoV infection, CDC recommends collecting and testing both upper and lower respiratory tract specimens.**** Additional specimen types (e.g., stool or urine) may be collected and stored. Specimens should be collected as soon as possible once a PUI is identified regardless of time since symptom onset.
3 p8 O  r. B  l$ s" r: U/ a& r   For persons who might have 2019-nCoV infection and their close contacts, information and guidance on how to reduce the risk for transmitting and acquiring infection is available at https://www.cdc.gov/coronavirus/ ... prevent-spread.html Close contacts should immediately call their health care providers if they develop symptoms. In addition, CDC is working closely with state and local health partners to develop and disseminate information to the public on general prevention of respiratory illness, including the 2019-nCoV. This includes everyday preventive actions such as washing your hands, covering your cough, and staying home when you are ill. Additional information and resources for this outbreak are available on the CDC website (https://www.cdc.gov/coronavirus/2019-ncov/index.html).   
  CDC目前建议对受调查人(PUI.Person Under Investigation)的检查采取谨慎的方法。一旦发现这些病人，应立即要求他们戴上医用外科口罩，并尽可能将他们引导到一个与他人至少隔开6英尺(2米)的单独区域。病人应该在一个关着门的私人房间里进行评估，如果可能的话，最好是一个防止空气传播感染的隔离室。进入房间的卫生保健人员应使用标准预防措施、接触预防措施、空气传播预防措施和眼睛保护(如护目镜或面罩)。
      临床医生应立即通知卫生保健机构的感染控制人员和当地卫生部门。卫生部门将确定该患者是否需要被视为2019-nCoV的PUI和是否需要进行感染检测。如果在卫生部门的指导下，为了增加2019-nCoV感染检测的有效性，CDC建议同时收集和检测上呼吸道和下呼吸道样本。****可能会收集和储存其他样本类型(例如粪便或尿液)。一旦发现PUI，应尽快采集标本，不考虑何时出现症状。
: y0 K" E. Y9 T9 `" _, x' q      对于可能感染2019-nCoV的人及其密切接触者，可通过https://www.cdc.gov/coronavirus/ ... prevent-spread.html获得关于如何降低传播和感染风险的信息和指导。如果密切接触者出现症状，应立即打电话给卫生保健提供者。此外，CDC正在与州和地方卫生合作伙伴密切合作，制定并向公众宣传关于呼吸道疾病的一般预防信息，包括2019-nCoV。这包括日常的预防措施，如洗手、遮盖咳嗽、生病时呆在家里。关于此次疫情的更多信息和资源可从CDC网站(https://www.cdc.gov/coronavirus/2019-ncov/index.html)获得。

Discussion
The 2019-nCoV has impacted multiple countries, caused severe illness, and sustained person-to-person transmission making it a concerning and serious public health threat. It is unclear how this virus will impact the U.S. over time. For the general population, who are unlikely to be exposed to this virus at the current time, the immediate health risk from 2019-nCoV is considered low. CDC, multiple other federal agencies, state and local health departments, and other partners are implementing aggressive measures to slow U.S. transmission of 2019-nCoV (4,5). These measures require the identification of cases and contacts in the United States and the effective management of the estimated 14,000 travelers arriving from mainland China to the United States each day (3). These measures are being implemented based on the assumption that there will be more U.S. 2019-nCoV cases occurring with potential chains of transmission, with the understanding that these measures might not prevent the eventual establishment of ongoing, widespread transmission of the virus in the United States.

讨论
/ Y9 V) w' t& E" A2019-nCoV已影响多个国家，造成严重疾病，并持续人际传播，使其成为一个令人担忧的严重公共卫生威胁。目前还不清楚这种病毒将如何影响美国。对于目前不太可能接触到这种病毒的普通人群来说，2019-nCoV的直接健康风险被认为是低的。CDC、其他多个联邦机构、州和地方卫生部门以及其他合作伙伴正在采取积极措施，以减缓2019-nCoV在美国的传播(4,5)。这些措施要求查明在美国的病例和接触者，并有效管理每天从中国大陆到美国的大约14000名游客(3)。这些措施的实施是基于这样的假设，即随着潜在的传播链美国将有更多的 2019-nCoV病例出现，并理解到这些措施可能无法阻止该病毒在美国最终形成持续、广泛的传播。

    It is important for public health agencies, health care providers, and the public to be aware of this new 2019-nCoV so that coordinated, timely, and effective actions can help prevent additional cases or poor health outcomes. The critical role that the U.S. health care system plays in halting or significantly slowing U.S. transmission of 2019-nCoV is already evident: eight of the first 11 U.S. cases were detected by clinicians collaborating with public health to test persons at risk. The early recognition of cases in the United States reduces transmission risk and increases understanding of the virus, including its transmission and severity, to inform national and global response actions.
" n5 r2 T- z' n$ L* W: I1 s% A    2019-nCoV symptoms are similar to those of influenza (e.g., fever, cough, or sore throat), and the outbreak is occurring during a time of year when respiratory illnesses from influenza, respiratory syncytial virus, and other respiratory viruses are highly prevalent. To prevent influenza, all persons aged ≥6 months should receive an annual influenza vaccine, and vaccination is still available and effective in helping to prevent influenza (10). Reducing the number of persons in the United States with seasonal influenza will reduce possible confusion with 2019-nCoV infection and possible additional risk to patients with seasonal influenza. Public health authorities are monitoring the situation closely. As more is learned about this novel virus and this outbreak, CDC will rapidly incorporate new knowledge into guidance for action.

4 U/ z4 D8 c. ?8 s* H    重要的是公共卫生机构、卫生保健提供者和公众应了解这一新2019-nCoV，以便协调、及时和有效的行动，有助于防止患病人数的增加或不良健康结果。美国卫生保健系统在阻止或显著减缓2019-nCoV在美国的传播方面发挥的关键作用已经很明显:美国最初11例病例中有8例是由临床医生与公共卫生部门合作检测高危人群发现的。美国对病例的早期识别降低了传播风险，并增加了对该病毒的了解，包括其传播方式和严重程度，从而为国家和全球应对行动提供信息。
0 e5 y5 h+ Z( T5 {" {    2019-nCoV的症状与流感类似(例如，发烧、咳嗽或喉咙痛)，这次暴发发生在一年中流感、呼吸道合胞体病毒和其他呼吸道病毒高度流行期间。为预防流感，所有年龄≥6个月的人都应每年接种流感疫苗，疫苗接种仍然有效，有助于预防流感(10)。减少美国季节性流感患者人数将减少与2019-nCoV感染混淆的可能性，以及季节性流感患者可能面临的额外风险。公共卫生当局正在密切监测情况。随着对这种新病毒和这次疫情的了解越来越多，CDC会迅速将新知识纳入行动指南。

+ J0 N4 t6 ]+ M7 r6 BAll authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.
所有作者均已填写并提交《国际医学期刊编辑委员会潜在利益冲突披露表》。没有潜在的利益冲突被披露。

6 U) n3 {$ ]( _& v* Includes any of the following: dyspnea, respiratory rate >30 breaths per minute, hypoxemia, or chest x-ray with multilobar infiltrates or >50% progression of pulmonary infiltration within 24–48 hours per WHO.
8 u& [5 i7 C  ^$ E. M* F* 包括下列任何一项:呼吸困难、呼吸频率每分钟大于30次、低氧血症、肺部影像学显示多叶性浸润或24–48小时内肺浸润进展大于50%（按照世卫组织标准）。
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* P+ }$ H, t' P8 m. ]5 ]) U( v# k§§ CDC’s initial health screening includes a measurement of each traveler’s temperature with a handheld noncontact thermometer, observation of these travelers for visible signs of respiratory illness (e.g., cough or difficulty breathing), and review of symptoms through a self-administered questionnaire.
$ o# O  T8 B8 n6 V+ F$ X' p§§CDC最初的健康筛查包括用手持非接触体温计测量每位旅客的体温，观察这些旅客是否有明显的呼吸道疾病症状(如咳嗽或呼吸困难)，通过自填式问卷调查对症状进行审查。
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, C( y+ j3 {) ?; d5 S9 u, t* D¶¶ The more comprehensive public health assessment determines, based on the traveler’s illness and exposure, whether the traveler should be taken to a hospital for further medical evaluation and care, which might include testing for 2019-nCoV.
# y, G! p1 k+ V) h4 |) O, X3 N: |¶¶更全面的公共卫生评估是基于旅行者的疾病和接触情况，决定旅行者是否应该被送往医院进行进一步的医疗评估和护理，其中可能包括2019-nCoV的检测。
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¶¶¶ Close contact is defined as 1) being within approximately 6 ft (2 m) of a 2019-nCoV patient for a prolonged period while not wearing recommended personal protective equipment (PPE) (e.g., gowns, gloves, National Institute for Occupational Safety and Health–certified disposable N95 respirator, and eye protection); close contact can occur while caring for, living with, visiting, or sharing a health care waiting area or room with a 2019-nCoV patient; or 2) having direct contact with infectious secretions of a 2019-nCoV patient (e.g., being coughed on) while not wearing recommended PPE.
¶¶¶密切接触定义为:1)未穿戴推荐的个人防护装备(PPE)(例如防护服、手套、国家职业安全与健康认证的一次性N95防护口罩和眼部保护)的情况下，与2019-nCoV患者保持约6英尺(2米)的距离长时间接触，密切接触在护理、共同生活、拜访或共享卫生保健候诊区或房间时发生；或2)在未穿戴推荐PPE的情况下，直接接触2019-nCoV患者的感染性分泌物(例如，被冲着咳嗽)。

On January 21, 2020, the first person in the United States with diagnosed 2019-nCoV infection was reported. As of February 4, a total of 293 persons from 36 states, the District of Columbia, and the U.S. Virgin Islands were under investigation based on current patient under investigation (PUI) definitions,¶ and also included those being evaluated because they are close contacts. Of these PUIs, 11 patients have confirmed 2019-nCoV infection using a real-time reverse transcription–polymerase chain reaction (RT-PCR) assay developed by CDC. These 11 cases were diagnosed in the following states: Arizona (one), California (six), Illinois (two), Massachusetts (one), and Washington (one) (Table). Nine cases were in travelers from Wuhan. Eight of these nine cases were identified as a result of patients seeking clinical care for symptoms and clinicians connecting with the appropriate public health systems. Two cases (one each in California and Illinois) occurred in close contacts of two confirmed cases and were diagnosed as part of routine monitoring of case contacts. All patients are being monitored closely for progressing illness. No deaths have been reported in the United States.
1 t# I! v; J3 U2020年1月21日，美国首例确诊为2019例nCoV感染者被报告。截至2月4日，共有来自36个州、哥伦比亚特区和美属维尔京群岛的293人根据当前受调查病人（PUI）的定义接受了调查，其中还包括因密切接触而接受评估的人。在这些接受调查病人中，有11名患者使用CDC开发的实时逆转录-聚合酶链反应（RT-PCR）检测法确认了2019例nCoV感染。这11个病例在下列州被确诊：亚利桑那州（1例）、加利福尼亚州（6例）、伊利诺伊州（2例）、马萨诸塞州（1例）和华盛顿州（1例）（表）。9例来自武汉的旅客。在这9个病例中，有8个是由于患者在求医过程中与临床护理，以及公共卫生系统有联系的临床医生引起的。两例（加利福尼亚州和伊利诺伊州各一例）发生在两例确诊病例的密切接触者中，作为病例接触者常规监测的一部分被诊断。所有病人都在密切监视病情进展。美国没有死亡报告。

CDC established a 2019-nCoV Incident Management Structure on January 7, 2020. On January 21, CDC activated its Emergency Operations Center to optimize coordination for domestic and international 2019-nCoV response efforts. To date, CDC has deployed teams to the U.S. jurisdictions with cases to assist with epidemiologic investigation and to work closely with state and local partners to identify and monitor close contacts and better understand the spectrum of illness, transmission, and virulence associated with this novel virus. Information learned from these investigations will help inform response actions. CDC has closely monitored the global impact of this virus with staff members positioned in CDC offices around the world, including mainland China, and in coordination with other countries and WHO. This coordination has included deploying CDC staff members to work with WHO and providing active support to CDC offices in affected countries. In addition, CDC in response to the escalating risks of travel from China has issued a series of Travelers’ Health Notices for both Wuhan and the rest of China regarding the 2019-nCoV outbreak. On January 27, CDC issued a Level 3 travel notice for travelers to avoid all nonessential travel to mainland China.
CDC于2020年1月7日建立了2019年nCoV事件管理架构。1月21日，中国疾控中心启动应急行动中心，优化协调国内外2019年nCoV应急工作。迄今为止，疾病预防控制中心已向美国司法管辖区部署了病例小组，协助开展流行病学调查，并与州和地方合作伙伴密切合作，以确定和监测密切接触者，更好地了解与这种新型病毒相关的疾病谱、传播和毒力。从这些调查中获得的信息将有助于为应对行动提供信息。疾病预防控制中心与包括中国大陆在内的世界各地疾病预防控制中心办事处的工作人员密切合作，并与其他国家和世卫组织协调，密切监测这种病毒对全球的影响。这种协调包括部署疾病预防控制中心工作人员与世卫组织合作，并向受影响国家的疾病预防控制中心办事处提供积极支持。此外，中国疾控中心针对来自中国的旅行风险不断上升，就2019年nCoV疫情向武汉和中国其他地区发出了一系列旅客健康通知。1月27日，中国疾控中心向旅客发出三级旅行通知，避免所有非必要的前往中国大陆的旅行。

U.S. quarantine stations, located at 18 major U.S. ports of entry, are part of a comprehensive regulatory system authorized under section 361 of the Public Health Service Act (42 U.S. Code Section 264), that limits the introduction of infectious diseases into the United States to prevent their spread. On January 17, consistent with existing communicable disease response protocols, CDC Quarantine staff members instituted enhanced entry screening of travelers on direct and connecting flights from Wuhan, China, arriving at three major U.S. airports: Los Angeles (LAX), New York City (JFK), and San Francisco (SFO),†† which then expanded to include travelers arriving in Atlanta (ATL) and Chicago (ORD). These five airports together receive approximately 85% of all air travelers from Wuhan, China, to the United States. U.S. Customs and Border Protection officers identified travelers arriving from Wuhan and referred them to CDC for health screening.§§ Any traveler from Wuhan with signs or symptoms of illness (e.g., fever, cough, or difficulty breathing) received a more comprehensive public health assessment performed by CDC public health and medical officers.¶¶ All travelers from Wuhan were also provided CDC’s Travel Health Alert Notice (T-HAN)*** that advised them to monitor their health for 14 days and described recommended actions to take if relevant symptoms develop. As of February 1, 2020, a total of 3,099 persons on 437 flights were screened; five symptomatic travelers were referred by CDC to local health care providers for further medical evaluation, and one of these persons tested positive for 2019-nCoV.
5 @# {+ i4 r4 H+ K% D! r  U; B位于美国18个主要入境港的美国检疫站根据《公共卫生服务法》（42美国法典第264节）第361节授权的综合监管体系的一部分，这一体系限制将传染病引入美国以防止其传播。1月17日，根据现有的传染病应对方案，疾病预防控制中心检疫人员对从中国武汉直飞和转机抵达美国三大机场的旅客实施了强化入境检查：洛杉矶（LAX）、纽约市（JFK）和旧金山（SFO），后来扩大到包括抵达亚特兰州大学（ATL）和芝加哥（ORD）的旅客。这五个机场总共接待了从中国武汉飞往美国的大约85%的航空旅客。 美国海关和边境保护官员确认了从武汉抵达的旅客，并将他们转介给疾病预防控制中心进行健康检查。任何从武汉来的有疾病的迹象或症状（如发烧、咳嗽，（或呼吸困难）的旅客由疾病预防控制中心公共卫生和医疗官员进行更全面的公共卫生评估。所有来自武汉的旅客也收到疾病预防控制中心的旅行健康警告通知（T-HAN）：建议他们监测14天的健康状况，并描述了如果出现相关症状应采取的建议措施发展。截至2020年2月1日，共对437个航班的3099人进行了筛查；疾控中心将5名有症状的旅客转介给当地医疗服务提供者进行进一步的医疗评估，其中1人检测出2019例nCoV呈阳性。

On January 24, 2020, travel bans began to be instituted by the Chinese government, resulting in restricted travel in and out of Hubei Province, including the city of Wuhan, and fewer travelers undergoing entry screening in the United States. In response to the escalating risks associated with travel from mainland China, on January 31, 2020, the Presidential Proclamation further refined the border health strategy to temporarily suspend entry, undergo additional screening, or possible quarantine for individuals that have visited China (excluding Hong Kong, Macau, and Taiwan) in the past 14 days. These enhanced entry screening efforts are taking place at 11 airports at which all air travelers from China are being directed.
2020年1月24日，中国政府开始实施旅行禁令，导致湖北省（包括武汉市）出入境受到限制，在美国接受入境检查的旅客减少。为应对与中国大陆旅行有关的不断升级的风险，2020年1月31日，总统宣言进一步完善了边境卫生战略，以暂时中止入境、进行额外的筛查，或对14天前曾访问过中国（不包括香港、澳门和台湾）的个人进行检疫。这些加强的入境检查工作正在11个机场开展，对来自中国的所有航空旅客都将在这些机场接受指导。

Laboratory and Diagnostic Support
% p# S( r% |: A2 u9 X. WChinese health officials posted the full 2019-nCoV genome sequence on January 10, 2020, to inform the development of specific diagnostic tests for this emergent coronavirus (1). Within a week, CDC developed a Clinical Laboratory Improvement Amendments–approved real-time RT-PCR test that can diagnose 2019-nCoV respiratory samples from clinical specimens. On January 24, CDC publicly posted the assay protocol for this test (https://www.cdc.gov/coronavirus/2019-nCoV/lab/index.html). On January 4, 2020, the Food and Drug Administration issued an Emergency Use Authorization to enable emergency use of CDC’s 2019-nCoV Real-Time RT-PCR Diagnostic Panel. To date, this test has been limited to use at CDC laboratories. This authorization allows the use of the test at any CDC-qualified lab across the country. CDC is working closely with FDA and public health partners, including the American Public Health Laboratories, to rapidly share these tests domestically and internationally through CDC’s International Reagent Resource (https://www.internationalreagentresource.org/external icon). In addition, CDC uploaded the genome of the virus from the first reported cases in the United States to GenBank, the National Institutes of Health genetic sequence database of publicly available DNA sequences (https://www.ncbi.nlm.nih.gov/genbank/external icon). CDC also is growing the virus in cell culture, which is necessary for further studies, including for additional genetic characterization. Once isolated, the virus will be made available through BEI Resources (https://www.beiresources.org/external icon) to assist research efforts.
实验室和诊断支持

中国卫生官员于2020年1月10日公布了2019年nCoV全基因组序列，以通报这一紧急冠状病毒（1）的具体诊断测试进展。一周内，疾控中心制定了一项临床实验室改进修正案——经批准的实时RT-PCR检测，可从临床样本中诊断2019份nCoV呼吸样本。1月24日，疾控中心公开发布了本次检测的检测方案（https://www.CDC.gov/coronavirus/2019 nCoV/lab/index.html）。2020年1月4日，美国食品药品监督管理局发布紧急使用授权书，允许紧急使用美国疾控中心2019年nCoV实时RT-PCR诊断仪。到目前为止，这项测试仅限于在CDC实验室使用。这个授权允许在全国任何一个CDC认证的实验室使用该测试。疾控中心正与FDA和包括美国公共卫生实验室在内的公共卫生合作伙伴密切合作，通过疾控中心的国际试剂资源（https://www.International Reagent Resource.org/external icon）在国内外迅速分享这些检测结果。此外，疾控中心还将美国首次报告病例中的病毒基因组上传至美国国立卫生研究院基因序列数据库GenBank（https://www.ncbi.nlm.nih.gov/GenBank/external icon）。CDC还在细胞培养中培养病毒，这对于进一步的研究是必要的，包括对额外的基因特征的研究。一旦分离，病毒将通过BEI资源（https://www.beirources.org/external icon）提供，以协助研究工作。

Laboratory and Diagnostic Support
: U9 }& r% D% I0 r6 H0 W( L8 U6 D6 fChinese health officials posted the full 2019-nCoV genome sequence on January 10, 2020, to inform the development of specific diagnostic tests for this emergent coronavirus (1). Within a week, CDC developed a Clinical Laboratory Improvement Amendments–approved real-time RT-PCR test that can diagnose 2019-nCoV respiratory samples from clinical specimens. On January 24, CDC publicly posted the assay protocol for this test (https://www.cdc.gov/coronavirus/2019-nCoV/lab/index.html). On January 4, 2020, the Food and Drug Administration issued an Emergency Use Authorization to enable emergency use of CDC’s 2019-nCoV Real-Time RT-PCR Diagnostic Panel. To date, this test has been limited to use at CDC laboratories. This authorization allows the use of the test at any CDC-qualified lab across the country. CDC is working closely with FDA and public health partners, including the American Public Health Laboratories, to rapidly share these tests domestically and internationally through CDC’s International Reagent Resource (https://www.internationalreagentresource.org/external icon). In addition, CDC uploaded the genome of the virus from the first reported cases in the United States to GenBank, the National Institutes of Health genetic sequence database of publicly available DNA sequences (https://www.ncbi.nlm.nih.gov/genbank/external icon). CDC also is growing the virus in cell culture, which is necessary for further studies, including for additional genetic characterization. Once isolated, the virus will be made available through BEI Resources (https://www.beiresources.org/external icon) to assist research efforts.
9 r& p8 G3 y2 v  X3 a7 ~实验室和诊断支持
  e! |2 h0 }* J  x
6 R" @$ Q8 b/ L: I; c4 n0 z中国卫生官员于2020年1月10日公布了2019年nCoV全基因组序列，以通报这一紧急冠状病毒（1）的具体诊断测试进展。一周内，疾控中心制定了一项临床实验室改进修正案——经批准的实时RT-PCR检测，可从临床样本中诊断2019份nCoV呼吸样本。1月24日，疾控中心公开发布了本次检测的检测方案（https://www.CDC.gov/coronavirus/2019 nCoV/lab/index.html）。2020年1月4日，美国食品药品监督管理局发布紧急使用授权书，允许紧急使用美国疾控中心2019年nCoV实时RT-PCR诊断仪。到目前为止，这项测试仅限于在CDC实验室使用。这个授权允许在全国任何一个CDC认证的实验室使用该测试。疾控中心正与FDA和包括美国公共卫生实验室在内的公共卫生合作伙伴密切合作，通过疾控中心的国际试剂资源（https://www.International Reagent Resource.org/external icon）在国内外迅速分享这些检测结果。此外，疾控中心还将美国首次报告病例中的病毒基因组上传至美国国立卫生研究院基因序列数据库GenBank（https://www.ncbi.nlm.nih.gov/GenBank/external icon）。CDC还在细胞培养中培养病毒，这对于进一步的研究是必要的，包括对额外的基因特征的研究。一旦分离，病毒将通过BEI资源（https://www.beirources.org/external icon）提供，以协助研究工作。