甲型H1N1流感专题，网聚公卫人力量！

haijunlv2004 · 发表于 2009-5-10 17:18:13

转自：中华人民共和国卫生部http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohyzs/s3585/200905/40478.htm
卫生部办公厅关于印发《甲型H1N1流感诊疗方案（2009年试行版第一版）》的通知
各省、自治区、直辖市卫生厅局，新疆生产建设兵团卫生局：

为指导医疗机构做好甲型H1N1流感医疗救治准备工作，应对可能发生的甲型H1N1流感疫情，我部组织专家在《人感染猪流感诊疗方案（2009版）》的基础上，结合世界卫生组织和其他国家甲型H1N1流感最新诊疗经验和相关资料，研究制定了《甲型H1N1流感诊疗方案（2009年试行版第一版）》。现印发给你们，供医疗机构在临床诊疗工作中使用。

我部将继续密切关注世界卫生组织和其他国家的最新诊疗经验和研究成果，必要时组织专家组再次对诊疗方案进行修订和完善。

2009年4月29日印发的《人感染猪流感诊疗方案（2009版）》同时废止。2009年5月7日印发的《甲型H1N1流感病例转运工作方案》中“疑诊病例”修改为“疑似病例”。

卫生部办公厅

二〇〇九年五月八日

甲型H1N1流感诊疗方案

（2009年试行版第一版）

2009年3月墨西哥暴发“人感染猪流感”疫情，造成人员死亡。4月30日世界卫生组织（以下简称WHO）宣布将流感大流行警告级别提高为5级。研究发现，此次疫情的病原为变异后的新型甲型H1N1流感病毒，该毒株包含有猪流感、禽流感和人流感三种流感病毒的基因片段，可以在人间传播。WHO初始将此次流感疫情称为“人感染猪流感”，但随着对疫情性质的深入了解，现已将其重新命名为“甲型H1N1流感”。我国卫生部于4月30日宣布将其纳入《中华人民共和国传染病防治法》规定的乙类传染病，依照甲类传染病采取预防、控制措施。

根据目前所掌握的资料，本次发生的甲型H1N1流感是由变异后的新型甲型H1N1流感病毒所引起的急性呼吸道传染病。通过飞沫、气溶胶、直接接触或间接接触传播，临床主要表现为流感样症状，少数病例病情重，进展迅速，可出现病毒性肺炎，合并呼吸衰竭、多脏器功能损伤，严重者可以导致死亡。由于这种甲型H1N1流感是一种新发疾病，其特点仍待进一步观察总结。

一、病原学

甲型H1N1流感病毒属于正粘病毒科（0rthomyxoviridae），甲型流感病毒属（Influenza virus A）。典型病毒颗粒呈球状，直径为80nm-120nm，有囊膜。囊膜上有许多放射状排列的突起糖蛋白，分别是红细胞血凝素（HA）、神经氨酸酶（NA）和基质蛋白M2。病毒颗粒内为核衣壳，呈螺旋状对称,直径为10nm。为单股负链RNA病毒，基因组约为13.6kb，由大小不等的8个独立片段组成。病毒对乙醇、碘伏、碘酊敏感；对热敏感，56℃30分钟可灭活。

二、流行病学

至北京时间2009年5月8日上午8时，全球共在24个国家和地区出现确诊甲型H1N1流感病例2371例，分布在美洲、欧洲、大洋洲和亚洲。其中墨西哥确诊1112例，死亡42例；美国确诊896例，死亡2例；我国香港特别行政区确诊1例。除墨西哥和美国外，其他国家和地区均无死亡病例报道。

（一）传染源。

甲型H1N1流感病人为主要传染源。虽然猪体内已发现甲型H1N1流感病毒，但目前尚无证据表明动物为传染源。

（二）传播途径。

主要通过飞沫或气溶胶经呼吸道传播，也可通过口腔、鼻腔、眼睛等处黏膜直接或间接接触传播。接触患者的呼吸道分泌物、体液和被病毒污染的物品亦可能造成传播。

（三）易感人群。

人群普遍易感。

三、临床表现和辅助检查

潜伏期一般为1-7天，多为1-4天。

（一）临床表现。

表现为流感样症状，包括发热（腋温≥37.5℃）、流涕、鼻塞、咽痛、咳嗽、头痛、肌痛、乏力、呕吐和（或）腹泻。

可发生肺炎等并发症。少数病例病情进展迅速，出现呼吸衰竭、多脏器功能不全或衰竭。

患者原有的基础疾病亦可加重。

（二）实验室检查。

1.外周血象：白细胞总数一般不高或降低。

2.病原学检查

（1）病毒核酸检测：以RT-PCR（最好采用real-time RT-PCR）法检测呼吸道标本（咽拭子、口腔含漱液、鼻咽或气管抽取物、痰）中的甲型H1N1流感病毒核酸，结果可呈阳性。

（2）病毒分离：呼吸道标本中可分离出甲型H1N1流感病毒。合并病毒性肺炎时肺组织中亦可分离出该病毒。

3.血清学检查：动态检测血清甲型H1N1流感病毒特异性中和抗体水平呈4倍或4倍以上升高。

（三）其他辅助检查。

可根据病情行胸部影像学等检查。合并肺炎时肺内可见斑片状炎性浸润影。

四、诊断

本病的诊断主要结合流行病学史、临床表现和病原学检查，早发现、早诊断是防控与治疗的关键。

（一）疑似病例。

符合下列情况之一即可诊断为疑似病例：

1.发病前7天内与甲型H1N1流感疑似或确诊病例有密切接触（在无有效防护的条件下照顾患者，与患者共同居住、暴露于同一环境，或直接接触患者的气道分泌物或体液），出现流感样临床表现。

2.发病前7天内曾到过甲型H1N1流感流行（出现病毒的持续人间传播和基于社区水平的流行和暴发）的国家或地区，出现流感样临床表现。

3.出现流感样临床表现，甲型流感病毒检测阳性，但进一步检测排除既往已存在的亚型。

（二）确诊病例。

出现流感样临床表现，同时有以下一种或几种实验室检测结果：

1．甲型H1N1流感病毒核酸检测阳性（可采用real-time RT-PCR和RT-PCR）。

2.分离到甲型H1N1流感病毒。

3.血清甲型H1N1流感病毒的特异性中和抗体水平呈4倍或4倍以上升高。

五、临床分类处理原则

（一）疑似病例：安排单间病室隔离观察，不可多人同室。同时行甲型H1N1流感病毒特异性检查。及早给予奥司他韦治疗。

（二）确诊病例：由定点医院收治。收入甲型H1N1流感病房，可多人同室。给予奥司他韦治疗。

六、治疗

（一）一般治疗。

休息，多饮水，密切观察病情变化；对高热病例可给予退热治疗。

（二）抗病毒治疗。

应及早应用抗病毒药物。初步药敏试验提示，此甲型H1N1流感病毒对奥司他韦（oseltamivir）和扎那米韦（zanamivir）敏感，对金刚烷胺和金刚乙胺耐药。

奥司他韦应尽可能在发热48小时内使用（36小时内最佳），疗程为5天。奥司他韦的成人用量为75mg b.i.d.。1岁及以上年龄的儿童患者应根据体重给药：体重不足15kg者，予30mg b.i.d.；体重15-23kg者，45mg b.i.d.；体重23-40kg者，60mg b.i.d.；体重大于40kg者，75mg b.i.d.。对于吞咽胶囊有困难的儿童，可选用奥司他韦混悬液。

（三）其他治疗。

1.如出现低氧血症或呼吸衰竭的情况，应及时给予相应的治疗措施，包括吸氧、无创机械通气或有创机械通气等。

2.出现其他脏器功能损害时，给予相应支持治疗。

3.对病情严重者（如出现感染中毒性休克合并急性呼吸窘迫综合征），可考虑给予小剂量糖皮质激素治疗。不推荐使用大剂量糖皮质激素。

4．合并细菌感染时，给予相应抗菌药物治疗。

（四）中医辨证治疗。

1.毒袭肺卫

症状：发热、恶寒、咽痛、头痛、肌肉酸痛、咳嗽。

治法：清热解毒，宣肺透邪。

参考方药：炙麻黄、杏仁、生石膏、柴胡、黄芩、牛蒡子、羌活、生甘草。

常用中成药：莲花清瘟胶囊、银黄类制剂、双黄连口服制剂。

2.毒犯肺胃

症状：发热或伴有恶寒、恶心、呕吐、腹痛腹泻、头痛、肌肉酸痛。

治法：清热解毒，化湿和中。

参考方药：葛根、黄芩、黄连、苍术、藿香、姜半夏、苏叶、厚朴。

常用中成药：葛根芩连微丸、藿香正气制剂等。

3.毒壅气营

症状：高热、咳嗽、胸闷憋气、喘促气短、烦躁不安、甚者神昏谵语。

治法：清气凉营。

参考方药：炙麻黄、杏仁、瓜蒌、生大黄、生石膏、赤芍、水牛角。

必要时可选用安宫牛黄丸以及痰热清、血必净、清开灵、醒脑静注射液等

epiman · 发表于 2009-5-10 22:47:36

转自：中华人民共和国卫生部http://www.moh.gov.cn/publicfile ... 85/200905/40478.htm
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haijunlv2004 发表于 2009-5-10 17:18

- D9 H9 {' Y& h( T* n9 M
登录/注册后可看大图

haijunlv2004对治疗更关注些。。。

陈无忧 · 发表于 2009-5-11 16:41:45

本帖最后由陈无忧于 2009-5-11 16:43 编辑

军事医学科学院甲型H1N1流感病毒研究获突破性进展
甲型H1N1流感病毒检测试剂形成配套体系
5月8日电，军事医学科学院承担的新甲型H1N1流感病毒攻关研究又取得突破性进展：由该院微生物流行病研究所病原微生物安全国家重点实验室自主研制的新甲型H1N1流感病毒诊断试剂盒形成了配套体系。
　　据主持这项研究的病毒学专家介绍，这次研制成功的系列诊断试剂盒，具有配套、准确、操作简便、快速管用的特点，能够基本满足各级各类医疗和防疫机构工作人员的检测需要。目前，这套试剂盒已开始批量组装。

　　这次军事医学科学院研制成功的系列配套检测试剂，由“新甲型H1N1流感病毒RT-PCR（反转录聚合酶链反应）检测试剂盒”、“新甲型H1N1流感病毒多重RT-PCR检测试剂盒”、“新甲型H1N1流感病毒实时荧光定量PCR检测试剂盒”、“新甲型H1N1流感病毒基因芯片检测试剂盒”四种组成。该院专家向记者介绍，新甲型H1N1流感病毒RT-PCR检测试剂盒，能够准确检测到新甲型H1N1流感病毒多个特异性基因，区分出季节性H1N1流感病毒，适用于普通医务和检验检疫人员使用；多重RT-PCR检测试剂盒，能够多点、全面检测到新甲型H1N1流感病毒的多个特异基因，适用于流感监测机构和医院；实时RT-PCR检测试剂盒，能够对检测到的基因片段直接进行序列测定，在最短时间内得出准确结果；基因芯片检测和分型试剂盒，能够同时实现多种甲型流感病毒亚型的大规模筛查，区分不同流感病毒，适用于病毒变异的分析、监测。这4种试剂盒对及时准确检测、诊断甲型H1N1流感病毒，为我国有效防控甲型H1N1流感，将发挥重要作用。

radge123 · 发表于 2009-5-12 16:18:18

要求越来越高，人手不够啊

liudew · 发表于 2009-5-12 19:28:02

四川也有猪流感了哎。。。

358866718 · 发表于 2009-5-12 22:32:36

支持~~~~~~~~~~~~~~~

陈无忧 · 发表于 2009-5-13 19:55:59

How Time and Mutations Engineered the New H1N1 Strain

H1N1病毒的"来龙去脉"

By David Brown
Washington Post Staff Writer
Monday, May 11, 2009

Once Upon a Time there was a little flu virus. It was probably born in Kansas in late 1917 or 1918, although nobody is really sure. Its name was H1N1. It grew up to be very wicked.

The story of the new strain of swine influenza now circling the world actually starts a lot farther back than the 20th century, but the year the "Spanish influenza" appeared is a good place to start.

From the second week in March 1918, when soldiers at an Army camp in Kansas began to get ill, until the final mini-waves of 1920, the Spanish flu infected about 97 percent of the people on Earth and killed at least 50 million of them.

The virus probably came from waterfowl, which carry dozens of different flu viruses. At some point, either before or after it got into human beings, the virus got into pigs, a species that can be infected by avian and human strains. It has stayed in swines ever since, and in people for almost as long.

The swine-origin influenza A (H1N1) virus circulating in Mexico, the United States and Canada, and present in two dozen other countries, is a descendant of the Spanish flu H1N1 virus. In the past 90 years, though, a lot of new blood -- metaphorically speaking -- has entered its lineage. It does not look or act much like its notorious ancestor.

This might be a good place to address this A and H and N business.

Influenza virus is part of a family called Orthomyxoviridae. There are four sub-classifications -- influenza virus A, influenza virus B, influenza virus C and thogotoviruses. It's like citrus fruit, which encompass oranges, lemons, limes, grapefruit, etc.

Influenza A and B cause illness in people; the others almost never do. There are many, many types of influenza A but only one influenza B.

The diversity of influenza A arises from variations in the two proteins on its surface, called hemagglutinin (abbreviated H or HA) and neuraminidase (N or NA). Together, the proteins make up the face that a flu virus presents to the immune system of a bird, a pig or a human being.

In this setting, the face's appearance is no small matter. The immune system's ability to recognize a virus is one of the first steps in stopping it.

One strategy involves antibodies. They attack only if they are tailor-made for the virus, which requires the immune system to get a good look at the surface proteins. The immune system can offer the best protection if it has seen the pathogen before and has the right antibodies ready.

Think of H as hair and N as nose, two features for learning and remembering the identity of a virus. In the world of influenza A, there are 15 subtypes of H (straight blond, wavy red, short black, kinky black, etc.) and nine subtypes of N (Roman, ski jump, flared, long, etc.). Each subtype is numbered -- H1N1, H3N2, H9N2 and so forth.

H1N1 is simply one combination of two of these subtypes that give the virus an appearance recognizable to the immune system -- say, short black hair and a long nose. Within these subtypes, however, there are subtle -- and sometimes not so subtle -- variations. They arise from mutations in the genes governing the H and N proteins.

Over time, an H1N1 influenza A virus can change its appearance significantly through random mutation. It can streak its short black hair and put a gold stud in its long nose one year, and shave its hair into a Mohawk and add a diamond stud in the other nostril the next. Pile up enough of these, and pretty soon the immune system no longer recognizes it as the virus with the short black hair and the long nose it once knew -- even though it still fits that description.

That is why the Spanish flu virus, the new swine flu virus and some of the human flu viruses circulating in recent winters can all be H1N1 viruses and yet look and behave so differently.

Research in the past few years on the Spanish flu virus -- which has been reconstructed from fragments extracted from lung-tissue samples from people who died in 1918 -- has revealed that much but not all of its killing potential resided in the H protein. One of the reassuring things about the new swine flu strain is that it does not have those same "virulence factors," even though it shares the same broad H1N1 features.

Studies done in the past two weeks suggest that people who have received flu shots in the past few years -- shots that protect against the most common human H1N1 strain in circulation -- are not protected against this swine flu strain, even though it also is H1N1. Why? Because it looks so different to the immune system that the virus-killing antibodies do not react.

Such is the importance of looks, immunologically speaking.

The human H1N1 flu virus -- and it's "human" only because it is in us -- that circulates each winter changes a little bit year to year in a phenomenon called "antigenic drift" as mutations creep into the H and N genes. But it can also change much more rapidly through something called "antigenic shift," which happens when entire H or N proteins (or both) are swapped out wholesale for new versions.

This is possible because influenza's genes are on eight separate strands, or "gene segments." One or two or more can be replaced, like cards in draw poker.

That's a rare event, however, and requires that two flu strains invade a single cell, replicate and then get their products mixed up in the packaging. The result is a virus dramatically different in immunological appearance, and sometimes in disease-causing capability, from either parent.

One way or another, a new influenza virus with the identity of H2N2 appeared in 1957. Because it was a new combination, nobody had immunity. It was called "Asian flu," and it spread everywhere, outcompeting H1N1 strains, which disappeared in people but remained in pigs.

In 1968, another strain, an H3N2 combination, appeared on the scene. Nobody had immunity to it either. It had a world's worth of susceptible victims and caused the "Hong Kong flu" pandemic that year and the next.

In 1977, a strange thing happened. The H1N1 virus, absent for years in people, reappeared. Curiously, it was almost exactly like the last strains in the 1950s. It was so close, in fact, that many people suspect it was released into the world by mistake from 1950s samples kept in a lab freezer.

Whatever the source, it spread widely as the "Russian flu," infecting lots of people born after the disappearance of H1N1 two decades earlier.

Since then, H1N1 and H3N2 strains have been circulating, mutating in small ways, and infecting new victims year to year. At the moment, the dominant H1N1 strain is one called A/Brisbane/59/2007. By chance, the dominant H3N2 strain was also found in Brisbane, Australia, in 2007 and is named A/Brisbane/10/2007. Influenza B, which has caused about one-third of infections in the United States this flu season, is dominated by a strain called B/Florida/04/2006.

But now comes a whole new H1N1 virus. It is formally labeled A/California/04/2009 (see graphic), and it was taken from a 10-year-old boy in San Diego who came down with the flu on March 30. It has an H from an H1N2 virus circulating in American pigs and an N from an H1N1 virus found mostly in Eurasian ones.

Our immune systems, familiar with other H's and N's, do not know what to make of it. We have no antibodies against the combination, so we have no protection against it. And we will generate antibodies only if we get infected by the virus or vaccinated with a killed version of it; either way will teach the immune system what it looks like.

This is the swine flu or, as the federal government likes to call it, confusingly but inoffensively, the H1N1 strain.

It's coming soon to a neighborhood near you. But we don't yet know how this tale will end

一笑而过 · 发表于 2009-5-15 12:08:39

中新网5月14日电据新加坡《联合早报》报道，世界卫生组织13日指出，季节性流行感冒病毒已经对药品达菲产生抵抗能力，为此，该组织已经加紧进行甲型H1N1流感疫苗的培育工作。

世界卫生组织全球流感项目专家进藤奈邦子13日在日内瓦的每日记者会上说，墨西哥和美国的甲型H1N1流感病人的住院率比较高，这使得疫苗的培育工作必须加紧进行，因为，我们面对的可能是有抗药能力的病毒。

进藤奈邦子说：“去年的季节性流感爆发时，病毒产生了抵抗药物奥斯他韦(达菲的主要成份)的能力。”

目前，在疫苗尚未培育成功的情况下，只有达菲和英国葛兰素史克公司生产的瑞乐砂能抗流感。

jykcdc · 发表于 2009-5-15 15:52:10

甲型H1N1流感蔓延趋势与过去的大流行相似
(Nature)Swine flu spread matches previous flu pandemics
Published online 11 May 2009 | Nature | doi:10.1038/news.2009.469
News
New analysis supports pandemic designation.
Heidi Ledford
An early analysis of the H1N1 swine-associated flu virus outbreak suggests that the virus spreads at a rate comparable to that of previous influenza pandemics.
The results, published online today by Science1 and compiled by the World Health Organization Rapid Pandemic Assessment Collaboration, support the designation of swine flu as a pandemic but also indicate that the fatality rates thus far are lower than those seen during the 1918 flu outbreak or those anticipated from an avian influenza pandemic.
Exposure to other H1N1 strains may mean people are more resistant to the current swine-associated strain.CDC
"It's a virus that almost certainly will cause a global epidemic," says study author Neil Ferguson, an epidemiologist at Imperial College London. "But it's not the catastrophic scenario people were fearing for bird flu."
Early results
The study focuses largely on data from Mexico, where the earliest known infections occurred. Such data are still preliminary, and it is too early to gain a complete picture of how the virus will behave in the population as a whole. But early modelling efforts can give officials an indication of what may lie ahead, says Ferguson.
By plugging early data into statistical models, Ferguson and his collaborators determined that 6,000–32,000 individuals had been infected in Mexico by late April. The team also used epidemiological data and information about the virus' genetic diversity to determine that the swine flu virus has a basic reproductive rate — a number that takes into account how easily the virus spreads within a population — of 1.2–1.6. Seasonal flu typically hovers around 1.2, whereas the second, more severe wave of the 1918 flu reached about 2.
"So far, I would put it at the cusp of a severe seasonal strain or a mild pandemic strain," says epidemiologist Ira Longini of the University of Washington School of Public Health in Seattle, who was not involved with the study. But Longini notes that these calculations are based on data compiled after the peak flu season. "It's hard to tell what it will be during the late fall and winter months in North America," he adds.
Children hardest hit
The World Health Organization analysis also supports observations that the swine flu strikes children more than the elderly — an unusual pattern compared with that of seasonal flu. When Ferguson and his collaborators attempted to fit their models to data collected from a community outbreak of swine flu in La Gloria, Veracruz, they found that the data fit best when susceptibility to the virus varied according to age.
One possibility, says Ferguson, is that H1N1 viruses are commonly seen in normal seasonal flu epidemics. Adults are more likely to have encountered those viruses and developed immunity to them, and it may be that in some cases this immunity is enough to provide protection against swine flu. This is still a hypothesis, however, and researchers have not yet found evidence that there is crossover protection from immunity against previous strains of H1N1.
Meanwhile, fatality rates from this season's swine flu outbreak are so far lower than those observed during the 1918 pandemic but on par with those seen in the milder 1957 influenza pandemic. The new analysis puts these rates at around 0.4%, but the data are very preliminary.
Nevertheless, healthcare providers should be on alert for the upcoming flu season, Ferguson says. In a normal flu year, officials expect about 10% of the population to become sick, whereas Ferguson estimates that 30% of the population could become sick if the swine flu returns next season.
"This means that even if the virus is as mild as normal seasonal flu — and people die from seasonal flu every year — there will be a substantially greater burden on health systems," he says.
References
Fraser, C. et al. Science 10.1126/science.1176062 (2009).

kame · 发表于 2009-5-15 22:57:31

教育部要求所有学校全面实施晨检
2009年05月15日 03:45京华时报
昨天，教育部发出紧急通知，要求各级教育部门和各级各类学校进一步落实甲型H1N1流感防控措施，全面实施晨检，确保中考、高考工作顺利进行。

通知要求各地各校进一步完善本地本校甲型H1N1流感防控工作预案，特别是中考、高考期间的防控应对措施。要切实按照教育部、卫生部通知要求，确保各项防控措施落实到位。要把甲型H1N1流感防控知识作为当前一个时期学校宣传教育重点，通过形式多样、形象生动的宣传形式普及科学防控知识，教育并督促学生保持良好个人卫生习惯。

通知还强调,要加强疫情监测。要全面实施晨检，对缺勤的师生员工逐一进行登记，并查明缺勤的原因，发现流感样疫情要在2小时内报告当地疾控机构和教育部门。加强对寄宿制学校特别是农村寄宿制中小学校防控工作的指导，制定并落实防控措施和工作制度。对患有流感样症状的师生要劝其及时就医，并遵照医嘱进行医学观察。

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[分享] 甲型H1N1流感专题，网聚公卫人力量！

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