美国新冠病毒疫情公共卫生应对和临床指南，招募翻译

Epidemiology of First U.S. Cases
6 B. ]( ]# M( p2 Q! r/ s" IOn 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.
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, L$ @& G% L" z( l! ~美国首例病例的流行病学特征
2020年1月21日，美国报告了首例确诊的新冠病毒感染病例。截至到2月4日，一共对来自36个州、哥伦比亚特区和美属维京群岛的293名疑似患者（PUI）和密切接触者进行了流病调查和评估。应用疾控中心研制的RT-PCR（逆转录-聚合酶链反应）检测技术对这些人进行了检测，其中11人被确诊为新冠病毒感染者。11名确诊病例来自如下州：亚利桑那1例、加利福尼亚6例、伊利诺斯2例、马萨诸塞1例、华盛顿1例（见表）。9例是来自武汉的输入性病例。依赖与临床信息互通的公共卫生系统，这9例中的8例患者在就医时就被发现。2例（分别来自加利福尼亚和伊利诺斯）是另外2例确诊病例的密接者，他们是在对密接者的常规监测时被确诊的。所有患者的病情进展都在密切观察中，美国境内也没有死亡病例的报告。（之前我也翻译了一段，能给钢镚不？）

Epidemiology of First U.S. Cases
8 w/ h- b6 y- D6 p/ h2 NOn January 21, 2020, the first person in the United
/ f* j9 ]: t* K5 d' IStates with diagnosed 2019-nCoV infection was reported.
As of February 4, a total of 293 persons from 36 states, the
" ~$ t7 c6 M% p' ?0 eDistrict of Columbia, and the U.S. Virgin Islands were under
investigation based on current patient under investigation
Morbidity and Mortality Weekly Report
' f; T4 H% v9 }, ~$ t1 rUS Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / February 7, 2020 / Vol. 69 / No. 5 141
# s4 V9 o" m- ~' H6 Y(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)
7 S2 O% }2 j) L1 x5 T, V6 tassay developed by CDC. These 11 cases were diagnosed in
+ L& g* ?) b% f3 u" S2 ^) Ithe following states: Arizona (one), California (six), Illinois
: Z$ h& {) }- S/ {9 T4 U(two), Massachusetts (one), and Washington (one) (Table).
/ u3 ~0 h) E* s/ ^) A* LNine cases were in travelers from Wuhan. Eight of these nine
. ]# u+ ^+ B3 }9 c/ Hcases were identified as a result of patients seeking clinical care
for symptoms and clinicians connecting with the appropriate
# d! [- _! @6 P; g! H6 B7 Ypublic 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.
: Y: y4 Z# x5 a9 N7 d, N  DAll patients are being monitored closely for progressing illness.
- o  c4 r: x. [" X% R! }8 w" V7 XNo deaths have been reported in the United States.
美国首例病例的流行病学：2020年1月21日，美国第一人报告了诊断为2019例nCoV感染的州。截至2月4日，共有来自36个州的293人，属于哥伦比亚特区和美属维尔京群岛基于当前调查患者的调查（PUI）定义，也包括被评估的定义。因为他们是亲密的接触者。其中11个病人已经确认了2019例nCoV感染逆转录-聚合酶链反应（RT-PCR）CDC开发的分析。这11例被诊断的病例来自以下州：亚利桑那州（1），加利福尼亚州（6），伊利诺伊州（2），马萨诸塞州（1），华盛顿州（1）。9例来自武汉的旅客。对于公共卫生系统来说，九个中的八个病例的症状被确定为寻求临床治疗的患者，其中两个案例（加利福尼亚和伊利诺伊州）发生在两个确诊病例的密切接触中被诊断为病例接触者常规监测的一部分。所有病人都在密切监视病情进展。美国没有死亡报告。

Public Health Response
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.
公共卫生响应
, e+ v3 [' D* D2020年1月7日，美国CDC构建了应对新冠病毒事件管理体系。1月21日，为了优化、协调国内外新冠病毒应急工作，CDC启动了其应急行动中心。目前，CDC已经向美国司法管辖范围内出现病例的区域派驻了技术团队，并与各州和当地密切合作，协助其开展流调，识别监测密触者，并进一步获取这种新型病毒的疾病谱、传播情况和毒力等相关信息。从这些调查中获取的信息将为制定应对措施提供科学依据。美国CDC与包括来自中国在内的世界各地CDC人员一同密切监测着新冠病毒对全球的影响，并同其他各国以及WHO开展协作，包括派出工作人员与WHO一同开展工作，向受病毒影响的国家积极提供支援。此外，面对新冠病毒疫情的爆发，赴中旅行的风险持续加大，CDC针对武汉和中国其他地区颁布了旅客健康注意须知。1月27日，CDC向旅客发出了三级旅行禁令，以避免那些非必须的赴中旅行。

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. T: j5 [+ r$ J7 sU.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.
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位于美国18个主要入境口岸的美国检疫站，作为综合监管体系的一部分，其执法行为由《公共卫生服务法》第361节（美国法典第42卷，第264节）赋权。检疫站禁止传染病引入美国境内，以预防疾病传播。1月17日，依据现行的传染病应对规程，CDC检疫人员在美国3个主要机场（洛杉矶国际机场、纽约肯尼迪机场、旧金山国际机场）加强了对来自武汉（包括直飞和转机经停）的旅客健康检查，随后健康检查又扩大到亚特兰州大学机场和芝加哥奥黑尔国际机场。从中国武汉飞抵美国的所有旅客中，约有85%选择降落在这5座机场。美国海关及边境保卫局找到了来自武汉的旅客，并将他们送至CDC进行健康检查。来自武汉并伴有症状和体征（如发热、咳嗽或伴有呼吸困难）的旅客，都会由CDC公卫和医务人员对其进行全面的健康评估。所有来自武汉的旅客也同时收到了CDC发出的旅游健康预警注意须知（T-HAN），建议他们持续14天监测自己的健康状况，并说明了如果相关症状加重，该采取的措置。截至2020年2月1日，CDC共对437个航班的3099人进行了健康检查；并将5名有症状的旅客送至当地医疗机构，以便进行进一步的医疗评估，这5名旅客中已有1人新冠病毒检测呈阳性。（P.S. 今天翻了2段，剩下的明天再翻）

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，中国政府对包括武汉市在内的湖北省实行了交通封闭，导致进入美国的旅客减少，接受健康检查的人数也有所下降。有过中国旅行史成为一种越来越高的风险。为了应对这种风险，2020年1月31日颁布的总统令进一步完善了边境卫生策略。暂时限制旅客入境、进行额外的健康检查，或对过去14天内曾到过中国内地（不包括香港、澳门和台湾）的个体进行隔离。目前，对降落在11个机场的所有来自中国的旅客实行了这些强化的边检工作。

Laboratory and Diagnostic Support
Chinese 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.
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实验室和诊断支持
; U6 j* u4 h# ~2 J8 |中国卫生官员于2020年1月10日公布了2019-nCoV的完整基因组序列，以告知对这一突发冠状病毒的具体诊断检测方法的发展(1)。在一周之内，美国CDC开发了一种美国临床实验室改进修正案批准的实时RT-PCR检测，可以诊断来自临床标本的2019-nCoV呼吸道样本。1月24日，CDC公布了此次检测的检测方案(https://www.cdc.gov/coronavirus/2019-nCoV/lab/index.html)。在2020年1月4日，食品和药物管理局发布了紧急使用授权，使CDC的2019-nCoV实时RT-PCR诊断试剂能够紧急使用。到目前为止，这项检测仅限于CDC实验室使用。

2 Q. e& s# d$ L4 ^; X; L8 g) V$ R" WThis 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/ ). 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/). 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/) to assist research efforts.

+ B9 G' M2 N& t. B+ v" g该授权允许全国任何CDC认证的实验室能够使用该测试。CDC正在与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CDC的国际试剂资源(https://www.internationalreagentresource.org/)在国内和国际上快速共享这些检测。此外，CDC还将美国首次报告病例的病毒基因组上传到美国国家卫生研究院的公共DNA序列数据库GenBank (https://www.ncbi.nlm.nih.gov/genbank/)。CDC还进行病毒的细胞培养，这对进一步的研究是必要的，包括进一步的遗传特性鉴定。一旦分离成功，该病毒将通过BEI Resources(https://www.beiresources.org/)提供，以帮助研究工作。

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! M' ^3 |5 C- j6 ^' M4 i# [; }0 z$ pClinical and Infection Control Guidance
& J9 L4 h4 C/ q  X. r. Y; Y    Additional information about 2019-nCoV is needed to better understand transmission, disease severity, and risk to the general population. Although CDC and partners are actively learning about 2019-nCoV, initial CDC guidance is based on guidance for management and prevention of respiratory illnesses including influenza, MERS, and SARS. No vaccine or specific treatment for 2019-nCoV infection is currently available. At present, medical care for patients with 2019-nCoV is supportive.
, G2 {+ [7 \6 x& J1 E    On January 31, CDC published its third Health Advisory with interim guidance for clinicians and public health practitioners.††† In addition, CDC issued a Clinical Action Alert through its Clinician Outreach and Communication Activity network on January 31.§§§ Interim guidance for health care professionals is available at https://www.cdc.gov/coronavirus/ ... nical-criteria.html
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临床和感染控制指导
& i) G0 R, s  d% M. }" F( q3 E+ X3 R       需要更好地了解有关2019-nCoV的传播方式、疾病严重程度和对普通人群的风险的更多额外信息。尽管CDC及其合作伙伴正在积极学习2019-nCoV，但CDC的初步指导以流感、中东呼吸综合征和SARS等呼吸道疾病的管理和预防指导为基础。目前还没有针对2019-nCoV感染的疫苗或特定治疗。目前，2019-nCoV患者的医疗护理是支持性的。
" q: R* t3 S4 k$ M8 y4 h1 B       1月31日，CDC发布了第三份健康建议，为临床医生和公共卫生从业人员提供了临时指南。另外，CDC于1月31日通过其临床医师外展和交流活动网络发布了临床行动警报。卫生保健专业人员临时指南可在https://www.cdc.gov/coronavirus/ ... nical-criteria.html查阅。

Health care providers should identify patients who might have been exposed and who have signs or symptoms related to 2019-nCoV infection, isolate these patients, and inform public health departments. This includes obtaining a detailed travel history for patients being evaluated with fever and lower respiratory tract illness. Criteria to guide evaluation and testing of PUIs for 2019-nCoV include 1) fever or signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) in any person, including health care workers, who has had close contact¶¶¶ with a patient with laboratory-confirmed 2019-nCoV infection within 14 days of symptom onset; 2) fever and signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) in any person with a history of travel from Hubei Province, China, within 14 days of symptom onset; or 3) fever and signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) requiring hospitalization in any person with a history of travel from mainland China within 14 days of symptom onset. Additional nonhospitalized PUIs may be tested based on consultation with state and local public health officials. Clinicians should evaluate PUIs for other possible causes of illness (e.g., influenza and respiratory syncytial virus) as clinically indicated.
# M! F- W& Q! i# P医疗机构应该识别出那些可能被新冠病毒感染以及出现症状或体征的患者，对其进行隔离，并上报公共卫生部门。这也包括了获取发热患者和下呼吸道疾病患者的详细旅行史。新冠病毒感染的肺炎诊断标准：1）与实验室确诊病例有过密切接触后的14天之内，出现发热或下呼吸道疾病的症状或体征（如咳嗽或呼吸急促）的所有个体，包括医护人员。2）有过中国湖北省的旅行史，并在随后的14天之内出现发热或下呼吸道疾病的症状或体征（如咳嗽或呼吸急促）的所有个体。3）有过中国大陆旅行史，并在随后的14天之内出现发热或下呼吸道疾病的症状或体征（如咳嗽或呼吸急促），且需住院治疗的所有个体；不需住院治疗的，在与各州和地方公共卫生官员讨论后，可对其进行检测。临床医生应根据其临床表现，判断其病因是否由有他（如流感、呼吸道合胞病毒）。