H1N1 ???? Swine-origin Influenza A (H1N1) Virus (S-OIV)

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H1N1 ????Swine-origin Influenza A (H1N1) Virus
(S-OIV)

• ????
• ???

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????H1N1??????- 8 May 2009
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Update to 8 May 2009 1200
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• ????(Influenza virus)
• ???(Human influenza) H1-3
• ???(Avian influenza) H1-15
• ???(Swine influenza) H1,H3
• ????(Novel influenza)
• ?????(Flu Pandemic)

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H1N1????

• H1N1???? (98.04.27)
• ????????
• ?H1N1?????,?????????????????
• ???????????
• ????????????????????,?????????????? ????????
• ?????????,???????
• ?? ?????????,?????????

???????????
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Triple reassortants
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Novel H1N1 Influenza A Triple reassortants
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????????

• ??????????????
• ??????????1?????7??????,??????????,???????????????
  ?
• ??????????????????

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H1N1???????
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Signs and symptoms

• Similar to the symptoms of regular human seasonal
  influenza- fever, lethargy, lack of appetite and
  cough- runny nose, sore throat, - nausea,
  vomiting and diarrhea (some)
• Severe illness - pneumonia- respiratory failure
  and deaths
• May cause a worsening of underlying chronic
  medical conditions

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http//www.cdc.gov/swineflu/key_facts.htm
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Characteristics and Symptoms of the 642 Patients
with Confirmed Swine-Origin Influenza A (H1N1)
Novel Swine-Origin Influenza A (H1N1) Virus
Investigation Team. N Engl J Med
200910.1056/NEJMoa0903810 Published at
www.nejm.org May 7, 2009
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????????????????????
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(No Transcript)
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WHO????
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?????????
??????2009.05.08
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(No Transcript)
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H1N1?????????
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H1N1????????

• ????(Person under investigation)
• ??????????????
• ????(Clinical criteria)
• ???????????(Acute febrile respiratory
  illness)(??????38?),???????????????(influenza-like
  illness)????????(pneumonia)??
• ??????(Epidemiology criteria)
• ?????????
• ???????????????????(close contact),???????????????
  ??????????????
• ?????????????????????

??????,?????????????????????????
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H1N1????????

• ????(Confirmed case)
• ???????????
• ?????(Probable case)
• ??????,?????????A ???,????????????????????????????
  ?????,?????????????
• ?????,???????????????????

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H1N1????

• ????(Laboratory criteria)
• ???????,??H1N1 ????????,?????????????
• 1.real-time RT-PCR
• 2.????
• 3.H1N1 ??????????4 ???
• ???????????????????? ?

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H1N1???????????-1
????????? ????????
1.?????????????? 2.?????????????
?????? ??????
??
??
??????? ???????
Yes
NO
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H1N1???????????-2
??? ???
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H1N1???????????-3
??????????
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H1N1????????????????
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H1N1????????????
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(No Transcript)
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???????

• ?????Influenza ??,????????????,?????????PPE
• ?????????N95 ????????(??)

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??????

• ?????????????
• ????8002200?????
• ????6?? - 2?
• ??????1230?1800??????
• ??????900?1500(????????)
• ????
• Rapid test (-) ? ???PCR??
• Rapid test () ???PCR?culture??
• ?????????(??standard)

??????? H1N1???????? real-time RT-PCR
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????????(BSL-3)???
?????? ( Real-Time PCR ??)
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????????
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??????????????

• ????????????????
• ????????????????,????????????
• ?????,???????????????????????????????????????

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????????
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??? ?????????

• ???????????????????(????38?)?????
• ????? ?????????????????,??Tamiflu?Relenza
• ????38??????,???????????????
• ?????48 ????????????

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?????????

• Viruses from 64 patients have been tested for
  resistance.
• All tested viruses are resistant to amantadine
  and rimantadine but susceptible to oseltamivir
  and zanamivir.
• ????36?????? oseltamivir and zanamivir?????,
  ?????

MMWR Dispatch April 28, 2009 / Vol. 58
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US CDCAntiviral Treatment ?????????
(April 26, 2009??????? )

• Suspected cases ????
• Empiric antiviral treatment is recommended for
  any ill person suspected cases- zanamivir
  (Relenza) alone- oseltamivir (Tamiflu) and
  amantadine or rimantadine
• should be initiated as soon as possible after the
  onset of symptoms (within 48hrs)
• Confirmed cases ????- either oseltamivir or
  zanamivir for 5 days
• Recommended duration of treatment 5 days
• Pregnancy Category C

???rimantadine
CDC Interim Guidance on Antiviral
Recommendations for Patients with Confirmed or
Suspected Swine Influenza A (H1N1) Virus
Infection and Close Contacts
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High-risk groups ?????

• Children younger than 5 years old. The risk for
  severe complications from seasonal influenza is
  highest among children younger than 2 years old.
• Adults 65 years of age and older.
• Persons with the following conditions
• Chronic pulmonary (including asthma),
  cardiovascular (except hypertension), renal,
  hepatic, hematological (including sickle cell
  disease), neurologic, neuromuscular, or metabolic
  disorders (including diabetes mellitus)
• Immunosuppression, including that caused by
  medications or by HIV
• Pregnant women
• Persons younger than 19 years of age who are
  receiving long-term aspirin therapy
• Residents of nursing homes and other chronic-care
  facilities.

CDC Interim Guidance on Antiviral
Recommendations for Patients with Confirmed or
Suspected Swine Influenza A (H1N1) Virus
Infection and Close Contacts
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Anti-influenza and fetus-1

• ???(Tamiflu)????(Relenza)???????????FDA???Pregnanc
  y Category C ???
• Tamiflu Relenza?????????????, ?adverse
  events,?????????????????
• ???????,?61????????????,???????????,??????????????
  ????,??????????
• ?????,?????????????,????????,????????,??????

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Anti-influenza and fetus-2

• ??????Tamiflu, ?????? ??????Relenza,
  ???????????, ???????????????
• Antiviral medication treatment or prophylaxis is
  not a contraindication for breastfeeding
• Swine flu ?????????, ????
• However, reports of viremia with seasonal
  influenza infection are rare

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???(Relenza)???
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H1N1???????????
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H1N1???????????????

• ????????44?,???????????????????????
• ?????????,?????????????,??????????
• ?????????????????

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?????????????????

• ?????????????7 ????,????7 ?????,????????????????

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?? ???????,?????????????,???????,?? ?????,????????
??/?????,???????,?? ??????????? ??
???????????????????????,???????????????
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??????????7 ??,???/??????????????????(?????),?????
?????/?? ?? ????????7 ??,????????,????( 38C
)?????????,???????,????????/?,??????????
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??????H1N1???????????
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?????????H1N1?????????????

• ??????????????????????????????????
• ???????????7??(????????????),???????????????,?????
  ????????????????????,???????????????????
• ?????????????,????????????,?????????????,?????????
  ?,??????

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?????????H1N1?????????????

• ??????????,?????????,????????????????????????????
  
• ????????????????????,???????????????(???????,?????
  6-12?,???????HEPA??)?
• ??????????????????????????????????????????????????
  ???????????????????????????????????????????????,??
  ?????????,????????N95??,???????????????????

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?????????H1N1?????????????

• ?????????(aerosol)????(??????????????????????????
  ??????????????????),?????????????N95??
• ?????????????,????????H1N1???????????,???????????
  ????????N95??

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?????????H1N1?????????????

• ???????????????
• ???????,????????/????(???????????????/?,??????????
  ????,?????????????????????????)?

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???????????????????????97?8?8??100?7?31?
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H1N1??????????????????????
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?????H1N1????,??????????????