H5N1?? (Influenza A (H5N1))

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

• ????
• ?????

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H5N1?? (Influenza A (H5N1))

• 93?12?29???????????????????????????,????????95?8?2
  9?????human infections with influenza
  A(H5N1)virus?????,??96?5?30???????H5N1???,????????
  ???????

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?????(Influenza)
??? ????? ??????(1997-HK??)
??? ?????(20??????)
???? ????????- ????(???????????????)
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????

• Type A B ? epidemics of disease
• Type C ? ???,?????
• ??(?Type A B ?????)????C???

• A??????????????
• B??
• C????

5
??????

• ?8?RNA??????(orthmyxovirus)??????????
• ??
• ??/??/??/????/????(HN)
• A/Moscow/10/99(H3N2)
• ????A?(H3N2)-1999???

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A?????????

• Hemagglutinin (H)??????Neuraminidase
  (N)??????????????
• H1-16 ???16?N1-9 ???9??????????????????

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??????

• A?H1-3?N1-2??
• ?????A(H1N1)?A(H3N2)
• B????

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?????

• ????
• ???? (1????)
• ????
• ??????3??
• ??????24?? ???7??????
• ???1-3?

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???(Avian Infueuza)

• Avian Flu(Bird Flu)
• ????A?????????????????????????
• ?????????????????,??????
• ?????????????
• A(H5N1)???????1961???????(??)?????

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???(Avian Infueuza)

• ????
• ????????????????,???????????H5?H7??????
• ????????????,?????????????????,???????????????,??
  ????????

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????

• ??
• 4? (?? 22 ?),30? (?? 0 ?)
• ??
• 56 ?/3??60 ?/30??100?/1??
• 70????????????????
• ????
• ???? (??????)
• ?????
• ??????
• ????????????????????????????,?H5?H7??

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????

• ???(Antigenic drift)
• ???????????????? (point mutation)
• ??????
• ???(Antigenic shift)
• ????????????,????????(reassortment)??????,????,???
  ??????
• ?????????,?????
• ?????????,???????

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?????(?????) -1

• 1997 Hong Kong-??????????
• 18???,6???(MR ? 33)
• ???????0.01
• A / Hong Kong / 156 / 97 H5N1
• ?????????????????
• ?????????????????(1-2 wks later)
• ??????5/29(17)????
• 3????150???,?????????????

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?????(?????) -2

• ??2003?2?,H7N7 84???,1???(conjunctivitis)
• ??????????H7N7???
• ??2003?12?,H5N1 2???,1???
• ??2004?1?,H5N1 10????????? ????????????? ?????

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??????????

• ??????????????????????????????,????,?????????????
  ??
• ???????????????1982???????H5N2??,????????????????
  ?????????????,?????????????????

16
???????????

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

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

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20????????
?20??,??A?????????????????,?????????????????(?10-4
0?????)
?? ???? ???? ??(???)
1918-19 191840 ????? "Spanish flu," A (H1N1) 50???? (5000??)
1957-58 195810 ????? (5?-?, 3?-?) "Asian flu," A (H2N2) 7??
1968-69 ????? (6?-?, 2?-?) " Hong Kong flu," A (H3N2) 3?4??
1968402008
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??? -- ????

• ??????(WHO)??,?(2008)???6?19???,????????????,?????
  ?????????????5?,?34?,??26?????????????(OIE)???,??
  ????????????,??22?444????

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Cumulative Number of Confirmed Human Cases of
Avian Influenza A/(H5N1) Reported to WHO
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?????-??

• 2004?12?29??????????????????????2004?2006???????0?
  ?
• 2004????5???(???????????????????)?8??????H5N2?????
  ????,??23????????????
• ?????????????????

21
??????????????

• ????3????????????????,?????????????

??????? ?????? ????
?????(Inter-pandemic) ???????,?????? ?????? 1
?????(Inter-pandemic) ???????,?????? ?????? 2
??????(Pandemic alert) ????????? ????????????????????? 3
??????(Pandemic alert) ????????? ???????????????? 4
??????(Pandemic alert) ????????? ??????????????? 5
???? (Pandemic) ??????????? 6
22
????????
?????????
????? 0 ?
?? ???????
0? ????H5?H7?????????? ? ???????????????????????
0? 1.?????????????????? 2.??????????????????
A1? ????????H5N1???????
A2? ???????????????????????H5N1???????
B? ????H5N1???????????
C? ????H5N1????????????????
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???????(Flu Pandemic)

• ????,?????,?????????,??????????????????
• ????????????????
• ??100?,??????1918?1957?1968?
• ????????,?H5N1?????????
• ????????????????????,????????

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

• I would like to end by drawing attention to
  the most serious known health threat the world is
  facing today, which is avian influenza.
• Address by the Director-General to the
• 58th World Health Assembly
• WHO??????????,????????????,????????
• ?????????,??????!

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???(Incubation period)

• ????????????(2?3?)??,?2??8??????
• ?????????7???????????????
• ?H5N1??????????,????????????

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????(Period of communicability)

• ?WHO??????H5N1?????????
• ??????(gt12?)???????????????????7?
• ??(lt12?)????????????????21?
• ???1?2???????????
• WHO??????????1???14??????????????????

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????????SARS??????
???? ????? SARS
??? H5N1?H7N2 H1?H2?H3?N1?N2 SARS CoV.
?? ???????????????????????????????????????(????????????)? ??????????? ???????????? ????38???????????????????????????????????????????????????X???????????
??? 5-9?,????????? 1-3?,????????? 3-10?,?????????????
???? ???????????????????????????? ???? ???????,??????????????????
?? ????? ???????-??? ???????-??? ??????????
?? ??? ???????? -????? -??? -????? ??? ???
???? 75?????? 75?????? 75??????
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????? SARS????

• ?????
• ??????????

• ??????
• ????????

• ?????SARS?????
• ?????????
• ???70??????????

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?????? (Flu-like Syndrome)

• ???????????
• ?????????????
• ??
• ??????????
• ??????????
• ?????????????
• ????????????

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????(Person under investigation)-1

• ?????????
• ??????????? ?????????????
• A.????(???
• ????)
• 1.??????????
• ??
• 2.??X????????

• ?????????(???????????)
• a.????,???(???38?C)??????
• b.??????????????????????
• c.?????????? ??????????

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????(Person under investigation)-2

• B.????????
• ???7???????????
• 1.??????(?????)?H5N1????????????????
• 2.???????H5N1??????????? ? ???????H5N1???????????,
  ?????????????????
• 3.????????????????
• ????????????????
• ??????????????????????????????????(?)????????????H
  5?????????

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????(Suspected H5N1 case)

• ??????,??????????,????????,
• ???????
• (?)?????????????????????(gt38?)??????????????
• (?)???
• 1. ???(suspected)???(probable)???(confirmed)
• ?H5N1??????????(??????,?????
• ????)?2. ????????????????H5N1?????????
• ??????,????(???????????????
• ????)?????????,?????????????3.
  ???????????????H5N1???????????
• ???,????????????4. ?????H5N1??????(????)?
  ?????5. ?????????,??????????,???????
• ?H5N1?????

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????(Probable H5N1 case)

• ???????????
• (?)?H5N1??????,???????? 1???X???????????????,
• ????????(???????)? 2????????A???,????????
  ?
• H5N1???
• (?)?H5N1???????????,??????
• ?????????????????????
• ???????

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????(Confirmed H5N1 case)

• ?H5N1???????????,????????
• ?????,??????????????
• (?)???H5N1????
• (?)H5???????(PCR)?????????
• ???????????(??A????H5
• HA?????)
• (?)???(??7??)?????H5N1?????
• ??????4????,??????????
• ?180
• (?)??14????????????H5N1???
• (microneutralization)?????180,??
• ????????????(???????
• ???????1160?H5??????????
• ???????)?

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????
????
??????????????
????????????
???? ????
???? ???? ????
????? ????????
????
????
36
????????

• ????
• ????
• ????
• ????
• ????
• ?????
• ????
• ????

• ????
• ????
• ????
• ??
• ??
• ??
• ??
• ????
• ??????
• ????

37
????

• ????
• ????
• ??????
• ???????
• ????

• ????
• ????
• ????
• ????
• ??????
• ???????

38
????

• ?????????
• (1)????????????????,????
• ????(2)??????????????,??????
• ?????????????????????
• ??,??????????????????(3)H5N1????????,?????
  ????
• ??,??,???????????????
• ??????????,?????????
• ??

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????

• ?????????????
• (1)????????? a.?????????????????????,??
• ?????,?????????,????????
• ?????????,???????????,??
• ?????????? b.???????????,????,??????
  9
• 12???,???????????????(???
• ???????????????,????????
• ????????) c.????(38C),???????????,
  ???
• ??,?119??????????????H5N1???
• ?,??????????? d.?????,??????????????
  ?????
• ????

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????

• ?????????????
• (2)???????,????????????
• (3)H5N1???????????????????
• ???????,??????
• (4)??????????,??????????
• (5)???????????????,?????
• ???????????????????
• ????????KTV?????

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????

• ????
• ???????19????A/H5N1?????,??9?5????,?????????????
  ????????????????????

42
????

• ???????????
• ??WHO?????????
• ???????,????????????
• ????????,??????
• ???3??,??????

43
????

• ?????
• 1. ?????????
• ?????A????????
• ??Amantadine?Rimantadine
• ?B?????????
• ???????????,????????
• 2.???????(neuraminidase inhibitor)
• ????????????
• ???????????
• ??????Zanamivir(Relenza, GSK)?
• Ostelmivir(Tamiflu, Roche)
• ?????A?B???,?????????
• Relenza????
• Ostelmivir??????,????????(???
• ????)

44
????

• ?????
• ? ????? --
• ???????H5N1????????
• ? ?????
• ? ????????????????????
• ?????
• ? ????????????????????
• ?,??????????????????
• ????,???????????
• ? ???????????,?????????
• ???????

45
??????????????

• ???????,????????????????????????????????(???)???
  ,?????????H5N1???????????
• ???????????H5N1??????????????????????,???????????
  ???????????????????

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

• ??
• (1)??????H5N1???????,????
• ??????????/??(???????
• ??????????)?(2)???????(??????)?????
• ????????????????????
• ??(3)???????70???????????
• ????????????????????
• ????????????,??????70
• ??????????????????

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

• ???????????????????????,??????,??
  38??,?????,??????????,????????,??????????????,???
  ????????
• ???????????????????????????????????,?????????????
  ?,?????????
• ?????????
• ?????????48???,?????????????,????????????????????
  ?????????????????????

48
??????

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

49
????

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

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??H5N1???????????

• ??????
• (?)???????????,????????
• ???????????
• (?)?????????????,??????
• ????? (PPE)?
• (?)?????????????,?????
• ????????????,???????
• ??????????
• (?)??????????????,????
• ?, ????????????????
• (?)??????,?????????
• (?)???????????
• (?)??????

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??H5N1???????????

• ??????????????
• (?)?????????????????
• ????
• (?)??????,??
• 1.????????
• 2.????????
• 3.????????
• ???????????????,??????????????????

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??H5N1???????????

• ?????? (standard precautions)
• ???????????????,?????????????,??
• (?)???
• (?)????????????????,
• ???????? (PPE)?
• (?)?????????????????
• (?)???????
• (?)?????????????????

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??H5N1???????????

• WHO????
• ???????????????,????????H5N1????,??????????????,??
  ?????????(?)????????????????????????(????????(????
  ???????))??????,?????????????
• ??????????????????????????H5N1????,??????????????(
  aerosol-generating procedure)?????????,???????????
  ???(???????????,???????)?
• ??????????????????????(?)????????,????H5N1????????
  ??????????????????(?????1??????????????????,??????
  ?)???????,?????????????

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??H5N1???????????

• ??????????????
• ??????????????(??????)?
• ???????????????
• ????????????
• ?????????? (?????????????)

55
?????????
????? ??????????????????
?????????????????????
?????,????????????????????????????
???(???)???(?)??????????????(??)????????????????
????
56
?????????
????? ??????????????????
?????????????????????????????????????????(?????
????)???????????????????
??
57
? ? ? ?

• ?????????????????
• ??,?????????????????????????????????????
  ?,
• 56???3 ???60???30???
• 100???1??????,????
• ?????????????????????????
• ???????????????????????,????
• ?,???,?????????

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Thank you