Just-in-Time Lecture ?????????: ?????? ???? ??????

1
Just-in-Time Lecture????????? ?????? ???? ??????
??????? ???? ?????? MD,MPH ? ???????????????
????? ? ??????? ??????? ???? ????? ????? ?
?????? ????????? ????? ??? ??????? ??????? ????
??????? 410-502-3116 rchotani_at_jhsph.edu
??????? ???? ?????? ???? ??? ??????? ???? ?????
??????? ?????? ??? ????? ????? ????? ? ?????
?????????? ??????? ??????? ???????? ??????? ????
????? ?????
2
????? ?????????

• 1) ?? ???
• A, B, C
• 2) ???? ?? ????
• H (???????????)
• N (???????????)
• 3) ?????????? ??? A ?? ???? ???? ????
• H3N2, H1N1 (???? ??????)
• H7N7 (??????? 2003? ????)
• H5N2 (????? ???????)
• H9N2 (????? ?????? ?? ??? ????? SAR ??? 2003)
• H5N1 (Strain ????? ????? ??? ????)

Credit L. Stammard, 1995
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?????? ?????????
4
?????? ??? ????? ????? ?????????
??? ???? ??? ????????
??? ???? ???????????
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A(H1N1) ?????????? ????????? 1918 -19

• ?? ?? ??????? ?? ??
• ?????? 19-1918
• ??????? ???? ?????? ???.
• ?? ?????? ???? ??????
• 20?????? ? ?? ??????
• ????? 500 ???? ???
• ??? ??? ?? ?? ??? ?????.

6
?????? ???? 1918
7
?????? ????? ?? ?????? ????????? - 1918 ???? ???
????? ? ?????
8
A(H2N2)?????????? ?????? A(H2N2)
?? ???? ??????? ?? ????????? ??????? ??????
59-1957 ?? ?????? ?????????? ????? ?? ??? ?????
???? ???? ?? ??? ???? ????? ??? ?? 1 ?????? ???
?? ????? ???? ? 70 ???? ??? ?? ?????? ????? ???
??????.
9
???????????????? H2N2 ??? 1957 ??????????
??????
10
?????????? ??? ??? A(H3N2)69-1968
????? ???? ??? ??? ?? ?? ????? ???? ???????
??? ?? ???? ?????? ?? ?????? ????????? ????????
???. ?????????? ??? ??? 69-1968 ??? ??
1 ?????? ?? ????? ???? ? 34 ???? ??? ?? ??????
????? ?? ?? ??? ?? ????.
11
?????? ??? ?????????? ??? ???
10 ????? ?? ??????? ??????!
1) ?????? 2) ?????? ??????? 3) ??????
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??????

• ?????? ?? ????/???? ??????? ?? ?? ?????
• ?????? - ?????? ?? ??? ????
• ?????? ???? ???
• ??????? ?? ????????? ?????? ?????? ? ??? ??????
• ???? ??????? ?????? ?????
• ???? ???? ???
• ??????? ?? ??????? ?? ???? ???????? ??????
• ?? ???? ???????? ???????? ????? ?? ??? ?? ??
  ????? ?????? ???? ???? ??? ????.

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???????? ?? ?????
????? ??? ???? ?????
WHO/WPRO ????
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???????? (?? ???)
????? ??? ???? ?????
WHO/WPRO ????
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?? ??????? ?? ?????
????? ??? ???? ?????

• ??? ???? SAR ????
• 1997 H5N1
• ??? ???? SAR ????
• 1999H9N2
• ???? 2003 ? H7N7
• ??? ????SAR ????
• 2003 ? H5N1

WHO/WPRO ????
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????? ???????
?????? ???? ???? ???
???????? ????? ???????
???????? ?? ?????
????? ?????
????? ???????
??? ???? ?????? ????? ?????????
???????? ?? ???
???????? ????? ?????? ??????? - ?????
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??? ?? ?????
WHO/WPRO ????
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A(H5N1), ?????????? ??????? 1998
?????????? A (H5N1) ??????? ???? 18 ????
????????? ????? ?? 6 ??? ?? ????? ??? ??? ??.
??????? ??????? ?? ???? ??? ????? ???? ??? ????
?? ?????? ????? ?????? ????? ?? ????? ???
????. C. Goldsmith and J. Katz. ????
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????? ?????????? ???????
Home to roost cormorants crowd the treetops at
the Mai Po marshes nature reserve. Experts are
beginning tests on birds attracted to the marshes
to find out whether they could be spreading the
bird flu virus. Picture by Oliver Tsang
??????? ?? ?????? ?????? ??? ???????? ??????
??????
??????? ??????? ?? ????? ??????? ?? ????? H5N1
?? ????? ??? ????? ??? ?? ???????? ?? ?????
???? ??? ???.
20
????? ?????????? ??????? ????? ?? ????
???? ?????
???? ???? ???????
???? ????? ??? ????? ?????????? ??????? ???
???? ?? ????? ????? ??? ? ??? ?? ??????????? ??
???? ????? ??? ??? ???? ????? ?? ??????? ??
??????? ?? ????? ????? ??? ???.
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(No Transcript)
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H5N1 ??? ?????? ??????????
- ????? ??????? ?? 9 ???? - 34 ????? ?????? ? 23
???? ??? ( 68 ) -??? ????gt 100 ?????? ????
?????? ??????? ?? ??? ??? - 18???? ??????
?????? ? 6 ???? ???(33) - ??? ???? ???????
- ????? ??????? ?? 4 ???? - 7 ???? ?????? ?
6 ??? ( 86 ) - ????? ?? ????? ??
????? ????? H5N1 ???????
2003
2004
1997
1998
1999
2000
2001
2002
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(No Transcript)
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(No Transcript)
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(No Transcript)
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(No Transcript)
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????? ???? ?????????? ?????? ? ????? ?????? ?????
?? ????? ??? ???? H5
???? ??????? ????? http//europa.eu.int/comm/hea
lth/ph_threats/com/Influenza/ai_current_en.htm
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????? ????? ????? ?????? ????? ??? ??????????
??????? A/(H5N1) ?? 26 ?????? 2003 ?? 9 ??????
2006
WHO ????
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????? ????? ????? ????? ??? ?????????? ??????
A/(H5N1) ?? 26 ?????? 2003 ?? 10 ????? 2006
WHO????
30
????? ???? ?????????? ??????? ? ????? ??????
????? ?? ????? ??? ???? H5
????? ????? ????? ?????? A/H5N1 ?? 8 ?????? 2005
?????? ?????? ?????? ???????
???????
????
???? ??????? ????? http//europa.eu.int/comm/hea
lth/ph_threats/com/Influenza/ai_current_en.htm
31
????? ????????? ( ??? ??? ?????? ) ?? ??? ????
???? ??????? ????? http//europa.eu.int/comm/heal
th/ph_threats/com/Influenza/images/influenza.jpg
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????? ?????? ? ?????? ??? ?????? 2005-2003
???? ??????? ????? http//europa.eu.int/comm/heal
th/ph_threats/com/Influenza/ai_recent_en.htm
33
????? ??????? ? ???????? ?????????? ??????? ??
???? (??3/2/ 2004)
34
?????? ??????? HPAI ?? ?????? ???? ???? ??????
???????
35
????? ???? ????? ?????????
???? WHO?????? ????? ?????????
36
????? ?????? ?????????

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

??????? ????? 2??? _360 ???????
?????
???? ?????? ? ????? ?????? 1?? 2 ??? ??
???? ????????? ????? 1?? 2 ???
???? WHO?????? ????? ?????????
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Key bottlenecks

• ???? ????
• ??????????? ?????
• ????? ????? ??? ???
• ????? ????????
• 3.???? ??? ?????? ??? ??????
• ?????? ?? ????? ??????.

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

• ......
• ......

???? WHO?????? ????? ?????????
38
????? ????? ?????
70 ????? ?? ????? ?? ????? ??? (5 ?????? ). 50
?? ??????? ?? ???? ?? ????? ???? ?? ???.
???? WHO?????? ????? ?????????
39
???? ????? - 2000
???? WHO?????? ????? ?????????
40
???? ??????

• ???? ???? ????? ?? ???? ????
• ????????? ( ?????? )
• ????????? ( ???????? )
• ???? ????? ??? ??? ????????
• ????????? ( Relenz)
• ?????? ????? 2.8 ?????? ???? ??????? ????? ( ??
  ????? 84300 ??? ?? ????? ???. )
• (Tamiflu) Oseltamivir
• Peramivir (??????? ?? ????????? ???? ???)

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?????

• ?????? ???? September 16, 2005 HHS
• ?????? ????? 100 ?????? ????? ??????? ?? ???!
• ????? ???? FDA ????? ???!
• ??? ???? ???? ??!
• ?????? ???? 2??20 ?????? ????????!

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• ??? ????
• ???????
• ???????
• ??????????? ?? ?? ?????????? ?? ????
• ????? ????? H5N1
• ????? ???? ???? ???????

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(No Transcript)
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(No Transcript)
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????? ????? ????? WHO ?? ?????? ?????????
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?????? ????

• ??????? ??????? ?????? ???? (CDC)
• 2 ?? 7.4 ?????? ??? ?? ????
• ?? ???? ??? ???????
• 134 ?? 233 ?????? ????? ?????? ????? ?? ????.
• 1.5 ?? 2.5 ?????? ?????
• 25 ?????? ?? ???? ?? ?????? ICU? ?????? ?????
  ?????? ?...

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?????

• ????? ????? ????? ?? ??? ????????? ?? ???????
  ????? ?? ?????? ???? ???? ????? ????? ?????
  ????.
• ????? ????? ?????? ?? ??????? ??????? ???? ?????
  ??? ????? ????.
• ???? ???? ?? ????? ???? ? ???? ??????? ??????
  ?????? ???? ?????? ???? ???.

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???? ??? ??? ?? ?? ?????? ???? ???? ?? ???????
???????? ??? ??? ?? ????? ???? ??? ??? ??? ??
????? ??? !!!
??? ???? ?????? ???? ?? ????? !!
?? ???? ???? ??? ???? ????? ???? ????? ????.
We have to prepare for the next pandemic!!!
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IL BIOSCUDO (The Bio-shield) Daniore, Chotani et
al.