???????(Orthomyxoviridae)

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?????????

• ?????
• ?????????????

2
????????
?? (Influenza, Flu) ???? (Common Cold)
??? ??A?B?C?? ????????? ?200?????????????????????????????????????
?????? 1-3???12? ?1??????
???? ??????????? ????? ?????????? ?????
??? ????????????????????????????? ???????
???? ????????????? ???,?????
3
???????

• ???????(Orthomyxoviridae)
• A?B?C??- based on nuclear material
• ???(nucleoproteinNP)
• ????(matrix proteinM)
• ?????2????
• ??????(hemagglutininHA)
• ?????(neuraminidaseNA)

Matrix protein (eg. M1, M2)
HA
NA
Lipid bilayer
80-120 nm
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????????????
A ?/???/?????/???? (H?N??)
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??????
2008 ?????????????????004???????????
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????????????????
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H1N1
???????
H5N1, H1N1
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????????
???? ????,?????????
??? ???14?,???2??
???? ????,??????????35?,??????710?? ?????????2
448?????????,????, ???????????2472?? ???????,
????????????????? ??????????,????,????,????21??
10
??????8?????
???? ?? ???? ???????? ?? ???? ????3 ??? ???
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??????
?????????????,?????????? , ?????????????
1.?????(Pulmonary complications)
2.???????(Neurological complications)
3.???(Myocarditis)?????(Pericarditis)
4.???????(Invasive bacterial infection)
5.???????1-4?????,????? ??????????
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????????????H1N1???
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?????????(Pandemic)
??? (H5N1), 18 ????
1997-8
1980
?? H1N1, H3N2, B ????
1977
Russian ?? (H1N1) ???
1968
"Hong Kong ??" (H3N2) ??33,000?
1956
Asian ?? (H2N2) 1?????
1918
Spanish ?? (H1N1) ?? 24 ?????
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??(Flu)???

• ?????????? ?????????
• ?????????????????????
• ???????
• 1.???????? ??
• 2.?????????????? ??
• 3.????????????????????4X???
• 4.?????????? ??
• sensitivity 31-69
• specificity 99

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?????????????
17
??????update9 ?10 ?
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??????????????????
19
??????????????????
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WHO FLU-NET ?????????
2009.6
H1N1???? ???????????,????????????2009-06-17
???????????,??????????????????2009-06-19
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The WHO Phase of Pandemic Alert
2009.6.11 phase 6
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??????????????H1N1???
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• Hemagglutinin (HA)- binding to cell-surface
  sialic acid receptors
• Neuraminidase (NA)- cleaves sialic acid from the
  cell membrane allowing viral escape

Chapter 39, Figure 5
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????????

• Zanamivir (Relenza)???
• ???5?(?)???????,?????,????10mg,????,?5??(???????
  ?)
• Oseltamivir (Tamiflu)???
• ???13?(?)?????,?????75mg,????,?5????13???,???????
  ??

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

• ???(Tamiflu)????(Relenza)???????????FDA?????????
  C ???
• ???????,?61????????????,???????????,??????????????
  ????,??????????
• ?????,?????????????,????????,????????,??????
• ??????Tamiflu, ??????
• ??????Relenza, ???????????
• ?????(Tamiflu)????(Relenza),??????

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?????????

• ??????????H1N1????? ???
• ?????????,?????????
• ??????, ??????? (60? ?) ??????
• ???????? ???????

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

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

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??????

• ???
• ?????????95 ,?? 3?95???1??,??????71.25,
  ??70?????????????
• ???? (???????)
• ????????5?????1100???0.05?500ppm??

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????
?????? ???,?????,??????? ?????,??????????????
? ?????????????(??A????B?)
???????????????????,? 2007/2008????????,??????
A/Solomon Islands/3/2006 (H1N1)-like virus
A/Wisconsin/67/2005 (H3N2)-like virus
B/Malaysia/2506/2004-like virus
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???????????????

1. ?????????,??????????????
2. ?????????,???????????????,?????????(2A1B),????????
   ???
3. ???????????
4. ?????????
5. ????????
6. ???????
7. ?????

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????????????
?????
????
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2007 2010 Flu vaccine ????

• 20072008 season
• A/Wisconsin/67/2005(H3N2)-like
• A/Solomon Islands/3/2006 (H1N1)-like, and
• B/Malaysia/2506/2004-like

• 20082009 season
• A/Brisbane/59/2007 (H1N1)-like
• A/Brisbane/10/2007 (H3N2)-like
• and B/Florida /4/2006-like

• 20092010 season
• A/Brisbane/59/2007 (H1N1)-like
• A/Brisbane/10/2007 (H3N2)-like
• and B/Florida /4/2006-like

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

• ?A/California/04/2009???????????
• 79??????????????,???????????????
• ?????????(2005?2009??????)??,??????????????????
• ???,?????????,?67-100???????
• ????????????3-19????????????????????????
• ???????????,???????????????????????

MMWR May 22, 2009 / 58(19)521-524
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????????????????
1)????????? 2)?? 3)1-6??????? 4)7???????? 5)7-12??
??? 6)13-15???? 7)16-18???? 8)19-24??? 9)25???????
????????????????????? 10)25-49?????? 11)50-64?????
? 12)65????? ???????,????????????????????
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????

• H1N1 ??????SARS??????????
• ?????????????????????,?????????????????
• A?????????H1N1??????
• ????H1N1 ???????????????????????
• ???????H1N1 ???????? ?????????????????????????
• ??????? ?????????????

???????????????????
39
Thank You For Your Attention