人感染高致病性禽流感的流行与预防

人感染高致病性禽流行性感冒（human infections with highly pathogenic avian influenza）简称人禽流感,是指人感染甲型禽流感病毒（avian influenza virus,AIV）某些亚型的毒株引起的急性呼吸道传染病。1997年5月,我国香港特别行政区1例3岁儿童死于不明原因的多脏器功能衰竭,同年8月经美国疾病预防和控制中心以及世界卫生组织（WHO）荷兰鹿特丹国家流感中心鉴定为禽甲型流感病毒H5N1引起的人类流感,这是世界上首次证实禽甲型流感病毒H5N1感染人类。     

成功救治人感染高致病性禽流感1例报告

1病例报告 患者,女,21岁,因发热、咳嗽咳痰6d,于2009年1月29日入院。2009年1月4日,患者家中鸡鸭陆续不明原因死亡,1月21日处理了3只死禽内脏。1月23日患者突然发热,体温383℃,最高40．6℃,同时出现全身乏力、肌肉酸痛,继而开始咳嗽,咳黄色粘痰,体温高时感呼吸稍困难,无畏寒、寒战,无恶心、呕吐。     

人感染高致病性禽流感的进展

人感染高致病性禽流感(简称"人禽流感")即人类在接触该病毒感染的病/死禽或暴露在被A(H5N1)污染的环境后发生的感染[1]。2011年12月20日香港将禽流感预警级别由戒备应变级别调至严重应变级别,2011年12月30日深圳报道1例确诊甲型H5N1禽流感死亡病例。一时间,禽流感再次进入人们的视野,距离1997年香港禽流感爆发已经15     

成功救治贵州省首例人感染高致病性禽流感报告

1 病例报告 患者,男,29岁,平素体健,2009年1月9日曾到市场购买鸭子1只,并亲自宰杀。2009年1月15日患者出现畏寒、发热,体温高达393℃,无鼻塞、流涕及咽痛,无咳嗽、咳痰及胸痛,无恶心、呕吐及腹泻,无头痛、抽搐及意识障碍。     

H5N1高致病性禽流感病毒研究进展

流行性感冒病毒属正粘病毒科,根据内部核蛋白（NP）和基质蛋白（MP）抗原性的不同,将流感病毒分为A型、B型和c型3型。A型流感病毒的基因组是由8个分节段的单负链RNA组成,编码11种蛋白质,表面糖蛋白为HA和NA,根据HA和NA的抗原差异分为16种HA亚型（H1一H16）和9种NA亚型（N1～N9）。     

1例2岁儿童人感染高致病性禽流感病例的成功救治

1病例报告 患儿,女,2岁,于2009年1月7日出现间断发热,体温最高达38℃,于1月12日出现阵发性干咳,伴乏力,纳差。患儿发病前与其母亲均有活禽市场暴露史,其母亲于1周前死于“重症肺炎”并“急性呼吸窘迫综合征”（acuterespiratory distress syndrome,ARDS）。     

江西省首例高致病性H5N1人禽流感临床特点分析

目的了解高致病性H5N1人禽流感病例的临床表现、实验室检查、影像学特征、治疗及其预后。方法对2005年12月在江西省遂川县人民医院收治的1例高致病性H5N1人禽流感的临床表现、实验室检查、心电图、影像学改变、病理变化和治疗等多方面的资料进行总结。结果患者经逆转录-聚合酶链反应（RT-PCR）、实时荧光定量PCR（real-time PCR）方法和病毒分离确诊为高致病性H5N1人禽流感病例。患者发病前有禽流感环境暴露史，以发热、畏寒起病，伴流感样症状，继之出现咳嗽、咳脓痰和脓血痰，病情进行性加重，出现腹泻和呼吸困难，伴外周血白细胞和淋巴细胞明显降低、大量尿蛋白、肝功能和心肌酶谱明显异常及血清白蛋白明显降低。发病第6天后痰培养多次发现耐苯唑西林肺炎球菌，在病情明显加重后，痰培养出现其他细菌和真菌。发病初期（第5天）胸部影像学可见右肺中下高密度病灶，继之迅速发展至双肺，出现急性呼吸窘迫综合征（ARDS）样肺部表现。经抗病毒、抗细菌、抗真菌、糖皮质激素和对症治疗未见好转，于发病后第27天死于感染性休克和多器官功能衰竭。病理表现为双肺弥漫性肺泡损伤合并感染，继发弥漫性血管内凝血（DIC）；淋巴组织中淋巴细胞明显减少，组织细胞增生；心肌水肿、空泡变性；肾小管广泛坏死。结论高致病性H5N1人禽流感患者病变进展为ARDS合并多器官功能损害时。预后不佳。     

北京市首例人感染高致病性禽流感患者院内感染的预防

截至2009年3月30日,世界卫生组织公布的2003年以来全球实验室确诊的人感染H5N1亚型禽流感病毒患者413例,死亡256例,病死率超过60％,由于人类对H5N1亚型禽流感病毒普遍缺乏免疫力,感染后病死率较高,WHO认为此病可能是使人类存在潜在威胁最大的疾病之一。为提高广大护理人员对此病的认识,减少护理人员感染此病的可能性,现将北京市2009年1月确认的首例禽流感患者预防院内感染护理措施报告如下。     

Response to avian influenza and preparedness for pandemic influenza: Thailand's experience

Thailand has been struggling to control and prevent H5N1 avian influenza on both the animal health and public health fronts. Prevention and control programs for animals and humans are improving, with infections in poultry currently under control and no human cases seen in 2007. In awareness of the risk of an influenza pandemic, Thailand is joining global efforts in pandemic influenza preparedness. The national preparedness plan highlights building of national capacity for self-reliance and regional/international cooperation. Public health response to avian influenza and pandemic preparedness benefit significantly from the experience of responses to severe acute respiratory syndrome. This underlines the need to strengthen infrastructure and manpower, ensure public confidence and cooperation, secure maximum government advocacy and support, and forge multi-sector and international cooperation.     

Risk factors for highly pathogenic avian influenza (HPAI) H5N1 infection in backyard chicken farms, Thailand

To reduce the risk of highly pathogenic avian influenza (HPAI) H5N1 infection in humans, the pathways by which HPAI is spread in poultry must be determined. Backyard poultry farmers are particularly vulnerable to the threat of HPAI, with both their health and livelihoods at risk. Identifying the risk factors for HPAI infection in backyard farms should allow control measures to be better targeted. To study the risk factors of HPAI H5N1 infection, we carried out a case-control study on backyard chicken farms in Thailand, analyzing 104 case farms and 382 control farms. Data on farming practices and environmental characteristics were analyzed using multivariate logistic regression models. We show that farms where owners bought live chickens from another backyard farm had a higher risk of HPAI H5N1 infection (OR 3.34, 95% CI 1.72–6.47), while those where owners used a disinfectant to clean poultry areas were exposed to lower risk (OR 0.48, 95% CI 0.26–0.87). Our results highlight the important role of the trade of poultry between farms in the transmission of HPAI H5N1, in addition to farming practices and environmental characteristics. Findings from this study may help to tailor prevention measures to the local circumstances of backyard farms in different regions of the world.     

安徽省阜阳市首例H5N1型人禽流感临床报告

目的了解人感染高致病性H5N1型禽流感流行病学和临床学特征及防治手段。方法对本院收治的1例人感染高致病性H5N1型禽流感病例的相关资料进行回顾性分析。结果患者为26岁年轻孕妇,有病、死家禽接触史,临床表现为以急性呼吸窘迫综合征为主的全身多器官功能障碍,治疗上采取了以机械通气为主的综合性措施,治愈出院。结果提高对人感染高致病性H5N1型禽流感诊断的警惕性,及早干预是降低病死率的关键环节。     

Global epidemiology of human infections with highly pathogenic avian influenza A (H5N1) viruses

Abstract:   From 1997 through 2007, human infections with highly pathogenic avian influenza A (H5N1) viruses resulted in rare, sporadic, severe and fatal cases among persons in 14 countries in Asia, the Middle East, Eastern Europe and Africa. Of 369 reported human H5N1 cases that occurred from 1997 through 2007, overall mortality was 60%. Ten antigenically and genetically distinct clades of H5N1 viruses have been identified to date, and strains from four clades have infected humans. Surveillance has focused upon hospitalized cases of febrile acute lower respiratory tract disease among persons with exposure to sick or dead poultry, or to a human H5N1 case. Detection of H5N1 virus infection is based primarily upon collection of respiratory tract specimens from suspected cases for RT-PCR testing. Most human H5N1 cases were previously healthy children or young adults who developed severe acute pulmonary or multi-organ disease following direct or close contact with sick or dead H5N1 virus–infected poultry. Occasional clusters of H5N1 cases have occurred, predominantly among blood-related family members. Limited human-to-human H5N1 virus transmission has been reported or could not be excluded in some clusters. The frequency of asymptomatic or clinically mild H5N1 virus infection is unknown, but limited investigations suggest that such infections have been rare since 2003. There is no evidence of sustained human-to-human H5N1 virus spread. However, H5N1 viruses continue to circulate and evolve among poultry in many countries, and there are many unanswered questions about human infection with H5N1 viruses. Thus, the pandemic influenza threat presented by H5N1 viruses persists.     

中国大陆人禽流感病1例报告及临床讨论

目的　了解中国大陆首例人禽流感病例的临床特征。方法 对禽流感病例临床资料进行分析总结。结果 该例禽流感患者病情凶险,预后差。以高热、咳嗽、呼吸困难、双肺进行性增多的斑块片状阴影和多器官衰竭综合征为特征,病毒分离培养和鉴定为甲型流感病毒H₅N₁。结论 人禽流感病是一种新发的严重、急性传染病,应该引起高度重视。     

The 1999-2000 avian influenza (H7N1) epidemic in Italy: veterinary and human health implications

From the end of March to the beginning of December 1999, 199 outbreaks of low pathogenicity avian influenza (LPAI) were diagnosed in the Veneto and Lombardia regions, which are located in the northern part of Italy. The virus responsible for the epidemic was characterized as a type A influenza virus of the H7N1 subtype of low pathogenicity. On the 17th of December, highly pathogenic avian influenza (HPAI) was diagnosed in a meat turkey flock in which 100% mortality was observed in 72 h. The infection spread to the industrial poultry population of northern Italy including chickens, guinea-fowl, quail, pheasants, ducks and ostriches for a total of 413 outbreaks. Over 13 million birds were affected by the epidemic, which caused dramatic economic losses to the Italian poultry industry with severe social and economic implications. The possibility of H7 virus transmission to humans in close contact with the outbreaks was evaluated through a serological survey. Seven hundred and fifty nine sera were collected and tested for the detection of anti-H7 antibodies by means of the micro-neutralization (MN) and single radial haemolysis (SRH) tests. All samples resulted negative. A limited number of clinical samples were also collected for attempted virus isolation with negative results. Current European legislation considers LPAI and HPAI as two completely distinct diseases, not contemplating any compulsory eradication policy for LPAI and requiring eradication for HPAI. Evidence collected during the Italian 1999-2000 epidemic indicates that LPAI due to viruses of the H7 subtype may mutate to HPAI, and, therefore, LPAI caused by viruses of the H5 or H7 subtypes must be controlled to avoid the emergence of HPAI. A reconsideration of the current definition of avian influenza adopted by the EU, could possibly be an aid to avoiding devastating epidemics for the poultry industry in Member States.     

人感染高致病性禽流感病毒病原学特点分析与启示

本文对近年频繁发牛的人感染高致病性禽流感病毒病原学特点、流行状况、传播途径、以及病毒致病的分子生物学基础进行了分析,并强调了进一步加强国际合作研究的重要性。