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。     

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。     

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。     

人感染高致病性禽流感的诊断和治疗

人感染高致病性禽流感是指在接触该病毒感染的病／死禽后出现的人体H5N1病毒感染。在2003年下半年世界上多个国家暴发了家禽和野生禽类的H5N1病毒感染,导致人类患病率增加。截止2007年10月25日,由WHO报道的全球确诊病例共332例,其中204例患者死亡,病死率高达61．45％,我国确诊病例共25例,16例患者死亡,病死率为64％。从住院患者的临床资料分析显示,呼吸衰竭是最常见的并发症,许多患者的病情迅速进展至急性呼吸窘迫综合征（ARDS）,甚至多器官功能衰竭。发现晚、病情重、进展快、病死率高是现阶段人感染高致病性禽流感的特点。如何及时发现患者并予以适当的治疗,改善患者的预后,是我国临床医务工作者工作中的重点和难点。     

上海市黄浦区1例人感染高致病性禽流感病例现场流行病学分析

人感染高致病性禽流感是由H5N1血清型引起的禽流感,其发病率和死亡率都很高,危害巨大。1997年中国香港首次证实禽流感病毒（H5N1）感染人类以后,世界各地相继报道了多例禽流感病毒感染人并导致死亡事件,禽流感病毒已对人类健康构成严重威胁,引起了全世界的关注。     

人高致病性禽流感的研究进展

禽甲型流感病毒中某些亚型毒株能跨越种属在人类引起高病死率的人禽流感,若出现具有人传人能力的新病毒株将会引起新一轮流感世界大流行,所以人禽流感目前已成为国际关注的突发公共卫生事件。加强对人禽流感的认识和深入研究刻不容缓。近年来在禽流感病毒的病原学、人感染的机制以及人禽流感的诊治方面取得了很多新的研究进展。     

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     

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。     

新疆2例人感染高致病H5N1禽流感疫情应急处置与分析

目的分析新疆2起人感染H5N1高致病性禽流感疫情应急处置措施,提出针对性防控策略。方法采用流行病学方法分析新疆2例人感染H5N1高致病性禽流感疫情发生过程和处置情况。结果 2例病例均在发病后第10d才首次检测血常规,由于发病前期的诊疗规范性不佳,错过了针对人感染高致病性禽流感抗病毒治疗的最佳时间和未采用有效抗病毒药物(48 h内服用神经氨酸酶抑制剂如达菲)及时治疗,虽然治疗后期多部门联合、专家组会诊,诊疗规范,但最终2例病例分别以合并感染和多器官衰竭死亡为结局;其中1例病例发病前有活禽宰杀市场暴露史,环境监测证实了病例的感染来源于活禽市场。结论对于人感染H5N1高致病性禽流感防控需要多部门、多系统联合,要做到早诊断、早治疗和早隔离,定期培训医护人员尤其是基层人员;应做好环境监测和公众的宣传,均是疾病防控的关键。     

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）。     

关于WHO 2005年以来高致病性H5N1禽流感病毒的临床和治疗进展

自1997年中国香港特别行政区报道首例人感染H5N1禽流感病毒以来,截至2008年9月10日,这场在禽类中史无前例地持续流行、造成了人类感染并具有高病死率的疫情已经波及到15个国家和地区,总发病387例,死亡245例,其中我国疫情30例,病死率超过60%,防控形势十分严峻.本文旨在整理分析2005年以来世界卫生组织和全球对禽流感病毒临床防治研究成果及人感染H5N1禽流感病例报道的最新信息,力求提供一个防治人禽流感方面的较为全面而清晰的介绍.     

Human infection with highly pathogenic H5N1 influenza virus

Highly pathogenic H5N1 influenza A viruses have spread relentlessly across the globe since 2003, and they are associated with widespread death in poultry, substantial economic loss to farmers, and reported infections of more than 300 people with a mortality rate of 60%. The high pathogenicity of H5N1 influenza viruses and their capacity for transmission from birds to human beings has raised worldwide concern about an impending human influenza pandemic similar to the notorious H1N1 Spanish influenza of 1918. Since many aspects of H5N1 influenza research are rapidly evolving, we aim in this Seminar to provide an up-to-date discussion on select topics of interest to influenza clinicians and researchers. We summarise the clinical features and diagnosis of infection and present therapeutic options for H5N1 infection of people. We also discuss ideas relating to virus transmission, host restriction, and pathogenesis. Finally, we discuss vaccine development in view of the probable importance of vaccination in pandemic control.     

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.     

Mapping H5N1 highly pathogenic avian influenza risk in Southeast Asia

The highly pathogenic avian influenza (HPAI) H5N1 virus that emerged in southern China in the mid-1990s has in recent years evolved into the first HPAI panzootic. In many countries where the virus was detected, the virus was successfully controlled, whereas other countries face periodic reoccurrence despite significant control efforts. A central question is to understand the factors favoring the continuing reoccurrence of the virus. The abundance of domestic ducks, in particular free-grazing ducks feeding in intensive rice cropping areas, has been identified as one such risk factor based on separate studies carried out in Thailand and Vietnam. In addition, recent extensive progress was made in the spatial prediction of rice cropping intensity obtained through satellite imagery processing. This article analyses the statistical association between the recorded HPAI H5N1 virus presence and a set of five key environmental variables comprising elevation, human population, chicken numbers, duck numbers, and rice cropping intensity for three synchronous epidemic waves in Thailand and Vietnam. A consistent pattern emerges suggesting risk to be associated with duck abundance, human population, and rice cropping intensity in contrast to a relatively low association with chicken numbers. A statistical risk model based on the second epidemic wave data in Thailand is found to maintain its predictive power when extrapolated to Vietnam, which supports its application to other countries with similar agro-ecological conditions such as Laos or Cambodia. The model's potential application to mapping HPAI H5N1 disease risk in Indonesia is discussed.     

Continued evolution of highly pathogenic avian influenza A (H5N1): updated nomenclature

Please cite this paper as: WHO/OIE/FAO. (2012) Continued evolution of highly pathogenic avian influenza A(H5N1): Updated nomenclature. Influenza and Other Respiratory Viruses 6(1), 1–5. Background Continued evolution of highly pathogenic avian influenza A (H5N1) throughout many regions of the eastern hemisphere has led to the emergence of new phylogenetic groups. A total of 1637 new H5N1 hemagglutinin (HA) sequences have become available since the previous nomenclature recommendations described in 2009 by the WHO/OIE/FAO H5N1 Evolution Working Group. A comprehensive analysis including all the new data is needed to update HA clade nomenclature. Methods Phylogenetic trees were constructed from data sets of all available H5N1 HA sequences. New clades were designated on the basis of phylogeny and p‐distance using the pre‐established nomenclature system (Emerg Infec Dis 2008; 14:e1). Each circulating H5N1 clade was subjected to further phylogenetic analysis and nucleotide sequence divergence calculations. Results All recently circulating clades (clade 1 in the Mekong River Delta, 2.1.3 in Indonesia, 2.2 in India/Bangladesh, 2.2.1 in Egypt, 2.3.2, 2.3.4 and 7 in Asia) required assignment of divergent HA genes to new second‐, third‐, and/or fourth‐order clades. At the same time, clades 0, 3, 4, 5, 6, 8, 9, and several second‐ and third‐order groups from clade 2 have not been detected since 2008 or earlier. Conclusions New designations are recommended for 12 HA clades, named according to previously defined criteria. In addition, viruses from 13 clades have not been detected since 2008 or earlier. The periodic updating of this dynamic classification system allows continued use of a unified nomenclature in all H5N1 studies.     

Revised and updated nomenclature for highly pathogenic avian influenza A (H5N1) viruses

The divergence of the hemagglutinin gene of A/goose/Guangdong/1/1996‐lineage H5N1 viruses during 2011 and 2012 (807 new sequences collected through December 31, 2012) was analyzed by phylogenetic and p‐distance methods to define new clades using the pre‐established nomenclature system. Eight new clade designations were recommended based on division of clade 1·1 (Mekong River Delta), 2·1·3·2 (Indonesia), 2·2·2 (India/Bangladesh), 2·2·1·1 (Egypt/Israel), and 2·3·2·1 (Asia). A simplification to the previously defined criteria, which adds a letter rather than number to the right‐most digit of fifth‐order clades, was proposed to facilitate this and future updates.