文章摘要
张顺祥,程锦泉,马汉武,何建凡,程小雯,蒋丽娟,牟瑾,吴春立,吕星,张韶华,张雅德,吴永胜,王昕.深圳市一例人禽流感病例现场流行病学分析[J].中华流行病学杂志,2008,29(3):248-252
深圳市一例人禽流感病例现场流行病学分析
A case of human highly pathogenic avian influenza in Shenzhen, China: application of field epidemiological study
收稿日期:2007-10-11  出版日期:2014-09-15
DOI:
中文关键词: 人感染高致病性禽流感;现场流行病学;突发公共卫生事件
英文关键词: Human highly pathogenic avian influenza;Field epidemiology;Emergency public health problems
基金项目:
作者单位
张顺祥 深圳市疾病预防控制中心 518020 
程锦泉 深圳市疾病预防控制中心 518020 
马汉武 深圳市疾病预防控制中心 518020 
何建凡 深圳市疾病预防控制中心 518020 
程小雯 深圳市疾病预防控制中心 518020 
蒋丽娟 深圳市疾病预防控制中心 518020 
牟瑾 深圳市疾病预防控制中心 518020 
吴春立 深圳市疾病预防控制中心 518020 
吕星 深圳市疾病预防控制中心 518020 
张韶华 深圳市疾病预防控制中心 518020 
张雅德 深圳市疾病预防控制中心 518020 
吴永胜 深圳市疾病预防控制中心 518020 
王昕 深圳市疾病预防控制中心 518020 
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中文摘要:
      目的 结合人禽流感病例的调查处理探索现场流行病学的应用效果.方法 对一例人禽流感病例开展流行病学调查和密切接触者观察,采用RT-PCR检测咽拭子或气管分泌物H5亚型核酸片段和血清中H5抗体;对气管分泌物中分离到的H5N1病毒进行主要基因片段的测序和分析.按照现场流行病学特征完成处理和控制.结果 根据临床表现和病原学检测结果,确诊为人禽流感病例;患者病前曾到过居住地附近的一间兼营活禽的菜市场,余无可疑接触史;对患者的98名接触者进行医学观察,并对其中的4名进行隔离观察,未发现人与人之间的传播.由患者气管分泌物分离到H5N1病毒[A/Guangdong/02/2006(H5N1)],基因序列分析仍为禽源性特征,但与2005年之前国内分离的病毒株明显不同.病例呈现起病急、进展快和多脏器严重损害等特征,经救治而康复.疫情处理以疾病预防控制和临床专业为技术支撑,注意了政府主导下的多部门参与、公众互动、媒体沟通、与香港交流等,收到了良好的效果.结论 及早发现和病原学确诊是病例成功救治的关键;病毒株仍为禽源性特征,未见人间传播现象,但病毒感染来源和传播因素不明;现场流行病学为突发公共卫生事件应对提供了重要的理论和方法.
英文摘要:
      Objective Based on analyzing the characteristics of a case with human avian influenza and the effects of field epidemiological study. Methods An emergency-response-system was started up to follow the probable human Highly Pathogenic Avian Influenza case initially detected by the Undefined Pneumonia Surveillance System of Shenzhen".Public health professionals administered several epidemiologic investigations and giving all the contacts of the patient with a 7-day-long medical observation for temporally related influenza-like illness. Reverse transcriptasc-polymerase chain reaction(RT-PCR) with primers for HS and N1 was applied to test respiratory tract samples and/or throat swabs of the patient and all his contacts specific for the hemagglutinin gene of influenza A HSNl. Activities and strategies such as media response,notification in the public, communications with multiple related sectors, social participation and information exchange with Hong Kong were involved in field control and management. Results The patient was a male,31 years old,with an occupation as a truck driver in a factory,and had been residing in Shenzhen for 7 years. Started with an influenza-like syndrome,the patient received treatment on the 4th day of the onset,from a clinic and on the 6`" day from a regular hospital. On the 8th day of the disease course,hen was confirmed by Shenzhen Center for Disease Control and Prevention as human avian flu case and was then transferred to Intensive Care Unit(ICU ).On the 83`} day of commence, the patients was healed and released from the hospital. The patient had no significant exposure to sick poultry or poultry that died from the illness before the onset of the disease. The patient and five family members lived together, but no family member was affected and no contact showed positive results for HSNl.A small food market with live poultry,which was under formal supervision and before illness the patient once visited, located near his apartment. Tota11y,35 swabs from live birds and bird's coops in the market for HS nucleic acid were tested and all were negative. The influenza HSNl virus isolated for the case was named as A/Guangdong/02/2006 ( HSNI ) or GD/2/06. Phylogenetic relationships and molecular characterization analysis revealed that all the segments of the HSN1 virus named GD/2/06 still belonged to avian segments. Investigation process and control measures were released to the general public through the media一Soon after the laboratory confirmatiori,information was released to the society, as well as Hong Kong Center for Health Protection. Loca( Departments of Agricultures, Industries&Business,and Entry-Exit Inspection&Quarantine Bureau together with the Public Health Department put up combined actions. A computer-based telephone survey was initiated to investigate attitudes and knowledge of residents in town,revealing that positive atmosphere dominated and no panic existed. Conclusion Rapid laboratory diagnosis of the virus was the key for successful treatment and survival result of the case. Still, the pathogen was from birds resources. No human-to-human transmission was observed,however, source of infection was unclear. Field epidemiological study could offer special methods for the responses of emergency public health problems.
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