h5n8禽流感病毒流行病学论文

文／朱淑娟

从1月9日屏东县大武山一处蛋鸡场爆发H5N2亚型高病原禽流感，其后在屏东、高雄、台南、嘉义、云林、彰化、桃园等县市，超过两百个鸡、鸭、鹅场爆发禽流感病毒，预估扑杀数量将达100万只以上，创台湾史上扑杀数最高纪录。

更复杂的是，到目前为止这波禽流感病毒已验出4种高病原型病毒，包括台湾原本就存在的旧型H5N2禽流感病毒，屏东县大武山蛋鸡场、台南一处肉鸡场都属于这型；其他三型高病原型都是台湾首度发现，包括新型H5N2亚型病毒、H5N8亚型病毒、H5N3亚型病毒。

这波禽流感从何而来？官方定调为候鸟带来的，但民间却有质疑声音。

此时正是台湾候鸟过境的高峰期，蔡向荣认为，这波疫情来自候鸟的可能性最大。他提出的证据是，H5N8这株病毒本身就是从候鸟身上分离出来的，韩国、加拿大、美国、日本都曾有三种候鸟分离过这株病毒。另外H5N2、H5N3这两株病毒的比对也几乎都来自候鸟。

中兴大学兽医学系名誉教授谢快乐支持蔡向荣说法，他表示，这次爆发疫情的水禽场都位于沿海地区，2014年11月，韩国也才刚爆发禽流感，台湾从12月起就陆续有水禽发现疫情。西海岸的水禽都是露天饲养，可能有某一批候鸟过境台湾， 看到水禽场有水、饲料，多少会经过。而他推测，这批候鸟粪便里的病毒量很大，才会同时在这么多县市的水禽场爆发禽流感。

台大公卫学院流行病学与预防医学研究所教授金传春，公布一份2012年到2013年与香港教授的研究报告。报告指出，在台湾北部一家屠宰场采集鸡鸭粪便、血液监测病毒与血清时，八百多个鸡血样本中，8成验出H9N2抗体阳性，而台湾官方从未公布台湾有H9N2病毒，研判台湾鸡可能有用禽流感疫苗。她要求农委会应尽快公布禽流感病毒八段基因、以及血清监测资料，供国际学者检视。

陈保基坦言，2003年台湾爆发H5N2低病原性禽流感病毒时，因扑杀力道不足，病毒没有清除干净，导致H5N2病毒已在地化且变异成高病原型。

由此可证，这次疫情是否一部分可能是本土病毒变异，而非单纯候鸟导致？目前官方说法与民间推论莫衷一是。

禽流感疫情爆发，对民众饮食安全影响有多大？陈保基表示，为避免移动感染，农委会禁止水禽屠宰两天。1月13日也决定，为争取处理时效，只要养禽场死亡率高达两成以上，且送来的检体经确认感染H5亚型病毒就扑杀。

屏东县环保局长鲁台营表示，第一个发现的屏东县大武山蛋鸡场，要扑杀的蛋鸡高达12万只，处理是一大考验。所幸在动员人力支援后，已顺利完成，而且为了保险起见，连同没有感染病毒的养禽场也一并消毒。他提到，农户这次损失惨重，农委会应重视农户的损失。

台湾一再发生禽流感病毒，已是公共卫生的重大议题。台大农艺学系教授郭华仁认为，台湾的禽畜饲养走入大型化，高密度圈养造成动物身心不健康，因此投药频繁，消费者吃到的是生病、含多量抗生素的动物体。

朱增宏提醒，畜牧政策不能只看经济面，还要考量食品安全与防疫成本。他建议，农委会应该建立总量观念，鼓励业者少养一点，民众也吃少一点，反而更健康。而这，就是最好的防疫之道。

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1878年从瘟鸡中分离得到的，1901年称这种“鸡瘟病原”为“过滤性因子”或鸡瘟病毒（Fowl plague virus，FPV）。后来，又发现新城疫病毒（Newcastle disease virus，NDV）在禽中也可引起鸡瘟样疾病，即我国俗称的“鸡瘟”。为区分两者，前者称为真性鸡瘟或欧洲鸡瘟病毒，后者称为伪鸡瘟或亚洲鸡瘟病毒。1955年，根据病毒颗粒核蛋白抗原特性，认定FPV为甲型流感病毒的一员。绝大多数在禽中并不引起鸡瘟，甚至呈静默感染或健康携带状态，如2013年在我国新发现的H7N9禽流感病毒，基本不导致禽间致病。H5N1亚型于1997年在香港首次发现能直接感染人类。截止到2013年3月，全球共报告了人感染高致病性H5N1禽流感622例，其中死亡了371例。病例分布于15个国家，其中，我国发现了45例，死亡30例。大多数人感染H5N1禽流感病例为年轻人和儿童。2013年3月，我国首次发现人感染H7N9禽流感病例。到2013年5月1日，上海、安徽、江苏、浙江、北京、河南、山东、江西、湖南、福建等10省（市）共报告确诊病例127例，其中死亡26例 。病例以老年人居多，男性多于女性。目前研究发现，人感染禽流感的传染源为携带病毒的禽类。而传播途径仍需明确。研究认为，人感染H5N1亚型禽流感的主要途径是密切接触病死禽，高危行为包括宰杀、拔毛和加工被感染禽类。少数案例中，当儿童在散养家禽频繁出现的区域玩耍时，暴露于家禽的粪便也被认为是一种传染来源。目前研究的多数证据表明存在禽－人传播，可能存在环境（禽排泄物污染的环境）－人传播，以及少数非持续的H5N1人间传播。目前认为，H7N9禽流感病人是通过直接接触禽类或其排泄物污染的物品、环境而感染。人感染H7N9禽流感病例仍处于散发状态，虽然出现了个别家庭聚集病例，但目前，未发现该病毒具有持续的人与人之间传播能力。

英文写作翻译频道为大家整理的关于h7n9的英语作文翻译：人感染H7N9禽流感诊疗方案，供大家参考! H7N9来势汹汹，人感染H7N9禽流感是由H7N9亚型禽流感病毒引起的急性呼吸道传染病。现在我们需要了解H7N9的根本然后来做出相对应的预防措施，下面让我们来了解一下吧。 H7N9 break in in full fury, human infection with the H7N9 avian influenza is an acute respiratory tract caused by avian influenza H7N9 virus infection. Now we need to understand the H7N9 fundamental and then make the corresponding preventive measures, let us to know about it. 一、病原学 A, etiology 禽流感病毒属正粘病毒科甲型流感病毒属。禽甲型流感病毒颗粒呈多形性，其中球形直径80～120nm，有囊膜。基因组为分节段单股负链RNA。依据其外膜血凝素(H)和神经氨酸酶(N)蛋白抗原性不同，目前可分为16个H亚型(H1～H16)和9个N亚型(N1～N9)。禽甲型流感病毒除感染禽外，还可感染人、猪、马、水貂和海洋哺乳动物。可感染人的禽流感病毒亚型为H5N1、H9N2、H7N7、H7N2、H7N3，此次报道的为人感染H7N9禽流感病毒。该病毒为新型重配病毒，其内部基因来自于H9N2禽流感病毒。 Avian influenza virus belonging to Orthomyxoviridae influenza a virus. Avian influenza A virus particles were polymorphic, the spherical diameter of 80 ~ 120nm, capsule. Genome is segmented negative-stranded RNA. On the basis of the outer membrane of hemagglutinin (H) and neuraminidase (N) proteins are antigenically different, can be divided into 16 subtypes of H (H1 to H16) and 9 N subtypes (N1 ~ N9). Avian influenza A virus in avian, can also be infected people, pigs, horses, mink and marine mammals. Infection of human avian influenza virus subtype H5N1, H9N2, H7N7, H7N2, H7N3, the reported human infection with the H7N9 avian influenza virus. This virus was a new reassortant virus, its internal genes from H9N2 avian influenza virus. 禽流感病毒普遍对热敏感，对低温抵抗力较强，65℃加热30分钟或煮沸(100℃)2分钟以上可灭活。病毒在较低温度粪便中可存活1周，在4℃水中可存活1个月，对酸性环境有一定抵抗力，在的条件下也具有一定的存活能力。在有甘油存在的情况下可保持活力1年以上。 Avian influenza virus is sensitive to heat, strong resistance of low temperature, 65 ℃ for 30 minutes or boiling (100 ℃) for more than 2 minutes can be inactivated. The virus in the lower temperature in feces can survive for 1 weeks, in 4 ℃ water can survive for 1 months, have a certain resistance to the acidic environment, but also has a certain ability to survive under the conditions of . In the presence of glycerol can keep the activity of 1 years. 二、流行病学 Two, epidemiology (一)传染源。目前尚不明确，根据以往经验及本次病例流行病学调查，推测可能为携带H7N9禽流感病毒的禽类及其分泌物或排泄物。 (a) the source of infection. It is not clear, according to a survey of past experience and the epidemiological, presumably to carry the H7N9 avian influenza virus in poultry and its secretion or excretion. (二)传播途径。经呼吸道传播，也可通过密切接触感染的禽类分泌物或排泄物等被感染，直接接触病毒也可被感染。现尚无人与人之间传播的确切证据。 (two) transmission. Spread through the respiratory tract, and also can be infected through close contact with infected birds secretion or excretion, direct contact with the virus can also be infected. There is no evidence of communication between now and the. (三)易感人群。目前尚无确切证据显示人类对H7N9禽流感病毒易感。现有确诊病例均为成人。 (three) the susceptible population. At present there is no conclusive evidence of human H7N9 avian influenza virus susceptibility. The confirmed cases were adult. (四)高危人群 。现阶段主要是从事禽类养殖、销售、宰杀、加工业者，以及在发病前1周内接触过禽类者。 (four) high risk population. At the present stage is mainly engaged in poultry breeding, slaughter, processing, sales, as well as in the 1 week prior to the onset of contact with poultry. 三、临床表现 Three, clinical manifestation 根据流感的潜伏期及现有H7N9禽流感病毒感染病例的调查结果，潜伏期一般为7天以内。 Based on the results of the investigation during the incubation period and the existing H7N9 avian influenza virus infection, incubation period is generally 7 days. (一) 一般表现。 (a) the general performance. 患者一般表现为流感样症状，如发热，咳嗽，少痰，可伴有头痛、肌肉酸痛和全身不适。重症患者病情发展迅速，表现为重症肺炎，体温大多持续在39℃以上，出现呼吸困难，可伴有咯血痰;可快速进展出现急性呼吸窘迫综合征、纵隔气肿、脓毒症、休克、意识障碍及急性肾损伤等。 Patients typically present with flu-like symptoms, such as fever, cough, less sputum, accompanied by headache, muscle pain and malaise. Patients with severe illness development is rapid, manifested as severe pneumonia, mostly persistent temperature over 39 ℃, difficulty in breathing, may be accompanied by hemoptysis sputum; rapid progress in acute respiratory distress syndrome, mediastinal emphysema, sepsis, shock, disturbance of consciousness and acute kidney injury. (二)实验室检查。 (two) laboratory. 1.血常规。白细胞总数一般不高或降低。重症患者多有白细胞总数及淋巴细胞减少，并有血小板降低。 1 blood. Total white cell count in general is not high or lower. Many patients with severe and the total number of lymphocytes decreased white blood cells, and platelets. 2.血生化检查。多有肌酸激酶、乳酸脱氢酶、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶升高，C反应蛋白升高，肌红蛋白可升高。 2 blood biochemical examination. There are many creatine kinase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase elevated C, elevated C-reactive protein, myoglobin can increase. 3.病原学检测。 Study 3 pathogen detection. (1)核酸检测。对患者呼吸道标本(如鼻咽分泌物、口腔含漱液、气管吸出物或呼吸道上皮细胞)采用real time PCR(或RT-PCR)检测到H7N9禽流感病毒核酸。 (1) nucleic acid detection. In patients with respiratory specimens (such as nasopharyngeal secretions, oral gargle, tracheal aspirate or respiratory epithelial cells) using real time PCR (or RT-PCR) to the H7N9 avian influenza virus nucleic acid detection. (2)病毒分离。从患者呼吸道标本中分离H7N9禽流感病毒。 (2) virus isolation. The separation of H7N9 avian influenza virus from patients with respiratory tract specimens. (三)胸部影像学检查。发生肺炎的患者肺内出现片状影像。重症患者病变进展迅速，呈双肺多发磨玻璃影及肺实变影像，可合并少量胸腔积液。发生ARDS时，病变分布广泛。 (three) the chest imaging. Pneumonia patients of lung lamellar image. In patients with severe lesions rapidly, a double multiple pulmonary ground-glass opacity and consolidation of lung image, with a small amount of pleural effusion. The occurrence of ARDS, lesions are widely distributed. (四)预后。人感染H7N9禽流感重症患者预后差。影响预后的因素可能包括患者年龄、基础疾病、合并症等。 (four) the prognosis. Of human infection with H7N9 avian influenza patients with poor prognosis. Prognostic factors may include patient age, underlying diseases, complications. 四、诊断与鉴别诊断 Four, diagnosis and differential diagnosis (一)诊断。根据流行病学接触史、临床表现及实验室检查结果，可作出人感染H7N9禽流感的诊断。在流行病学史不详的情况下，根据临床表现、辅助检查和实验室检测结果，特别是从患者呼吸道分泌物标本中分离出H7N9禽流感病毒，或H7N9禽流感病毒核酸检测阳性，可以诊断。 (a) diagnosis. According to the epidemiological contact history, clinical manifestations and laboratory test results, can make the diagnosis of human infection with the H7N9 avian influenza. In the history of epidemiology of unknown circumstances, according to the detection results of clinical manifestation, auxiliary examination and laboratory, especially H7N9 avian influenza viruses isolated from patients with respiratory tract secretion samples, or nucleic acid of H7N9 avian influenza virus detection, diagnosis. 1.流行病学史。发病前1周内与禽类及其分泌物、排泄物等有接触史。 1 epidemiological history. 1 week prior to the onset of poultry and its secretion and excretion, contact history. 2.诊断标准。 2 diagnostic standards. (1)疑似病例：符合上述临床症状及血常规、生化及胸部影像学特征，甲型流感病毒通用引物阳性并排除了季节性流感，可以有流行病学接触史。 (1) cases of suspected: meet the characteristics of the clinical symptoms and blood routine, biochemical and imaging of the chest, influenza virus a universal primer positive and eliminate the seasonal flu, can have the epidemiological contact history. (2)确诊病例：符合疑似病例诊断标准，并且呼吸道分泌物标本中分离出H7N9禽流感病毒或H7N9禽流感病毒核酸检测阳性。 (2) cases with suspected cases: diagnostic criteria, and respiratory secretion were isolated from H7N9 avian influenza virus or avian H7N9 influenza virus nucleic acid detection positive. 重症病例：肺炎合并呼吸功能衰竭或其他器官功能衰竭者为重症病例。 Severe cases: pneumonia complicated with respiratory failure or other organ failure in severe cases. (二)鉴别诊断。应注意与人感染高致病性H5N1禽流感、季节性流感(含甲型H1N1流感)、细菌性肺炎、传染性非典型肺炎(SARS)、新型冠状病毒肺炎、腺病毒肺炎、衣原体肺炎、支原体肺炎等疾病进行鉴别诊断。鉴别诊断主要依靠病原学检查。 (two) the differential diagnosis. Attention should be paid to the highly pathogenic H5N1 avian influenza, seasonal flu and human infection (including the influenza a H1N1 influenza), bacterial pneumonia, infectious atypical pneumonia (SARS), a novel coronavirus pneumonia disease, adenovirus pneumonia, Chlamydia pneumoniae, mycoplasma pneumonia, differential diagnosis. Differential diagnosis should mainly rely on the etiological examination. 五、治疗 Five, treatment (一)对临床诊断和确诊患者应进行隔离治疗。 (a) for clinical diagnosis and diagnosed patients should be treated in isolation. (二)对症治疗。可吸氧、应用解热药、止咳祛痰药等。 (two) for symptomatic treatment. Application of oxygen, can be antipyretic, cough expectorant. (三)抗病毒治疗。应尽早应用抗流感病毒药物。 (three) antiviral treatment. Early application of antiviral drugs. 1.神经氨酸酶抑制剂：可选用奥司他韦(Oseltamivir)或扎那米韦(Zanamivir)，临床应用表明对禽流感病毒H5N1和H1N1感染等有效，推测对人感染H7N9禽流感病毒应有效。奥司他韦成人剂量75mg每日两次，重症者剂量可加倍，疗程5-7天。扎那米韦成人剂量10mg，每日两次吸入。 1 neuraminidase inhibitors: use oseltamivir or zanamivir (Oseltamivir) (Zanamivir), clinical application shows that effective against avian influenza virus H5N1 and H1N1 infection, speculated that the effective of human infection with the H7N9 avian influenza virus. Oseltamivir adult dose of 75mg two times a day, severe dose may be doubled, treatment 5-7 days. Zana Mi Vee adult dose 10mg, two times daily intake. 2.离子通道M2阻滞剂：目前实验室资料提示金刚烷胺(Amantadine)和金刚乙胺(Rimantadine)耐药，不建议单独使用。 2 M2 ion channel blocker: the laboratory data suggest that amantadine and rimantadine (Amantadine) (Rimantadine) resistance, is not recommended to use alone. (四)中医药治疗。 (four) treated with traditional Chinese medicine. 1.疫毒犯肺，肺失宣降 1 disease drug lung, lung loses Xuan drop 症状：发热，咳嗽，少痰，头痛，肌肉关节疼痛。 Symptoms: fever, cough, less sputum, headache, muscle and joint pain. 治法：清热宣肺 Method: heat Xuanfei 参考处方： Reference prescription: 桑叶 金银花 连翘 炒杏仁 生石膏 知母 芦根 青蒿 黄芩 生甘草 Mulberry leaf honeysuckle and Forsythia Chao Xingren Anemarrhenae Rhizoma Phragmitis gypsum Artemisia Scutellaria Radix Glycyrrhizae 水煎服，每日1—2剂，每4—6小时口服一次。 Shuijianbi, daily 1 - 2, every 4 - 6 hours once oral. 加减：咳嗽甚者加枇杷叶、浙贝母。 Addition and subtraction: cough worse add loquat leaf, Zhejiang fritillaria. 中成药：可选择疏风解毒胶囊、连花清瘟胶囊、清开灵注射液。 Proprietary Chinese medicine: can choose Shufengjiedu capsule, Lianhua Qingwen capsule, Qingkailing injection. 2.疫毒壅肺，内闭外脱 The 2 epidemic disease in the lung, unconsciousness and collapse 症状：高热，咳嗽，痰少难咯，憋气，喘促，咯血，四末不温，冷汗淋漓，躁扰不安，甚则神昏谵语。 Symptoms: fever, cough, sputum less difficult to argue, shortness of breath, dyspnea, hemoptysis, four end not warm, cold sweat, manic disturbed, even Shenhun delirium. 治法：清肺解毒，扶正固脱 Treatment: the Qingfei detoxification, strengthening the body resistance 参考处方： Reference prescription: 炙麻黄 炒杏仁 生石膏 知母 鱼腥草 黄芩 Chinese ephedra Chao Xingren gypsum Anemarrhena Houttuynia Scutellaria 炒栀子 虎杖 山萸肉 太子参 Fried Gardenia Polygonum cuspidatum Cornus heterophylla 水煎服，每日1—2剂，每4—6小时口服或鼻饲一次。 Shuijianbi, daily 1 - 2, every 4 - 6 hours of oral or nasal feeding time. 加减：高热、神志恍惚、甚至神昏谵语者，上方送服安宫牛黄丸;肢冷、汗出淋漓者加人参、炮附子、煅龙骨、煅牡蛎;咯血者加赤芍、仙鹤草、侧柏叶;口唇紫绀者加三七、益母草、黄芪、当归尾。 Addition and subtraction: high fever, trance, and even coma, above take of Angong Niuhuang Pill; cold limbs, sweating profusely with ginseng, Cyperus rotundus, calcined keel, calcined oyster; hemoptysis and radix paeoniae rubra, agrimony, Oriental Arborvitae; cyanosis plus three seven, motherwort, astragalus, angelica tail. 中成药：可选择参麦注射液、生脉注射液。 Proprietary Chinese medicine: choice of Shenmai injection, Shengmai injection. (五)加强支持治疗和预防并发症。注意休息、多饮水、增加营养，给易于消化的饮食。密切观察，监测并预防并发症。抗菌药物应在明确继发细菌感染时或有充分证据提示继发细菌感染时使用。 (five) to strengthen support for the treatment and prevention of complications. Pay attention to rest, more water, increase nutrition, to easily digestible diet. Close observation, monitoring and prevention of complications. Antimicrobial agents should be sufficient evidence of secondary bacterial infection in clear secondary bacterial infection or. (六)重症患者的治疗。重症患者应入院治疗，对出现呼吸功能障碍者给予吸氧及其他相应呼吸支持，发生其它并发症的患者应积极采取相应治疗。 (six) in treatment of severe patients. Patients should be hospitalized, support oxygen and other relevant respiration to respiratory dysfunction, patients with other complications should actively take corresponding treatment. 1.呼吸功能支持： 1 respiratory support: (1)机械通气：重症患者病情进展迅速，可较快发展为急性呼吸窘迫综合征(ARDS)。在需要机械通气的重症病例，可参照ARDS机械通气的原则进行。 (1) mechanical ventilation: the progression of severe patients rapidly, which can rapidly developed acute respiratory distress syndrome (ARDS). In need of mechanical ventilation in severe cases, can consult ARDS mechanical ventilation principle. ①无创正压通气：出现呼吸窘迫和(或)低氧血症患者，早期可尝试使用无创通气。但重症病例无创通气疗效欠佳，需及早考虑实施有创通气。 The noninvasive positive pressure ventilation: respiratory distress and (or) hypoxemia in patients with early, can try to use noninvasive ventilation. But severe cases of noninvasive ventilation poor efficacy, they should consider implementing invasive mechanical ventilation. ②有创正压通气：鉴于部分患者较易发生气压伤，应当采用ARDS保护性通气策略。 ② invasive positive pressure ventilation: given that some patients are more prone to barotrauma, should adopt the ARDS protective ventilation strategies. (2)体外膜氧合(ECMO)：传统机械通气无法维持满意氧合和(或)通气时，有条件时，推荐使用ECMO。 (2) the extracorporeal membrane oxygenation (ECMO): conventional mechanical ventilation is unable to maintain satisfactory oxygenation and (or) ventilation, conditional, recommend the use of ECMO. (3)其他：传统机械通气无法维持满意氧合时，可以考虑俯卧位通气或高频振荡通气(HFOV)。 (3) other: conventional mechanical ventilation is unable to maintain satisfactory oxygenation, can consider the prone position ventilation or high-frequency oscillatory ventilation (HFOV). 2.其他治疗：在呼吸功能支持治疗的同时，应当重视其他器官功能状态的监测及治疗;预防并及时治疗各种并发症尤其是医院获得性感染。 2 other treatment: in the respiratory support therapy at the same time, should pay attention to monitoring and treatment of other organs of state; prevention and timely treatment of complications especially hospital acquired infection. 六、其它 Six, other 严格规范收治人感染H7N9禽流感患者医疗机构的医院感染控制措施。遵照标准预防的原则，根据疾病传播途径采取防控措施。具体措施依据《人感染H7N9禽流感医院感染预防与控制技术指南(2013年版)》的相关规定。 Strictly regulate the patients medical H7N9 avian influenza were hospital infection control measures. In accordance with the standards of the precautionary principle, control measures according to the disease transmission. "Specific measures on the basis of human infection with the H7N9 avian influenza prevention and control of hospital infection technical guide (2013 Edition)" the relevant provisions. 看完了以上的措施和规定，不知你是否已经明白了呢?快去告诉身边的人吧，预防禽流感，人人有责! After reading the above measures and regulations, I do not know whether you understand? Go and tell the people around it, to prevent bird flu, is everyone's responsibility!