1、Swine influenzaInterim Guidance of WHO&US CDC98-04-27A reassortant virusWhat is swine influenza?n Most influenza type A H1N1 virus,other subtypes(H1N2,H3N2,and H3N1)also circulating in pigs-first isolated from a pig in 1930-killed by cooking temperatures of 160 F/70 Cn A highly contagious acute resp
2、iratory disease of pigs-asymptomatic carrier pigs exist-morbidity tends to be high and mortality low(1-4%)n Human-to-human transmission has occurredn Current seasonal influenza vaccine does NOT contain swine influenza virus-Not known whether current human seasonal influenza vaccines can provide any
3、protection 2http:/www.who.int/csr/swine_flu/swine_flu_faq_26april.pdfhttp:/www.cdc.gov/swineflu/key_facts.htm流感疫苗保護效果仍未流感疫苗保護效果仍未知知Signs and symptomsn Similar to the symptoms of regular human seasonal influenza-fever,lethargy,lack of appetite and cough-runny nose,sore throat,-nausea,vomiting and dia
4、rrhea(some)n Severe illness-pneumonia-respiratory failure and deathsn May cause a worsening of underlying chronic medical conditions3http:/www.cdc.gov/swineflu/key_facts.htmResidents of States with Swine Influenza Cases給民眾的衛教給民眾的衛教n Cover your nose and mouth with a tissue when you cough or sneeze.Th
5、row the tissue in the trash after you use it.(咳嗽與呼吸道禮節咳嗽與呼吸道禮節)n Wash your hands often with soap and water,especially after you cough or sneeze.Alcohol-based hands cleaners are also effective.(洗手洗手)n Try to avoid close contact with sick people.(避免接觸病人避免接觸病人)n If you get sick,CDC recommends that you
6、stay home from work or school and limit contact with others to keep from infecting them.(生病盡量留在家中生病盡量留在家中)n Avoid touching your eyes,nose or mouth.Germs spread that way.(避免散播避免散播)4n Medications to Help Lessen Symptoms of the Flun When to Seek Emergency Medical Care51.Stay home for 7 days after the s
7、tart of illness and fever is gone 2.Monitor yourself and household members for flu symptoms and contact a telephone hotline or health care provider if symptoms occurCDC:Interim Guidance for Swine influenza A(H1N1):Taking Care of a Sick Person in Your Home(April 25,2009)強調盡量待在家中強調盡量待在家中Steps to Lesse
8、n the Spread of Flu in the Homen Placement of the sick person(如何在家安置病人如何在家安置病人)-Keep the sick person in a room separate from the common areas of the house-Keep the sickroom door closed-Have the sick person wear a surgical mask if they need to be in a common area of the house near other persons n Pro
9、tect other persons in the home(保護家中其他人保護家中其他人)-Avoid having pregnant women care for the sick person.n If you are the caregiver self-monitor(自我監測與防護自我監測與防護)n Using Facemasks or Respirators(用口罩和用口罩和N95的時機的時機)-wear a facemask(for example,surgical mask)or N95 disposable respirator-N95 if respiratory tre
10、atments using a nebulizer or inhaler6Clinicians 臨床醫師應有的警覺與採檢臨床醫師應有的警覺與採檢 Consider the possibility of swine influenza virus infections n Symptomatic individual(acute respiratory symptoms with or without fever)(急性呼吸症狀和以下三項中任一急性呼吸症狀和以下三項中任一)-Live in area where human cases of swine influenza A (H1N1)has
11、 been identified or (居住地居住地)-Have traveled to an area where human cases of swine influenza A(H1N1)has been identified or(旅遊史旅遊史)-Have been in contact with ill persons from these areas in the 7 days prior to their illness onset(接觸史接觸史)n Obtain a respiratory swab for swine influenza testing and place
12、it in a refrigerator(not a freezer)-timely diagnosis at a state public health laboratory7Definitions of Respiratory Illness(April 24-26,2009)n Acute respiratory illness(急性呼吸道症狀急性呼吸道症狀):Recent onset of at least two of the following:urhinorrhea or nasal congestion usore throat ucough ufever or feveris
13、hness(發燒非必要條件發燒非必要條件)n Influenza-like illness:fever 37.8 C(100 F)plus cough or sore throat 8CDC:Interim Guidance on Case Definitions to be Used For Investigations of Swine Influenza A(H1N1)Cases*(April 26,2009)CDC:Case definitions 病例定義病例定義(April 26,2009)used For Investigations of Swine Influenza A(H
14、1N1)Casesn Confirmed case 確定病例確定病例a person with an acute respiratory illness with laboratory confirmed swine influenza A(H1N1)virus infection at CDC by one or more of the following tests:-real-time RT-PCR-viral culture-four-fold rise in swine influenza A(H1N1)virus specific neutralizing antibodies n
15、 Probable case 極可能病例極可能病例 a person with an acute respiratory illness with an influenza test that is positive for influenza A,but H1 and H3 negative.9CDC:Interim Guidance on Case Definitions to be Used For Investigations of Swine Influenza A(H1N1)Cases*(April 26,2009)n Suspected case 疑似病例疑似病例1.A pers
16、on with acute respiratory illness who was a close contact to a confirmed case of swine influenza A(H1N1)virus infection during the cases infectious period,OR 2.A person with an acute respiratory illness with a recent history of contact with an animal with confirmed or suspected swine influenza A(H1N
17、1)virus infection OR 3.A person with an acute respiratory illness who traveled to or resides in an area where there are confirmed cases of swine influenza A(H1N1)virus infection10CDC:Interim Guidance on Case Definitions to be Used For Investigations of Swine Influenza A(H1N1)Cases*(April 26,2009)n I
18、nfectious period(可傳染期可傳染期):1 day prior to the cases illness onset to 7 days after onset(發病前一日至發病後七日發病前一日至發病後七日)n Close contact:within about 6 feet(2 meter)of an ill person who is a confirmed or suspected case of swine influenza A(H1N1)virus infection during the cases infectious periodWHO:having care
19、d for,lived with,or had direct contact with respiratory secretions or body fluids of a probable or confirmed case of swine influenza A(H1N1).11Infectious period for confirmed cases=1 day before onset to 7 days after onset of illnessDay before onset=Day-1Onset day=Day 0Days after onset=Days 1-7CDC:In
20、terim Guidance on Case Definitions for Swine Influenza A(H1N1)Human Case Investigations(April 24-26,2009)WHO未訂距離CDC:Case definitions 病例定義病例定義 Antiviral Recommendations for patients with confirmed or suspected Swine Influenza A(H1N1)Virus Infection and Close Contacts(April 25,2009)n Confirmed case A
21、person with an acute respiratory illness with laboratory confirmed at CDC by one or more of the following tests:-real-time RT-PCR-viral culture n Suspected case 1)A person with acute respiratory illness who was a close contact to a confirmed case of swine influenza A(H1N1)virus infection during the
22、cases infectious period,OR 2)A person with an acute respiratory illness who traveled to or resides in an area where there are confirmed cases of swine influenza A(H1N1)virus infection.n Acute respiratory illness:recent onset of at least two of the following:rhinorrhea or nasal congestion,sore throat
23、,cough(with or without fever or feverishness)12刪除血清學四倍上升之定義刪除動物接觸史之定義不論有無發燒，症狀要有兩項Interim WHO guidance for the surveillance of human infectionwith swine influenza A(H1N1)virus(April 26,2009)n Clinical case description:Acute febrile respiratory illness(fever 38C)with the spectrum of disease from infl
24、uenza-like illness to pneumonia.n Confirmed case:an individual with laboratory confirmed swine influenza A(H1N1)virus infection by one or more of the following tests:n real-time RT-PCRn viral culturen four-fold rise in swine influenza A(H1N1)virus specific neutralizing antibodies.n Probable case:an
25、individual with an influenza test that is positive for influenza A,but is unsubtypable by reagents used to detect seasonal influenza virus infection OR A individual with a clinically compatible illness or who died of an unexplained acute respiratory illness who is considered to be epidemiologically
26、linked to a probable or confirmed case.http:/www.who.int/csr/disease/swineflu/WHO_case_definition_swine_flu_2009_04_26.pdfWHO剛出爐之病例定義剛出爐之病例定義無臨床症狀者亦須通無臨床症狀者亦須通報報WHOUS CDCAcute respiratory illness包含無症狀者包含無症狀者Infection Control of Ill Persons in a Healthcare Setting(April 24,2009)n Suspected or confirm
27、ed case-status should be placed in a single-patient room (單人房，最好是負壓病房單人房，最好是負壓病房)-If available,an airborne infection isolation room(AIIR)with negative pressure can be used-for suctioning,bronchoscopy,or intubation,use a procedure room with negative pressure air handlingn ill person should wear a sur
28、gical mask when outside of the patient room(在病房外，病人需戴外科口罩在病房外，病人需戴外科口罩)-wash hands frequently-follow respiratory hygiene practicesn Routine cleaning and disinfection strategies used during influenza seasons(清潔與消毒照常清潔與消毒照常)15CDC:Interim Guidance for Infection Control for Care of Patients with Confirm
29、ed or Suspected Swine Influenza A(H1N1)Virus Infection in a Healthcare Setting(April 24,2009)Infection Control of Ill Persons in a Healthcare Setting-patient care activities照顧病人時的一般措施照顧病人時的一般措施 n All patient care activities should be used-Standard,Droplet and Contact precautions-Hand hygiene by wash
30、ing with soap and water or using hand sanitizer(標準、飛沫、接觸防護措施及洗手)n Prevent conjunctival exposure-wear disposable non-sterile gloves,gowns,and eye protection(e.g.,goggles)n Maintained for 7 days after illness onset or until symptoms have resolved-Children,especially younger children,might potentially
31、be contagious for longer periods16CDC:Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A(H1N1)Virus Infection in a Healthcare Setting(April 24,2009)Masks and respirators N95 的使用時機的使用時機n Personnel engaged in aerosol generating activities(e.g.,col
32、lection of clinical specimens,endotracheal intubation,nebulizer treatment,bronchoscopy,and resuscitation involving emergency intubation or cardiac pulmonary resuscitation)for suspected or confirmed swine influenza A(H1N1)cases should wear a fit-tested disposable N95 respirator.*n Pending clarificati
33、on of transmission patterns for this virus,personnel providing direct patient care for suspected or confirmed swine influenza A(H1N1)cases should wear a fit-tested disposable N95 respirator when entering the patient room.17CDC:Interim Guidance for Infection Control for Care of Patients with Confirme
34、d or Suspected Swine Influenza A(H1N1)Virus Infection in a Healthcare Setting(April 24,2009)Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A(H1N1)Virus Transmission Has Been Detected(April 26,2009)n Whenever possible,rather than relying on the use of facemasks or res
35、pirators,close contact with people who might be ill and being in crowded settings should be avoided.(應盡量避免到人潮擁擠處)n Facemasks should be considered for use by individuals who enter crowded settings,both to protect their nose and mouth from other peoples coughs and to reduce the wearers likelihood of c
36、oughing on others;the time spent in crowded settings should be as short as possible.(外出至人多處，應戴外科口罩)n Respirators*should be considered for use by individuals for whom close contact with an infectious person is unavoidable.This can include selected individuals who must care for a sick person(e.g.,fami
37、ly member with a respiratory infection)at home(密切接觸時須帶*N95等級以上)18CDC:Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A(H1N1)Virus Infection in a Healthcare Setting(April 24,2009)Treatment and chemoprophylaxis of swine influenza virus infection(
38、April 26,2009)n WHO-Information is insufficient to make recommendation on the use of the antivirals in prevention and treatmentn United States:sensitive to oselatmivir and zanamivir but resistant to amantadine and remantadine.n CDC-recommends the use of oseltamivir or zanamivir for the treatment and
39、/or prevention of infection with swine influenza viruses.19http:/www.who.int/csr/swine_flu/swine_flu_faq_26april.pdfhttp:/www.cdc.gov/swineflu/key_facts.htmAntiviral Treatment 使用抗病毒藥物治療使用抗病毒藥物治療n Suspected cases 疑似病例疑似病例n Empiric antiviral treatment is recommended for any ill person suspected cases-
40、zanamivir(Relenza)alone-oseltamivir(Tamiflu)and amantadine or rimantadinen should be initiated as soon as possible after the onset of symptomsn Confirmed cases 確定病例確定病例-either oseltamivir or zanamivir for 5 daysn Recommended duration of treatment:5 daysn Pregnancy Category C20CDC:Interim Guidance on
41、 Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A(H1N1)Virus Infection and Close Contacts台灣無rimantadine21CDC HEALTH ADVISORY December 19,2008 美國美國CDC抗病毒藥物用抗病毒藥物用藥建議藥建議(seasonal flu)Need to consider potential infection with swine influenza A(H1N1)virus as well as h
42、uman influenza viruses,and their different antiviral susceptibilities.Antiviral Chemoprophylaxis 藥物預防藥物預防 n(pre-exposure or post-exposure)with either oseltamivir or zanamivir is recommended for the following individuals1.Persons with certain chronic medical conditions,elderly-Household close contact
43、s who are at high-risk for complications of influenza of a confirmed or suspected case.-Travelers to Mexico who are at high-risk for complications of influenza-Border workers(Mexico)who are at high-risk for complications of influenza2.-School children who are at high-risk for complications of influe
44、nza(persons with certain chronic medical conditions)who had close contact(face-to-face)with a confirmed or suspected case3.Health care workers or public health workers who had unprotected close contact with an ill confirmed case of swine influenza A(H1N1)virus infection during the cases infectious p
45、eriod.22CDC:Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A(H1N1)Virus Infection and Close Contactsn Considered for the following:1.Any health care worker who is at high-risk for complications of influenza(persons with certain chronic medical
46、conditions,elderly)who is working in an area with confirmed swine influenza A(H1N1)cases,and who is caring for patients with any acute febrile respiratory illness.2.Non-high risk persons who are travelers to Mexico,first responders,or border workers who are working in areas with confirmed cases of s
47、wine influenza A(H1N1)virus infection.23Antiviral Chemoprophylaxis 藥物預防藥物預防 CDC:Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A(H1N1)Virus Infection and Close ContactsRecommended duration is 5-7 days after the last known exposure24香港衛生防護中心香港衛生防護中心專題網頁專題網頁
