1、目前卫生部门对疫情的研判目前卫生部门对疫情的研判 内容简介内容简介一、病原学一、病原学二、流行病学二、流行病学三、临床表现三、临床表现 四、诊断与鉴别诊断四、诊断与鉴别诊断五、治疗五、治疗 六、其它六、其它七、转科或出院标准七、转科或出院标准附件：有疫情地区人感染附件：有疫情地区人感染H7N9禽流感早禽流感早检早治流程图检早治流程图HPAI H7N7、H7N3、H7N1LPAI H7Nx、H7N2、H7N3、H7N1、H7N9HPAI H7N7、H7N3、H7N4HPAI H7N3（Pakistan）HPAI H7N3LPAI H7N9HPAI H7N3LPAI H7N9禽中暴发的禽中暴发的H
2、7H720062006年前暴发的均为年前暴发的均为HPAI H7HPAI H7欧洲：意大利、英国、德国、比利时、荷兰、丹麦、挪威、欧洲：意大利、英国、德国、比利时、荷兰、丹麦、挪威、捷克、西班牙、瑞典捷克、西班牙、瑞典LPAI H7N8、H7N9（Korea）LPAI H7N9近年来人感染禽流感病毒病例CDC.Avian Influenza A Virus Infections of Humans.http:/www.cdc.gov/flu/avian/gen-info/avian-flu-humans.htm.血清学证据：人感染H4,H5,H6,H7,H9,H10,H11 AIVs.H7H7
3、感染人（感染人（100人人）美国、英国、意大利、荷兰、加拿大美国、英国、意大利、荷兰、加拿大HPAILPAI19591/USA H7N719771/USA H7N71979-19804/USAH7N719961/EnglandH7N720021/USAH7N220031/USAH7N27/ItalyH7N389/NetherlandsH7N71 died20041/CanadaH7N31/CanadaH7N320061/NorfolkH7N320074/WalesH7N22/MexicoH7N3共25株均为LPAI无感染人病例亚洲：7株均来自野禽5株韩国2株蒙古LPAI H7N9Nose(wh
4、ite bars),lung(black bars)HPAI H7N3HPAI H7N3和和LAPI H7N9LAPI H7N9均不需经过适应便均不需经过适应便可在小鼠体内有效复制，且可在小鼠体内有效复制，且均能在雪貂上均能在雪貂上下呼吸道有效复制下呼吸道有效复制。HPAI H7N3LPAI H7N9LPAI H7N9HPAI H7N3高致病性的高致病性的HPAI H7N3HPAI H7N3致小鼠死亡，致小鼠死亡，在雪貂模型中可通过接触传播，但在雪貂模型中可通过接触传播，但LAPI H7N9LAPI H7N9在雪貂模型中不传播。在雪貂模型中不传播。A/Baers pochard/HuNan/4
5、14/2010(H7N1)A/chicken/Hebei/1/2002(H7N2)A/duck/Guangdong/1/1996(H7N3)A/duck/Hubei/126/1985(H7N8)A/duck/Jiangxi/1742/03(H7N7)A/duck/Jiangxi/1760/03(H7N7)A/duck/Jiangxi/1786/03(H7N7)A/duck/Jiangxi/1814/03(H7N7)A/duck/Nanchang/1904/1992(H7N1)A/duck/Nanchang/1944/92(H7N1)A/duck/Zhejiang/10/2011(H7N3)A/
6、duck/Zhejiang/12/2011(H7N3)A/duck/Zhejiang/2/2011(H7N3)A/magpie-robin/China/28710/93(H7)亚型：H7N1,H7N2,H7N3,H7N7,H7N8野禽居多LPAI病毒分离病毒分离PB2PB1HANPNAMPNSPA6 6个内部片段来源于个内部片段来源于H9N2H9N2序列测定序列测定 A/northern_pintail/Akita/1370/2008_H7N7_Japan A/mallard/Korea/GG3/2007_H7N7_South_Korea A/environment/Mongolia/1-51
7、/2007_H7N7_Mongolia A/duck/Korea/BC10/2007_H7N3_South_Korea A/duck/Mongolia/119/2008_H7N9_Mongolia A/duck/Korea/A349/2009_H7N2_South_Korea A/duck/Thailand/CU-LM7291T/2010_H7N6_Thailand A/quail/Thailand/CU-J2882/2009_H7N1_Thailand A/wild_bird/Korea/5-77/2005_H7N8_South_Korea A/duck/Zhejiang/12/2011_H
8、7N3_China A/Shanghai/1/2013 A/Shanghai/2/2013 A/Anhui/1/2013 A/duck/Jiangxi/1742/03_H7N7_China A/wild_bird_feces/Korea/HDR16/2003_H7N2_South_Korea A/duck/Mongolia/867/2002_H7N1_Mongolia AY338455_A/Netherlands/127/03_H7N7_Netherlands AY338457_A/Netherlands/33/03_H7N7_Netherlands AY338459_A/Netherland
9、s/219/2003_H7N7_Netherlands A/chicken/Italy/444/99_H7N1_Italy A/chicken/Italy/322/2001_H7N1_Italy A/quail/Italy/4610/2003_H7N2_Italy A/turkey/Italy/5425/2007_H7N3_Italy A/mallard/Sweden/100993/2008_H7N7_Sweden A/mute_swan/Hungary/5973/2007_H7N7_Hungary A/mallard/Italy/497-35/2006_H7_Italy A/goose/Cz
10、ech_Republic/1848-K9/2009_H7N9_Czech_Republic A/mallard/Korea/822/2010_H7N7_South_Korea A/duck/Thailand/CU-10507T/2011_H7N4_Thailand A/wild_goose/Dongting/PC0360/2012_H7N7_China A/spot-billed_duck/Korea/447/2011_H7N9_South_Korea A/parrot/England/1174/94_H7N1_United_Kingdom A/ostrich/South_Africa/535
11、2/92_H7N1_South_Africa AF028020_A/England/268/1996_H7N7_United_Kingdom GU053110_A/England/AV877/1996_H7N7_United_Kingdom A/England/AV877/1996_H7N7_United_Kingdom A/chicken/Pakistan/16/99/95_H7N3_Pakistan A/chicken/Karachi/NARC-23/2003_H7N3_Pakistan A/quail/Aichi/1/2009_H7N6_Japan A/duck/Hong_Kong/30
12、1/1978_H7N2_Hong_Kong A/black_kite/Egypt/054/2004_H7N7_Egypt A/chicken/Jena/1816/87_H7N7_Germany A/chicken/Hebei/1/2002_H7N2_China A/African_starling/England-Q/983/1979_H7N1_United_Kingdom A/duck/Vietnam/OIE-0178/2012_H7N1_Viet_NamEurasian A/mallard/New_Zealand/1365-355/2005_H7N7_New_Zealand A/equin
13、e/Prague/1/1956_H7N7_Czech_Republic A/equine/Cambridge/1/63_H7N7_United_Kingdom A/equine/Argentina/1/1977_H7N7_ArgentinaEquine A/chicken/Chile/184240-1/2002_H7N3_Chile A/cinnamon_teal/Bolivia/4537/2001_H7N3_Bolivia A/turkey/Oregon/1971_H7N3_USA A/shorebird/Delaware_Bay/274/1994_H7N5_USA A/mallard/De
14、laware/418/2005_H7N3_USA A/blue-winged_teal/Ohio/566/2006_H7N9_USA A/green-winged_teal/MD/648/2004_H7N3_USA CY015006_A/Canada/rv504/2004_H7N3_Canada A/goose/Nebraska/17097-4/2011_H7N9_USA CY125728_A/Mexico/InDRE7218/2012_H7N3_Mexico A/chicken/Jalisco/CPA1/2012_H7N3_Mexico A/pheasant/Minnesota/917/19
15、80_H7N3_USA A/green-winged_teal/ALB/228/1985_H7N3_Canada A/laughing_gull/Delaware/22/2002_H7N3_USA A/duck/Guangdong/1/1996_H7N3_China A/turkey/New_York/Sg-00255/1994_H7N2_USA A/quail/PA/20304/1998_H7N2_USA A/Guinea_fowl/New_York/10196-7/2005_H7N2_USA A/chicken/New_York/63806-12/2005_H7N2_USA A/turke
16、y/VA/66/02_H7N2_USA EU587368_A/New_York/107/2003_H7N2_USA A/Guinea_fowl/New_York/31621-8/2005_H7N2_USAAmerican A/chicken/Victoria/1976_H7N7_Australia A/duck/Tasmania/277/2007_H7N2_Australia A/duck/Victoria/512/2007_H7N6_Australia A/chicken/Queensland/1994_H7N3_Australia A/chicken/New_South_Wales/2/1
17、997_H7N4_Australia A/fowl/Egypt/45_H7N1_Egypt A/chicken/Japan/1925_H7N7_Japan A/duck/Taiwan/33/1993_H7N7_Taiwan A/chicken/Rostock/45/1934_H7N1_Germany A/FPV/Dutch/1927_H7N7_United_Kingdom A/chicken/Brescia/1902_H7N7_Italy1001009910010010010010081828873991001009110010010010010010078100921001009994998
18、91007810087841008778917896711009888981001007698979810098869992899370990.05H7进化树进化树红色标记为本次病例红色标记为本次病例H7 人感染病例人感染病例 A/mallard/Minnesota/Sg-00177/2007_USA_H12N9 A/mallard/Ohio/2033/2009_USA_H4N9 A/American_black_duck/New_Brunswick/03451/2009_Canada_H3N9 A/mallard/Alberta/64/2000_Canada_H11N9 A/mallard/
19、MN/158/2000_USA_H3N9 A/northern_shoveler/California/8675/2008_USA_H11N9 A/ruddy_turnstone/Delaware_Bay/220/1995_USA_H7N9 A/mallard/Alberta/193/2000_Canada_H11N9 A/black_duck/Ohio/161/1999_USA_H11N9 A/ruddy_turnstone/DE/1538/2000_USA_H7N9 A/American_black_duck/New_Brunswick/02485/2007_Canada_H11N9 A/
20、American_white_pelican/Minnesota/Sg-0611/2008_USA_H13N9 A/shorebird/Delaware_Bay/424/2007_USA_H13N9 A/shorebird/Delaware_Bay/48/2002_USA_H11N9 A/ruddy_turnstone/New_Jersey/980/2002_USA_H2N9 A/ruddy_turnstone/Delaware_Bay/96/2002_USA_H1N9 A/thick-billed_murre/Alaska/44085-090/2006_USA_H11N9 A/glaucou
21、s_gull/Alaska/44199-104/2006_USA_H13N9 A/guinea_fowl/Nebraska/17096-1/2011_USA_H7N9 A/northern_shoverl/Mississippi/11OS145/2011_USA_H7N9 A/king_eider/Alaska/44397-858/2008_USA_H10N9 A/blue-winged_teal/Guatemala/CIP049-01/2008_Guatemala_H7N9 A/turkey/Minnesota/1/1988_USA_H7N9 A/gull/Maryland/18/1977_
22、USA_H2N9 A/pintail/Alberta/293/1977_Canada_H2N9 A/Black_Duck/Ohio/239/1986_USA_H11N9 A/ruddy_turnstone/Delaware/2368/1988_USA_H4N9 A/redhead_duck/Alberta/357/1983_Canada_H11N9 A/turkey/Wisconsin/1/1968_USA_H5N9 A/tern/Australia/G70C/1975_Australia_H11N9American A/duck/Vietnam/OIE-2386/2009_Viet_Nam_
23、H11N9 A/duck/Vietnam/OIE-3301/2011_Viet_Nam_H6N9 A/goose/Zambia/09/2009_Zambia_H11N9 A/mallard/New_Zealand/1440-365/2005_New_Zealand_H11N9 A/mallard/Czech_Republic/15902-18K/2009_Czech_Republic_H6N9 A/goose/Czech_Republic/1848-K9/2009_Czech_Republic_H7N9 A/mallard/Switzerland/WV1071028/2007_Switzerl
24、and_H11N9 A/Duck/Nanchang/2-0492/2000_China_H2N9(2)A/mallard/Sweden/48/2002_Sweden_H11N9 A/gadwall/Mongolia/OIE-191/2012_Mongolia_H2N9 A/duck/Hunan/1590/2007_China_H6N9 A/duck/Mongolia/119/2008_Mongolia_H7N9 A/mallard/Czech_Republic/13438-29K/2010_Czech_Republic_H11N9 A/Anas_crecca/Spain/1460/2008_S
25、pain_H7N9 A/duck/Vietnam/LBM81/2012_Viet_Nam_H11N9 A/wild_duck/Korea/SH20-27/2008_South_Korea_H7N9 A/shorebird/Korea/S8/2006_South_Korea_H11N9 A/duck/Chiba/7/2006_Japan_H11N9 A/duck/Hokkaido/W245/2004_Japan_H11N9 A/shorebird/Korea/S331/2006_South_Korea_H10N9 A/wild_bird/Korea/A3/2011_South_Korea_H7N
26、9 A/wild_bird/Korea/A14/2011_South_Korea_H7N9 A/Shanghai/1/2013 A/Shanghai/2/2013 A/Anhui/1/2013Eurasian A/kelp_gull/Argentina/LDC4/2006_Argentina_H13N9 A/emu/NY/12716/1994_USA_H5N9 A/shoveler/Netherlands/19/1999_Netherlands_H11N9 A/chicken/Italy/22A/1998_Italy_H5N9 A/wedge-tailed_shearwater/Western
27、_Australia/2327/1983_Australia_H15N9 A/shearWater/Australia/2576/1979_Australia_H15N9 A/duck/Hong_Kong/278/1978_Hong_Kong_H2N9 A/duck/Hong_Kong/562/1979_Hong_Kong_H10N910010010010010010010010098100998081100759292898999837396100981009993100999986759777900.02N9 进化树进化树红色标记为本次病例红色标记为本次病例 A/Shanghai/1/20
28、13 A/Shanghai/2/2013 A/Anhui/1/2013 A/brambling/Beijing/16/2012_H9N2 A/chicken/Shanghai/C1/2012_H9N2 A/chicken/Zhejiang/329/2011_H9N2 A/chicken/Shandong/02/2010_H9N2 A/chicken/Shandong/H/2009_H9N2 A/equine/Guangxi/3/2011_H9N2 A/chicken/Zhejiang/607/2011_H9N2 A/chicken/Anhui/HF/2010_H9N2 A/chicken/Ji
29、angsu/Q3/2010_H9N2 A/chicken/Shuanggou/1/2011_H9N2 A/duck/Shandong/009/2008_China_H5N1 A/avian/Japan/8KI0162/2008_Japan_H3N8 A/avian/Japan/8KI0068/2008_Japan_H3N6 A/environment/Korea/CSM05/2004_South_Korea_H3N1 A/mallard/Jiangxi/8341/2004_China_H6N5 A/environment/Korea/ESD18/2004_South_Korea_H3N6 A/
30、duck/Guangxi/3333/2006_China_H6N1 A/duck/Guangxi/1248/2006_China_H6N2 A/wild_bird/Korea/YJ117/2007_South_Korea_H4N6 A/turkey/Italy/977/1999_Italy_H7N1 A/turkey/Italy/1067/99_Italy_H7N1 A/turkey/Italy/1265/1999_Italy_H7N1 A/mallard/Czech_Republic/13438-29K/2010_H11N9 A/avian/Egypt/920431/2006_H9N2 A/
31、spot-billed_duck/Korea/447/2011_H7N9 A/wild_bird/Korea/A14/2011_H7N9 A/wild_bird/Korea/A3/2011_H7N9 A/goose/Czech_Republic/1848-K9/2009_H7N9 A/goose/Czech_Republic/1848-T14/2009_H7N9 PC0360_H7N7-PB2.seq A/duck/Jiangxi/1814/03_China_H7N7 A/wild_duck/Mongolia/1-241/2008_H7N9 A/Anas_crecca/Spain/1460/2
32、008_H7N9 A/mallard/Sweden/105/2002_Sweden_H7N7 A/gadwall/Netherlands/1/2006_H9N2 A/Netherlands/219/2003_Netherlands_H7N7 A/chicken/Netherlands/2586/2003_Netherlands_H7N7 A/England/AV877/1996_United_Kingdom_H7N7 A/chicken/Israel/184/2009_H9N2 A/chicken/Korea/MS96-CE6/1996_H9N2 A/chicken/China/Guangxi
33、14/2000_H9N2 A/chicken/Guangdong/6/97_H9N2 A/chicken/Pakistan/4/99_H9N2 A/chicken/Pakistan/UDL-03/2008_H9N2 A/duck/Zhejiang/12/2011_H7N3 A/swine/Hong_Kong/9/98_H9N2 A/swine/Guangxi/7/2007_H9N2 A/chicken/Yokohama/aq120/2001_H9N2 A/wild_bird/Korea/A9/2011_H7N9 A/chicken/Korea/A146/2009_H9N2 A/chicken/
34、Guangxi/55/2005_H9N2 A/duck/Nanchang/4-361/2001_H9N2 A/chicken/Shandong/KD/2009_H9N2 A/chicken/Hebei/A/2007_H9N2 A/duck/Fujian/FQ2/2007_H9N2 A/swine/Guangxi/S11/2005_H9N2 A/chicken/Yokohama/aq134/2002_H9N2 A/turkey/Minnesota/1/1988_H7N9 A/Canada/rv504/2004_Canada_H7N3 A/New_York/107/2003_USA_H7N2 A/
35、ruddy_turnstone/Delaware_Bay/220/1995_H7N9 A/northern_shoverl/Mississippi/11OS145/2011_H7N9 A/blue-winged_teal/Ohio/566/2006_H7N9 A/ruddy_turnstone/DE/1538/2000_H7N9 A/Mexico/InDRE7218/2012_Mexico_H7N3 A/blue-winged_teal/Guatemala/CIP049-01/2008_H7N9 A/blue-winged_teal/Guatemala/CIP049-02/2008_H7N9100869070998810010010010083789910010010071911001008982981001009993991009990100818810088909881740.02PB2进化树进化树红色标记为本次病例红色标记为本次病例H7 人感染病例人感染病例
