解读人感染HN禽流感防控技术方案与诊疗方案.ppt

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禽流感早检早治流程图禽流感早检早治流程图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均不需经过适应便可在小鼠体内均不需经过适应便可在小鼠体内有效复制，且有效复制，且均能在雪貂上下呼吸道有效复制均能在雪貂上下呼吸道有效复制。HPAI H7N3LPAI H7N9LPAI H7N9HPAI H7N3高致病性的高致病性的HPAI H7N3HPAI H7N3致小鼠死亡，在雪貂模型致小鼠死亡，在雪貂模型中可通过接触传播，但中可通过接触传播，但LAPI H7N9LAPI H7N9在雪貂模型中在雪貂模型中不传播。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