流感
DESCRIPTION
流感TRANSCRIPT
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3
!!
(Seasonal Influenza or Seasonal Flu) H1N1H3N2 A/ B!
)Influenza Season or Flu Season* 7 1 6 30
)Influenza Epidemic Period* 11 3 6 9
(Complicated Influenza ) ()()
(Pneumonia and Influenza, P&I) 1975 (ICD-9) 480-487
(480)(481)(482)(485*(486)(487)
(Cluster) !!!!
3
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4
!
2008 2009 H1N1 2011 9 2012 2011 12H5N1 ICRapiacta
2013
4
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5
(Description of Disease)
(Influenza )
(Influenza virus) 1 4(1,2)
(1-3) 10
3~7 2(2,3)common cold
(Influenza)
(Common Cold)
200
/ 3-4 1-2 2-5
() ()
5
-
6
(Reye syndrome)(1-5)
1933Wilson Smith(1-3) A(H1N1) ABC A B A B 1977A(H1N1 H3N2) B
)Orthomyxoviridae)
ABC Segmented RNA 80-120nmenvelope 2 - HemagglutininHA, H NeuraminidaseNA, N (1-5)M1M2A B 8 (-)RNA (-)RNA NucleoproteinNPTranscriptaseRNA PB1PB2PA C 7(1,3,4)
(HA NA) A (H ) (N )
6
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H 17 H1-H17N 10 N1-N10(1-4,7) HA NA H1N1 A HA-1 NA-1 H3N2 A HA-3 NA-2 B C(1-4)
A B A H1N1H2N2H3N2 H1N1H7N7 H3N8 B BC(1,3,4)
A 1957 1968 ( A/H2N2 A/H3N2)
A B C 8 8 7 11 11 9 (Antigenic
drift) (Antigenic shift)
(Antigenic drift)
(Antigenic drift)
A
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2009 H1N1
1. A B 8 RNA C 7
2. 3.
4. 5. Zanamivir(Relenza ) Oseltamivir(Tamiflu )
6. Reassortment
ABC 1980(WHO) H N (1,6)A (HnNn) A/swine/Lowa/15/33 (H1N1) A1933 Lowa H1N1 15A/Beijing/262/95 (H1N1) A 1995 262Beijing H1HA N1NA(1-4) B /// HA NAB/Beijing/243/97 C(1-4)
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A -(1,3,4) RNA RNA"""# HA NA"Antigenic drift""" A B "Antigenic shift""" 20-30(1,3,4) A
48 60 5 10 (1,3,6)
(NA)SheddingViremia(1-4)
9
-
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Mode of transmission!
Incubation period 1~4 2
12 3
Period of communicability 3~5 7-10 (1,2) 24-48 24-72 5 (4,6)(1,2,5) 21
Susceptibility and resistance Antigenic drift(2,5) (2,5)
AB
A C
10
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Pandemics(Seasonal epidemics)(Sporadic cases*
(WHO) 3 5 25 50(1)(Centers for Disease Control and Prevention, CDC) 10 3 10 4 2~4 5 100(100/100,000) 500/100,000(2,6,8)2012-2013 11 1A/H3N2 (9)11 3 42012-2013 12 2(EuroFlu) 2012-2013 94,000 63% A 2009 A/H1N1( 66%) (9)! Centre for Health Protection 12 7 82012-2013 A/H3N2 2009 A/H1N1(10) 2012-201311 2013 1 2 A/H3N2(9,11) (National Notifiable Diseases Surveillance System(NNDSS)) 5-6 8-9 2013 (1 1 8 4 )1,164 A/H3N2(12)
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7 1 6 30 11 12 3 11%(13) B A/H3N2 2009 H1N12009 7 H1N12010-2011 A/H3N2 12 2009 A/H1N1 2011-2012 BA/H3N2 2012-2013 2010-2011
2009-2013
2008-2009 282009-2010 1,3122010-2011 1,7852011-2012 1,7042012-2013 968 749140155 68 2009
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H1N12008-2009 651-62009-2010 H1N1 180-6 65(13)2010-2011 650-32012-2013 65 50-642009 A/H1N1 0-6 65
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10-20 40-50
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B A BA Antigenic drift Antigenic shift
1-2
665 65 1996 2011 7.7% 10.9%
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Real-time PCR() Virus isolation ()
Real-time PCR() Virus isolation ()
Real-time PCR() Virus isolation ()
Real-time PCR() Virus isolation ()
Real-time PCR() Virus isolation ()
Real-time PCR(+)rapid antigen testvirus isolation(+) 14 21 21 21 H1H3 INF untype,
!Real-time PCR
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IC Real-time Outbreak and Disease
SurveillanceRODS1999 9 2004 RODS2006 11 ICD-9-CM1701080%ICD-9-CM
RODS2008ICIC RODS
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() 1.Nasal swab
2.Nasopharyngeal swab 3.Nasal wash fluid
4.Throat swab 5. Transtracheal aspirateBronchoalveolar lavage fluidSputumLung biopsy Post-mortem lung or Tracheal tissue 6. Acute serumConvalescent serum
()
3(Nasopharyngeal aspirate)Throat swab
Immunofluorescence staining
assay, IFA 4 4 48-72-70
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() 1. 10g veal infusion broth 2g bovine albumin fraction V 400 ml
2. 0.8 ml gentamicin sulfate solution (50mg/ml) 3.2 ml amphotericin B (250ug/ml)
3. () 0.8NaCl
()Rapid antigen detection Enzyme immunoassay
Nucleoprotien, NP A B 15-30
()Virus culture 7-14 MDCK(Madin-Darby Canine Kidney cell)Cytopathic Effect, CPEHemagglutination- inhibition, HI () RT-PCR Real-time RT-PCR
7-14 Reverse transcriptase-Polymerase chain reaction (RT-PCR) Realtime RT-PCR
34
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RT-PCR Realtime RT-PCR(Primer)(RT-PCR)(Realtime RT-PCR)
()
Paired sera104
Neutralization test, NT Hemagglutination inhibition test, HINTHISubtypeStrainHI
Immunofluorescence staining assay, IFA IFA
A B A H1 H3 H5 Anti-mouse IgG FITC conjugate
Virus Culture
MDCK cell(HI)()
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RT-PCR Real-time RT-PCR RT-PCR
RNAPCRReverse transcriptase, RTRNAcDNAPCRHANAMWHO
RT-PCRRT-PCRRT-PCRInternal control
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27X10(2,3,4)A B A B B A (Viral pneumonia)(Bacterial pneumonia)(Encephalitis)(Encephalophy)(Myocarditis)(Pericarditis)(Tansverse myelitis).(Guillain-Barr syndrome)Reye syndrome(2-5) 65() 72
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48 48 65 M2 protein(Neuraminidase)M2 protein Aneuraminidase AB () M2 protein
Amantadine Rimantadine M2 protein (ion channel) M2 protein Amantadine Rimantadine M2 protein M2 protein
Amantadine Rimantadine Amantadine Amantadine CatecholamimeRimantadine
Amantadine 10% 2% Rimantadine A (* () (Neuraminidase)
38
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Zanamivir (Relenza TM)Oseltamivir (Tamiflu) Peramivir (Rapiacta)A(Hemagglutinin)(Neuraminidase)N-acetylneuraminic acid ( Sialic acid) hemagglutininneuraminidaseSialic acid neuraminidase neuraminidase A BZanamivir 78% 15% 5-15% 2%Oseltamivir oseltamivir carboxylate 75%) 6-10 99%Rapiacta ZanamivirOseltamivir Peramivir 36-48 1-2 0.4% neuraminidase 4% )*!M2 protein A Amantadine Rimantadine
() Neuraminidase Oseltamivir Zanamivir 1-1.5
39
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() M2 protein M2 proteinAmantadine Rimantadine H3N2 H1N1 100%
() Neuraminidase 1.5% Oseltamivir
M2 protein Neuraminidase M2 protein A B Neuraminidase Oseltamivir Zanamivir A B
M2 protein Neuraminidase
M2 protein Neuraminidase Amantadine Rimantadine Oseltamivir Zanamivir Peramivir Symmetrel, Symadine
Flumadine Tamiflu Relenza Rapiacta
A A A B A B A B 1 1 1-1.5 1-1.5 1 (10%) (2%) (2%) (1.5%) (90-100%) (90-100%) (1.5%)
() Oseltamivir (Tamiflu)
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1.(10) 2 5 2.(10) 1 10 () Zanamivir (Relenza)
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1. 2(25) 2 5 2. 2(25) 1 10
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3(2A1B)4(2A2B)1B2013-2014
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1. World Health Organization.The world health report 2007 : a safer future : global public health security in the 21st century. World Health Organization; 2007: 45-48.
2. Mandell, GL., Bennett, JE., and Dolin, R. Principles and Practice of Infectious Diseases, 6th eds. Elsevier Inc. 2005: 2060-2078.
3. U.S. Centers for Disease Control and Prevention, National Center for Prevention Services. Prevention and Control of Vaccine-Preventable Diseases: Influenza, 7th eds. U.S. Dept. of Health and Human Services. 2003; 2006: 235-56.
4. Cox N.J. and Subbarao K. Influenza. Lancet; 1999;354: 1277-82. 5. Nicholson K.G., Wood J.M. and Zambon M. Influenza. Lancet; 2003; 362:1733-45. 6. U.S. Centers for Disease Control and Prevention. Prevention and control of
Influenza.Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2006;55(RR 10):1-42.
7. Centers for Disease Control and Prevention. Influenza Type A Viruses and Subtypes, 2013. Available at: http://www.cdc.gov/flu/avianflu/influenza-a-virus-subtypes.htm
8. World Health Organization. Influenza. Available athttp://www.who.int/csr/disease/influenza/en/
9. World Health Organization. Weekly Epidemiological Record. Review of the 2012-2013 Winter Influenza Season, Northern Hemisphere; 2013; 88:225-232
10. Sentinel Surveillance. Centre for Health Protection in Hong Kong. Monthly summary tables of influenza virus isolation 2012, 2013. Available at: http://www.chp.gov.hk/en/sentinel/26/44/292.html
11. National Institute of Infectious Disease. Isolation/detection of influenza virus in Japan, week 36/2012-week 11/2013 (as of March 18, 2013). Available at: http://www.nih.go.jp/niid/en/iasr-inf-e.html#graph
12. Australian Government Department of Health and Ageing. Australian Influenza Surveillance Report; 2013 No.4
13. 2002 2004; 20:478-487
14. 2010 2012; 28:113-126
15. Masahiko Katayose et al. The effectiveness of trivalent inactivated influenza vaccine in children over six consecutive influenza seasons. Vaccine 2011;29:1844-49.
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Pr
imer
A/H
3 H
3-2:
5-
AA
T TT
T G
AT
GC
C T
GA
AA
C C
GT-
3Fl
uA-F
:5-
AA
G A
CC
AA
T C
CT
GTC
AC
C T
CT
GA
-3
FluA
-R :5
-C
AA
AG
C G
TC T
AC
GC
T G
CA
GTC
C-3
Fl
uB-F
: 5-
GA
G A
CA
CA
A T
TG C
CT A
CC
TG
C T
T -3
Fl
uB-R
: 5
TTC
TTT
CC
C A
CC
GA
A C
CA
AC
-3
FluA
pro
be-F
AM
-5 T
TT G
TG T
TC A
CG
CTC
AC
C G
T 3
-TA
MR
AFl
uB p
robe
-VIC
-5A
GA
AG
A T
GG
AG
A A
GG
CA
A A
GC
AG
A A
CT
AG
C 3-T
AM
RA
FluA
pro
be: 5
FA
M -
TTTG
TGTT
CA
CG
CTC
AC
CG
T 3
BB
QFl
uB p
robe
: 5H
EX-A
GA
AG
ATG
GA
GA
AG
GC
AA
AG
CA
GA
AC
TAG
C
Run
gel
and
read
dat
a
1.5
agar
ose
gel
100
40
Ethi
dium
bro
mid
e
5
5
! ! ! ! ! ! ! !
69
-
70
!!! / 1
2 ()
3 /
(1)38 (2) (3)
1. 2. /
1 / 2 3 MIS
70
-
71
()
/
() MIS
()
!
71
-
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