Go homepage(回首页)
Upload pictures (上传图片)
Write articles (发文字帖)

The author:(作者)归海一刀
published in(发表于) 2014/1/30 6:31:11
Experts say H7N9 avian influenza fatality or near 30%， clinical treatment difficulties

Original title: H7N9 avian influenza fatality or near the 30% difficulties in clinical treatment, experts say

International online coverage (reporter Pan Ying): H7N9 avian flu confirmed cases have been reported in mainland China so far this year have exceeded hundred examples, 20 people died. CDC experts said the fatality rate of the disease or of up to 20% per cent, with a case fatality rate is high. At the same time, because this virus no pathogenicity in poultry and are therefore more difficult to guard against, there is difficulty of clinical treatment.

From the end of March last year, since the first report of human infection H7N9 avian influenza cases in China, currently has reached more than 200 the number of cases confirmed, which killed more than 60 people. Calculation of number of cases and deaths, H7N9 fatality rate reached 20% per cent. Feng Zijian, China CDC Deputy Director stressed that the current fatality rate is also not strict, scientific sense of the case-fatality rate: "this is not a scientific case-fatality rate because we now see many patients who had not been there it ends, still hospitalized for treatment, unable to get the final accurate CFR. (And) we found that patients with severe now, small patients, doctors might not have suspected that he was attending it. So we see the case-fatality rate (deaths), but the denominator (number) is not accurate. ”

Compared with another common avian influenza virus H5N1, H7N9 more easily infect humans, and case-fatality rate is relatively low. Data show that China only 45 cases of H5N1 avian influenza in a decade, and H7N9 avian flu in less than a year has had more than 240 reports of more cases. However, the H5N1 avian flu virus case fatality rate of approximately 60% and H7N9 avian flu virus death rate of less than one half of its.

National Influenza Center Director Shu Yue-lung said, the similarities of these two viruses is that popular primarily in the poultry, transmissibility is weak, cannot result in widely circulated in the crowd like a seasonal flu. In contrast, H7N9 more difficult than H5N1 preparedness: "the biggest difference is that a class is a highly pathogenic H5N1 in poultry, poultry deaths caused, H7N9 this virus endemic in birds without symptoms, however, it is also the more difficult challenge of prevention and control. ”

Avian influenza situation analysis will be held a few days ago, Ministry of agriculture, reported H7N9 avian influenza virus mainly in the live poultry business sites, has not yet been checked out at poultry farms, H7N9 avian influenza virus in poultry are avirulent.

Peking University people hospital breathing medicine Gao zhancheng Professor introduced said, in clinical aspects, relative Yu H5N1 avian influenza for, H7N9 avian influenza virus of diagnosis more difficult, clinical doctor must strengthened on epidemic learn history of asked, strengthened distinguish: "H5N1 chicken also onset, we easy thought and fatality poultry of contact has relationship, and H7N9 of diagnosis, to clinical doctor brings is big difficult, because poultry class is health of. First-line physicians in the diagnosis on the basis of the lack of effective, it is difficult to expect H7N9 at an early stage, clinical doctors to strengthen epidemiological inquiry into history, is there any live poultry trading, whether the live bird market, enabling clinicians to H7N9 epidemiological inquiry to enhance identification and screening. ”

Early discovery, early reports, early diagnosis, early treatment, strengthening of severe cases where is the key to effective prevention and control, reduce the fatality rate. From the monitor stand, H7N9 virus is still sensitive to antiviral drugs such as Tamiflu and found no resistance.

Beijing Ditan Hospital Treatment Center said Li Xingwang, Director of infectious diseases, according to H7N9 avian flu diagnosis and treatment programme, conditional medical institutions to carry out H7N9 avian influenza testing was not equipped to be submitted in a timely manner. He said, now H7N9 avian influenza cases also hard do 100% seized out, so even detection is negative of patients, if suspected infection has H7N9, also should as soon as possible using up Philip, resistance HIV drug for treatment, to reduced fatality rate: "up Philip, resistance HIV drug on influenza virus is has effect of, premise is more early with more good, once patients appeared influenza sample symptoms, fever cough, suddenly heat, even detection is negative of, we also advocated giving resistance HIV treatment, to reduced seriously ill people of incidence. Now some patients due to various reasons causes the test results come back negative, this patient is also possible (h7n9 avian) flu. ”

Experts warn that for the elderly, in patients with underlying diseases such as heart disease, high blood pressure, high risk groups, such as pregnant women, obese people, and if you develop flu-like symptoms, should be even more timely treatment with antiviral drugs such as Tamiflu.

Earlier reports that China H7N9 avian flu vaccine research and development of key technology and product development subject has been essentially completed preclinical studies. Enterprises have now declared to the drug regulatory authority, but is still listed on the vaccine could not be determined.

　　原标题：H7N9禽流感病死率或近三成 专家称临床救治有难点

　　国际在线报道(记者 潘莹)：今年以来中国内地报告的H7N9禽流感确诊病例数已超百例，死亡20人。疾控专家表示，这种疾病的病死率或可高达20%－30%，病死率比较高。同时，由于这种病毒对禽类无致病力，因此更难防范，临床救治还存在难点。

　　从去年三月底中国首次报告人感染H7N9禽流感病例以来，目前确诊的人数已经达到200多例，其中死亡超过60人。以现有病例数和死亡数字计算，H7N9的病死率达到20%－30%。但中国疾控中心副主任冯子健强调，目前病死率还不是严格的、科学意义上的病死率：“这不是科学的病死率，因为我们现在看到的很多病人还没有出现结局，还在住院进行治疗，无法得到最终准确的病死率。(此外，)我们现在发现的病人都是重症为主，轻型的病人，就诊的时候医生也许没有怀疑他是这个病。因此我们看到了病死率的分子(死亡人数)，但分母(感染人数)没有准确掌握。”

　　与另外一种常见的禽流感病毒H5N1相比，H7N9更容易感染人类，同时病死率也相对较低。数据显示，中国内地H5N1禽流感病例在十年中只有45例，而H7N9禽流感不到一年已经有240多例报告。不过，H5N1禽流感病毒的病死率约在60%，而H7N9禽流感病毒的致死率不足其一半。

　　国家流感中心主任舒跃龙介绍说，这两种病毒的相似之处是，都主要在禽间流行，人际传播能力较弱，不能像季节性流感一样造成人群中广泛传播。相比较而言，H7N9比H5N1更加难以防范：“最大的区别是H5N1在禽类是高致病性的，会造成禽类死亡，但H7N9这个病毒在禽间无症状流行，也是目前更难防控的挑战。”

　　农业部日前召开禽流感防控形势分析会，通报称H7N9禽流感病毒主要存在于活禽经营场点，尚未在养禽场检出，H7N9禽流感病毒对家禽仍无致病力。

　　北京大学人民医院呼吸内科高占成教授介绍说，在临床方面，相对于H5N1禽流感来说，H7N9禽流感病毒的诊断更加困难，临床医生必须加强对流行病学史的询问，加强辨别：“H5N1鸡也发病，我们容易想到与病死禽的接触有关系，而H7N9的诊断，给临床大夫带来很大困难，因为禽类是健康的。一线医生在缺乏有效诊断的基础上，很难在早期想到是H7N9，所以临床大夫要加强流行病学史的追问，有没有活禽交易，是否去了活禽市场，提高临床医生对H7N9流行病学的询问意识，加强辨别和甄别。”

　　早发现、早报告、早诊断、早治疗，加强重症病例救治，是有效防控、降低病死率的关键。从目前监测来看，H7N9病毒对达菲等抗病毒药物仍然敏感，没有发现耐药性。

　　北京地坛医院感染性疾病诊疗中心主任李兴旺说，按照H7N9禽流感诊疗方案，有条件的医疗机构要开展H7N9禽流感的检测，没有条件的要及时送检。他说，现在H7N9禽流感病例还很难做到100%检出，因此即使检测呈阴性的患者，如果怀疑感染了H7N9，也应该尽早使用达菲等抗病毒药物进行治疗，以降低病死率：“达菲等抗病毒药物对流感病毒是有效果的，前提是越早用越好，一旦病人出现流感样症状，发烧咳嗽，突然高热，即使检测是阴性的，我们也主张给予抗病毒治疗，才能降低重病人的发病率。现在有的病人由于各种原因导致检测结果是阴性的，这种病人也有可能是(h7n9禽)流感病例。”

　　专家提示，对于老年人，心脏病高血压等基础性疾病患者、孕妇、肥胖人群等高危人群，一旦出现流感样症状，更应该及时使用达菲等抗病毒药物进行治疗。

　　此前曾有消息称，中国H7N9禽流感病毒疫苗研发关键技术及产品研发课题已基本完成临床前研究。目前已有企业向药监部门进行申报，但疫苗上市的时间目前仍无法确定。

赞