Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

Embed Size (px)

DESCRIPTION

Τριμηνιαία έκδοση της Ελληνικής Παιδιατρικής Εταιρείας

Text of Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος -...

  • 1 CURRENT ISSUE

    : ;. , . , .

    : 20 . 21 , . - , , . -. 51 . . , ., (reassortment) . , 51 - . - . , - - . , , , . , - 51.

    : , , .

    Avian flu: a new pandemic threat?

    M. Tsolia, I. Logotheti, A. Konstantopoulos

    Abstract: During the course of the 20th century the world experienced three influenza pandemics.Today, at the dawn of the 21st century the emergence of a new pandemic seems inevitable. In recentyears, an increasing number of epidemics caused by high pathogenicity avian influenza viruses haveoccurred, mainly in Asian countries but also in other parts of the world. The current widespreaddissemination of H5N1 avian virus in wild and domestic birds in Asia is unprecedented and has causedglobal concern. What is more troubling is the fact that this virus has been transmitted from birds tohumans causing disease and death. Although human-to-human transmission is known to haveoccurred, the virus cannot be transmitted between humans with great efficiency. However, it mayacquire this capacity either by reassortment with a human strain or through adaptive mutations. In thiscase, the H5N1 strain will cause explosive global spread and a new influenza pandemic will occur. Aneffort should be made by governments and poultry producers to improve biosecurity and conducteducation programmes with a view to restriction of the spread of avian influenza. An operationalpandemic plan should be available in every country and an adequate amount of antiviral medicationstockpiled. Immunization will be the most effective way to reduce the impact of a pandemic andresearchers are currently trying to develop a vaccine against the H5N1 strain.

    Key words: Influenza, avian influenza, pandemic.

    , . .

    A: 5, . , .. 171 23e-mail: giannalogotheti@yahoo.gr

    2nd Paediatric Clinic,University of Athens, P. & A. Kyriakou ChildrensHospital

    Correspondence:Logotheti Ioanna5 Lykeias Str., N. Smyrni, 171 23, Athense-mail:giannalogotheti@yahoo.gr

    2006;69:1-9

    Pediatr Jan-Feb 06 final allges 27-01-06 15:34 1

  • , , - , . -, , , . - 20 - , , - o (1-3). 21 , - . H5N1, - (3-6). - , . , . 51 , . - , - - .

    8 - RNA, - 10 . - - () () ( 1) (1-3) . -

    - - . - - , - .

    ,, C. C . , H N. - 16 9 . - , , , , . , , -, . , - . 144 (16 x 9) - - . - - , (2,3). ,

    1. . T (2).

    O

    2

    RNA

    2 . .

    2006;69:1-9

    Pediatr Jan-Feb 06 final allges 27-01-06 15:34 2

  • 3

    , - . , , - .

    , - . - -. - - (antigenic drift) (1-3). (antigenicshift) () / (), . , - (1-3).

    . - , - . , (reassortant) (3). 8 - . - - 8 , - -, (reassortment), - . , - . - - -, -

    , - .

    ( ) - (6). - -, . - , 5 . - - , , ( 1).

    - - . - - .

    20 - . , - - .

    2006;69:1-9

    1.

    ,

    1995, 77

    1997, 51

    1999, 92

    2003, 51

    2003, 77

    2003, H9N2

    2004, 51

    2004, 51

    2004, 73

    2004, 107

    Pediatr Jan-Feb 06 final allges 27-01-06 15:34 3

  • 4 . .

    , , (2,4). - (1918) 11. - 20 - (5). - 1957, - 22, 1968, 32. 1918 ., - - (reassortment) (7). - 32, , 11 . , , 32, 11 .

    1957 1968, 1918 - (reassortment) (7). - 11 1918 Taubeneberger , 8 - - (8). - , .

    1918 (9). , - . 100 -

    . , - - (9). - , . , - , - . , - - . - , (7).

    51

    , . - - (10). , - , , . - , - . - - , . - - - 5 , 7,

    2006;69:1-9

    Pediatr Jan-Feb 06 final allges 27-01-06 15:34 4

  • 5

    (high patho-genicity avian influenza, HPAI).

    1997, (HPAI) . . - - 1878 , - - , (6). ... - , .

    7 - .

    , , . -.

    - 51 (11-13). - . 51 - 1996. 1997 - -. 18

    2006;69:1-9

    2. . (reassortment) 8 . - - . (5).

    (51)

    Pediatr Jan-Feb 06 final allges 27-01-06 15:34 5

  • 6 . .

    6 . - 1,6 - . ., 51 , , - - . 2003 , (11,13). - -, . 2003 - , . - , -, , , , , , -, ( -), , - (15). 51 - . - 51 , , (6).

    - - 51 - (5). 51 , - .

    51 (14). - . , -

    - 3300 5 150 -, 142 - . - 142 - - 74 - 52% (15). -o . - -, (14,16). - (17). , - , . .

    , , 51 - - - . - , - - - - (5). - - . - - - .

    , , - . , - ,

    2006;69:1-9

    Pediatr Jan-Feb 06 final allges 27-01-06 15:34 6

  • 7

    . - - , - - - (10,11,13,16).

    , - 51 . - , - . (16). , - , , . 51 . - 51 . - (16). , - , . , - - .

    - - -. - ( -) 2. -, 51 . oseltamivir (Tamiflu) zanamivir(Relenza) -. , -

    . 51 - - - , - - (18). - .

    - , . Tamiflu - Relenza -. , , - Tamiflu. - , -, (19,20). - 12 , . , - , , . , - . , - , , . , - - .

    - - , - . - - - (20).

    2006;69:1-9

    Pediatr Jan-Feb 06 final allges 27-01-06 15:34 7

  • 8 . .

    , .

    10 51 ..., (19). - - , - . - - - - . - , . . , - - -. , - (adjuvants) (20,21) - .

    300 , - (19). . - - , - - (22). , , , - - .

    , - . - -

    , , . . . - , - - - .

    1. Treanor G. Influenza virus. In: Mandell GL, BennettJE, Dolin R (eds). Mandel, Douglas and Bennett'sPrinciples and practice of infectious diseases. 5thedition. Churchill Livingstone, Philadelphia, 2000:1823-1849.

    2. Laver WG, Bischofberger N, Webster RG. Disarm-ing flu viruses. Sci Am 1999;280:78-87.

    3. Osterhaus A. H5N1: the lessons to be learned. In:Zambon MC, ed. United Kingdom: Advances in in-fluenza. Blackwell Science; 1999. p. 11-17.

    4. Laver G, Garman E. Virology. The origin and controlof pandemic influenza. Science 2001;293:1776-1777.

    5. Hien TT, De Jong M, Farrar J. Avian influenza - AChallenge to global health care structures. N Engl JMed 2004;351:2363-2365.

    6. Perez DR, Sorrell EM, Donis RO. Avian influenza:an omnipresent pandemic threat. Pediatr Infect DisJ 2005;24 (11 Suppl):S208-S216.

    7. Belshe RB. The Origins of Pandemic Influenza -lessons from the 1918 Virus. N Eng J Med 353;21:2209-2211.

    8. Taubenberger JK, Reid AH, Lourens RM, Wang R,Jin G, Fanning TG. Characterization of the 1918 in-fluenza virus polymerase genes. Nature 2005;437:889-893.

    9. Tumpey TM. Basler CF, Aguilar PV, Zeng H,Solorzano A, Swayne DE et al. Characterization ofthe reconstructed 1918 Spanish influenza pandemicvirus. Science 2005;310:77-80.

    10. Centers for Disease Control and Prevention Influen-za (flu): information about Avian influenza andAvian influenza A [Internet]. 2005: Webpage:http://www.cdc.gov/flu.

    11. Macfarlane JT, Lim WS. Bird flu and pandemic flu.BMJ 2005;331:975-976.

    12. Monto AS. The threat of an avian influenza pan-demic. N Eng J Med 2005;352:323-325.

    13. Stohr K. Avian influenza and pandemics-Researchneeds and opportunities. N Eng J Med 2005;352:405-407.

    2006;69:1-9

    Pediatr Jan-Feb 06 final allges 27-01-06 15:34 8

  • 9

    14. Beigel JH, Farrar J, Han AM, Hayden FG, Hyer R, deJong MD et al; Writing Committee of the WorldHealth Organization (