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人類 H7N9 流感及醫療院所之因應作為. 衛福部 疾病管制署 中區傳染病防治醫療網 王任賢 指揮官. 大綱. H7N9 疫情流行現況 H7N9 感染者之臨床表現 H7N9 病毒來源探討 H7N9 疑似或確認病例之通報原則 H7N9 疑似或臨床病例之收治與轉送原則 H7N9 臨床檢體之採集 H7N9 醫院之因應作為. H7N9 疫情流行現況. - PowerPoint PPT Presentation
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H7N9*
H7N9H7N9H7N9H7N9H7N9H7N9H7N9*
H7N9*
*3/31H7N94/30126(25)( )4H7N999.4%H7N9()Updated: 2013/5/1:
*H7N9():6/3-6/923/31131H7N9(39)() Updated: 2013/06/112
*4/13(7)244/151H7N94H7N9(): Updated: 2013/4/23
*4/452(56)4/14/5H7N94/10H7N9
H7N9(): Updated: 2013/4/23
*H7N9(87)2/193/422/20-2/25112H7N94
H7N9(): Updated: 2013/4/23
*24/234/164/21(4)4/274/28H7N9()Updated: 2013/5/1:
*1,500H7N9(0.08%)H7N9()Updated: 2013/4/23:
*1,000
H7N9(): WHO EISUpdated: 2013/4/23
Updated: 2013/06/10
*H7N9H7N9
H7N9*
*: Updated: 2013/4/99:00
H7N9*
(n=24) (n=7):16:86:1 ()57.7 (n=23)54.3 (n=7)3/21 (14.3%)1/7 (14.3%)19/19 (100%)5/5 (100%) ()9.0 (n=16)8.76 (n=5) ()-2.2 (n=5)
H7N9()10-147-92009 WHO339GOT,GPT,CKCBC*
H7N9()7-92-3*
631000H7N9*
*: Updated: 2013/4/57:00
H7N9?*
H7N9*
*NA/N9 H7N9 (A/wild bird/Korea/A3/2011)
PB2PB1PAHA-H7NPNA-N9MPNS2013 H7N9PB2PB1PAHA-H9NPNA-N2MPNSH9N22010~2012 HA/H7 H7N3 (A/duck/Zhejiang/2/2011)
H7N9H7N9H7N9H7N9*
H7N93/31GISAIDH7N93HH7NH7N9H9N2Nature doi:10.1038/nature.2013.12728
*H7N9:
Determination of viral pathogenicityProteinPositionPathogenicity2013 H7N9FunctionLowHighPB2627EKKreplication ability701DQDNuclear ImportPB1-F266NSNinduction of apoptosisHACleavage siteSingle basic aaMultiple basic aaSingle basic aaHA cleavageNS192DEDunknownC- terminus (PDZ)RSEVESEV13 C terminal aa truncatedunknown
H7N9TamifluAmantadine *
H7N9H7N9H7N9
*
H7N9()()()
*
*102-4-25
H7N9()
*
H7N9()H7N9H7N9*
H7N9
*
H7N9
38()()
14()H7N9()()H7N9()
H7N9H7N9
H7N9
>38*
H7N9*
H7N9
H7N9119*
H7N9*
Nasopharyngeal SwabInsert dry swab into nostril and back to nasopharynxLeave in place for a few secondsSlowly remove swab while slightly rotating it
Nasopharyngeal Swabcontinued
Use a different swab for the other nostrilPut tip of swab into vial containing VTM, breaking applicators stick
Oropharyngeal SwabAsk the subject to open his or her mouthDepress the tongueSwab the posterior pharynxAvoid the tonsils
Collection of laboratory specimens
Upper respiratory tract (above larynx)Standard and Droplet PrecautionWHOCDCN95Lower respiratory tract specimensAerosol-generating procedures IPC measuresWHOCDCN95
High risk aerosol-generating proceduresEnhance respiratory protection including the N95 is recommended for such procedures. The procedures should include:open suctioning of airway secretionsresuscitation involving emergency incubationcardiac pulmonary resuscitationendotracheal intubationHowever the following should not be included: collection of nasopharyngeal specimens close suctioning of airway secretions administration of nebulized medications*
Intubation and related proceduresCardiopulmonary resuscitationBronchoscopy Surgery and autopsy
H7N9*
WHO guidance for infection prevention and control for H1N1
Standard precautionHand hygiene (HH)Use of PPE does not eliminate hand hygienewhen procedures include relevant risk:medical mask and PPE for eye protectiona gown and clean glovesDroplet Precautionsmedical mask if < 1m of patientHH before and after patient contact and after removal of mask
Performing aerosol-generating procedures
Wear a particulate respiratorAdequately ventilated room, min of 6-12 ACHLimit only to those with patient careHH before & after patient contact and PPE removalSpecial considerations (eg. BiPAP, Nebulization)above measures also for open suctioning system
Personal Protective Equipment
GlovesMaskGownEye protection
Packing Specimens for Transportation
Use three packaging layersFirst layer should be water tightUse absorbent material in all layerNo more than 500 mL should be in the specimen container
Transporting Specimens from Field to Lab
Keep specimens at 4 C Fill a cooler with ice packs or coolant packsDouble-bag specimens if you use dry iceInclude an itemized list of specimens with identification numbers and laboratory instructions Packing Specimens for Transportation
H7N9*
:I14()
*
:II(N95)()MOPP*
:III
*
*
*
**********Module 5: Laboratory Diagnosis, Specimen Collection, and Biosafety Issues*Now we will discuss how to collect specimens. First, we will describe how to collect a nasopharyngeal swab. First, insert a dry drayon, rayon, or polyester swab into the nostril and back to the nasopharynx. Leave the swab in place for a few seconds. Then slowly remove the swab while slightly rotating it.Module 5: Laboratory Diagnosis, Specimen Collection, and Biosafety Issues*Use a different swab for the other nostril. Put the tip of the swab into a vial containing VTM, and break off the applicators stick.Module 5: Laboratory Diagnosis, Specimen Collection, and Biosafety Issues*Next, we will describe how to collect an oropharyngeal swab. You will swab the posterior pharynx, the area in the back of the throat behind the tonsils. Oropharyngeal swabs are preferred specimens.First, ask the subject to open his or her mouth. Next, depress the tongue using a tongue depressor. Swab the posterior pharynx, avoiding the tonsils.
Module 5: Laboratory Diagnosis, Specimen Collection, and Biosafety Issues*Personal protective equipment such as gloves, masks, gowns, and eye protection should be included in the specimen collection kit. Multiple sizes of the gloves and masks should be available to assure that the people collecting the samples can use the correct size. Module 5: Laboratory Diagnosis, Specimen Collection, and Biosafety Issues*When you are ready to pack specimens for transportation from the field to the laboratory, you must use three packaging layers. This is done to protect specimens from damage during transportation. The first packaging layer should be water tight, and all layers should be absorbent in case there are any leaks. There should be no more than 500 mL of liquid in the specimen collection container.Module 5: Laboratory Diagnosis, Specimen Collection, and Biosafety Issues*Here is an image of a properly packed specimen ready for shipment to a laboratory. Included are the three layers of packaging, the absorbent packing material, the specimen ID, the biohazard label, the itemized list of contents, and the labeling of the outer package as UN 3373 diagnostic specimens. If this material is not available to you, transport specimens in a cool box with ice.Module 5: Laboratory Diagnosis, Specimen Collection, and Biosafety Issues*Just as it is important to keep specimens cold during storage, it is important to keep specimens cold during transportation. Try to keep specimens at 4 C. A cooler filled with ice packs can be used for this purpose, but do not use dry ice unless the specimens are double-bagged and airtight; carbon dioxide from the dry ice can inactivate the virus.
In all specimen shipments, include an itemized list of specimens, with specimen identification numbers and instructions for the laboratory.