病毒各论-2011 April.ppt

我国计划免疫：从2月龄开始连续3次口服OPV，每次间隔1个月，4岁时加强一次。 CURRENT RECOMMENDATIONS : 4 doses of IPV at ages 2 months, 4 months, 6-18 months, and 4-6 years. Hand, foot and mouth disease 手足口病 HEPATITIS A VIRUS 27nm, +ssRNA, Picornavirus, nonenveloped Transmission: Oral-fecal route Close personal contact: household contact, child day care centers Contaminated food, water: infected food handler, raw shellfish Intestinal tract- Bloodstream-liver parenchymal cells-bile-stool CLINICAL FEATURES HAV引起急性和无症状感染，不引起慢性感染。 儿童是最易感人群。 临床表现：疲乏、食欲不振，恶心、呕吐，可伴右上腹疼痛；尿颜色变深，粪便颜色变浅，不久出现黄疸，首先是巩膜，然后皮肤，伴痒感。 ALT升高，血胆红素升高。 多数病人发病都与饮水、食用消毒不彻底的食物有关，常有外出旅游、在外就餐史。 CLINICAL FEATURES Immunity IgM is generally present 5-10 days before the onset of symptoms, which is used in diagnosis. IgG remains detectable for lifetime and confers lifelong immunity. The present of Total Ig without IgM indicates past infection. There is cytotoxic T cell and natural killer cell response that kills infected cells. Most pathological effects are the results of the immune response rather than the virus itself. 流 行 特 点 全球分布性疾病，通过污染的水源和食物传播。 在不发达国家，人群感染率达80%以上，发病者主要是儿童、青少年。 HAV的宿主是人类。平均潜伏期为30天，隐性感染者是有症状患者的10倍。 一般在3个月内病人自行恢复。临床上不出现慢性肝炎和长期持续排毒者。 Epidemiology Many infected persons are asymptomatic, but still shed infectious virus. Peak infectivity occurs during the 2-week period before onset of jaundice, when the concentration of virus in stool is highest. Members of family are most at risk. Virus may be spread in contaminated drinking water since the virus can survive for months in fresh and salt water. Particularly problematic is contamination of oysters and other shellfish. In developing countries, most people get mild HAV infections as children and then retain life-long immunity. Diagnosis An ELIZA test for anti-HAV IgM is available. Diagnosis is also made from the symptoms and the clusters of cases that occur. Treatment There is no treatment. Supportive care should be given. Immune globulin administration within two weeks aft