甲型H1N1流感诊疗方案（2009年第三版）的制定及临床应用体会汇.ppt

甲型H1N1流感诊疗方案（2009年第三版）的制定及临床应用体会 北京朝阳医院 呼吸与危重症医学科 曹志新 2009-10-27 流行病学-传播途径 主要通过飞沫经呼吸道传播，…… 通过气溶胶经呼吸道传播有待进一步确证。 流行病学-高危人群 CDC. September 8, 2009. Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season. 临床表现-轻症患者 国内1054例A/H1N1患者体征特点 重症患者的临床表现呈多样性 国内重症病例特点需进一步总结 提示对A/H1N1流感监测的调整 WHO. 10 July 2009. Human infection with pandemic (H1N1) 2009 virus: updated interim WHO guidance on global surveillance. CDC. September 8, 2009. Interim Guidance for State and Local Health Departments for Reporting Influenza-Associated Hospitalizations and Deaths for the 2009-2010 Season. 关于甲型H1N1流感的诊断标准 “诊断标准”的条件 流行病学史 疫源地或确诊病例接触史 暴发疫情中的病例 临床表现 流感样病例（ILI） 特异性检查 检测是否为甲型流感 检测是否为新型A/H1N1流感 real-time RT-PCR或RT-PCR方法检测A/H1N1病毒核酸阳性 分离到A/H1N1病毒 双份血清A/H1N1病毒的特异性抗体水平呈4倍或4倍以上升高 两类不同的诊断标准 三分类法 疑似病例 临床诊断病例 确诊病例 两分类 疑似病例 确诊病例 三分类法：美国CDC诊断标准 Confirmed case a person with an influenza-like illness with laboratory confirmed novel influenza A (H1N1) virus infection by one or more of the following tests: real-time RT-PCR viral culture Probable case a person with an influenza-like-illness who is positive for influenza A, but negative for human H1 and H3 by influenza RT_PCR Suspected case a person who does not meet the confirmed or probable case definition, and is not novel H1N1 test negative, and is/has: a previously healthy person 65 years hospitalized for ILI OR ILI and resides in a state without confirmed cases, but has traveled to a state or country where there are one or more confirmed or probable cases OR ILI and has an epidemiologic link in the past 7 days to a confirmed case or probable case 两分类法：WHO诊断标准 Confirmed case an individual with laboratory confirmed swine influenza A(H1N1) virus infection by one or more of the following tests real-time RT-PCR viral culture four-fold rise in swine influenza A(H1N1) virus specific neutralizing antibodies Probable case an individual with an influ