Catbird
Senior Moderator
Machine translation from Sina's Top 100 Domestic News at zhttp://news.sina.com.cn/hotnews/china/Daily/index.shtml
"The Guardian Planning Commission announced
2013 04 03
Provinces, autonomous regions and municipalities health bureau, the Xinjiang Production and Construction Corps, Health Bureau:
Recently, some provinces in China found that people infected with the H7N9 avian influenza. Good people infected with the H7N9 avian influenza medical treatment, to protect people's health and life safety, I appointed to organize experts to develop a "people infected with the H7N9 avian flu (2013) guided by medical institutions. Is issued to you for medical institutions to use the reference in the clinical work.
Human infection with the H7N9 avian flu
First edition (2013)
People infected with the H7N9 avian flu caused by the H7N9 subtype of avian influenza virus in acute respiratory infections. Since February 2013, Shanghai, Anhui, Jiangsu Province has occurred unexplained cases of severe pneumonia, which confirmed human infection of H7N9 avian influenza 3 cases, 2 deaths. The three cases are sporadic cases, has not yet found the epidemiological association between the three cases.
I. Etiology
The avian influenza virus is a genus of the Orthomyxoviridae Influenza A virus. The avian influenza virus particles were pleomorphic spherical diameter of 80 ~ 120nm, capsulotomy. Genome segmented single-stranded negative RNA. Based on its outer membrane hemagglutinin (H) and neuraminidase (N) protein antigenicity can be divided into 16 H subtypes (H1 ~ H16) and 9 N subtypes (N1 to N9). Apart from infected poultry, avian influenza virus also infect humans, pigs, horses, mink and marine mammals. Infected with the avian influenza virus subtypes H5N1, H9N2, H7N7, H7N2, H7N3, and the reports of human infection of H7N9 avian influenza virus. The virus to a new reassortant virus, its internal genes from the H9N2 avian influenza virus.
Avian influenza viruses in general are sensitive to heat, strong resistance to low temperature, 65 ℃ can be inactivated by heating for 30 minutes or boiling (100 ? C) 2 minutes or more. The virus can survive in the lower temperature feces one week in the the 4 ℃ water can survive for a month, have a certain resistance to the acidic environment also has some ability to survive under conditions of pH4.0. In the case of the presence of glycerol can maintain vitality for more than 1 year.
Second, the epidemiology
(A) the source of infection. It is not clear, based on past experience and the epidemiological investigation, suggesting that might carry the H7N9 avian influenza virus in poultry and poultry secretions or excretions.
(B) the route of transmission. The spread of the respiratory tract, may also be infected through close contact with infected poultry secretions or excretions, direct contact with the virus may also be infected. Now there is no conclusive evidence of human-to-human transmission.
(C) susceptible populations. There is no conclusive evidence to show that human H7N9 avian influenza virus susceptible. Existing confirmed cases are adults.
(D) high-risk groups. This stage is mainly engaged in poultry breeding, sale, slaughter, processing industry, as well as 1 week prior to the onset of contact to birds.
Third, the clinical manifestations
According to the findings of the incubation period for influenza and the the existing H7N9 avian influenza virus infections, the incubation period is generally less than seven days.
(A) the general performance.
The general performance of in patients with for the the the symptoms of influenza-like, such as fever, cough, with scanty sputum, can be accompanied by headache, the muscle soreness and the whole body is does not apply. Rapidly in patients with severe progression of the disease, manifested as severe pneumonia, the body temperature is mostly sustained above 39 ℃, difficulty in breathing, can be associated with hemoptysis sputum; rapid progress acute respiratory distress syndrome, mediastinal emphysema, sepsis, shock, awareness disorder and acute kidney injury.
(B) laboratory tests.
1. Blood count. The total number of white blood cells is generally not high or reduced. More than the total number of white blood cells in patients with severe lymphopenia and thrombocytopenia.
Blood biochemical tests. Much creatine kinase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, myoglobin increased.
3 pathogen detection.
(1) nucleic acid detection. Of patients with respiratory tract specimens (such as nasopharyngeal secretions, mouth gargle, tracheal aspirate or a respiratory epithelial cells) using real time PCR (or RT-PCR) to detect the H7N9 avian flu virus nucleic acid.
(2) virus isolation. The H7N9 avian flu virus isolated from patients with respiratory tract specimens.
(C) the chest radiograph. Pneumonia in the lungs of patients flake image. The rapid progress of patients with severe disease, showed multiple lung ground-glass opacities and lung consolidation images can be combined with a small amount of pleural effusion. Of ARDS, the lesions are widely distributed.
(D) the prognosis. Of human infection with the H7N9 avian flu critically ill patients with poor prognosis. Prognostic factors may include the patient's age, underlying diseases and complications.
Fourth, the diagnosis and differential diagnosis
(A) diagnosis. Epidemiological contact history, clinical manifestations and laboratory findings to make the diagnosis of human infection with the H7N9 avian influenza. In the case of the epidemiological history is unknown, according to the clinical manifestations, laboratory examinations, and laboratory test results, especially isolated from patients with respiratory secretion samples of the H7N9 avian flu virus, or H7N9 avian influenza virus nucleic acid testing positive can be diagnosed.
1. Epidemiology history. 1 week prior to the onset of a history of exposure to poultry and their secretions, excretions.
Diagnostic criteria.
(1) suspected cases: in line with the clinical symptoms and blood, biochemical and chest imaging characteristics of influenza A virus universal primer positive side-by-side in addition to the seasonal flu, can epidemiological contact history.
(2) of the confirmed cases: Complies with suspected cases of diagnostic criteria, and respiratory secretion samples isolated nucleic acid testing positive of the H7N9 avian flu virus, or H7N9 avian influenza virus.
In severe cases: pneumonia complicated by respiratory failure or other organ failure in severe cases.
(B) the differential diagnosis. Should be noted that people infected with the highly pathogenic H5N1 avian influenza, seasonal influenza (including H1N1), bacterial pneumonia, infectious atypical pneumonia (SARS) the novel coronavirus pneumonia, adenovirus pneumonia, Chlamydia pneumoniae, Mycoplasma pneumonia and other diseases for differential diagnosis. Differential diagnosis depends on pathogenic examination.
V. Treatment
(A) clinical diagnosis and diagnosis of patients should be treated in isolation.
(B) symptomatic treatment. Oxygen, application antipyretic drugs, cough expectorant drug.
(C) the anti-viral treatment. Antiviral drugs for influenza should apply as soon as possible.
Neuraminidase inhibitors: the choice of Oseltamivir (Oseltamivir) or bar zanamivir (Zanamivir), clinical application showed that the avian influenza virus H5N1 and H1N1 infection, suggesting that human infection with the H7N9 avian influenza virus should effective. Oseltamivir adult dose of 75mg twice daily, severe dose may be doubled, the course of 5-7 days. Zanamivir adult dose of 10 mg twice daily inhaled.
2. Ion channel M2 blockers: laboratory data suggest Amantadine (Amantadine) and rimantadine (Rimantadine) resistance is not recommended to be used alone.
(D) in the medical treatment.
1. Immunotoxin the Fanfei lung failure declared down
Symptoms: fever, cough, little sputum, headache, muscle and joint pain.
Governing law: heat Xuanfei
Reference prescription:
The mulberry leaves Honeysuckle Forsythia fried almonds the gypsum Anemarrhena reed rhizome the Artemisia annua skullcap raw licorice
Shuijianbi 1-2 agent orally every 4-6 hours.
Modified: cough worse plus loquat, Fritillaria.
Proprietary Chinese medicines: optional Shufeng detoxification capsules, and even spent Qingwen capsule, Qing Kai Ling Injection.
2. Immunotoxin the obstruct the lung within closed outside off
Symptoms: high fever, cough, sputum less difficult slightly, hold your breath, breathlessness, hemoptysis, four at the end not warm, cold sweat dripping, manic scrambling uneasy, even coma delirium.
Governing Law: Qingfei detoxification, righting solid off
Reference prescription:
Sunburn ephedra fried almonds Gypsum Anemarrhena Houttuynia skullcap
Fried Gardenia cuspidatum cornus heterophylla
Shuijianbi 1-2 agent, once every 4-6 hours oral or nasal.
Modified: high fever, trance, and even coma delirium, delivery service above Angongniuhuang Pill; limbs, the sweating profusely plus ginseng, guns the aconite, calcined keel, calcined oyster; hemoptysis plus red peony, Agrimony Oriental Arborvitae; cyanotic lips plus thirty-seven, motherwort, astragalus, angelica tail.
Proprietary Chinese medicines: Optional Injection, Shengmai injection.
(E) to strengthen support for the treatment and prevention of complications. Attention to rest, drink plenty of water, increase nutrition, to the easy-to-digest diet. Close observation, monitoring and prevention of complications. Antimicrobial drugs should be clearly secondary bacterial infection, or when there is sufficient evidence suggests that secondary bacterial infection.
(Vi) the treatment of critically ill patients. Critically ill patients should be hospitalized and given oxygen and other appropriate respiratory support for respiratory dysfunction, and other complications occur, the patient should actively take the appropriate treatment.
Respiratory function support:
(1) mechanical ventilation: patients with severe disease progresses rapidly, and rapid development of acute respiratory distress syndrome (ARDS). In severe cases require mechanical ventilation, mechanical ventilation of ARDS may refer to the principle.
① noninvasive positive pressure ventilation: the emergence of respiratory distress and (or) hypoxemia early you can try using non-invasive ventilation. But in severe cases of noninvasive ventilation efficacy of the poor, the need to consider implementing early invasive ventilation.
② invasive positive pressure ventilation: In view of the fact that some patients are more prone to barotrauma, should adopt the ARDS protective ventilation strategy.
(2) extracorporeal membrane oxygenation (ECMO): conventional mechanical ventilation can not maintain the satisfaction oxygenation and (or) ventilation, conditional, recommend the use of ECMO.
(3) Other: conventional mechanical ventilation can not maintain a satisfactory oxygenation can be considered the prone position ventilation or high frequency oscillatory ventilation (HFOV).
Other treatment: supportive care in respiratory function, attention should be paid to the monitoring and treatment of the functional status of other organs; especially hospital-acquired infection prevention and timely treatment of various complications.
Six other
Strict norms admitted to hospital infection control measures of human infection with the H7N9 avian flu medical institutions. Follow standard precautionary principle, according to the route of transmission of disease prevention and control. Specific measures in accordance with human infection with the H7N9 avian influenza Hospital Infection Prevention and Control Technical Guide (2013 Edition) "provisions. "
"The Guardian Planning Commission announced
2013 04 03
Provinces, autonomous regions and municipalities health bureau, the Xinjiang Production and Construction Corps, Health Bureau:
Recently, some provinces in China found that people infected with the H7N9 avian influenza. Good people infected with the H7N9 avian influenza medical treatment, to protect people's health and life safety, I appointed to organize experts to develop a "people infected with the H7N9 avian flu (2013) guided by medical institutions. Is issued to you for medical institutions to use the reference in the clinical work.
Human infection with the H7N9 avian flu
First edition (2013)
People infected with the H7N9 avian flu caused by the H7N9 subtype of avian influenza virus in acute respiratory infections. Since February 2013, Shanghai, Anhui, Jiangsu Province has occurred unexplained cases of severe pneumonia, which confirmed human infection of H7N9 avian influenza 3 cases, 2 deaths. The three cases are sporadic cases, has not yet found the epidemiological association between the three cases.
I. Etiology
The avian influenza virus is a genus of the Orthomyxoviridae Influenza A virus. The avian influenza virus particles were pleomorphic spherical diameter of 80 ~ 120nm, capsulotomy. Genome segmented single-stranded negative RNA. Based on its outer membrane hemagglutinin (H) and neuraminidase (N) protein antigenicity can be divided into 16 H subtypes (H1 ~ H16) and 9 N subtypes (N1 to N9). Apart from infected poultry, avian influenza virus also infect humans, pigs, horses, mink and marine mammals. Infected with the avian influenza virus subtypes H5N1, H9N2, H7N7, H7N2, H7N3, and the reports of human infection of H7N9 avian influenza virus. The virus to a new reassortant virus, its internal genes from the H9N2 avian influenza virus.
Avian influenza viruses in general are sensitive to heat, strong resistance to low temperature, 65 ℃ can be inactivated by heating for 30 minutes or boiling (100 ? C) 2 minutes or more. The virus can survive in the lower temperature feces one week in the the 4 ℃ water can survive for a month, have a certain resistance to the acidic environment also has some ability to survive under conditions of pH4.0. In the case of the presence of glycerol can maintain vitality for more than 1 year.
Second, the epidemiology
(A) the source of infection. It is not clear, based on past experience and the epidemiological investigation, suggesting that might carry the H7N9 avian influenza virus in poultry and poultry secretions or excretions.
(B) the route of transmission. The spread of the respiratory tract, may also be infected through close contact with infected poultry secretions or excretions, direct contact with the virus may also be infected. Now there is no conclusive evidence of human-to-human transmission.
(C) susceptible populations. There is no conclusive evidence to show that human H7N9 avian influenza virus susceptible. Existing confirmed cases are adults.
(D) high-risk groups. This stage is mainly engaged in poultry breeding, sale, slaughter, processing industry, as well as 1 week prior to the onset of contact to birds.
Third, the clinical manifestations
According to the findings of the incubation period for influenza and the the existing H7N9 avian influenza virus infections, the incubation period is generally less than seven days.
(A) the general performance.
The general performance of in patients with for the the the symptoms of influenza-like, such as fever, cough, with scanty sputum, can be accompanied by headache, the muscle soreness and the whole body is does not apply. Rapidly in patients with severe progression of the disease, manifested as severe pneumonia, the body temperature is mostly sustained above 39 ℃, difficulty in breathing, can be associated with hemoptysis sputum; rapid progress acute respiratory distress syndrome, mediastinal emphysema, sepsis, shock, awareness disorder and acute kidney injury.
(B) laboratory tests.
1. Blood count. The total number of white blood cells is generally not high or reduced. More than the total number of white blood cells in patients with severe lymphopenia and thrombocytopenia.
Blood biochemical tests. Much creatine kinase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, myoglobin increased.
3 pathogen detection.
(1) nucleic acid detection. Of patients with respiratory tract specimens (such as nasopharyngeal secretions, mouth gargle, tracheal aspirate or a respiratory epithelial cells) using real time PCR (or RT-PCR) to detect the H7N9 avian flu virus nucleic acid.
(2) virus isolation. The H7N9 avian flu virus isolated from patients with respiratory tract specimens.
(C) the chest radiograph. Pneumonia in the lungs of patients flake image. The rapid progress of patients with severe disease, showed multiple lung ground-glass opacities and lung consolidation images can be combined with a small amount of pleural effusion. Of ARDS, the lesions are widely distributed.
(D) the prognosis. Of human infection with the H7N9 avian flu critically ill patients with poor prognosis. Prognostic factors may include the patient's age, underlying diseases and complications.
Fourth, the diagnosis and differential diagnosis
(A) diagnosis. Epidemiological contact history, clinical manifestations and laboratory findings to make the diagnosis of human infection with the H7N9 avian influenza. In the case of the epidemiological history is unknown, according to the clinical manifestations, laboratory examinations, and laboratory test results, especially isolated from patients with respiratory secretion samples of the H7N9 avian flu virus, or H7N9 avian influenza virus nucleic acid testing positive can be diagnosed.
1. Epidemiology history. 1 week prior to the onset of a history of exposure to poultry and their secretions, excretions.
Diagnostic criteria.
(1) suspected cases: in line with the clinical symptoms and blood, biochemical and chest imaging characteristics of influenza A virus universal primer positive side-by-side in addition to the seasonal flu, can epidemiological contact history.
(2) of the confirmed cases: Complies with suspected cases of diagnostic criteria, and respiratory secretion samples isolated nucleic acid testing positive of the H7N9 avian flu virus, or H7N9 avian influenza virus.
In severe cases: pneumonia complicated by respiratory failure or other organ failure in severe cases.
(B) the differential diagnosis. Should be noted that people infected with the highly pathogenic H5N1 avian influenza, seasonal influenza (including H1N1), bacterial pneumonia, infectious atypical pneumonia (SARS) the novel coronavirus pneumonia, adenovirus pneumonia, Chlamydia pneumoniae, Mycoplasma pneumonia and other diseases for differential diagnosis. Differential diagnosis depends on pathogenic examination.
V. Treatment
(A) clinical diagnosis and diagnosis of patients should be treated in isolation.
(B) symptomatic treatment. Oxygen, application antipyretic drugs, cough expectorant drug.
(C) the anti-viral treatment. Antiviral drugs for influenza should apply as soon as possible.
Neuraminidase inhibitors: the choice of Oseltamivir (Oseltamivir) or bar zanamivir (Zanamivir), clinical application showed that the avian influenza virus H5N1 and H1N1 infection, suggesting that human infection with the H7N9 avian influenza virus should effective. Oseltamivir adult dose of 75mg twice daily, severe dose may be doubled, the course of 5-7 days. Zanamivir adult dose of 10 mg twice daily inhaled.
2. Ion channel M2 blockers: laboratory data suggest Amantadine (Amantadine) and rimantadine (Rimantadine) resistance is not recommended to be used alone.
(D) in the medical treatment.
1. Immunotoxin the Fanfei lung failure declared down
Symptoms: fever, cough, little sputum, headache, muscle and joint pain.
Governing law: heat Xuanfei
Reference prescription:
The mulberry leaves Honeysuckle Forsythia fried almonds the gypsum Anemarrhena reed rhizome the Artemisia annua skullcap raw licorice
Shuijianbi 1-2 agent orally every 4-6 hours.
Modified: cough worse plus loquat, Fritillaria.
Proprietary Chinese medicines: optional Shufeng detoxification capsules, and even spent Qingwen capsule, Qing Kai Ling Injection.
2. Immunotoxin the obstruct the lung within closed outside off
Symptoms: high fever, cough, sputum less difficult slightly, hold your breath, breathlessness, hemoptysis, four at the end not warm, cold sweat dripping, manic scrambling uneasy, even coma delirium.
Governing Law: Qingfei detoxification, righting solid off
Reference prescription:
Sunburn ephedra fried almonds Gypsum Anemarrhena Houttuynia skullcap
Fried Gardenia cuspidatum cornus heterophylla
Shuijianbi 1-2 agent, once every 4-6 hours oral or nasal.
Modified: high fever, trance, and even coma delirium, delivery service above Angongniuhuang Pill; limbs, the sweating profusely plus ginseng, guns the aconite, calcined keel, calcined oyster; hemoptysis plus red peony, Agrimony Oriental Arborvitae; cyanotic lips plus thirty-seven, motherwort, astragalus, angelica tail.
Proprietary Chinese medicines: Optional Injection, Shengmai injection.
(E) to strengthen support for the treatment and prevention of complications. Attention to rest, drink plenty of water, increase nutrition, to the easy-to-digest diet. Close observation, monitoring and prevention of complications. Antimicrobial drugs should be clearly secondary bacterial infection, or when there is sufficient evidence suggests that secondary bacterial infection.
(Vi) the treatment of critically ill patients. Critically ill patients should be hospitalized and given oxygen and other appropriate respiratory support for respiratory dysfunction, and other complications occur, the patient should actively take the appropriate treatment.
Respiratory function support:
(1) mechanical ventilation: patients with severe disease progresses rapidly, and rapid development of acute respiratory distress syndrome (ARDS). In severe cases require mechanical ventilation, mechanical ventilation of ARDS may refer to the principle.
① noninvasive positive pressure ventilation: the emergence of respiratory distress and (or) hypoxemia early you can try using non-invasive ventilation. But in severe cases of noninvasive ventilation efficacy of the poor, the need to consider implementing early invasive ventilation.
② invasive positive pressure ventilation: In view of the fact that some patients are more prone to barotrauma, should adopt the ARDS protective ventilation strategy.
(2) extracorporeal membrane oxygenation (ECMO): conventional mechanical ventilation can not maintain the satisfaction oxygenation and (or) ventilation, conditional, recommend the use of ECMO.
(3) Other: conventional mechanical ventilation can not maintain a satisfactory oxygenation can be considered the prone position ventilation or high frequency oscillatory ventilation (HFOV).
Other treatment: supportive care in respiratory function, attention should be paid to the monitoring and treatment of the functional status of other organs; especially hospital-acquired infection prevention and timely treatment of various complications.
Six other
Strict norms admitted to hospital infection control measures of human infection with the H7N9 avian flu medical institutions. Follow standard precautionary principle, according to the route of transmission of disease prevention and control. Specific measures in accordance with human infection with the H7N9 avian influenza Hospital Infection Prevention and Control Technical Guide (2013 Edition) "provisions. "