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目的通过2例家庭聚集性H7N9禽流感的流行病学调查,为进一步认识与防治禽流感提供科学依据。方法运用描述流行病学方法对患者、密切接触者及农贸市场等开展现场流行病学调查与监测,采用real-time PCR方法检测H7N9禽流感病毒核酸。结果患者(A、B)为父子关系,均无明显禽类接触史,经积极救治痊愈出院。患者A病情极危重,发病后5 d进展为ARDS,呈典型的“白肺”征,白细胞2.4×109/L。患者B临床轻症,肺炎,白细胞17.7×109/L。除患者B,其他密切接触者均未发现异常临床表现;应急监测201人,结果均为阴性。农贸市场环境标本检出H7N9禽流感病毒核酸阳性。结论感染来源可能与农贸市场暴露有关,或有特异性受体,短时间内临床症状急剧加重,早发现、确诊对提高治愈率,降低病死率尤为重要。为有效防控禽流感,需扩大监测,进一步研究人禽流感感染的来源、病毒变异、传播途径和影响因素等。
Objective To provide a scientific basis for further understanding and prevention of bird flu through the epidemiological investigation of two H9N9 bird flu in domestic families. Methods Epidemiological methods were used to carry out on-the-spot epidemiological investigation and monitoring of patients, close contacts and farmer’s markets. The nucleic acid of H7N9 bird flu virus was detected by real-time PCR. Results Patients (A, B) were father-son relationship. There was no obvious history of bird contact and were discharged after active treatment. Patient A was in critical condition. ARDS progressed on the fifth day after onset, showing typical signs of “white lung” and white blood cells of 2.4 × 109 / L. Patient B clinical mild, pneumonia, leukocytes 17.7 × 109 / L. In addition to patient B, other close contacts were found no abnormal clinical manifestations; emergency monitoring of 201 people, the results were negative. H7N9 bird flu positive for nucleic acid was detected in the farmer’s market environment specimens. Conclusion The sources of infection may be related to the exposure of farmers’ markets or to specific receptors. The clinical symptoms are rapidly aggravated in a short period of time. Early detection and diagnosis are particularly important to improve the cure rate and reduce the mortality rate. In order to effectively prevent and control bird flu, it is necessary to expand monitoring and further study on the source of human bird flu infection, virus variation, transmission routes and influencing factors.