江苏发现两例布尼亚病毒人传人病例
苏省疾病预防控制中心主任汪华教授带领该中心急性传染病防治所鲍昌俊副主任医师等人，通过实验室检测等多种方式研究发现了1例家族聚集性布尼亚病毒感染是通过人传人的方式传染的病例。该研究论文10月25日在线发表在《临床传染病杂志》（Clin Infect Dis）。据介绍，2007年4月27日，1名80岁妇女因高热、白细胞减少和血小板减少死亡。当时调查情况显示，该死亡病例在发病前无外出史、无病死禽接触史、无类似病例接触史。该死亡病例所在的住地属典型的丘陵地区，死者平时身体状况良好，但时常至野外山坡采摘茶叶。在该首例病例死亡后不久，其亲属和家庭中部分成员陆续出现发热、全省乏力、头痛、恶心、血小板减少等类似症状，但最初的调查并没有发现传染病源头。2009年12月，一种被命名为发热伴血小板减少综合征布尼亚病毒的新型布尼亚病毒，被确认为在中国引起上述症状的病原体。研究者重新检测了该家族成员血样，并分析了首发病例和继发病例的流行病学资料和临床数据。通过实时定量聚合酶链式反应(RT-PCR)、病毒培养、基因测序、微量中和实验（MNA）、间接免疫荧光法（IFA）等方法检测继发病例血样。检测结果发现这6名患者的血样均呈发热伴血小板减少综合征布尼亚病毒(SFTSV)阳性，其中1例患者的血样中成功分离得到SFTSV。这6名患者无一与可疑动物或带菌者有过接触，但都与首发病例有过密切接触。
另外，江苏省疾病预防控制中心急性传染病防治所还发现另一例布尼亚病毒人传人病例。首发病例为一位59岁的男性，发病时间为2010年10月，而与患者密切接触的照顾者随后也出现了发烧伴血小板减少症状。同样经过检测，成功分离出发热伴血小板减少综合征布尼亚病毒，基因测序也是完全一致。该结果发表在今年9月出版的《新英格兰医学杂志》。
参与研究的鲍昌俊副主任医师分析指出，发热伴血小板减少综合征布尼亚病毒的成功检测，为该病的治疗指明了方向，对降低该病的病死率大有好处；同时，人传人的报道，证实该病传播的新方式，对该病防范、阻断传播途径以及加强新发传染病的监测具有重要意义。
国在发现新型布尼亚病毒导致的虫媒传染病方面走在了前列，希望能出更多的成果。
《临床传染病杂志》（Clin Infect Dis）上发表的论文摘要
A Family Cluster of Infections by a Newly Recognized Bunyavirus in Eastern China, 2007: Further Evidence of Person-to-Person Transmission
Chang-jun Bao1,a, Xi-ling Guo2,a, Xian Qi1,a, Jian-li Hu1,a, Ming-hao Zhou3,a, Jay K. Varma4, Lun-biao Cui2, Hai-tao Yang3, Yong-jun Jiao2, John D. Klena4, Lu-xun Li5, Wen-yuan Tao6, Xian Li2, Yin Chen2, Zheng Zhu2, Ke Xu1, Ai-hua Shen5, Tao Wu2, Hai-yan Peng2, Zhi-feng Li1, Jun Shan1, Zhi-yang Shi2, and Hua Wang3
+ Author Affiliations
1Department of Acute Infectious Diseases Control and Prevention
2Pathogenic Microorganism Institute, and
3Headquarters, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
4Centers for Disease Control and Prevention, Atlanta, Georgia
5Lishui County Centre for Disease Control and Prevention
6People’s Hospital of Lishui County, Nanjing, China
Abstract
Background.?Seven persons in one family living in eastern China developed fever and thrombocytopenia during May 2007, but the initial investigation failed to identify an infectious etiology. In December 2009, a novel bunyavirus (designated severe fever with thrombocytopenia syndrome bunyavirus ) was identified as the cause of illness in patients with similar clinical manifestations in China. We reexamined this family cluster for SFTSV infection.
Methods.?We analyzed epidemiological and clinical data for the index patient and 6 secondary patients. We tested stored blood specimens from the 6 secondary patients using real time reverse transcription polymerase chain reaction (RT-PCR), viral culture, genetic sequencing, micro-neutralization assay (MNA), and indirect immunofluorescence assay (IFA).
Results.?An 80-year-old woman with fever, leucopenia, and thrombocytopenia died on 27 April 2007. Between 3 and 7 May 2007, another 6 patients from her family were admitted to a local county hospital with fever and other similar symptoms. Serum specimens collected in 2007 from these 6 patients were positive for SFTS viral RNA through RT-PCR and for antibody to SFTSV through MNA and IFA. SFTSV was isolated from 1 preserved serum specimen. The only shared characteristic between secondary patients was personal contact with the index patient; none reported exposure to suspected animals or vectors.
Conclusions.?Clinical and laboratory evidence confirmed that the patients of fever and thrombocytopenia occurring in a family cluster in eastern China in 2007 were caused by a newly recognized bunyavirus, SFTSV. Epidemiological investigation strongly suggests that infection of secondary patients was transmitted to family members by personal contact.
病毒新的研究进展，不容易。
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