[BMJ最新文章]：衢州疾控中心报告：甲型禽流感H7N9病毒可疑的院内传播

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[BMJ最新文章]：衢州疾控中心报告：甲型禽流感H7N9病毒可疑的院内传播
2015年12月02日 ⁄ 时讯速递, 进展交流 ⁄ 暂无评论
Nosocomial transmission of avian influenza A (H7N9) virus in China: epidemiological investigation
Chun-Fu Fang, Maj-Juan Ma, Bing-Dong Zhan, et al
BMJ 2015; 351: h5764
ABSTRACT(摘要)
Study Question目的
Can avian influenza A (H7N9) virus be transmitted between unrelated individuals in a hospital setting?

甲型禽流感(H7N9)病毒能否在医院环境下不相关的个体之间传播？

Methods方法
An epidemiological investigation looked at two patients who shared a hospital ward in February 2015, in Quzhou, Zhejiang Province, China. Samples from the patients, close contacts, and local environments were examined by real time reverse transcriptase (rRT) polymerase chain reaction (PCR) and viral culture. Haemagglutination inhibition and microneutralisation assays were used to detect specific antibodies to the viruses. Primary outcomes were clinical data, infection source tracing, phylogenetic tree analysis, and serological results.

2015年2月在中国浙江省衢州市针对一家医院同一病房内收治的两名患者进行的流行病学调查。对患者标本、密切接触者的标本以及环境标本进行实时逆转录酶(rRT)聚合酶链反应(PCR)及病毒培养。采用血清凝集素抑制试验及微中和反应检测病毒特异性抗体。主要终点为临床资料，感染源追踪，系统进化树分析以及血清学结果。

Study answer and limitations研究结果与局限性
A 49 year old man (index patient) became ill seven days after visiting a live poultry market. A 57 year old man (second patient), with a history of chronic obstructive pulmonary disease, developed influenza- like symptoms after sharing the same hospital ward as the index patient for five days. The second patient had not visited any poultry markets nor had any contact with poultry or birds within 15 days before the onset of illness. H7N9 virus was identified in the two patients, who both later died. Genome sequences of the virus isolated from both patients were nearly identical, and genetically similar to the virus isolated from the live poultry market. No specific antibodies were detected among 38 close contacts. Transmission between the patients remains unclear, owing to the lack of samples collected from their shared hospital ward. Although several environmental swabs were positive for H7N9 by rRT-PCR, no virus was cultured. Owing to delayed diagnosis and frequent hospital transfers, no serum samples were collected from the patients, and antibodies to H7N9 viruses could not be tested.

一名49岁男性（指示病例）在前往活禽市场后7天发病。一名57岁男性（第二例患者）COPD患者在与指示病例共用同一病房5天后出现流感样症状。第二例患者在发病前15天内并未造访活禽市场，也未接触任何禽类或鸟类。两名患者均检测出H7N9病毒，两人最终均死亡。两名患者分离病毒的基因组测序几乎相同，而且与活禽市场分离的病毒在遗传学特征方面也极为相似。38名密切接触者均未检测到特异性抗体。由于没有收集病房的标本，患者之间是否出现病毒传播尚不清楚。尽管部分环境标本rRT-PCR检测H7N9为阳性，但病毒培养结果为阴性。由于诊断较晚且病程中多次转院，两名患者均未留取血清学标本，因此无法检测H7N9病毒抗体。

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H7N9


What this study adds临床意义
Nosocomial H7N9 transmission might be possible between two unrelated individuals. Surveillance on patients with influenza-like illness in hospitals as well as chickens in live poultry markets should be enhanced to monitor transmissibility and pathogenicity of the virus.

在两名不相关患者之间可能发生了H7N9的院内传播。应当加强对于院内流感样症状患者以及活禽市场的监测，以关注病毒的传染性及致病性。

jcyyhlb

谢谢老师的资料分享，学习了。

心存感恩

给老师点赞。我们以前也出现过这样的院内感染情况，ICU收治一例确诊H7N9病例，随后一位多年住ICU老病人也被感染确诊，不敢报告，只能删除检测报告和修改诊断。不能排除H7N9直接人传人。