流 行 性 感 冒 病 毒 研 討 會

陳伯彥 劉武哲

臺中榮民總醫院小兒部 臺北榮民總醫院病理檢驗部臨床病毒科

流行性感冒病毒研討會內容大綱

前言與歷史背景

流行性感冒病毒流行病學

流行性感冒病毒病理機制

A 型流行性感冒病毒的分子生物學

A 型流行性感冒病毒感染的臨床症狀與併發症

流行性感冒病毒感染的的診斷

流行性感冒的治療與預防況控制

A 型流行性感冒病毒的疫苗策略

台北地區的流行性感冒病毒流行情況

流行性感冒病毒疫情監測系統的建立

　

前言與歷史背景

※History of influenza virus

》Literature records, serological review and virus isolation (1932)

》Outbreak in 20th century

》The last great uncontrolled plaque of mankind

※1971 designation: HA(hemagglutinin) / NA(Neuraminidase)

》Hsw = swine type; Nav = avian origin

※1981: H1-13 & N1-9; only H1-3 & N1-2 infect human

※Designation: A/mississippi/1/87(H3N2)

=Influ A / palce / Lab. no. / year / H & N subtype

No H/N of influ. B due to no antigenic shift)

※Antigenic variation: drift(mutation) & shift (reassortment)

※Natural reservoir of influenza virus

　

流行性感冒病毒流行病學

※病與病毒

》Enveloped and is inactivated by detergents

》8 segmented genome facilitates major strain change:HA/NA

》Infect many vertebrate species

》Co-infection with resulting genetic reassortment

》Transmission of virus often preceded symptoms

※傳播

》Inhaled droplets by talking, breathing, coughing

》Virus "likes cool, less humid“ weather(e.g. winter heating season)

》Spread extensively by school children

※誰是危險群?

》Seronegative individuals

》Adults: classic "flu syndrome"

》Children: asymptomatic to severe respiratory infections

》High risk groups: elderly, immunosuppressed individuals

with cardiac or respiratory problems (asthma & smokers)

※地域分佈與季節

》Worldwide: epidemics local; pandemics worldwide

》Disease more common in winter

※可控制的方式

》Avoid contact

》Amantadine approved for prophylaxis or early treatment

》Killed vaccine containing the predicted yearly strains of

Influenza A & B

　

流行性感冒病毒病理機制

A 型流行性感冒病毒的基因重組機制(Genetic ressortment)

Natural reservoir, intermediate host, human and environment factors

　

A 型流行性感冒病毒的基因Shift and drift

A 型流行性感冒病毒的分子生物學

※ 正粘液病毒 Orthomyxovirus：

Ortho = true or regular; myxo = mucus

※ 分類：Type A, B and C influenza virus

※ 8 negative strand RNA genome segment (7 for type C)

※ > 10 polypeptides

※ HA(hemagglutinin) & NA(neuraminidase); HEF of type C

　

A 型流行性感冒病毒的基因的功能

A 型流行性感冒病毒感染的臨床症狀與併發症

※Acute infectionin adults:

Rapid onset of fever, malaise, myalgia, sorethroat & non-productive cough

※Acute infection in children:

Similar to adults but having higher fever, GI symptom(abdominal pain,

vomiting), otitis media, myositis, and croup more frequently

※Complication:

Primary viral / secondary bacterial pneumonia

Myositis and cardiac involvement

Neurological syndromes: Guillain-Barre syndrome, encephalopathy,

encephalitis, Reye's syndrome

　

流行性感冒病毒感染的診斷

Season/area consideration

Contact consideration

Clinical presentation: Influ syndrome

Serological evaluation

Antigen detection

Virus isolation: MDCK, PMK, vero cell etc.

Molecular evidence: PCR (polymerase chain reactions)

Type/strain identification: CDC

　

　

流行性感冒病毒感染的治療與預防

1.Antiviral therapy

2.Vaccination

3.Contact avoidance

　

A 型流行性感冒病毒的疫苗策略

A.Prevent the increased risk of complications and mortality:

1.People > 65 Y/O

2.Ptients with chronic disease. esp. cardiopulmonary

3.Immunosuppressed patients, including AIDS

4.Children on long term aspirin therapy (risk of Reye syndrome)

5.Pregnant women

B.Immunize potential transmitters of infection to high risk people:

1.Medical and paramedical personnel

2.Household contacts of high risk people

C.Prevent morbidity:

1.Community workers(e.g., fire fighter, police officers)

2.High risk of virus exposure (e.g., those in schools, nursing home)

3.People of foreign or domestic travel

4.Any one who wish to reduce their risk of acquiring influenza

　

美國註冊並已上市的 A 型流行性感冒病毒的疫苗(1993-1994)

美國註冊上市的 A 型流行性感冒病毒疫苗注射劑量 (1993-1994)

台北地區的流行性感冒病毒流行情況 1979-1996 (年份)

台北地區的 A/H1N1 流行性感冒病毒流行情況 1979-1988

台北地區的 A/H3N2 流行性感冒病毒流行情況 1979-1988

流行性感冒病毒疫情監測系統的建立

區域疫情監測中心的建立

疫情監測的目的

疫情監測系統的規劃參與人員聯絡

區域醫療資源的運用與整合

監測點的建立與臨床醫技人員的考量

監測點的選擇

臨床醫師的考量

-疾病的定義

-採檢的考量-數量或比例或依定義

-採檢技術的考量(疾病的採檢時期與部位)

-門診量的考量

-運送與保存培養基

實驗室的建立與檢體保存運送

實驗室地點的考量

實驗室的規劃

　

參考資料

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infections.

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