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【medical-news】禽流感病毒（H5N1亚型）可能存在经
Author: Ungchusak, K; Auewarakul, P; Dowell, SF, et al.
Source: NEW ENGLAND JOURNAL OF MEDICINE Volume: 352 Issue: 4 Pages: 333-340 Published: JAN 27 2005
Times Cited: 238
BACKGROUND: During 2004, a highly pathogenic avian influenza A (H5N1) virus caused poultry disease in eight Asian countries and infected at least 44 persons, killing 32; most of these persons had had close contact with poultry. No evidence of efficient person-to-person transmission has yet been reported. We investigated possible person-to-person transmission in a family cluster of the disease in Thailand. METHODS: For each of the three involved patients, we reviewed the circumstances and timing of exposures to poultry and to other ill persons. Field teams isolated and treated the surviving patient, instituted active surveillance for disease and prophylaxis among exposed contacts, and culled the remaining poultry surrounding the affected village. Specimens from family members were tested by viral culture, microneutralization serologic analysis, immunohistochemical assay, reverse-transcriptase-polymerase-chain-reaction (RT-PCR) analysis, and genetic sequencing. RESULTS: The index patient became ill three to four days after her last exposure to dying household chickens. Her mother came from a distant city to care for her in the hospital, had no recognized exposure to poultry, and died from pneumonia after providing 16 to 18 hours of unprotected nursing care. The aunt also provided unprotected nursing care; she had fever five days after the mother first had fever, followed by pneumonia seven days later. Autopsy tissue from the mother and nasopharyngeal and throat swabs from the aunt were positive for influenza A (H5N1) by RT-PCR. No additional chains of transmission were identified, and sequencing of the viral genes identified no change in the receptor-binding site of hemagglutinin or other key features of the virus. The sequences of all eight viral gene segments clustered closely with other H5N1 sequences from recent avian isolates in Thailand. CONCLUSIONS: Disease in the mother and aunt probably resulted from person-to-person transmission of this lethal avian influenzavirus during unprotected exposure to the critically ill index patient. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 题目：禽流感（H5N1）可能存在人传人风险
背景：2004年期间，一种名为H5N1高致病性禽流感蹂躏了东南亚的8个国家，感染了至少44个人，其中导致32人死亡；其中大部分的患者都与家禽有密切接触。目前没有证据表明禽流感已经产生人传人。因此我们对发生在泰国的一例家庭感染事件分析禽流感产生人传人的可能。
方法：对于患病的三个泰国人，我们逐个分析了他们接触家禽和别人的环境和时间。对存活者进行分组隔离和处理，建立对疾病的有效监督和对暴露源接触的预防，并对受感染村庄周围残余的家禽进行统一处理。对来自这个家庭成员的标本进行了病毒培养，血清中和实验，免疫组化，RT-PCR和基因测序。
结果：这个起源病人首先是接触了病死的家禽后3-4天病发的;她的妈妈从另外一个城市来到医院照看她，并没有接触到家禽,但是在对她女儿无安全措施的照看16-18小时后，她自己也死于肺炎。同时，女起源患者的阿姨也对她进行了无保护措施的照看，在患者母亲发烧之后5天也开始发烧，之后7天也产生肺炎。对患者母亲进行尸检和对患者阿姨的咽喉和鼻腔取样分析，都检测到H5N1阳性。没有发现有别的传播途径，而且病毒没有发生血凝素结合位点的基因差异和关键指标的变异。这8株病毒序列与目前在泰国发现的H5N1病毒基本同源。
结论：患者母亲和阿姨所感染的高致病性禽流感很有可能是由于对患者没有保护措施的照顾情况下发生的人传人事件。 [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-06-09 17:20
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