新发传染病基孔肯雅热研究概况

新发传染病基孔肯雅热研究概况,主要内容Contents,一、前言Introduction 二、全球流行概况 三、CHIK主要传播媒介 四、最新研究结果,一、前言Introduction,基孔肯雅热（Chikungunya fever，CHIK）：,单链正义RNA病毒A single strand positive sense RNA virus,披膜病毒科（Togaviridae） 甲病毒属 (Alphavirus) 基孔肯雅病毒(Chikungunya virus，CHIKV) 西门利克森林病毒亚组(Semliki forest，SF),临床症状,主要临床表现为发热、关节剧烈疼痛、皮疹和轻度出血体征，类似于流行性登革热 (dengue fever，DF)。该病起病急骤和关节剧烈疼痛，被迫采取弯曲体位，当地的土语形容这种姿势为“基孔肯雅”Kimakonde language meaning to become contorted(WHO, 1985)。1952年，它首次分离于坦桑尼亚（Tanzania） (Sourisseau et al., 2007)。截至目前为止，还没有有效的疫苗或防制药剂。,地理概况,白纹伊蚊在法国流域分布Aedes albopictus distribution on the French Riviera,意大利白纹伊蚊分布Distribuzione di Aedes albopictus in Italia per provincie nel 2000,瑞士虫媒病毒分布The distribution of other arbovirus around Switzerland,虫媒病毒Arbovirus,genus Alphavirus, family Togaviridae,Sindbis virus (SIN),In Europe Asia Australia South American Africa(Strauss & Strauss, 1994),genus Flavivirus, family Flaviviridae,genus Phlebovirus, family Bunyaviridae,Yellow fever virus (YFV),Eg: Spain, Italy (Livorno), France (Saint-Nazaire) and Portugal and so on (Vainio & Cutts, 1998),Dengue fever virus (DFV),TropNetEurop: such as Israel and Dutch et al (Wichmann et al., 2003),Wset Nile virus (WNV),In western Mediterranean and southern Russia in 1962-64, Belarus and Ukraine in the 1970s and 1980s, Romania in 1996-97, Czechland in 1997, and Italy in 1998) (Hublek & Halouzka, 1999).,In Italy, Portugal and other Mediterranean countries (Snchez-Seco et al., 2003).,Toscana virus (TOSV),Sandfly fever virus (SFV),Rift Valley Fever virus (RVFV),2007年瑞士提契诺地区白纹伊蚊监测过程中阳性诱卵器数Proportion of positive ovitraps checked during the monitoring program on Ae. albopictus in Ticino, Switzerland, 2007（Wymann等，2008）,不含Chiasso地区(without Chiasso),Chiasso地区(in Chiasso),Fig. Sequencing strategy for CHIK genomic RNA by RTPCR. Boxes indicate the coding regions of non-structural and structural proteins. (Khan et al., 2002),CHIKV, 全基因组complete genome (NCBI: NC_004162, 11,826 nt),Nucleotide sequencing of the E1 gene of CHIKV was used to investigate the relatedness of the samples.,/entrez/viewer.fcgi?db=nuccore&id=27754751,CHIK Outbreaks The Globalization of Vectorborne Diseases , past old geographicboundariesCharrel et al. 2007-N Engl J Med,二、全球CHIK分布概况(between 1952-2006) The distribution of CHIK around the world,在地域分布上，CHIK主要经非洲传播至东南亚、欧洲与南美洲等国家。,基孔肯雅热：不再是第三世界疾病Chikungunya: No Longer aThird World Disease-Science (Enserink, 2007),Paper trail. The number of papers with “CHIK” in the titlehas risen from fewer than five per year before 2004 to more than70 in 2007.,Emilia-Romagna,多个国家CHIK案例数（February 2005 to April 2006）,欧洲监测Euro Surveillance, 2006 , 11(5)/ew/2006/060511.asp#2,2007年意大利CHIK暴发流行趋势图Epidemic curve Distribution of dates of onset of symptoms for CHIKV cases by presumed place of infection（Rezza et al., 2007).,CHIKV疫源地及病例空间分布：A：015天；B：045天；C：加权cumulatively；D：Ravenna省 （Rezza et al., 2007).,感染CHIKV病例特征,白纹伊蚊活动与欧洲、美国和印度洋CHIK暴发流行同步性分析Synchronisation of Aedes albopictus activity in Europe and the USA and of Asian and Indian Oceans outbreaks. The arrow indicates the date of return from India to Italy of the presumed index case of the Italian outbreak.,三、CHIKV传播媒介CHIKV transmission of vector,主要传播媒介：亚洲虎蚊Asian Tiger mosquito白纹伊蚊( Aedes albopitus，Diptera: Culicidae) 和埃及伊蚊（Ae. Aegypti）。20世纪初期，白纹伊蚊起源于东南亚、西太平洋和印度洋岛屿，现已扩散到非洲、中东、欧洲和美洲 (Gratz, 2004)。,传播方式Transmission mode,美洲埃及伊蚊再度侵害状况Reinfestation of the Americas by Aedes aegypti,1930s 1970s 2006s,* 资料来源Source: 美国CDC/PAHO,主要传染源,基孔肯雅病毒感染的主要传染源：人和猴类。在城市型疫源地中，病人和隐性感染者是主要传染源，病毒主要以人-蚊-人的方式传播。在丛林型疫源地中，猴、猩猩等灵长目和野生动物是本病的主要传染源。病毒以灵长目动物-蚊-灵长目动物方式传播。,媒介生