《新冠病毒无症状感染者管理规范》解读

1、新冠病毒无症状感染者管理新冠病毒无症状感染者管理规规范解读范解读1内内 容容 简简 介：介：国国务务院对院对于于新冠病新冠病毒毒无症状无症状感感染者管染者管理理规规范范发发布（第布（第一一次次），），对对于各级于各级医医疗机构疗机构加加强无症强无症状状感染感染管管理理 具具有有一一定定的的指指导导意意义义，特特整整理理成成PPT，供供大大家家参参考考，后后 期会继期会继续续根据对根据对于于无症状无症状感感染者的染者的最最新研究新研究进进展加展加以以补补 充，敬请多指点！重点充，敬请多指点！重点部部分用分用红红色色字字体体标出！标出！2背景：背景：20202020年年4 4月月6 6日日国务院应

2、对新型冠状病毒感染肺炎疫情联防联控机制关于印发新冠病国务院应对新型冠状病毒感染肺炎疫情联防联控机制关于印发新冠病毒毒无无症状感染者管理规范的通症状感染者管理规范的通知知（国办发明电（国办发明电202020201313号号）各省、自治区、直辖市人民政各省、自治区、直辖市人民政府府，国务院各部委、各直属机构：，国务院各部委、各直属机构：新冠病毒无症状感染者管理规新冠病毒无症状感染者管理规范范已经中央应对新型冠状病毒感染已经中央应对新型冠状病毒感染肺肺炎炎 疫情工作领导小组同疫情工作领导小组同意意，现印发给你们，请认真贯彻落实，现印发给你们，请认真贯彻落实。国务院应对新型冠状病毒感染国务院应对新型冠

3、状病毒感染肺炎疫情联防联控机制肺炎疫情联防联控机制3新冠病毒无症状感染者管理规范：新冠病毒无症状感染者管理规范：第一条第一条总的原则：总的原则：为为加加强对强对新新冠病冠病毒毒无症无症状状感染感染者者的发的发现现、报、报告告、 管理管理工工作作，依依据据中中华人华人民民共和共和国国传染传染病病防治防治法法、中华人民共和国国境中华人民共和国国境卫卫生检生检疫疫法法，制定制定本本规范。规范。4第二第二条条定义及分类定义及分类：新冠病毒无症状感染者（以下简称无症状感染新冠病毒无症状感染者（以下简称无症状感染者者）是指：）是指：无无相相关临床表关临床表现现，如发，如发热热、咳嗽、咽痛等、咳嗽、咽痛等可

4、可自我自我感感知或可临知或可临床床识识别别的的 症状与症状与体征体征，但但呼呼吸吸道道等等标标本本新冠病毒新冠病毒病病原学检测原学检测呈呈阳性阳性者者。核核酸检酸检测测？抗抗体阳体阳性性？ 无症无症状感染者有两种情形状感染者有两种情形：真正的无症状真正的无症状？一是一是经经14天的天的隔隔离离医医学观学观察察，均均无任何无任何可自可自我感知我感知或可或可临床识临床识别别的的症状与症状与 体征；体征；二是处于潜伏期的二是处于潜伏期的“无症状感染无症状感染”状态。状态。恢复期无症状恢复期无症状？5病人没有主诉病人没有主诉就是无症状？就是无症状？6Signs and symptoms：Those i

5、nfected with the virus may be asymptomatic or develop flu-likesymptoms, including fever, cough, fatigue, and shortness of breath.Emergency symptoms include difficulty breathing, persistent chest pain or pressure, confusion, difficulty waking and bluish face or lips; immediate medical attention is ad

6、vised if these symptoms are present.Less commonly, upper respiratory symptoms, such as sneezing, runny nose or sore throat may be seen. Symptoms such as nausea, vomiting and diarrhoea have been observed in varying percentages.Some cases in China initially presented only with chest tightness and palp

7、itations.In March 2020 there were reports indicating that loss of the sense of smell (anosmia) may be a common symptom among those who have mild disease, although not as common as initially reported.In some, the disease may progress to pneumonia, multi-organ failure and death.In those who develop se

8、vere symptoms, time from symptom onset to needing mechanical ventilation is typically eight days.7Signs and symptoms：20%无症状无症状感感染者！染者！As is common with infections, there is a delay between the moment when a person is infected with the virus and the time when they develop symptoms.This is called the

9、incubation period. The incubation period for COVID-19 is typically five to six days but may range from two to 14 days. 97.5% of people who develop symptoms will do so within 11.5 days of infection.Reports indicate that not all who are infected develop symptoms, but their role in transmission is unkn

10、own.Preliminary evidence suggests asymptomatic cases may contribute to the spread of the disease.The proportion of infected people who do not display symptoms is currently unknown and being studied, with the Korea Centers for Disease Control and Prevention (KCDC) reporting that 20% of all confirmed

11、cases remained asymptomatic during their hospital stay.Chinas National Health Commission began including asymptomatic cases in its daily cases on 1 April, of the 166 infections on that day, 130 (78%) wereasymptomatic10诊诊 断？断？核酸检测核酸检测 ？RT-PCR金金标标准准？血清学检测？血清学检测？IgM?IgG?留两次血清标本做留两次血清标本做检检测，测，相相隔隔2周周？回顾

12、性诊断，即使阳性回顾性诊断，即使阳性能能否诊否诊断断 ？9对于对于SARS-CoV-2感染的最终确诊？感染的最终确诊？X 目前不推荐目前不推荐 RT-PCR或或NGSSARS-CoV-2分离或分离或培培养养SARS-CoV-2全基因全基因或或基因片段基因片段血清学检测血清学检测抗原抗原抗体抗体X 没有推荐没有推荐！部分可运用部分可运用10不同国家不同国家PCR引物设计靶位？引物设计靶位？哪哪一种一种更更佳？佳？11结果解读，非证实的流行区：结果解读，非证实的流行区：两个靶位阳性两个靶位阳性！Laboratory confirmation of cases by NAAT in areas wi

13、th no known COVID-19 virus circulationTo consider a case as laboratory-confirmed by NAAT in an area with no COVID- 19 virus circulation, one of the following conditions need to be met:_A positive NAAT result for at least two different targets on the COVID-19 virus genome, of which at least one targe

14、t is preferably specific for COVID-19 virus using a validated assay (as at present no other SARS-like coronaviruses are circulating in the human population it can be debated whether it has to be COVID-19 or SARS-like coronavirus specific); OR- One positive NAAT result for the presence of betacoronav

15、irus, and COVID-19 virus further identified by sequencing partial or whole genome of the virus as long as the sequence target is larger or different from the amplicon probed in the NAAT assay used.12结果解读，非证实的流结果解读，非证实的流行行区：区：一个靶位阳性足矣一个靶位阳性足矣！Laboratory confirmed case by NAAT in areas with establishe

16、d COVID-19 virus circulationIn areas where COVID-19 virus is widely spread a simpler algorithm might be adopted in which for example screening by rRT-PCR of a single discriminatory target is considered sufficient.One or more negative results do not rule out the possibility of COVID-19 virus infectio

17、n. A number of factors could lead to a negative result in an infected individual, including:poor quality of the specimen, containing little patient material (as a control, consider determining whether there is adequate human DNA in the sample by including a human target in the PCR testing)the specim

18、en was collected late or very early in the infectionthe specimen was not handled and shipped appropriatelytechnical reasons inherent in the test, e.g. virus mutation or PCR inhibition.13血清学诊断？血清学诊断？Serological testingSerological surveys can aid investigation of an ongoing outbreak andretrospective a

19、ssessment of the attack rate or extent of an outbreak.In cases where NAAT assays are negative and there is a strong epidemiological link to COVID-19 infection, paired serum samples (in the acute and convalescent phase) could support diagnosis once validated serology tests are available.Serum samples

20、 can be stored for these purposes.Cross reactivity to other coronaviruses can be challenging (24) but commercial and non-commercial serological tests are currently under development.Some studies with COVID-19 serological data on clinical samples have been published (25,26).14关于血标本检测？关于血标本检测？Blood te

21、sts can be used, but these require two blood samples takentwo weeks apart and the results have little immediate value.Chinese scientists were able to isolate a strain of the coronavirus and publish the genetic sequence so laboratories across the world could independently develop PCR tests to detect

22、infection by the virus.As of 4 April 2020, antibody tests (which may detect active infections and whether a person had been infected in the past) were in development, but not yet widely used.The FDA approved the first point-of-care test on 21 March 2020 for use at the end of that month.15血清新型冠状病毒血清新

23、型冠状病毒特异性特异性IgM抗体和抗体和IgG抗抗体阳体阳性性；血清新型冠状病毒血清新型冠状病毒特异性特异性IgG抗体由抗体由阴阴性转性转为为阳性；阳性；血清新型冠状病毒血清新型冠状病毒特异性特异性IgG抗体恢抗体恢复复期较期较急急性性期期4倍倍升升高高。国内第七版指南：国内第七版指南：新冠病毒无症状感染者新冠病毒无症状感染者分分类类？潜伏期的潜伏期的“无症状感染无症状感染”状态状态？将来转变为病将来转变为病人！人！恢复期无症状恢复期无症状？早期曾经有症状，没有引起重早期曾经有症状，没有引起重视视而而已已！真正无症状感染？真正无症状感染？所占比例！所占比例！50%！17这类感染者有无传染性这类

24、感染者有无传染性？第三条第三条无症状感染者具有传染无症状感染者具有传染性性，存在存在着着传播传播风风险险。无症状感染者有无传染无症状感染者有无传染性性？取决于？取决于体体内有内有无无感染感染性性病毒病毒排排出出？肯定有！肯定有！传染性大小传染性大小？取决于体内排出感染性病毒取决于体内排出感染性病毒量？量？目前不确定？目前不确定？18怎么发现这类感染怎么发现这类感染者者？第四条第四条加强对无症状感染者的监测和发现：加强对无症状感染者的监测和发现：5类重点人类重点人群群！1. 密密切切：对新冠肺炎病例：对新冠肺炎病例的的密密切切接触者医学观察期间的主动检测；接触者医学观察期间的主动检测；2. 聚聚

25、集集：在在聚聚集集性疫情调查中的主动检测；性疫情调查中的主动检测；3. 暴暴露露：在新冠肺炎病例的传染源追踪过程中：在新冠肺炎病例的传染源追踪过程中对对暴暴露露人群的主动检测；人群的主动检测；4. 疫疫区区：对对部部分分有有境境内内外外新冠新冠肺肺炎炎病病例持例持续续传传播播地地区区旅旅居居史史人员人员的的主主动检测动检测；5. 意意外外：在流行病学调查：在流行病学调查和和机会机会性性筛查中发现的相关人筛查中发现的相关人员员。19第三条第三条无症状感染者具有传染无症状感染者具有传染性性，存在着传播风，存在着传播风险险。 具有传染具有传染性性？大？大小小？第四条第四条加强对无症状感染者的监测和发

26、现：加强对无症状感染者的监测和发现：5类重点人类重点人群群！1. 密密切切：对新冠肺炎病例：对新冠肺炎病例的的密密切切接触者医学观察期间的主动检测；接触者医学观察期间的主动检测；2. 聚聚集集：在在聚聚集集性疫情调查中的主动检测；性疫情调查中的主动检测；3. 暴暴露露：在新冠肺炎病例的传染源追踪过程中：在新冠肺炎病例的传染源追踪过程中对对暴暴露露人群的主动检测；人群的主动检测；4. 疫疫区区：对对部部分分有有境境内内外外新冠新冠肺肺炎炎病病例持例持续续传传播播地地区区旅旅居居史史人员人员的的主主动检测动检测；5. 意意外外：在流行病学调查：在流行病学调查和和机会机会性性筛查中发现的相关人筛查中

27、发现的相关人员员。20第三条第三条无症状感染者具有传染无症状感染者具有传染性性，存在着传播风，存在着传播风险险。 具有传染具有传染性性？大？大小小？第四条第四条加强对无症状感染者的监测和发现：加强对无症状感染者的监测和发现：5类重点人类重点人群群！1. 密密切切：对新冠肺炎病例：对新冠肺炎病例的的密密切切接触者医学观察期间的主动检测；接触者医学观察期间的主动检测；2. 聚聚集集：在在聚聚集集性疫情调查中的主动检测；性疫情调查中的主动检测；3. 暴暴露露：在新冠肺炎病例的传染源追踪过程中：在新冠肺炎病例的传染源追踪过程中对对暴暴露露人群的主动检测；人群的主动检测；4. 疫疫区区：对对部部分分有有

28、境境内内外外新冠新冠肺肺炎炎病病例持例持续续传传播播地地区区旅旅居居史史人员人员的的主主动检测动检测；5. 意意外外：在流行病学调查：在流行病学调查和和机会机会性性筛查中发现的相关人筛查中发现的相关人员员。21报告制度：发现、流调及解除隔离报告制度：发现、流调及解除隔离均均需报需报告告！第五条第五条规范无症状感染者的报规范无症状感染者的报告告。报告时间报告时间2小时小时：各级各级各各类类医疗卫医疗卫生生机构发机构发现现无症状无症状感感染染者者，应应 当于当于2小时小时内进行网络直报。内进行网络直报。流流调调时时间间24小时小时内内：县县级级疾疾控控机机构构接接到到发发现现无无症症状状感感染染者

29、者报报告告后后， 24小时小时内完成个内完成个案案调调查查，并并及时进及时进行行密切接密切接触触者登者登记记，将个将个案案调调 查表或调查报告及时通过传染病报查表或调查报告及时通过传染病报告告信息信息管管理系理系统统进行进行上上报报。解解除除隔隔离离日日期期需需报报告告：无无症症状状感感染染者者解解除除集集中中医医学学观观察察后后，医疗，医疗 卫卫生生机构应机构应当当及时在及时在传传染病报染病报告告信息管信息管理理系统系统中中填写解填写解除除医学观医学观察察 日期。日期。22信息公开制信息公开制度度！第六条第六条强化信息公强化信息公开开。国国务务院院卫卫生生健健康康行行政政部部门门每每天天公公

30、布布无无症症状状感感染染者者报报告告、转转归和归和管管 理情理情况况。各各省省（区区、市市）公公布布本本行行政政区区域域的的情情况况，本本土土传传播播和和境境外外输入输入情情 况分别统计报况分别统计报告告。23第七条第七条加强对无症状感染者的管加强对无症状感染者的管理理。无症状感染者应无症状感染者应当当集集中中医学观医学观察察14天天。某种程度上比患者还要严某种程度上比患者还要严格格！期间出现新冠肺炎相关临床症状和期间出现新冠肺炎相关临床症状和体体征者征者转转为确为确诊诊病病例例。这部这部分分，非真正的无症非真正的无症状状，潜伏潜伏期期！集集中中医医学学观观察察满满14天天且且连连续续两两次次标标本本核核酸酸检检测测呈呈阴阴性性者者（采采样样时时 间间至至少间少间隔隔24小小时时）可可解除集解除集中中医学观医学观察察，核酸核酸检检测仍为测仍为阳阳性性且且 无临床症状者需继续集中医学观无临床症状者需继续集中医学观察察。 这描述没有意这描述没有意义义！24第第八八条条无无症症状感染状感染者者在集中在集中医医学观察学