流行病感冒介绍

1、02Mar201512IntroductionPathogenesis 病理Epidemiology 流行病学Clinical FeaturesProphylaxis and TreatmentRecommendationsPhases in clinical trialInfluenza, commonly referred to as the flu, Influenza, commonly referred to as the flu, is an is an infectious disease infectious disease caused by caused by RNA RN

2、A viruses viruses of the family Orthomyxoviridae(of the family Orthomyxoviridae(正粘病毒科)Although it is often confused with other Although it is often confused with other influenza-like illnesses, especially the common influenza-like illnesses, especially the common cold, influenza is a more severe dis

3、ease caused by cold, influenza is a more severe disease caused by a different type of virus.a different type of virus.Influenza spreads around the world in seasonal Influenza spreads around the world in seasonal epidemics, resulting in the deaths of between epidemics, resulting in the deaths of betw

4、een 250,000 and 250,000 and 500,000 people every year500,000 people every year3Classification In virus classification, there are three types of influenza viruses: A, B and C viruses(变异性强). Influenza A and B viruses are the major human pathogens and are morphologically(形态) similar The type A viruses

5、are the most virulent（恶性） human pathogens among the three influenza types and cause the most severe disease.Vaccination The most effective way to prevent influenza, vaccination annually, WHO Vaccination against influenza with an influenza vaccine is often recommended for high-risk groups, such as ch

6、ildren and the elderly, or in people who have asthma, diabetes, heart disease, or are immuno-compromised(免疫损害患者).4Known flu pandemicsName of pandemicDateDeathsCase fatality rateSubtype involvedAsiatic (Russian) Flu18891890 1 million0.15%H3N81918 flu pandemic(Spanish flu)1918192020 to 100 million2%H1

7、N1Asian Flu195719581 to 1.5 million0.13%H2N2Hong Kong Flu196819690.75 to 1 million40kg 150mg/d, 每日2次 75mg, 每日1次6-11月50mg/d，每日2次25mg, 每日1次3-5月40mg/d，每日2次20mg, 每日1次7岁） 10mg(5mg/粒)吸入 每日1次（5岁）22Efficacy According to the CDC(The Centers for Disease Control and Prevention ), Tamiflu, zanamivirs main compe

8、titor, is not as effective at treating the Influenza viruses as zanamivir, especially in H1N1 Seasonal Dosing is limited to the inhaled route(吸入). This restricts its usage, as treating asthmatics could induce bronchospasmsl FluSide effects GlaxoSmithKline (GSK) and FDA notified healthcare profession

9、als of a report of the death of a patient with influenza who received Relenza (zanamivir) Inhalation Powder which was solubilized and administered by mechanical ventilation23RIMANTADINE (金刚乙胺) Indications: type A only, needs to be given early Dosage:金刚乙胺成人200mg/d, 1次或分2次同治疗量1-9岁儿童5mg/kg.d, （6.6mg/kg

10、.d） 1次或分2次，不超过150mg/d5mg/kg.d, （6.6mg/kg.d），1次，不超过150mg/d10岁的儿童200mg/d, 1次或分2次 同治疗量24When taken within one to two days of developing symptoms, rimantadine can shorten the duration and moderate the severity of influenza. According to the CDC, 100% of seasonal H3N2 and 2009 pandemic flu samples tested

11、 have shown resistance to rimantadine and it is no longer recommended to prescribe for treatment of the flu.25AMANTADINE (金刚烷胺) type A only, needs to be given early Dosage:金刚烷胺成人 200mg/d, 1次或分2次 同治疗量1-9岁儿童5-8mg/kg.d，1次或分2次（不超过150mg/d），用至症状消失后24-48小时5-8mg/kg.d，1次或分2次 （不超过150mg/d）10岁的儿童200mg/d, 1次或分2次

12、 同治疗量26Amantadine is no longer recommended for treatment of influenza A infectionFor the 2008/2009 flu season, the United States Centers for Disease Control and Prevention (CDC) found that 100% of seasonal H3N2 and 2009 pandemic flu samples tested have shown resistance to adamantanes. The CDC issued

13、 an alert to doctors to prescribe the neuraminidase inhibitors oseltamivir and zanamivir instead of amantadine and rimantadine for treatment of current circulating flu27Persons at High Risk for Influenza-Related Persons at High Risk for Influenza-Related ComplicationsComplications 65 years residents

14、 of nursing homes and other chronic-care facilities children and teenagers (6 months to 18 yrs) receiving long-term aspirin therapy - might be at risk for developing Reye syndrome after influenza women who will be in the 2nd or 3rd trimester of pregnancy during the influenza season28Persons Who Can

15、Transmit Influenza to Persons Who Can Transmit Influenza to Those at High RiskThose at High Risk Persons who are clinically or subclinically infected can transmit influenza virus to persons at high risk for complications from influenza. physicians, nurses, and other personnel in both hospital and ou

16、tpatient-care settings29加强个人卫生知识宣传教育 1保持室内空气流通，流行高峰期避免去人群聚集场所。 2咳嗽、打喷嚏时应使用纸巾等，避免飞沫传播。 3经常彻底洗手，避免脏手接触口、眼、鼻。 4流行期间如出现流感样症状及时就医，并减少接触他人，尽量居家休息。 5流感患者应呼吸道隔离1周或至主要症状消失。患者用具及分泌物要彻底消毒。 6加强户外体育锻炼，提高身体抗病能力。 7 秋冬气候多变，注意加减衣服。30In Phase 1 trialsIn Phase 1 trials treatment in a small group of people (20-80) eval

17、uate its safetysafety, determine a safe dosage range identify side effects.In Phase 2 trialsIn Phase 2 trials treatment is given to a larger group of people (100-300) see if it is effectiveeffective further evaluate its safety.In Phase 3 trialsIn Phase 3 trials, , treatment is given to large groups

18、of people (1,000-3,000)confirm its effectivenessconfirm its effectiveness, monitor side effects, compare it to commonly used treatmentscompare it to commonly used treatmentsIn Phase 4 trialsIn Phase 4 trials postmarketing studies delineate additional information, including the drugs risks, benefits, and optimal use.drugs risks, benefits, and optimal use.31Phase 1 Phase 1 Early use of drugEarly use of drugMainly aimed at establishing safety Mainly aimed at establishi