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1、Viral Hemorrhagic Fever广州网站建设 Center for Food Security and Public Health Iowa State University - 2004What is Viral Hemorrhagic Fever?Severe multisystem syndrome Damage to overall vascular systemSymptoms often accompanied by hemorrhageRarely life threatening in itselfIncludes conjunctivitis, petechia

2、, echymosisCenter for Food Security and Public Health Iowa State University - 2004OverviewOrganismHistoryEpidemiologyTransmissionDisease in HumansDisease in AnimalsPrevention and ControlCenter for Food Security and Public Health Iowa State University - 2004The OrganismsCenter for Food Security and P

3、ublic Health Iowa State University - 2004Viral Hemorrhagic FeverViruses of four distinct familiesArenavirusesFilovirusesBunyaviruses FlavivirusesRNA viruses Enveloped in lipid coating Survival dependent on an animal or insect host, for the natural reservoirCenter for Food Security and Public Health

4、Iowa State University - 2004ClassificationCenter for Food Security and Public Health Iowa State University - 2004ArenaviridaeJunin virusMachupo virusGuanarito virusLassa virusSabia virusCenter for Food Security and Public Health Iowa State University - 2004Arenaviridae HistoryFirst isolated in 19331

5、958: Junin virus - Argentina First to cause hemorrhagic feverArgentine hemorrhagic fever1963: Machupo virus BoliviaBolivian hemorrhagic fever1969: Lassa virus NigeriaLassa feverCenter for Food Security and Public Health Iowa State University - 2004Arenaviridae TransmissionVirus transmission and ampl

6、ification occurs in rodentsShed virus through urine, feces, and other excretaHuman infection Contact with excretaContaminated materialsAerosol transmissionPerson-to-person transmissionCenter for Food Security and Public Health Iowa State University - 2004Arenaviridae EpidemiologyAfrica LassaSouth Am

7、erica Junin, Machupo, Guanarito, and SabiaContact with rodent excreta Case fatality: 5 35% Explosive nosicomial outbreaks with Lassa and MachupoCenter for Food Security and Public Health Iowa State University - 2004Arenaviridae in HumansIncubation period1014 daysFever and malaise24 daysHemorrhagic s

8、tageHemorrhage, leukopenia, thrombocytopeniaNeurologic signsCenter for Food Security and Public Health Iowa State University - 2004BunyaviridaeRift Valley Fever virusCrimean-Congo Hemorrhagic Fever virusHantavirusCenter for Food Security and Public Health Iowa State University - 2004Bunyaviridae His

9、tory 1930: Rift Valley Fever EgyptEpizootic in sheep1940s: CCHF - Crimean peninsulaHemorrhagic fever in agricultural workers1951: Hantavirus KoreaHemorrhagic fever in UN troops5 genera with over 350 viruses Center for Food Security and Public Health Iowa State University - 2004Bunyaviridae Transmiss

10、ionArthropod vectorException HantavirusesRVF Aedes mosquito CCHF Ixodid tickHantavirus RodentsLess commonAerosolExposure to infected animal tissue Center for Food Security and Public Health Iowa State University - 2004Bunyaviridae EpidemiologyRVF - Africa and Arabian Peninsula1% case fatality rateCC

11、HF - Africa, Eastern Europe, Asia30% case fatality rateHantavirus - North and South America, Eastern Europe, and Eastern Asia1-50% case fatality rateCenter for Food Security and Public Health Iowa State University - 2004Bunyaviridae HumansRVF Incubation period 2-5 days0.5% - Hemorrhagic FeverCCHF In

12、cubation period 3-7 daysHemorrhagic Fever - 36 days following clinical signsHantavirus Incubation period 721 daysHPS and HFRSCenter for Food Security and Public Health Iowa State University - 2004Bunyaviridae AnimalsRVFAbortion 100%Mortality rate 90% in young5-60% in older animalsCCHFUnapparent infe

13、ction in livestockHantavirusesUnapparent infection in rodentsCenter for Food Security and Public Health Iowa State University - 2004FiloviridaeMarburg virusEbola virusCenter for Food Security and Public Health Iowa State University - 2004Filoviridae History1967: Marburg virusEuropean laboratory work

14、ers1976: Ebola virusEbola ZaireEbola Sudan1989 and 1992: Ebola RestonUSA and ItalyImported macaques from Philippines1994: Ebola Cte dIvoire Center for Food Security and Public Health Iowa State University - 2004Filoviridae Transmission Reservoir is UNKNOWNBats implicated with MarburgIntimate contact

15、Nosicomial transmissionReuse of needles and syringesExposure to infectious tissues, excretions, and hospital wastesAerosol transmissionPrimatesCenter for Food Security and Public Health Iowa State University - 2004Filoviridae EpidemiologyMarburg AfricaCase fatality 23-33%Ebola - Sudan, Zaire and Cte

16、 dIvoire AfricaCase fatality 53-88%Ebola Reston PhilippinesPattern of disease is UNKOWNCenter for Food Security and Public Health Iowa State University - 2004Filoviridae HumansMost severe hemorrhagic feverIncubation period: 410 daysAbrupt onsetFever, chills, malaise, and myalgiaHemorrhage and DICDea

17、th around day 711Painful recoveryCenter for Food Security and Public Health Iowa State University - 2004Filoviridae AnimalsHemorrhagic feverSame clinical course as humansEbola RestonHigh primate mortality - 82%Center for Food Security and Public Health Iowa State University - 2004FlaviviridaeDengue

18、virusYellow Fever virusOmsk Hemorrhagic Fever virusKyassnur Forest Disease virusCenter for Food Security and Public Health Iowa State University - 2004Flaviviridae History1648 : Yellow Fever described17th20th centuryYellow Fever and Dengue outbreaks1927: Yellow Fever virus isolated1943: Dengue virus

19、 isolated1947Omsk Hemorrhagic Fever virus isolated1957: Kyasanur Forest virus isolatedCenter for Food Security and Public Health Iowa State University - 2004Flaviviridae TransmissionArthropod vectorYellow Fever and Dengue virusesAedes aegyptiSylvatic cycleUrban cycleKasanur Forest VirusIxodid tickOm

20、sk Hemorrhagic Fever virusMuskrat urine, feces, or bloodCenter for Food Security and Public Health Iowa State University - 2004Flaviviridae EpidemiologyYellow Fever Virus Africa and AmericasCase fatality rate variesDengue Virus Asia, Africa, Australia, and AmericasCase fatality rate 1-10%Kyasanur Fo

21、rest virus IndiaCase fatality rate 35%Omsk Hemorrhagic Fever virus EuropeCase fatlity rate 0.53%Center for Food Security and Public Health Iowa State University - 2004Flaviviridae HumansYellow Fever Incubation period 36 daysShort remissionDengue Hemorrhagic FeverIncubation period 25 daysInfection wi

22、th different serotypeKyasanur Forest DiseaseOmsk Hemorrhagic FeverLasting sequelaCenter for Food Security and Public Health Iowa State University - 2004Flaviviridae AnimalsYellow Fever virusNon-human primates varying clinical signsDengue virusNon-human primates No symptomsKyasanur Forest Disease Vir

23、usLivestock No symptomsOmsk Hemorrhagic Fever VirusRodents No symptomsCenter for Food Security and Public Health Iowa State University - 2004Disease in HumansCenter for Food Security and Public Health Iowa State University - 2004Clinical SymptomsDiffer slightly depending on virusInitial symptomsMark

24、ed feverFatigueDizzinessMuscle achesExhaustionCenter for Food Security and Public Health Iowa State University - 2004Clinical SymptomsMore severe Bleeding under skinPetechiae, echymoses, conjunctivitisBleeding in internal organsBleeding from orificesBlood loss rarely cause of deathCenter for Food Se

25、curity and Public Health Iowa State University - 2004DiagnosisSpecimens must be sent toCDCU.S. Army Medical Research Institute of Infectious Disease (USAMRIID)SerologyPCRIHCViral isolationElectron microscopyCenter for Food Security and Public Health Iowa State University - 2004TreatmentSupportive tr

26、eatment RibavirinNot approved by FDAEffective in some individuals Arenaviridae and Bunyaviridae onlyConvalescent-phase plasma Argentine HF, Bolivian HF and EbolaStrict isolation of affected patients is requiredReport to health authoritiesCenter for Food Security and Public Health Iowa State Universi

27、ty - 2004Prevention and ControlCenter for Food Security and Public Health Iowa State University - 2004Prevention and ControlAvoid contact with host speciesRodentsControl rodent populationsDiscourage rodents from entering or living in human populationsSafe clean up of rodent nests and droppingsInsect

28、sUse insect repellentsProper clothing and bed netsWindow screens and other barriers to insectsCenter for Food Security and Public Health Iowa State University - 2004Prevention and ControlVaccine available for Yellow fever Experimental vaccines under studyArgentine HF, Rift Valley Fever, Hantavirus a

29、nd Dengue HFIf human case occurs Decrease person-to-person transmissionIsolation of infected individualsCenter for Food Security and Public Health Iowa State University - 2004Prevention and ControlProtective clothingDisposable gowns, gloves, masks and shoe covers, protective eyewear when splashing m

30、ight occur, or if patient is disoriented or uncooperative WHO and CDC developed manual“Infection Control for Viral Hemorrhagic Fevers In the African Health Care Setting”Center for Food Security and Public Health Iowa State University - 2004Protective equipment worn by a nurse during Ebola outbreak i

31、n Zaire, 1995Center for Food Security and Public Health Iowa State University - 2004Prevention and ControlAnyone suspected of having a VHF must use a chemical toiletDisinfect and dispose of instrumentsUse a 0.5% solution of sodium hypochlorite (1:10 dilution of bleach)Center for Food Security and Public Health Iowa State University - 2004VHF Agents as Biological WeaponsOutbreak of undifferentiated febrile illness 2-21 days following attackCould incl