Professional Documents
Culture Documents
流感
流感
!
(Seasonal Influenza or Seasonal Flu)
H1N1H3N2 A / B
!
(Complicated Influenza )
(
)()
(Cluster)
!!!
!
33
2008
2009 H1N1
2011 9
2012
2011 12
H5N1
IC
Rapiacta
2013
44
(Description of Disease)
(Influenza )
(Influenza virus) 1 4 (1,2)
( 1-3) 10
3~7 2
(2,3)
common cold
(Influenza)
(Common Cold)
200
3-4
1-2
2-5
()
()
55
(Reye syndrome)(1-5)
1933 Wilson Smith(1-3)
A (H1N1)
ABC A B
A
B
1977 A (H1N1 H3N2)
B
)Orthomyxoviridae)
ABC Segmented RNA
80-120nmenvelope 2
- Hemagglutinin HA, H
NeuraminidaseNA, N (1-5) M1
M2A B 8
(-)RNA (-)RNA NucleoproteinNP
TranscriptaseRNA PB1PB2PA C
7 (1,3,4)
(HA NA) A
(H ) (N )
66
H 17 H1-H17N 10
N1-N10(1-4,7) HA NA H1N1 A
HA-1 NA-1 H3N2 A
HA-3 NA-2 B C (1-4)
A B
A H1N1H2N2H3N2
H1N1
H7N7 H3N8 B
B C
(1,3,4)
A
B
8
8
11
11
(Antigenic
(Antigenic drift)
drift)
(Antigenic shift)
C
7
9
(Antigenic drift)
1957 1968
( A/H2N2 A/H3N2)
77
2009 H1N1
1. A B 8 RNA C
7
2.
3.
4.
5. Zanamivir(Relenza ) Oseltamivir(Tamiflu )
6.
Reassortment
88
A
-
(1,3,4)
RNA RNA
"""#
HA NA
"Antigenic drift"""
A B
"Antigenic shift""
"
20-30 (1,3,4) A
48 60
5 10
(1,3,6)
(NA)
Shedding
Viremia
(1-4)
99
Mode of transmission!
Incubation period
1~4 2
12 3
Period of communicability
3~5 7-10 (1,2)
24-48
24-72 5 (4,6)
(1,2,5)
21
Antigenic drift(2,5)
(2,5)
A B
A C
10
10
Pandemics
(Seasonal epidemics)(Sporadic cases*
(WHO) 3 5
25 50 (1)
(Centers for Disease Control and Prevention,
CDC) 10 3
10 4
2~4 5
100 (100/100,000)
500/100,000(2,6,8)2012-2013
11 1
A/H3N2 (9)
11 3 4 2012-2013 12 2
(EuroFlu) 2012-2013
94,000 63% A 2009 A/H1N1
( 66%) (9)!
Centre for
Health Protection
12
7 8 2012-2013 A/H3N2
2009 A/H1N1 (10) 2012-2013
11 2013 1 2
A/H3N2(9,11)
(National Notifiable
Diseases Surveillance System(NNDSS)) 5-6
8-9 2013 (1 1 8 4 )
1,164 A/H3N2
(12)
11
11
7 1 6 30
11 12 3 11%
(13)
2009-2013
12
12
H1N1
2008-2009 65
1-6 2009-2010 H1N1 18
0-6 65 (13)2010-2011 65 0-3
2012-2013 65 50-64 2009
A/H1N1
0-6 65
(http://www.cdc.gov.tw)//
7 10
10-20
40-50
13
13
B A
B A Antigenic
drift Antigenic shift
1-2
6 65 65
1996 2011 7.7% 10.9%
14
14
(Surveillance System)
1.
2.
3.
4.
5.
6.
IC
1999
2000
2004
2007
2011 9
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15
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(3)(real-time RTPCR*
2.
Real-time PCR()
Virus isolation ()
Real-time PCR()
Virus isolation ()
1. Virus isolation Real-time PCR()
Virus isolation ()
2. Real-time
Real-time PCR()
Virus isolation ()
PCR
Real-time PCR()
Virus isolation ()
Real-time PCR(+)rapid antigen testvirus isolation(+) 14
21 21
21
!Real-time PCR
22
22
(
)
(http://cdc.gov.tw)//
//
( )
IC
Real-time Outbreak and Disease
SurveillanceRODS1999 9
2004 RODS
2006 11
ICD-9-CM
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ICD-9-CM
RODS
2008
IC
IC
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!
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32
()
1.Nasal swab
2.Nasopharyngeal swab
3.Nasal wash fluid
4.Throat swab
5.
Transtracheal aspirateBronchoalveolar lavage fluidSputumLung
biopsy Post-mortem lung or Tracheal tissue
6.
Acute serum
Convalescent serum
()
3 (Nasopharyngeal
aspirate)Throat swab
Immunofluorescence staining
assay, IFA 4
4
48-72
-70
33
33
()
1. 10g veal infusion broth 2g bovine albumin fraction V
400 ml
2. 0.8 ml gentamicin sulfate solution (50mg/ml) 3.2 ml amphotericin
B (250ug/ml)
3.
() 0.8NaCl
()Virus culture
7-14 MDCK (MadinDarby Canine Kidney cell)
Cytopathic Effect, CPE
Hemagglutination- inhibition, HI
34
34
(
)
Paired sera
10
4
Neutralization test, NT
Hemagglutination inhibition test, HINTHI
SubtypeStrainHI
Virus Culture
MDCK cell
(HI)
()
35
35
WHO
RT-PCR
RT-PCR
RT-PCR
Internal control
36
36
27
10
(2,3,4)
A
B
A B B
A
(Viral pneumonia)
(Bacterial pneumonia)(Encephalitis)(Encephalophy)
(Myocarditis)(Pericarditis)(Tansverse myelitis)
.(Guillain-Barr syndrome)Reye syndrome(2-5)
65
()
72
37
37
48
48
65
M2 protein
(Neuraminidase)M2 protein A
neuraminidase AB
() M2 protein
Amantadine Rimantadine M2 protein
(ion channel) M2 protein
Amantadine Rimantadine
M2 protein M2 protein
Amantadine
Rimantadine Amantadine
A (
*
() (Neuraminidase)
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38
A B
Zanamivir 78%
15% 5-15%
2%
Oseltamivir
oseltamivir carboxylate 75%) 6-10
99%Rapiacta
ZanamivirOseltamivir Peramivir
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4%
)*!M2 protein
A Amantadine Rimantadine
() Neuraminidase
Oseltamivir Zanamivir
1-1.5
39
39
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M2 protein
Amantadine Rimantadine
H3N2 H1N1 100%
() Neuraminidase
1.5% Oseltamivir
M2 protein Neuraminidase M2
protein A B
Neuraminidase Oseltamivir
Zanamivir A B
M2 protein Neuraminidase
M2 protein
Amantadine
Rimantadine
Symmetrel,
Flumadine
Symadine
A
A
1
1
(10%)
(2%)
(90-100%) (90-100%)
Neuraminidase
Oseltamivir
Zanamivir
Peramivir
Tamiflu
Relenza
Rapiacta
A B
1-1.5
(2%)
(1.5%)
A B
1-1.5
(1.5%)
A B
() Oseltamivir (Tamiflu)
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1()
40
40
1.(10 ) 2 5
2.(10 ) 1 10
() Zanamivir (Relenza)
5()
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2. 2 (25 ) 1 10
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41
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6185 50
body-mass indext35)
<5t506
65
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60-64
Whole virus
vaccine
Split-virus vaccine
Subunit vaccine
Purified surface-antigen vaccine
HANA
(cell based)
influenza virus-like particle, VLP
WHO
83110
2
42
42
A(A/H1N1A/H3N2)B
3(2A1B)
4(2A2B)
1B
2013-2014
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2
6570-90%(3-5)
30 70% ( Pneumonia and
Influenza, P&I)3040%
50~60%80%(2,5,6)
7612
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universal influenza vaccine
43
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12 3 9
11
65 66
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6 3 0.25 ml3
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53
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!
!
1. World Health Organization.The world health report 2007 : a safer future : global
public health security in the 21st century. World Health Organization; 2007: 45-48.
2. Mandell, GL., Bennett, JE., and Dolin, R. Principles and Practice of Infectious
Diseases, 6th eds. Elsevier Inc. 2005: 2060-2078.
3. U.S. Centers for Disease Control and Prevention, National Center for Prevention
Services. Prevention and Control of Vaccine-Preventable Diseases: Influenza, 7th
eds. U.S. Dept. of Health and Human Services. 2003; 2006: 235-56.
4. Cox N.J. and Subbarao K. Influenza. Lancet; 1999;354: 1277-82.
5. Nicholson K.G., Wood J.M. and Zambon M. Influenza. Lancet; 2003; 362:1733-45.
6. U.S. Centers for Disease Control and Prevention. Prevention and control of
Influenza.Recommendations of the Advisory Committee on Immunization Practices
(ACIP). MMWR 2006;55(RR 10):1-42.
7. Centers for Disease Control and Prevention. Influenza Type A Viruses and
Subtypes, 2013. Available at: http://www.cdc.gov/flu/avianflu/influenza-a-virussubtypes.htm
8. World Health Organization. Influenza. Available at
http://www.who.int/csr/disease/influenza/en/
9. World Health Organization. Weekly Epidemiological Record. Review of the 20122013 Winter Influenza Season, Northern Hemisphere; 2013; 88:225-232
10. Sentinel Surveillance. Centre for Health Protection in Hong Kong. Monthly
summary tables of influenza virus isolation 2012, 2013. Available at:
http://www.chp.gov.hk/en/sentinel/26/44/292.html
11. National Institute of Infectious Disease. Isolation/detection of influenza virus in
Japan, week 36/2012-week 11/2013 (as of March 18, 2013). Available at:
http://www.nih.go.jp/niid/en/iasr-inf-e.html#graph
12. Australian Government Department of Health and Ageing. Australian Influenza
Surveillance Report; 2013 No.4
13. 2002
2004; 20:478-487
14. 2010
2012; 28:113-126
15. Masahiko Katayose et al. The effectiveness of trivalent inactivated influenza
vaccine in children over six consecutive influenza seasons. Vaccine 2011;29:184449.
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Fever!
VL-001
!!!!!!!!::/19/37 211/12/12 !
!!!
___________________
Bar-code
Throat swab
Nasopharyngeal secretion or swab
Others____________
Throat swab
Nasopharyngeal secretion or swab
Others____________
1382
!!
!!!!!!!!!!!!!!!!!!!!!!!!!
!
!
02-23123456*66908
02-87923311*13568
03-2118800 5497
04-23592525 5701
04-7238595 5930
06-2353535 2653
07-7317123*2578
03-85618255 2090
58
58
!!
!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!!!!!!!!!!!!!!!!!!!!!!!!!! 1.34 !
!!!!!!!!!!!!!!!!!!!!!!!!! 1.34 !
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MDCK cell
*MK-2 cell
CPE!
(-)
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passage
1.
!!
67
RNA
68
RNase-free water
0.3 L
Real-time RT-PCR
FluA-F primer10 M 1.0 L
RT reaction63
3 !
FluA-R primer10 M 1.0 L
Taq activation95 30
FluB-F primer10 M 1.0 L
PCR reaction
FluB-R primer10 M 1.0 L
95 10
FluA probe5 M
0.5 L
58 30!
FluB probe5 M
0.5 L
72 3 45 cycles
Enzyme master mix
7.4 L
Enhancer
1.0 L
Activator
1.3 L
RNA sample
5.0 L
Real-time RT-PCR
2X Master mix buffer
12.5 L
RT reaction48
30
FluA-F primer10 M 1.0 L
Taq activation95 10
FluA-R primer10 M 1.0 L
PCR reaction
FluB-F primer10 M 1.0 L
95 15
FluB-R primer10 M 1.0 L
60
145 cycles
FluA probe5 M
0.5 L
FluB probe5 M
0.5 L
RNA enzyme mix
0.67 L
RNase-free water
1.83 L
template
5.0 L
FLUA/B
69
!
!
!
!
!
!
!
!
!!
Primer A/H1 H1-1: 5-GAT GCA GAC ACA ATA TGT AGA GG-3
Primer A/H1 H1-2: 5-CNC TAC AGA GAC ATA AGC ATT T-3
Primer A/H3 H3-1: 5-TCA GAT TGA AGT GAC TAA TGC T-3
Primer A/H3 H3-2: 5-AAT TTT GAT GCC TGA AAC CGT-3
FluA-F :5- AAG ACC AAT CCT GTC ACC TCT GA -3
FluA-R :5- CAA AGC GTC TAC GCT GCA GTC C -3
FluB-F: 5- GAG ACA CAA TTG CCT ACC TGC TT -3
FluB-R: 5 TTC TTT CCC ACC GAA CCA AC -3
FluA probe- FAM -5 TTT GTG TTC ACG CTC ACC GT 3-TAMRA
FluB probe -VIC-5AGA AGA TGG AGA AGG CAA AGC AGA ACT AGC 3-TAMRA
FluA probe: 5FAM - TTTGTGTTCACGCTCACCGT 3BBQ
FluB probe: 5HEX-AGAAGATGGAGAAGGCAAAGCAGAACTAGC
!!!
/
2 ()
3 /
(1)38
(2)
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2. /
1 /
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()
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!
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