Influenza A H1N1 influenza treatment program

March 2009, the Mexican outbreak "of human infection with swine flu" epidemic, and quickly spread worldwide. World Health Organization (WHO) this initial influenza known as the "swine flu", will be renamed as "influenza H1N1 influenza." June 11, WHO announced that influenza H1N1 pandemic warning level to upgrade six, global access to pandemic phase. The flu is a new respiratory disease, the pathogenic H1N1 influenza virus for the new strains of influenza virus gene contains swine influenza, avian flu and human influenza virus gene fragments.

The treatment program is in the July 10 program based on the second edition of clinics, according to recent research results at home and abroad and our experience in diagnosis and treatment of influenza H1N1 Influenza amendments made. Because of this Influenza H1N1 influenza is an emerging disease, the disease needs further observation and study law.

I. Etiology

Influenza A H1N1 influenza virus belongs to the Orthomyxoviridae Division (0rthomyxoviridae), influenza virus, (Influenza virus A). Typical virus particles were spherical with a diameter of 80nm ~ 120nm, with envelope. Sac membrane of many processes arranged radially glycoprotein hemagglutinin were red blood cell (HA), neuraminidase (NA) and matrix protein M2. Nucleocapsid within the viral particles, spiral symmetry, a diameter of 10nm. For the single strand RNA virus minus-strand genome of about 13.6kb, ranging from the size composition of 8 separate segments. Virus on ethanol, iodine, iodine and other disinfectants commonly used sensitive; on the heat-sensitive, 56 ℃ 30 minutes under the conditions of inactivation.

Second, epidemiological

(A) source of infection.

Influenza A H1N1 influenza patients as the main source of infection, asymptomatic infection is also contagious. There is no evidence of animals to humans.

(Ii) transmission.

Mainly through droplets spread by the respiratory tract, but also through the mouth, nose, eyes, mucous membranes, etc., directly or indirectly contact. Contact with respiratory secretions, body fluids and items contaminated by the virus may cause infection. Spread by aerosol to be further confirmed by the respiratory tract.

(C) of the susceptible population.

Was susceptible to SARS.

(D) easier to be at high risk of severe cases.

Influenza-like symptoms following the crowd, the easier the development of the severe cases, should be given high priority, early detection of influenza A H1N1 influenza virus nucleic acids and other necessary checks.

1. Pregnant women;

2. With the following diseases or conditions are: chronic respiratory disease, cardiovascular disease (except hypertension), kidney disease, liver disease, blood disorders, nervous system and neuromuscular diseases, metabolic and endocrine system disorders, immune suppression ( including the application of immunosuppressive agents or HIV infection induced Low), 19 years of age who take aspirin long-term;

3. Obesity (body mass index ≥ 40 high risk, body mass index may be risk factors in 30-39);

4. Aged <5 years of age (age <2 years old were more susceptible to serious complications);

5. Aged ≥ 65 years old.

Third, clinical manifestations and laboratory examinations

Incubation period is usually 1 to 7 days, more than 1 to 3 days.

(A) of the clinical manifestations.

Manifests itself in flu-like symptoms, including fever, sore throat, runny nose, stuffy nose, cough, cough, headache, body aches, fatigue. In some cases vomiting and / or diarrhea. Only a small number of cases of mild upper respiratory symptoms, no fever. Signs include swelling of the throat and tonsil congestion.

Complications such as pneumonia can occur. A small number of cases are progressing rapidly, respiratory failure, multiple organ dysfunction or failure.

Can induce aggravation of the original underlying diseases, rendering the corresponding clinical manifestations.

Severe cases can lead to death.

(B) laboratory tests.

1. Peripheral blood examination: WBC count generally is not high or lower.

2. Blood biochemical tests: Some cases are hypokalemia, a small number of cases of creatine kinase, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase increased.

3. Etiological examination:

(1) Nucleic acid testing: the RT-PCR (preferably with real-time RT-PCR) Detection of respiratory tract specimens (throat swab, nasal swab, nasopharyngeal or tracheal aspirate, sputum) of influenza H1N1 influenza virus nucleic acid, the results can be positive.

(2) virus isolation: respiratory specimens could separate Influenza H1N1 influenza virus.

(3) serum antibody test: dynamic detection of double Influenza H1N1 influenza virus-specific serum antibody levels were four times or four times higher.

(C) of the chest radiograph.

When combined with pneumonia lung visible flakes
Shadow.

IV diagnosis

Diagnosis combined with epidemiological history, clinical manifestations and pathology examination, early detection, early diagnosis and effective treatment is the key to prevention and control.

(A) of the suspected cases.

One of the following conditions can be diagnosed as suspected cases:

1. 7 days prior to the onset and spread of influenza H1N1 have close contact with confirmed cases of influenza and influenza-like clinical manifestations.

Close contact is not effective protection in the case, treatment, care transmission of influenza A H1N1 influenza patients; and were living together; contact with respiratory secretions, body fluids and so on.

2. Have been to 7 days before the onset of influenza H1N1 influenza pandemic (human spread of a virus, and sustainable level of popular and community-based outbreak) areas, the incidence of influenza-like clinical manifestations.

3. Flu-like clinical manifestations, influenza virus-positive, yet further testing virus subtype.

These three kinds of circumstances, in conditions permitting, may cause pathogenic influenza A H1N1 influenza inspection.

(B) clinically diagnosed cases.

Limited to the following clinical circumstances: with the H1N1 influenza outbreak with influenza outbreak, not laboratory-confirmed cases of influenza-like symptoms, the exclusion of other diseases caused by influenza-like symptoms can be diagnosed clinically diagnosed cases.

Influenza A H1N1 influenza outbreak is an unusual area or unit a short number of influenza-like cases of influenza confirmed by laboratory tests H1N1 flu.

In the conditions allow, the clinical diagnosis etiological examination can be arranged.

(C) of the confirmed cases.

Influenza-like clinical presentation, while one or more of the following laboratory test results:

1. Influenza H1N1 influenza virus nucleic acid testing positive (can use real-time RT-PCR and RT-PCR method);

2. Isolated influenza A H1N1 influenza virus;

3. Double Influenza H1N1 influenza virus serum antibody level was 4 times or 4 times higher.

5, severe and critical illness

(A) one of the following conditions for the severe cases:

1. Persistent fever> 3 days;

2. Severe cough, cough Nong Tan, hemoptysis, or chest pain;

3. Respiration rate fast, difficulty breathing, lips cyanosis;

4. Consciousness change: slow reaction, sleepiness, restlessness, convulsions, etc.;

5. Severe vomiting, diarrhea, dehydration performance;

6. Imaging signs of pneumonia;

7. Creatine kinase (CK), creatine kinase (CK-MB) and other cardiac enzyme levels increased rapidly;

8. Significantly increase the original basis of disease.

(B) one of the following conditions for the critical cases:

1. Respiratory failure;

2. Septic shock;

3. Multiple organ dysfunction syndrome;

4. Appears in need of care treatment of other severe clinical conditions.

Six principles of clinical classification

(A) of suspected cases: well-ventilated room in a separate isolation. Hospitalized cases of influenza pathogenic H1N1 influenza to do inspections.

(B) clinical diagnosis of cases: well-ventilated room in a separate isolation. Hospitalized cases of influenza pathogenic H1N1 influenza to do inspections.

(C) confirmed cases: well-ventilated isolation rooms. Inpatients may be people in the same room.

7, the principle of patient

Under the condition of patients and local medical resources, according to the principle of priority arrangements severe hospitalized.

(A) give priority to cases admitted to hospital with severe and critical. In critically ill patients, according to local medical facilities conditions, timely prevention and control into the conditions with severe Medicine (ICU) treatment.

(B) do not have the severe and critical cases where the conditions of medical institutions, in ensuring the safety of the premise of health care, patients should be promptly transported to the hospital with conditions; condition not suitable for referral, the local health administrative department or higher level health administrative departments experts on the spot to active treatment.

(C) high-risk groups to become more easily infected with influenza A H1N1 influenza severe cases, appropriate arrangements for hospital treatment. Such as the implementation of home quarantine treatment, should closely monitor the patient's condition deteriorated to the event of a timely diagnosis and treatment arrangements for hospitalization.

(D) of the mild cases, arrangements can be isolated for observation and treatment at home.

8, treatment

(A) general treatment.

Rest, drinking water, close observation of changes in condition; on the heat treatment of fever cases may be granted.

(B) anti-viral treatment.

Studies have shown that influenza A H1N1 influenza virus present this to the neuraminidase inhibitors oseltamivir (oseltamivir), zanamivir (zanamivir) sensitive to amantadine and rimantadine
Resistance.

For less serious symptoms and no complications, the condition has become self-limiting influenza A H1N1 influenza cases, no positive application of the neuraminidase inhibitors.

When the disease is a serious condition, the dynamic deterioration after onset of disease cases were infected with influenza A H1N1 influenza high-risk groups should be timely and the neuraminidase inhibitors for antiviral therapy. Start delivery time should be possible within 48 hours of onset (36 hours for the best). For severe cases easier to become a high risk of influenza-like symptoms if not necessarily wait for the virus nucleic acid test results, you can start antiviral therapy. Influenza-like symptoms in pregnant women after the early appropriate treatment to the neuraminidase inhibitors.

Oseltamivir: Adult dosage of 75mg bid, treatment for 5 days. For critical or severe cases, doses of oseltamivir may be added as appropriate to 150mg bid. For persistent cases of illness, medication may be appropriate to extend the time. 1 year old and older pediatric patients should be administered according to body weight: 15kg underweight persons, to 30mg bid; weight of 15 ~ 23kg person, to 45mg bid; weight of 23 ~ 40kg person, to 60mg bid; weight greater than 40kg person, I 75mg bid. Have difficulty swallowing capsules for children can choose oseltamivir suspension.

Zanamivir: for adults and children over 7 years. Inhalation adult dosage of 10mg bid, treatment for 5 days. Children over 7 years of age and usage with adults.

(C) other treatment.

1. If there hypoxemia or respiratory failure, should be timely and appropriate treatment measures, including oxygen therapy or mechanical ventilation.

2. Combined to give the corresponding anti-shock, shock therapy.

3. There other organ damage, given the appropriate supportive treatment.

4. With bacterial and / or fungal infection, to give the corresponding anti-bacterial and / or antifungal treatment.

5. For the severe and critical cases, you can also consider the use of Influenza H1N1 influenza patients recovering from recent vaccination by immune serum or plasma treatment.

1 week on the incidence of severe and critical cases, the premise of ensuring medical safety, appropriate early use. Recommended Usage: General Adult 100 ~ 200ml, child 50ml (or antibodies were adjusted according to the amount of plasma), intravenous. When necessary, can be reused. Use of the process, pay attention to allergic reactions.

(D) of the TCM treatment.

Mild syndrome treatment

1. Wind-heat guilty Wei

Main symptoms: early onset, fever, or fever, red throat discomfort, Qing Ke little phlegm, no sweat.

Tongue and Pulse: red tongue, thin coating or a thin greasy, floating pulse.

Governing Law: breeze heat

Basic Recipe: Silver Flower Forsythia 15g 15g 10g Chrysanthemum grandiflorum leaf 10g 15g 10g Arctium Mint Leaves 30g 6g reed rhizome (post under) 3g 3g Health and liquorice

Decoction method: water simmer in water, decoction 400 ml per dose per oral administration of 200 ml, 1, 2; if necessary Day Service 2, orally every 6 hours 1 per 200 ml.

Modified: thick greasy coating plus patchouli, Perrin; cough re-Almond, loquat; diarrhea Kagawa Coptis, wide woody; sore throat weight increase Physalis.

Commonly used Chinese patent medicines: breeze heat of Chinese patent medicines such as Shufeng detoxification capsules, Xiangju capsules, Yinqiaojiedu class, Sang Ju cold type, Shuanghuanglian class of oral agents; Huoxiangzhengqi, class preparation, etc. Gegenqinlian.

2. Heat pulmonary drug raid

Main symptoms: high fever, cough, sputum expectoration uncomfortable sticky, thirsty hi drink, sore throat, red eyes.

Tongue and Pulse: red tongue, yellowish or greasy slippery pulse.

Governing Law: Qingfei detoxification

Basic Recipe: Roasted Almond ephedra 3g 10g 10g Health and liquorice Gypsum (Xian Jian) 30g 10g Fritillaria Campanulaceae Anemarrhenae 10g 15g 15g Chai Hu 15g skullcap

Decoction method: water simmer in water, decoction 400 ml per dose per oral administration of 200 ml, 1, 2; if necessary Day Service 2, orally every 6 hours 1 per 200 ml.

Modified: constipation Add rhubarb; sustained high fever plus Artemisia annua, paeonol.

Commonly used Chinese patent medicines: Qingfei antidote Lianhuaqingwen proprietary Chinese medicines such as capsules, silver and yellow class preparation, class preparation and other Lotus heat.

Differential Treatment of severe and critical illness plan

1. Hot drug obstruct pulmonary

Main symptoms: high fever, cough cough, yellow sputum, breathlessness and shortness of breath; or palpitations, ankle interference disturbed, cyanotic lips.

Tongue and Pulse: tongue red, yellow and greasy fur, or gray greasy, slippery pulse.

Governing Law: heat Xie Fei, detoxification Sanyu
p; Zhimu Houttuynia 15g 10g 10g Fagopyrum Descurainiae skullcap 10g 10g 10g Fritillaria Moutan Rhubarb 10g 10g 15g Artemisia annua

Decoction method: water simmer in water, decoction 400 ml per dose per oral administration of 200 ml, 1, 2; if necessary Day Service 2, orally every 6 hours 1 per 200 ml.

Modified: sustained high fever, coma delirium plus Angong Niuhuang Wan; seizures plus antelope horn, silkworm, pheretima etc.; bloating will end plus Zhishi and sodium sulfate.

Commonly used Chinese patent medicines: Xiyanping, Tanreqing, Qingkailing injection.

2. Gas business the two burnt

Main symptoms: high fever, thirst, irritability, serious was coma delirium, cough or hemoptysis, chest tightness, shortness of breath and suffocating.

Tongue and Pulse: scarlet tongue, yellow coating, pulse breakdown.

Governing Law: Qing Qi Liang Camp

Basic recipe: buffalo habitat 15g 30g 15g Salvia Radix 10g Silver Flower Forsythia 15g 12g 10g Radix Gypsum Leaf 30g 6g kirilowii (Xian Jian) 30g 12g Gardenia

Decoction method: water simmer in water, decoction 400 ml per dose per oral administration of 200 ml, 1, 2; if necessary Day Service 2, orally every 6 hours 1 per 200 ml.

Modified: constipation Add rhubarb; febrile seizures plus antelope horn powder body.

Commonly used Chinese patent medicines: Angong Niuhuang Wan, Xuebijing, XNJI so.

Note: The above drugs should be used under the guidance of the physician; dose for reference, children's doses reduce it; have complications, patients with a history of chronic basis, with the certificate and giving of treatment. If see shock, multiple organ dysfunction syndrome, or combined with other serious diseases, while in the application of western medicine, according to the actual situation with the card and giving of treatment.

9, discharge standards

1. Temperature is normal 3 days, other flu-like symptoms disappeared, clinically stable, can be discharged.

2. The basis of illness or complications due to heavier, take longer hospitalized cases of influenza A H1N1 influenza, influenza A H1N1 influenza virus in throat swab DNA test became negative after the isolation ward from the ward go to the corresponding further treatment.