????: H5N1???????

1
???? H5N1???????
2
??? A(H5N1), 1997
??? A(H5N1) ????18???,??6???. ???????????????????
????
3
H5N1??????????

• 9???????
• 34 ????,?? 23??? (68)
• ??gt100 m ??

• ??????
• 18 ????,??
• 6???(33)
• ????

• 4???????
• 7????,6?
• ?? (86)
• ???????

• ?????????? H5N1???

2003
2004
1997
1998
1999
2000
2001
2002
4
2003???????H5N1???????????
As of May 24, 2006. Source WHO/WPRO
5
2006???????H5N1???????????
As of May 24, 2006. Source WHO/WPRO
6
?????????????2006?5?29????????
7
2003-12-262006-5-24????????? A/(H5N1) ???????
?????
????
???
??
??
???
???
??
???
??
??
???
Source WHO
As of May 24, 2006.
8
2003-12-262006-5-24????????? A/(H5N1) ???????
Mortality 43
Mortality 65
?????
Mortality 70
Mortality 100
??
Source WHO
As of May 24, 2006.
9
2003-12-262006-5-24????????? A/(H5N1) ???????
??
??
Source WHO
As of May 24, 2006.
10
??H5N1????????? (?2003-12-26?2006-5-24)
?????
??
Source WHO
As of April 24, 2006.
11
?H5N1?????????? (2006?5?19?)
Dept of Health and Human Services
www.pandemicflu.gov
12
??????
13
??????????????
?????????????
????? ??????
??????? WHO CC
????? ??? ????
???????????? ??????
?????????
Source WHO Global Influenza Program
14
???????
Source WHO Global Influenza Program
15
??????????
???? 2??3?????
??????????????????????????? ??????
??
????????? 1-2????????
?????? 1-2??
0
2
4
6
??
Source WHO Global Influenza Program
16
?? ??
??????
????
?????
????EGG ????
??????????????????
????
Source WHO Global Influenza Program
17
??????
??70 ??????????(5???)
50???????????????
Source WHO Global Influenza Program
18
????? - 2000
Source WHO Global Influenza Program
19
??

• ??
• ?H3N2?H1N1?????,?H5 HA???????
• ?????,??H5?????2??????????????????????
• ?????????????????
• HPAI H5N1?????2??????????
• ??????,???????

20
??

• 2005?9?16? HHS
• ??????
• ??DHHS????1????????
• ?????FDA??
• ??????????
• ??200?2000????

21
??

• ??????
• Sanofi Pasture?????????????H5N1????
• ????????????? (450 ??, 18-64 ?) ????2??? (????
  140)
• ???????????
• ??,??????
• MedImmune (????????) ??16?HA???????????????
• H5?H9???????????(??????)

22
??

• Sanofi Pasture????????????H5N1????(???2004????????
  ?) NEJM??
• ??????,???????
• ?90-mcg?????99??, ??????,54??????????????140????
  ?????
• ?15-mcg????100??,??22????????????
• ????,?????????????????????
• ???????????????
• ????????????????????????
• ??????????????????????????????????????????????
• ???????????????????

23
??

• CDC???????????????????????????
• Hoelscher MA at al. Lancet. 2006 Feb
  11367(9509)475-81.
• ?????????????A??????????????????????2003-2005?????
  ???????????A/Vietnam/1203/2004 (H5N1)
  (VN/1203/04) ?????????
• Gao W et al. Protection of mice and poultry from
  lethal H5N1 avian influenza virus through
  adenovirus-based immunization. J Virol. 2006
  Feb80(4)1959-64.

24
????

• ?????(M2???)
• Amantidine (Symmetrel)
• Remantidine (Flumadine)
• ????????
• Zanamivir (Relenza)
• ??????280? (??? 84,300 ?)
• Oseltamivir (Tamiflu)
• Peramivir (?????)???

25
????

• Relenza
• ?????????????????
• First Study ?18?????????,?????,???????????????6.1
  ,?Relenza???2.0
• The second community study ?????12??94?(56????65
  ?)
• ??????,????????????????????1.4???Relenza??

26
????????

• ????
• ?????????????????????
• ????????
• ???????????????0.3????????????????
• ??? ?????? ?????
• ?????????????
• ???????????????????????,??N95????????????0.3??????
  ?95?????
• ??????????????????????????2H???????,????0.027?????
  ???

27
????

• ??????(?????????????70?)????H5N1???
• ???????????????
• ????????H5N1?????????????
• ????????????????????????????????????
• ?????(??)???(?????)?????H5N1????H5N1??????????????
  ??????(?????)????????????????????????
• ???????????,???????????????????H5N1???
• ?????????????????????????
• ???????????????????????,??????????????????????????
  ???????????,?????????

28
??????????

• (WHO) ????????????
• ????????1 ?????,5???15??????,???????????????
• ???7g/l??70??,???????????
• 70????????????????????????
• ???????????

????????????????(HPAI)?????????????
29
??????

• ???????(FDA)?????CDC????????????,?????????????H5??
  ?????
• ????A/H5????(?????)??RT-PCR??????????????,??????
  ?????H5???????????
• ??H5???????,???????????????
• ???????????????????,??????????????
• ????
• CDC. New laboratory assay for diagnostic testing
  of avian influenza A/H5 (Asian lineage). MMWR.
  200655(RR5)127.

30
????????
31
??WHO??????????
?????????
??????? ???????,??????
?????????
???????-???
??????? ?????????
?????-?????
????????-?????
??????-???
???????
?? WHO ??????
32
?????????

• ????????????? (CDC)
• ??200?-740???
• ??????
• 1.34-2.33???????
• 150?-520?????
• ICU????????????25

33
???? ??????

• 50?????????????
• ?????????????????????????

?? (??1957) ?? (??1918)
?? 90 million (30) 90 million (30)
???????? 45 million (50) 45 million (50)
???? 865,000 9,900,000
ICU?? 128,750 1,485,000
???? 64,875 745,500
?? 209,000 1,903,000
34
?????????

• ??
• ??????
• ????????
• ??
• Ring??
• ?????????
• H5N1????
• ???????
• ???????
• ???????????
• Handwashing??, ????
• ??
• ??
• ????????????????????????
• ????
• ?????????

35
?????????????2006???????????(33?)
??????
?? ????? ?????? ???? ?????? ???? ????
Dept of Health and Human Services
www.pandemicflu.gov
36
??????

• ??????????????,??????????????????
• ????????????????????
• ?????????????????,????????????????????
• ?????????,????????????????????????

37
??????????,??????????
???????????????????????????????????
Be Proactive NOT Reactive!!!!
????????????????!!!