豚インフルエンザ診断治療について

同日(4.26)厚労省より担当部局あて事務連絡にて日本語訳が出ている。
http://www.mhlw.go.jp/kinkyu/kenkou/influenza/090426-02.html

故に、以下の情報の大半は上記厚労省の資料にて日本語訳確認できる。<以上、4/27追記>


豚インフルエンザ 2009年 04月 25日に続いてだが

Statement by WHO Director-General, Dr Margaret Chan
25 April 2009
によれば、結論から言えば、
The Committee further agreed that more information is needed before a decision could be made concerning the appropriateness of the current phase 3.
ということで、現状把握が十分でないことなどのため、phaseの変更を即断しなかった。

私には賢明な判断だと思える

米国やメキシコからの帰国者に遭遇する場合は別だが今すぐに臨床上役立つ機会はまずないだろう
なんせ対象者は
1. Live in San Diego County or Imperial County, California or San Antonio, Texas or
2. Have traveled to San Diego and/or Imperial County, California or San Antonio, Texas or
3. Have been in contact with ill persons from these areas in the 7 days prior to their illness onset.
だから
一応検体は、気道系ぬぐい液を採取、冷却器に保存し、検査センターに(米国では)

だが、その辺の人たちに医師としての知識を試されることもあるかもしれないため知識の整理をしておいた方が良いのかもしれない。

現時点では信頼できるサイトは、Human Swine Influenza Investigationくらいか?

CDC:Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts
診断:
1. real-time RT-PCR
2. viral culture
3. four-fold rise in swine influenza A (H1N1) virus-specific neutralizing antibodies



疑う事例:
Clinicians should consider swine influenza A (H1N1) virus infection in the differential diagnosis of patients with febrile respiratory disease and who 1) live in areas in the U.S. with confirmed human cases of swine influenza A (H1N1) virus infection or 2) who traveled recently to Mexico or were in contact with persons who had febrile respiratory illness and were in the areas of the U.S. with confirmed swine influenza cases or Mexico in the 7 days preceding their illness onset.



薬剤抵抗性:
This swine influenza A (H1N1) virus is sensitive (susceptible) to the neuraminidase inhibitor antiviral medications zanamivir and oseltamivir. It is resistant to the adamantane antiviral medications amantadine and rimantadine.



通常のinfluenza A陽性例で、季節循環性インフルエンザH3やH1陰性例では治療をすべき

小児にアスピリン投与禁止(ライ症候群など)




Swine Influenza A (H1N1) Infection in Two Children --- Southern California, March--April 2009
On April 21, this report was posted as an MMWR Early Release on the MMWR website (http://www.cdc.gov/mmwr).
Initial testing at the clinic using an investigational diagnostic device identified an influenza A virus, but the test was negative for human influenza subtypes H1N1, H3N2, and H5N1.



2名の患者のウィルスでは、amantadine、rimantadine抵抗性で、neuraminidase阻害剤であるoseltamivir、zanamivirの感受性に関しては試験中
"The viruses in these two patients demonstrate antiviral resistance to amantadine and rimantadine, and testing to determine susceptibility to the neuraminidase inhibitor drugs oseltamivir and zanamivir is under way."


Swine Flu and You Apr 24, 2009
What is swine flu? Are there human infections with swine flu in the U.S.? …

Swine Flu Video Podcast Apr 25, 2009
Dr. Joe Bresee, with the CDC Influenza Division, describes swine flu - its signs and symptoms, how it's transmitted, medicines to treat it, steps people can take to protect themselves from it, and what people should do if they become ill.

Key Facts about Swine Influenza (Swine Flu) Apr 24, 2009, 5:45 PM ET
How does swine flu spread? Can people catch swine flu from eating pork? …

部分訳:現時点ではCDCは、治療and/or予防にoseltamivirやzanamivirの使用を推奨 At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.





“現在使われている迅速キットで診断可能か?”
いずれのキットもインフルエンザA型ウイルスであれば、鳥や動物由来のものでもヒト由来のものでも、H5N1を含め検出します。しかしながら、これらは薬事品ですので、ヒトの診断以外の使用を考えている相手に積極的に使用を勧めないでください(某検査キットの会社:http://www.bdj.co.jp/pdf/48-avianflu-Q&A.pdf

・・・一般の季節性インフルエンザと同じ反応を示すだろうということ(結果に関しては検討されてないから当然誰も責任はとれないだろうが・・・)



BBC newsの”Mexico flu: Your experiences ”が話題となっている。
アメリカの情報と異なり、“The truth is that anti-viral treatments and vaccines are not expected to have any effect, even at high doses.”という・・・Antonio Chavez, Mexico Cityという人の話

“I understand the government doesn't want to generate panic, but my personal opinion is that they issued the alert too late. Still now, the population is not getting the information they need.”という医師たちの主張を信じるべきなのか・・・

by internalmedicine | 2009-04-26 07:15 | インフルエンザ  

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