WHOのFAQ：中国・インフルエンザA(H7N9)に関する想定回答集

CDC サイト
http://www.cdc.gov/flu/avianflu/h7n9-virus.htm

医療専門家向け

• Interim Guidance on Case Definitions to be Used for Novel Influenza A (H7N9) Case Investigations in the United States
• CDC Health Alert Network (HAN) Human Infections with Novel Influenza A (H7N9) Viruses

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WHO・FAQ

検査上では抗ウィルス薬有効なようだ。臨床実践例はないようだが・・・

Frequently Asked Questions on human infection with A(H7N9) avian influenza virus, China
http://www.who.int/influenza/human_animal_interface/faq_H7N9/en/index.html
1. What is the influenza A(H7N9) virus?　：インフルエンザ A (H7N9)ウィルスは？

Influenza A H7 viruses are a group of influenza viruses that normally circulate among birds. The influenza A(H7N9) virus is one subgroup among the larger group of H7 viruses. Although some H7 viruses (H7N2, H7N3 and H7N7) have occasionally been found to infect humans, no human infections with H7N9 viruses have been reported until recent reports from China.

インフルエンザ A H7ウィルスは、鳥で通常循環しているインフルエンザ群。インフルエンザA（H7N9)ウィルスは、H7ウィルス群の一サブグループ。特定のH7ウィルス（H7N2、 H7N3、 H7N7)ではヒト感染しばしば認める。H7N9ウィルスのヒト感染は直近中国例まで報告されてなかった。


2. What are the main symptoms of human infection with influenza A(H7N9) virus?　：インフルエンザ A(H7N9)感染したヒトの主な症状は？

Thus far, patients with this infection have had severe pneumonia. Symptoms include fever, cough and shortness of breath. However, information is still limited about the full spectrum of disease that infection with influenza A(H7N9) virus might cause.

とにかく、この感染での患者は重症肺炎。発熱、咳嗽、息切れを含む。しかし、インフルエンザ A(H7N9)ウィルスが生じる症状の完全なスペクトラムについての情報は現時点で限られている。

3. How many human cases of influenza A(H7N9) virus have been reported in China to date?　：　中国で報告されている、インフルエンザA(H7N9)ウィルス・ヒト症例数は？

As of 3 April 2013, seven laboratory-confirmed cases have been detected in China. Details of the most current information on cases can be found in Disease Outbreak News.

症例数は、上記リンクで！

4. Why is this virus infecting humans now?　：なぜ、今、ヒト感染？

We do not know the answer to this question yet, because we do not know the source of exposure for these human infections. However, analysis of the genes of these viruses suggests that although they have evolved from avian (bird) viruses, they show signs of adaption to growth in mammalian species. These adaptations include an ability to bind to mammalian cells, and to grow at temperatures close to the normal body temperature of mammals (which is lower than that of birds).

この疑問への解答は現時点で不明、ヒト感染の暴露源未だ不明のため。しかし、このウィルスの遺伝子解析で、鳥ウィルス由来だが、ほ乳類内での増殖適応の徴候が示されていることが示唆されている。この適応がほ乳類への結合能力、ほ乳類内の通常体温に近い状態での増殖が可能となった(通常、鳥では体温が低い）

5. What is known about previous human infections with H7 influenza viruses globally?　：H7インフルエンザウィルスの世界的なヒト感染事例は？

From 1996 to 2012, human infections with H7 influenza viruses (H7N2, H7N3, and H7N7) were reported in Netherlands, Italy, Canada, USA, Mexico and the United Kingdom. Most of these infections occurred in association with poultry outbreaks. The infections mainly resulted in conjunctivitis and mild upper respiratory symptoms, with the exception of one death, which occurred in the Netherlands. Until now, no human infections with H7 influenza viruses have been reported in China.

1996年から2012年まで、H7インフルエンザ（H7N2、H7N3、H7N7)ヒト感染例が、オランダ、イタリア、カナダ、米国、メキシコ、英国で報告。感染症は、オランダでの1例死亡をのぞき、結膜炎・軽症上気道症状が主。 現在まで、中国でのH7インフルエンザ・ヒト感染報告はなかった。

7. How did people become infected with the influenza A(H7N9) virus?　：　インフルエンザA(H7N9)ウィルスはどうのように感染？

Some of the confirmed cases had contact with animals or with an animal environment but the virus has not thus far been found in animals. It is not yet known how these persons became infected. The possibility of animal-to-human transmission is being investigated, as is the possibility of person-to-person transmission.

動物との接触及び動物の居る接触環境にいたが、ウィルスそのものは現時点で確認されてない確定診断例が存在する。感染様式不明。動物→ヒト伝播可能性調査中、ヒト・ヒト伝播の可能性も同様調査中。




8. How can infection with influenza A(H7N9) virus be prevented?　：予防策

Although both the source of infection and the mode of transmission are uncertain, it is prudent to follow basic hygienic practices to prevent infection. They include hand and respiratory hygiene and food safety measures.

感染源・伝播様式とも不明だが、基本的感染防御方式に従うことで予防可能性のエビデンス豊富。　手指・気道系予防策、食品安全の計測も含まれる。

Hand hygiene:　手指予防
• Wash your hands before, during, and after you prepare food; before you eat; after you use the toilet; after handling animals or animal waste; when your hands are dirty; and when providing care when someone in your home is sick. Hand hygiene will also prevent the transmission of infections to yourself (from touching contaminated surfaces) and in hospitals to patients, health care workers and others.
• Wash your hands with soap and running water when visibly dirty; if not visibly dirty, wash your hands with soap and water or use an alcohol-based hand cleanser.

食品を扱う場合、その前、間、その後に手洗いを。食べる前、トイレ語、動物や動物の排泄物を扱った後、手が汚れた後、誰か具合の悪いひとが居る場合の世話をした後。
手洗いは、自分、患者、医療関係者、他への感染伝播予防策となる 。
見た目で汚い場合、石けんで手洗いし、流水でながす。もし見た目が汚くない場合、石けんで洗い、水もしくはアルコールベースのハンドクリーナーを使用する。

Respiratory hygiene:　気道系予防
• Cover your mouth and nose with a medical mask, tissue, or a sleeve or flexed elbow when coughing or sneezing; throw the used tissue into a closed bin immediately after use; perform hand hygiene after contact with respiratory secretions.

メディカルマスクで口・鼻を多い、咳嗽・鼻水の時はティッシュ・袖・肘の一部固定部分でぬぐう。使用したティッシュは使用後は即座に密閉瓶へ投げ入れる。気道分泌物に触れた場合、即、手指衛生。

9. Is it safe to eat meat, i.e. poultry and pork products?　：　肉を食べも安全？　家禽類・ポーク製品

Although we do not yet know the mode of transmission, it is prudent to follow basic principles of hygienic food preparation, as follows: Diseased animals should not be eaten. Otherwise, it is safe to eat properly prepared and cooked meat. Because influenza viruses are inactivated by sufficient heating, normal temperatures used for cooking (such that food reaches 70°C in all parts— "piping" hot — no "pink" parts) will kill the virus. In areas experiencing outbreaks, meat products can be safely consumed provided that these items are properly cooked and properly handled during food preparation. The consumption of raw meat and uncooked blood-based dishes is a high-risk practice and is discouraged. Always keep raw meat separate from cooked or ready-to-eat foods to avoid contamination. Do not use the same chopping board or the same knife for raw meat and other foods. Do not handle both raw and cooked foods without washing your hands in between and do not place cooked meat back on the same plate or surface it was on before cooking. Do not use raw or soft-boiled eggs in food preparations that will not be heat treated or cooked. After handling raw meat, wash your hands thoroughly with soap and water. Wash and disinfect all surfaces and utensils that have been in contact with raw meat.

伝播様式がわからないが、衛生的食品取り扱い原則に従うことでの予防は十分な根拠あり。；疾患動物は食さない。一方、適切に処理され・調理された肉は食しても安全。インフルエンザウィルスは、通常の調理用いられる加熱で不活化される（全部位で食品が70度に到達： "piping" hot — no "pink" parts; 　ピンク部分がないように十分焼くことでウィルス消失。・・・　

10. Is there a vaccine for the influenza A(H7N9) virus?　：　インフルエンザ A(H7N9)感染予防ワクチンはあるか？

No vaccine for the prevention of influenza A(H7N9) infections is currently available. However, viruses have already been isolated and characterized from the initial cases. The first step in development of a vaccine is the selection of candidate viruses that could go into a vaccine. WHO, in collaboration with partners, will continue to characterize available influenza A(H7N9) viruses to identify the best candidate viruses. These candidate vaccine viruses can then be used for the manufacture of vaccine if this step becomes necessary.

現在利用できるインフルエンザ A(H7N9)感染予防ワクチンは存在しない。しかし、ウィルスは、初期ケースで、すでに分離済みで、特徴も確認済み。ワクチン開発最初のステップはワクチン開発へ進行可能なウィルスの選別である。 WHOは、パートナーと共同で、インフルエンザ A(H7N9)ウィルスの特性研究中で、ベストな候補ウィルス同定中。これらの候補ワクチンウィルスが使用できるなら、次のステップは必要だが、ワクチン製造可能となるだろう。

11. Does treatment exist for influenza A(H7N9) infection?　：　インフルエンザ A(H7N9)感染への治療は存在？

Laboratory testing conducted in China has shown that the influenza A(H7N9) viruses are sensitive to the anti-influenza drugs known as neuraminidase inhibitors (oseltamivir and zanamivir). When these drugs are given early in the course of illness, they have been found to be effective against seasonal influenza virus and influenza A(H5N1) virus infection. However, at this time, there is no experience with the use of these drugs for the treatment of H7N9 infection.

 中国で行われた検査で、インフルエンザ A (H7N9)ウィルスは抗インフルエンザ薬剤(オセルタミビル、ザナビル）に感受性ありということが示されている。これらの薬剤が臨床早期に与えられたら、季節型インフルエンザやインフルエンザA(H5N1)ウィルス感染に有効であることが判明しているが、現時点で、H7N9感染治療への薬剤使用経験は無い。

13. Are health care workers at risk from the influenza A(H7N9) influenza virus?　：　インフルエンザ A(H7N9)ウィルスの医療従事者へのリスクは？

Health care workers often come into contact with patients with infectious diseases. Therefore, WHO recommends that appropriate infection prevention and control measures be consistently applied in health care settings, and that the health status of health care workers be closely monitored. Together with standard precautions, health care workers caring for those suspected or confirmed to have influenza A(H7N9) infection should use additional precautions (http://www.who.int/csr/resources/publications/swineflu/WHO_CDS_EPR_2007_6/en/index.html).

医療労働者は感染性患者遭遇多い。故に、WHOは適正な感染予防・制御計測を医療機関では一貫して適応すべきで、医療労働者の健康状態を密にモニターすべき。標準予防策とともに、医療関係者はインフルエンザA(H7N9)感染疑い・確認例のケアに当たる医療労働者は、追加対策を行うべき

15. Does this influenza virus pose a pandemic threat?　：　パンデミック脅威を有するか？

Any animal influenza virus that develops the ability to infect people is a theoretical risk to cause a pandemic. However, whether the influenza A(H7N9) virus could actually cause a pandemic is unknown. Other animal influenza viruses that have been found to occasionally infect people have not gone on to cause a pandemic.

ヒトへの感染能出現した、どの動物インフルエンザウィルスも、パンデミックとなる理論的リスクはある。しかし、H7N9がパンデミックの現実的原因になるかは不明。
時折発見されるヒトへの感染例となる他の動物インフルエンザウィルスもパンデミックの原因とならなかった。