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[新型甲型H1N1流感/2009:医护人员之间的病毒传播]

[Novel influenza H1N1/2009: virus transmission among health care worker].

作者信息

Wicker S, Rabenau H F, Bickel M, Wolf T, Brodt R, Brandt C, Berger A, Doerr H W, Lehmann R

机构信息

Betriebsärztlicher Dienst, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt.

出版信息

Dtsch Med Wochenschr. 2009 Nov;134(48):2443-6. doi: 10.1055/s-0029-1242012. Epub 2009 Nov 11.

Abstract

HISTORY AND ADMISSION FINDINGS

A 27-year-old female presented with fever (40 C) and infection of the upper respiratory tract in an emergency room (ER) department of our university hospital. Within the last days, she worked as a nurse in that ER, responsible for taking care of patients with novel influenza and also executing screening-examinations of suspicious cases.

INVESTIGATIONS

Patient in a reduced condition of health. C-reactive protein was significantly elevated (6.6 mg/dl - norm < 0.5). A PCR carried out on the admission day revealed a highly positive reaction (CT:19.29).

DIAGNOSIS, TREATMENT AND COURSE: Due to positive PCR laboratory report for H1N1/2009 and multiple occupational contacts with H1N1/2009 patients, therapy with neuraminidase inhibitor was started. After a five-day antiviral therapy and clinical signs of recovery, PCR was negative on the sixth treatment day.

CONCLUSION

Health care workers (HCWs) are at risk of occupational exposure to influenza. Against the backdrop of the spread of H1N1 (2009) appropriate protective measures should be implemented to reduce the risk for transmission in health-care settings. The acquisition of epidemiologic data of occupational infections in Germany ought to be optimized. Required protective measures should be evaluated with regard to practicability and effectiveness.

摘要

病史及入院检查结果

一名27岁女性因发热(40摄氏度)和上呼吸道感染,在我校医院急诊科就诊。在过去几天里,她在该急诊科担任护士,负责照顾新型流感患者并对疑似病例进行筛查检查。

检查

患者健康状况不佳。C反应蛋白显著升高(6.6毫克/分升,正常范围<0.5)。入院当天进行的聚合酶链反应(PCR)显示反应呈强阳性(CT值:19.29)。

诊断、治疗及病程:由于PCR实验室报告显示H1N1/2009呈阳性,且该患者与H1N1/2009患者有多次职业接触,遂开始使用神经氨酸酶抑制剂进行治疗。经过为期五天的抗病毒治疗且出现临床康复迹象后,在治疗的第六天PCR检测结果为阴性。

结论

医护人员面临职业性接触流感的风险。在H1N1(2009)传播的背景下,应采取适当的防护措施,以降低医疗机构内的传播风险。德国职业感染的流行病学数据收集工作应予以优化。所需的防护措施应在实用性和有效性方面进行评估。

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