甲型H1N1流感疫情及药物治疗面临的挑战。
Influenza a (H1N1) outbreak and challenges for pharmacotherapy.
作者信息
Chawla Raman, Sharma Rakesh Kumar, Bhardwaj Janak Raj
机构信息
Division of CBRN Defence, Institute of Nuclear Medicine and Allied Sciences, Brig. S. K. Mazumdar Marg, Delhi - 110 054.
出版信息
Indian J Physiol Pharmacol. 2009 Apr-Jun;53(2):113-26.
Influenza A (H1N1) virus, a genetic reassortment of endemic strain of human, avian flu and swine flu, with an inherent ability to mutate continuously has developed a subtype which is causing present flu in humans. As on 10th May, 2009, twenty nine countries are affected with officially reported 4379 cases with Mexico--1626 affected (45 deaths), US 2254 affected (02 deaths); Canada 280 (01 deaths) and Costa Ricia -8 cases (01 death) respectively. Rest of 15 countries have reported less than 100 officially confirmed cases of H1N1 infection. WHO has already declared Pandemic Alert V on 29th April, 2009. If the present flu achieves equivalent virulence to that of 1918-19 pandemic flu, expected deaths will be 62 million people. Travel advisory, stockpiling of antiviral drugs--Tamiflu & Relenza; vaccine development, activation of business continuity planning for maintenance of essential serives etc., are some of the important mitigation approaches, being followed all over the world. WHO has a regional reserve of 10,000 million doses of anti-viral drugs. National Disaster Management Authority (NDMA), Government of India, an apex body for disaster management, in active coordination with Ministry of Health & other stakeholders/service providers is maintaining a constant state of vigil on the present Influenza A (H1N1) outbreak. In collaboration with UNDMT, NDMA has outlined a strategy for Pandemic Preparedness beyond Health in April, 2008. Various non-pharmaceutical interventions like detection, isolation and quarantine are required to contain the situation. Accordingly, stockpiling of 10 million doses of anti viral drugs, surveillance at airports, isolation with strict enforcement of quarantine procedures, sustained supply of respiratory masks & other personal protective equipment; deployment of rapid response teams are some of the activities being undertaken by Indian Government proactively. As situation goes to Phase VI, there will be a shift in strategy from active surveillance, detection and quarantine to containment, treatment, prevention of spread of disease and maintenance of business continuity beyond health sectors. The major concern is to utilise this latency period, between phase V and VI, to fill the gaps in state of preparedness. It is also essential to focus on development/procurement of appropriate vaccine to manage the situation arising from any further mutation of the existing causative virus to be resistant against existing anti viral therapies. It is a continued effort which can save many lives around the world and everyone has to play its assigned role effectively.
甲型H1N1流感病毒是人流感、禽流感和猪流感地方流行毒株的基因重配体,具有持续变异的内在能力,现已产生一种导致人类当前流感疫情的亚型。截至2009年5月10日,29个国家受到影响,官方报告4379例病例,其中墨西哥1626例(45人死亡),美国2254例(2人死亡);加拿大280例(1人死亡),哥斯达黎加8例(1人死亡)。其余15个国家报告的甲型H1N1感染官方确诊病例少于100例。世界卫生组织已于2009年4月29日宣布进入大流行预警级别5级。如果当前流感的毒力达到1918 - 1919年大流行流感的水平,预计死亡人数将达6200万。旅行建议、储备抗病毒药物(达菲和乐感清);疫苗研发、启动业务连续性计划以维持基本服务等,是全球各地正在采取的一些重要缓解措施。世界卫生组织有100亿剂抗病毒药物的区域储备。印度政府的国家灾害管理局(NDMA)作为灾害管理的最高机构,与卫生部及其他利益相关者/服务提供者积极协调,对当前甲型H1N1流感疫情保持持续警惕。2008年4月,NDMA与联合国灾害管理小组合作,制定了一项超越卫生领域的大流行防范战略。需要采取各种非药物干预措施,如检测、隔离和检疫来控制局势。因此,印度政府正在积极开展一些活动,如储备1000万剂抗病毒药物、在机场进行监测、严格执行检疫程序进行隔离、持续供应呼吸口罩及其他个人防护设备;部署快速反应小组等。随着疫情发展到第6阶段,战略将从主动监测、检测和检疫转向控制、治疗、预防疾病传播以及维持卫生领域以外的业务连续性。主要关注点是利用第5阶段和第6阶段之间的潜伏期来填补准备状态的差距。同样重要的是,要专注于研发/采购合适的疫苗,以应对现有致病病毒进一步变异从而对现有抗病毒疗法产生抗性所引发的情况。这是一项持续的努力,能够拯救世界各地许多人的生命,每个人都必须有效地发挥自己的作用。