本帖最後由 lsc0019 於 2009-5-27 00:36 編輯
作者：Emma Hitt, PhD
出處：WebMD醫學新聞
May 12, 2009 — 世界衛生組織(WHO)正在發展使用抗病毒藥物治療新的A型流感(H1N1)病毒株的臨床處置指引，而WHO與疾病控制與預防中心(CDC)都建議，除了在高風險情況外，反對濫用。
WHO全球流感計畫醫療官員、WHO之H1N1流感爆發反應臨床小組組長Nikki Shindo醫師在記者會中指出，新指引將強調大多數病患不需要住院或抗病毒藥物治療這個事實。
最新的WHO統計為，30國共有5,251例H1N1流感確認案例。
根據Shindo醫師表示，簡單的支持治療，如退燒藥與補充水分，對許多案例來說已經足夠；其他支持治療包括給予氧氣和抗生素。指引建議，因為考量雷氏症候群而不建議使用阿斯匹靈。
她表示，疾病程度從輕微的、稱為類流感的症狀，到很嚴重的疾病類型，如有時需機械性輔助呼吸的肺炎。許多重症與死亡都發生在有潛在慢性醫療狀況的人，但是還不清楚何以在健康成人與小孩也有許多重症案例。
Shindo醫師指出，相較於墨西哥和美國，歐洲國家已經積極使用抗病毒藥物，雖然有待確認，但這可能就是在歐洲國家比較少嚴重案例的原因。她指出，在季節性流感來說，抗藥性的出現似乎與特定國家使用抗病毒藥物無直接相關。
今天，CDC報告指出，在46州與華盛頓特區共有約3,600例可能與確認案例，在44州與華盛頓特區有3,002例確認案例，3例死亡。總共有116例住院報告。目前，有29州自己進行新型H1N1流感病毒株的實驗室確認檢測。
【孕婦的併發症風險較高】
今天的CDC記者會由科學與公共衛生計畫代理主任Anne Schuchat醫師主持，聚焦在H1N1對孕婦的影響。
Schuchat醫師表示，孕婦流感併發症的風險較高，我們在今年的新型H1N1病毒發現一些孕婦有嚴重併發症，我們有大約20例調查中的孕婦案例。
Schuchat醫師表示，一些孕婦有嚴重併發症，包括1例死亡；流感會造成懷孕時的嚴重併發症，包括肺炎、脫水與一些新生兒的問題。
她表示，我們認為，當醫師照顧疑似流感的孕婦時，提供適當的抗病毒藥物治療是很重要的；有時候，醫師不願意用藥物治療孕婦、孕婦不願意服用藥物，但是，抗病毒藥物治療孕婦流感的好處大於一些有關此藥的理論性顧慮。
Oseltamivir或zanamivir都可以在懷孕期間服用。
Schuchat醫師在記者會中向Medscape Infectious Diseases表示，仍然不清楚病毒在秋天時會如何擴散。同時發生高傳染性的新型H1N1病毒株、致命性的H5N1禽流感病毒株、以及對oseltamivir有抗藥性的H1N1季節性流感病毒株，將是不幸的狀況。
Antivirals Should Be Used Only in High-Risk H1N1 Flu Cases
By Emma Hitt, PhD
Medscape Medical News
May 12, 2009 — The World Health Organization (WHO) is developing clinical management guidelines for the use of antivirals in the treatment of the novel influenza A (H1N1) strain, and both WHO and the Centers for Disease Control and Prevention (CDC) are advising against overuse except in higher-risk cases, the agencies announced today.
Dr. Nikki Shindo, medical officer in the WHO Global Influenza Programme and leader of the clinical team of the WHO response to the H1N1 influenza outbreak, noted during a media briefing that the new guidance will highlight "the fact that most of the patients will not require hospitalization or antiviral therapy."
The latest WHO estimate of confirmed H1N1 influenza cases is 5251 cases in 30 countries.
According to Dr. Shindo, simple supportive therapy, such as antipyretics and hydration are "sufficient" for many cases. Other supportive therapies include oxygen and antibiotics. The guidelines recommend against using aspirin due to the risk of Reye's syndrome.
"We have seen a spectrum of disease from mild, typically what you call influenza-like illness...to very severe form of this disease, this is pneumonia sometimes requiring mechanical ventilation," she said. Many of the severe illnesses and deaths occurred in persons with underlying chronic medical conditions, but it is still unknown why many severe cases were also occurring in healthy adults and children, she said.
Dr. Shindo pointed out that European countries have been using antivirals aggressively compared with countries such as Mexico and the United States, and while it remains to be confirmed, this "could be the reason why we are seeing less severe cases in European countries." She noted that in seasonal influenza, emergence of resistance does not seem to be directly related to use of antivirals in a given country.
As of today, the CDC is reporting about 3600 probable and confirmed cases in 46 states and Washington, DC, with 3002 confirmed cases in 44 states and Washington, DC, with 3 reported fatalities. A total of 116 hospitalizations have been reported. Currently, 29 states are doing their own confirmatory testing for the novel H1N1 influenza strain.
Pregnant Women at Higher Risk for Complications
Today's media briefing at the CDC was led by Anne Schuchat, MD, the interim deputy director for Science and Public Health Program, and focused on the effects of H1N1 influenza on pregnant women.
"Pregnant women are at higher risk of complications with influenza...and we are also seeing some severe complications among pregnant women in this year's novel H1N1 virus problem," Dr. Schuchat said. "We have about 20 cases under investigation" in pregnant women.
According to Dr. Schuchat, a few of the pregnant patients have had severe complications, including 1 fatality. Influenza can cause worse complications in pregnancy, including pneumonia, and dehydration and problems for newborns.
"We think it's very important when doctors are caring for pregnant women who they suspect may have influenza, that they issue prompt treatment with antiviral medicines," she said. "Sometimes physicians are reluctant to treat pregnant women with medicines and pregnant women are reluctant to take medicines..." but "the benefits of using antiviral drugs to treat influenza in a pregnant woman outweigh the theoretical concerns about the drug."
Oseltamivir or zanamivir can both be used in pregnancy.
It remains unclear how the virus will spread during the fall, Dr. Schuchat told Medscape Infectious Diseases during the press conference. The simultaneous circulation of the highly transmissible novel H1N1 strain, the very virulent H5N1 avian strain, and the oseltamivir-resistant H1N1 seasonal influenza strain is an "unfortunate circumstance," she added. |
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