Prevention and control scheme of human infection with H7N9 avian influenza (second edition)

Prevention and control scheme of human infection with H7N9 avian influenza (second edition)

One. area of application

This scheme is suitable for the prevention and control of human infection with H7N9 avian influenza in medical and health institutions at this stage, and will be updated in time according to the deepening of the understanding of the disease and the changes in the epidemic situation.

Second, the discovery and reporting of cases.

Definition of a case

1. For the definition of suspected cases and confirmed cases of human infection with H7N9 avian influenza, please refer to the Diagnostic and Therapeutic Plan for Human Infection with H7N9 Avian Influenza (2nd Edition, 20 13) (Wei Power Generation [2013]17).

2. Aggregation cases refer to people who find 2 or more confirmed or suspected cases of H7N9 avian influenza in a small area (such as a family or a community) within 7 days (at least 65,438 cases +0 confirmed cases in the aggregation cases), suggesting that there may be interpersonal transmission or infection due to the same contact. ?

② Discovery and report

Medical institutions at all levels should ask about the exposure history of poultry or live poultry market in response to influenza-like cases, focusing on people engaged in live poultry breeding, slaughtering, selling, transportation and other industries. Suspected cases and confirmed cases of human infection with H7N9 avian influenza should be reported directly through China Disease Surveillance Information Management System within 24 hours and 2 hours respectively. The reported disease category is "Human Infected with H7N9 Avian Influenza" in "Other Infectious Diseases". Medical institutions that do not have the conditions for online direct reporting shall report to the local county-level CDC by the fastest communication method (telephone, fax, etc.). ) and send an infectious disease report card, and the county-level CDC will immediately report directly to the network after receiving the report.

Three. Epidemiological investigation, sampling and detection of cases

(1) Epidemiological investigation

After receiving the confirmed cases of human infection with H7N9 avian influenza reported by medical institutions within their jurisdiction, the county-level CDC conducted an investigation according to the epidemiological investigation plan of human infection with H7N9 avian influenza formulated by China CDC.

For a single case, the investigation contents mainly include the basic situation, pathogenesis, clinical manifestations, laboratory examination, diagnosis and prognosis, family and home environment, exposure history, close contacts and so on. For poultry breeding or trading places where cases may be exposed, environmental samples such as poultry droppings and cage swabs should be collected to carry out pathogen detection. If necessary, organize active case search according to the investigation.

For clustered cases, on the basis of the above work, it is necessary to investigate the suspected cases immediately, and focus on the exposure history of cases and the epidemiological relationship between cases, and analyze the homology of viruses isolated from cases and environmental samples to determine whether there is interpersonal transmission or infection due to * * *.

(2) Specimen collection, transportation and laboratory testing

When medical staff suspect that patients are infected with H7N9 avian influenza virus, they should collect upper and lower respiratory tract samples (especially lower respiratory tract samples), acute phase serum within 7 days of onset and serum collected at an interval of 2-4 weeks from acute phase serum as soon as possible.

Medical institutions with the conditions to carry out nucleic acid detection should carry out H7N9 virus nucleic acid detection on respiratory tract samples, make case diagnosis and guide the early application of antiviral drugs; Medical institutions that do not have the conditions to carry out nucleic acid detection should use rapid antigen detection reagents to carry out influenza A virus antigen detection as soon as possible, and send positive samples of influenza A virus antigen detection to the local influenza surveillance network laboratory to further carry out H7N9 virus nucleic acid detection. Specimen collection, packaging, transportation, etc. Should be strictly in accordance with the "Regulations on the transportation management of highly pathogenic microorganisms (viruses) that can infect humans" (Order No.45 of the Ministry of Health) and other biosafety related regulations. Network laboratories with BSL-3 biosafety conditions immediately carry out virus isolation and send the isolated virus to the National Influenza Center in time as required; Network laboratories that fail to carry out virus isolation need to send the original samples of H7 nucleic acid positive cases to the National Influenza Center in time as required.

The serum samples collected by medical institutions are sent to the local influenza surveillance network laboratory, and the local network laboratory sends the serum samples to the provincial CDC and the National Influenza Center for antibody testing.

Please refer to the Strategy for Specimen Collection and Laboratory Detection of Human Infected with H7N9 Avian Influenza Virus formulated by China CDC for specific operation points.

Four. Information report

All kinds of medical institutions at all levels and relevant personnel should fill in the infectious disease report card in accordance with the regulations after discovering the suspected or confirmed cases of human infection with H7N9 avian influenza, and report it directly through the network of China disease surveillance information management system. For the confirmed cases, the medical institutions reporting the cases should also fill in the patient's condition change information daily through the information management system of human infection with H7N9 avian influenza, and fill in the Questionnaire of Human Infection with H7N9 Avian Influenza-Clinical Part online within 24 hours after discharge or death (see the Epidemiological Investigation Plan of Human Infection with H7N9 Avian Influenza for details). For death cases, it is necessary to fill in the relevant contents of death medical certificate carefully, and report directly through the network through the death registration report information system. After completing the preliminary investigation, the county-level CDC in the jurisdiction should fill in the Questionnaire on Human Infected with H7N9 Avian Influenza-Epidemiological Part online (see the Epidemiological Investigation Plan on Human Infected with H7N9 Avian Influenza for details), supplement and improve the questionnaire information in time according to the investigation progress, and update the medical observation of close contacts daily.

If the case directly reported by the network is transferred to the hospital for treatment, the medical institution that transferred the case should input the case transfer information through the information management system of human infection with H7N9 avian influenza. The medical institution receiving the case should inquire and verify the case information through the above system, and input the treatment of the case.

Once the cluster case is diagnosed, it should be reported directly through the public health emergency report management information system within 2 hours, and the progress report and closing report should be made in time according to the progress of the incident.

When laboratory tests are carried out, China Center for Disease Control and Prevention shall timely input the specimen information and test results into China Influenza Surveillance Information System.

Verb (abbreviation of verb) case management and infection prevention

Medical institutions should refer to the Technical Guide for Hospital Infection Prevention and Control of Human Infections with H7N9 Avian Influenza (20 13 Edition) (Wei Power Generation [2013] No.6) and implement measures such as patient isolation, hospital infection prevention and control, and medical personnel protection.

When carrying out epidemiological investigation and sample collection, the personnel of disease control institutions shall do a good job in personal protection, and guide the poultry-related practitioners and poultry-related disposal personnel to do a good job in personal protection.

Six, suspicious exposure and close contact management

(1) Management of suspected exposure

Suspicious exposure refers to people who are exposed to poultry and the environment that are positive for H7N9 avian influenza virus and have not taken effective protection during exposure.

County health (health and family planning) administrative departments shall, jointly with relevant departments of agriculture, industry and commerce, transportation and so on. Inform the health of the suspected exposed persons, instruct them to seek medical advice in time when they have symptoms of acute respiratory infection such as fever (underarm temperature ≥37.5℃) and cough, and take the initiative to inform them that they have been exposed to poultry.

② Management of close contacts

Close contacts refer to medical personnel who have not taken effective protective measures during the diagnosis and treatment of suspected and confirmed cases or their families who have taken care of the patients; Persons who had lived together or had other close contact with patients before the onset of suspected or confirmed cases 1 day to isolation treatment or before death; Or other personnel who need to be managed as close contacts as judged by the on-site investigators. County-level health (health and family planning) administrative departments organize follow-up and medical observation for close contacts, and measure their body temperature 1 time every morning and evening to find out whether there are symptoms of acute respiratory infection in time. Body temperature measurement can be carried out by close contacts or medical and health institutions. The medical observation period is 7 days after the last exposure or contact with cases without effective protection.

Once close contacts have symptoms of acute respiratory infection such as fever (underarm temperature ≥37.5℃) and cough, they will be immediately transferred to local designated medical institutions for diagnosis, report and treatment. When close contacts have acute respiratory symptoms, their throat swabs should also be collected and sent to the local influenza surveillance network laboratory for testing.

Seven. Intensive surveillance of influenza-like cases

Counties (districts) with confirmed cases of human infection with H7N9 avian influenza should carry out intensive monitoring for 2 weeks after the case is confirmed. All secondary and above medical institutions timely collect respiratory tract samples from emergency patients who meet the definition of influenza-like cases and hospitalized patients with severe acute respiratory tract infection, ask about the exposure history, and carry out relevant tests according to the strategy of sample collection and laboratory detection of human infection with H7N9 avian influenza virus formulated by China CDC. Each medical institution collects and reports the total number of influenza-like cases, the total number of inpatients with severe acute respiratory infection, the number of samples, the number of people tested in our hospital, the number of people sent to disease control institutions for testing, the number of positive cases and positive results every week. The specific reporting method refers to the relevant technical requirements of the enhanced monitoring information report issued by China CDC. All localities can appropriately expand the monitoring scope and time according to the work situation.

In areas where there are no cases of human infection with H7N9 avian influenza, the monitoring intensity should be improved on the basis of previous influenza-like cases. In 20 13 years, the number of samples collected and tested increased. Every hospital in southern province collects 20 samples of influenza-like cases and cases related to human infection with H7N9 avian influenza every week, 20 samples from April to September in northern province, and 20 samples from 10 to March next year, and sends them to the local influenza surveillance network laboratory for testing.

Eight, timely carry out the epidemic situation research.

Health (health and family planning) administrative departments at all levels should promptly organize experts to judge the epidemic situation according to the situation of human infection with H7N9 avian influenza, pathogen monitoring and research progress. When the emergency standard is reached, the corresponding emergency response mechanism should be started in time according to the relevant plan, and the response should be terminated according to the relevant regulations.

Nine, do a good job in health education.

All localities should actively carry out public opinion monitoring, focus on hot issues of public and social concern, actively do a good job in epidemic prevention and control knowledge propaganda and risk communication, guide and promote the public to develop good health habits, and especially strengthen health education and risk communication for people engaged in live poultry breeding, slaughtering, trafficking and transportation.

Ten, strengthen the training of medical personnel and supervision and inspection.

Medical and health institutions should carry out training in case discovery and reporting of human infection with H7N9 avian influenza, epidemiological investigation, specimen collection, laboratory testing, case management, infection prevention and control, and risk communication.

Health (health and family planning) administrative departments at all levels are responsible for organizing supervision and inspection of prevention and control work within their respective jurisdictions, and handling problems in a timely manner when found.

Eleven, vigorously carry out patriotic health campaign.

Ivy at all levels should give full play to the role of deliberation and coordination, strengthen organization, management, supervision and inspection, mobilize the masses and grass-roots units in combination with the activities of creating health towns, and carry out in-depth centralized rectification actions of urban and rural environmental sanitation. It is necessary to focus on strengthening the health management of farmers' markets and focus on solving the outstanding health problems existing in live poultry sales and slaughter.