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1、ViralHemorrhagicViralHemorrhagicFeverFeverCenter for Food Security and Public Health Iowa State University-2004WhatisViralWhatisViralHemorrhagicFever?HemorrhagicFever?SeveremultisystemsyndromeDamagetooverallvascularsystemSymptomsoftenaccompaniedbyhemorrhageRarelylifethreateninginitselfIncludesconjun
2、ctivitis,petechia,echymosisCenter for Food Security and Public Health Iowa State University-2004OverviewOverviewOrganismHistoryEpidemiologyTransmissionDiseaseinHumansDiseaseinAnimalsPreventionandControlCenter for Food Security and Public Health Iowa State University-2004TheOrganismsTheOrganismsCente
3、r for Food Security and Public Health Iowa State University-2004ViralHemorrhagicFeverViralHemorrhagicFeverVirusesoffourdistinctfamiliesArenavirusesFilovirusesBunyavirusesFlavivirusesRNAvirusesEnvelopedinlipidcoatingSurvivaldependentonananimalorinsecthost,forthenaturalreservoirCenter for Food Securit
4、y and Public Health Iowa State University-2004ClassificationClassificationCenter for Food Security and Public Health Iowa State University-2004ArenaviridaeArenaviridaeJunin virusMachupo virusGuanarito virusLassa virusSabia virusCenter for Food Security and Public Health Iowa State University-2004Are
5、naviridaeHistoryArenaviridaeHistoryFirstisolatedin19331958:Juninvirus-ArgentinaFirsttocausehemorrhagicfeverArgentinehemorrhagicfever1963:MachupovirusBoliviaBolivianhemorrhagicfever1969:LassavirusNigeriaLassafeverCenter for Food Security and Public Health Iowa State University-2004ArenaviridaeTransmi
6、ssionArenaviridaeTransmissionVirustransmissionandamplificationoccursinrodentsShedvirusthroughurine,feces,andotherexcretaHumaninfectionContactwithexcretaContaminatedmaterialsAerosoltransmissionPerson-to-persontransmissionCenter for Food Security and Public Health Iowa State University-2004Arenavirida
7、eEpidemiologyArenaviridaeEpidemiologyAfricaLassaSouthAmericaJunin,Machupo,Guanarito,andSabiaContactwithrodentexcretaCasefatality:535%ExplosivenosicomialoutbreakswithLassaandMachupoCenter for Food Security and Public Health Iowa State University-2004ArenaviridaeinHumansArenaviridaeinHumansIncubationp
8、eriod1014daysFeverandmalaise24daysHemorrhagicstageHemorrhage,leukopenia,thrombocytopeniaNeurologicsignsCenter for Food Security and Public Health Iowa State University-2004BunyaviridaeBunyaviridaeRift Valley Fever virusCrimean-Congo Hemorrhagic Fever virusHantavirusCenter for Food Security and Publi
9、c Health Iowa State University-2004BunyaviridaeHistoryBunyaviridaeHistory1930:RiftValleyFeverEgyptEpizooticinsheep1940s:CCHF-CrimeanpeninsulaHemorrhagicfeverinagriculturalworkers1951:HantavirusKoreaHemorrhagicfeverinUNtroops5generawithover350virusesCenter for Food Security and Public Health Iowa Sta
10、te University-2004BunyaviridaeTransmissionBunyaviridaeTransmissionArthropodvectorExceptionHantavirusesRVFAedesmosquitoCCHFIxodidtickHantavirusRodentsLesscommonAerosolExposuretoinfectedanimaltissueCenter for Food Security and Public Health Iowa State University-2004BunyaviridaeEpidemiologyBunyavirida
11、eEpidemiologyRVF-AfricaandArabianPeninsula1%casefatalityrateCCHF-Africa,EasternEurope,Asia30%casefatalityrateHantavirus-NorthandSouthAmerica,EasternEurope,andEasternAsia1-50%casefatalityrateCenter for Food Security and Public Health Iowa State University-2004BunyaviridaeHumansBunyaviridaeHumansRVFIn
12、cubationperiod2-5days0.5%-HemorrhagicFeverCCHFIncubationperiod3-7daysHemorrhagicFever-36daysfollowingclinicalsignsHantavirusIncubationperiod721daysHPSandHFRSCenter for Food Security and Public Health Iowa State University-2004BunyaviridaeAnimalsBunyaviridaeAnimalsRVFAbortion100%Mortalityrate90%inyou
13、ng5-60%inolderanimalsCCHFUnapparentinfectioninlivestockHantavirusesUnapparentinfectioninrodentsCenter for Food Security and Public Health Iowa State University-2004FiloviridaeFiloviridaeMarburg virusEbola virusCenter for Food Security and Public Health Iowa State University-2004FiloviridaeHistoryFil
14、oviridaeHistory1967:MarburgvirusEuropeanlaboratoryworkers1976:EbolavirusEbolaZaireEbolaSudan1989and1992:EbolaRestonUSAandItalyImportedmacaquesfromPhilippines1994:EbolaCtedIvoireCenter for Food Security and Public Health Iowa State University-2004FiloviridaeTransmissionFiloviridaeTransmissionReservoi
15、risUNKNOWNBatsimplicatedwithMarburgIntimatecontactNosicomialtransmissionReuseofneedlesandsyringesExposuretoinfectioustissues,excretions,andhospitalwastesAerosoltransmissionPrimatesCenter for Food Security and Public Health Iowa State University-2004FiloviridaeEpidemiologyFiloviridaeEpidemiologyMarbu
16、rgAfricaCasefatality23-33%Ebola-Sudan,ZaireandCtedIvoireAfricaCasefatality53-88%EbolaRestonPhilippinesPatternofdiseaseisUNKOWNCenter for Food Security and Public Health Iowa State University-2004FiloviridaeHumansFiloviridaeHumansMostseverehemorrhagicfeverIncubationperiod:410daysAbruptonsetFever,chil
17、ls,malaise,andmyalgiaHemorrhageandDICDeatharoundday711PainfulrecoveryCenter for Food Security and Public Health Iowa State University-2004FiloviridaeAnimalsFiloviridaeAnimalsHemorrhagicfeverSameclinicalcourseashumansEbolaRestonHighprimatemortality-82%Center for Food Security and Public Health Iowa S
18、tate University-2004FlaviviridaeFlaviviridaeDengue virusYellow Fever virusOmsk Hemorrhagic Fever virusKyassnur Forest Disease virusCenter for Food Security and Public Health Iowa State University-2004FlaviviridaeHistoryFlaviviridaeHistory1648:YellowFeverdescribed17th20thcenturyYellowFeverandDengueou
19、tbreaks1927:YellowFevervirusisolated1943:Denguevirusisolated1947OmskHemorrhagicFever virusisolated1957:KyasanurForestvirus isolatedCenter for Food Security and Public Health Iowa State University-2004FlaviviridaeTransmissionFlaviviridaeTransmissionArthropodvectorYellowFeverandDenguevirusesAedes aegy
20、ptiSylvaticcycleUrbancycleKasanurForestVirusIxodidtickOmskHemorrhagicFevervirusMuskraturine,feces,orbloodCenter for Food Security and Public Health Iowa State University-2004FlaviviridaeEpidemiologyFlaviviridaeEpidemiologyYellowFeverVirusAfricaandAmericasCasefatalityratevariesDengueVirusAsia,Africa,
21、Australia,andAmericasCasefatalityrate1-10%KyasanurForestvirusIndiaCasefatalityrate35%OmskHemorrhagicFevervirusEuropeCasefatlityrate0.53%Center for Food Security and Public Health Iowa State University-2004FlaviviridaeHumansFlaviviridaeHumansYellowFeverIncubationperiod36daysShortremissionDengueHemorr
22、hagicFeverIncubationperiod25daysInfectionwithdifferentserotypeKyasanurForestDiseaseOmskHemorrhagicFeverLastingsequelaCenter for Food Security and Public Health Iowa State University-2004FlaviviridaeAnimalsFlaviviridaeAnimalsYellowFevervirusNon-humanprimatesvaryingclinicalsignsDenguevirusNon-humanpri
23、matesNosymptomsKyasanurForestDiseaseVirusLivestockNosymptomsOmskHemorrhagicFeverVirusRodentsNosymptomsCenter for Food Security and Public Health Iowa State University-2004DiseaseinHumansDiseaseinHumansCenter for Food Security and Public Health Iowa State University-2004ClinicalSymptomsClinicalSympto
24、msDifferslightlydependingonvirusInitialsymptomsMarkedfeverFatigueDizzinessMuscleachesExhaustionCenter for Food Security and Public Health Iowa State University-2004ClinicalSymptomsClinicalSymptomsMoresevereBleedingunderskinPetechiae,echymoses,conjunctivitisBleedingininternalorgansBleedingfromorifice
25、sBloodlossrarelycauseofdeathCenter for Food Security and Public Health Iowa State University-2004DiagnosisDiagnosisSpecimensmustbesenttoCDCU.S.ArmyMedicalResearchInstituteofInfectiousDisease(USAMRIID)SerologyPCRIHCViralisolationElectronmicroscopyCenter for Food Security and Public Health Iowa State
26、University-2004TreatmentTreatmentSupportivetreatmentRibavirinNotapprovedbyFDAEffectiveinsomeindividualsArenaviridaeandBunyaviridaeonlyConvalescent-phaseplasmaArgentineHF,BolivianHFandEbolaStrictisolationofaffectedpatientsisrequiredReporttohealthauthoritiesCenter for Food Security and Public Health I
27、owa State University-2004PreventionandPreventionandControlControlCenter for Food Security and Public Health Iowa State University-2004PreventionandControlPreventionandControlAvoidcontactwithhostspeciesRodentsControlrodentpopulationsDiscouragerodentsfromenteringorlivinginhumanpopulationsSafecleanupof
28、rodentnestsanddroppingsInsectsUseinsectrepellentsProperclothingandbednetsWindowscreensandotherbarrierstoinsectsCenter for Food Security and Public Health Iowa State University-2004PreventionandControlPreventionandControlVaccineavailableforYellowfeverExperimentalvaccinesunderstudyArgentineHF,RiftVall
29、eyFever,HantavirusandDengueHFIfhumancaseoccursDecreaseperson-to-persontransmissionIsolationofinfectedindividualsCenter for Food Security and Public Health Iowa State University-2004PreventionandControlPreventionandControlProtectiveclothingDisposablegowns,gloves,masksandshoecovers,protectiveeyewearwh
30、ensplashingmightoccur,orifpatientisdisorientedoruncooperativeWHOandCDCdevelopedmanual“InfectionControlforViralHemorrhagicFeversIntheAfricanHealthCareSetting”Center for Food Security and Public Health Iowa State University-2004ProtectiveequipmentwornbyanurseduringEbolaoutbreakinZaire,1995Center for F
31、ood Security and Public Health Iowa State University-2004PreventionandControlPreventionandControlAnyonesuspectedofhavingaVHFmustuseachemicaltoiletDisinfectanddisposeofinstrumentsUsea0.5%solutionofsodiumhypochlorite(1:10dilutionofbleach)Center for Food Security and Public Health Iowa State University
32、-2004VHFAgentsasVHFAgentsasBiologicalWeaponsBiologicalWeaponsOutbreakofundifferentiatedfebrileillness2-21daysfollowingattackCouldincludeRash,hemorrhagicdiathesisandshockDiagnosiscouldbedelayedUnfamiliarityLackofdiagnostictestsRibavirintreatmentmaybebeneficialCenter for Food Security and Public Healt
33、h Iowa State University-2004VHFAgentsasVHFAgentsasBiologicalWeaponsBiologicalWeaponsMostarenotstableindryformMosthaveuncertainstabilityandeffectivenessinaerosolformArenaviruseshavetestedeffectivenessinaerosolformMarburgandEbolahavehighcasefatalityratesRiftValleyisthemoststableVHFinliquidorfrozenstat
34、eVHFsdoposeathreatasaerosolizedagentsCenter for Food Security and Public Health Iowa State University-2004AcknowledgmentsAcknowledgmentsDevelopment of this presentation was funded by a grant from the Centers for Disease Control and Prevention to the Center for Food Security and Public Health at Iowa State University.Center for Food Security and Public Health Iowa State University-2004AcknowledgmentsAcknowledgmentsAuthor:Co-authors:JamieSnow,DVM,MPHRadfordDavis,DVM,MPHStacyHolzbauer,DVMCenter for Food Security and Public Health Iowa State University-2004