裂谷热

裂谷热（Rift Valley fever, RVF）是一种应予通报的疾病。尚无证据表明该病存在人际间传播；但仍应实施标准预防措施。

大部分患者无症状；然而，有些患者可能有轻度自限性疾病，伴有发热和肝脏异常。患者可能有以下重度症状：眼部病变（10%）、脑炎（8%）或出血性发热（1%）。[1]National Institute for Communicable Diseases. Healthcare workers guidelines on Rift Valley fever (RVF). Jan 2021 [internet publication]. https://www.nicd.ac.za/wp-content/uploads/2021/02/Rift-Valley-Fever-2021-Guidelines-for-Health-Care-Workers_110321.pdf [2]Jankovic J, Mazziotta J, Pomeroy S, et al. Bradley and Daroff's neurology in clinical practice, 2-volume set. 8th ed. Elsevier. 2021. 研究还证实，裂谷热病毒可导致疫区很高比例的发热孕妇流产。[3]Baudin M, Jumaa AM, Jomma HJE, et al. Association of Rift Valley fever virus infection with miscarriage in Sudanese women: a cross-sectional study. Lancet Glob Health. 2016 Nov;4(11):e864-71. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30176-0/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27692776?tool=bestpractice.com

支持性治疗是标准治疗，因为没有特异性抗病毒治疗。诊断方法应以患者到疫区（即东非、西非和南非）的旅行史和接触牲畜的情况为指导，尤其是如果患者在这些地区宰杀动物或协助接生。

由裂谷热病毒（又被称为 RVFV）引起的感染，表现为轻度且通常为自限性。该病毒属于布尼亚病毒目白纤病毒科（白蛉病毒属）。该病毒以肯尼亚的东非大裂谷命名，20 世纪 10 年代初首次在此地的牲畜中发现该病毒。[4]Murithi RM, Munyua P, Ithondeka PM, et al. Rift Valley fever in Kenya: history of epizootics and identification of vulnerable districts. Epidemiol Infect. 2011 Mar;139(3):372-80. http://www.ncbi.nlm.nih.gov/pubmed/20478084?tool=bestpractice.com [5]Daubney R, Hudson JR, Garnham PC. Enzootic hepatitis or Rift Valley fever. An undescribed virus disease of sheep, cattle and man from east Africa.1931;34(4):545-79. 人类通过接触受感染动物（最常见的是牛、羊、山羊或骆驼）的血液、其他体液（例如羊水）、器官或者饮用其生奶而感染该病毒。[6]Pepin M, Bouloy M, Bird BH, et al. Rift Valley fever virus (Bunyaviridae: Phlebovirus): an update on pathogenesis, molecular epidemiology, vectors, diagnostics and prevention. Vet Res. 2010;41:61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2896810 http://www.ncbi.nlm.nih.gov/pubmed/21188836?tool=bestpractice.com 传播还可通过蚊媒进行，包括伊蚊属和库蚊属。[7]Tantely ML, Rakotoniaina JC, Tata E, et al. Biology of mosquitoes that are potential vectors of Rift Valley fever virus in different biotopes of the central highlands of Madagascar. J Med Entomol. 2013;50:603-10. http://www.ncbi.nlm.nih.gov/pubmed/23802456?tool=bestpractice.com [8]LaBeaud AD, Ochiai Y, Peters CJ, et al. Spectrum of Rift Valley fever virus transmission in Kenya: insights from three distinct regions. Am J Trop Med Hyg. 2007 May;76(5):795-800. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367216 http://www.ncbi.nlm.nih.gov/pubmed/17488893?tool=bestpractice.com [9]Golnar AJ, Turell MJ, LaBeaud AD, et al. Predicting the mosquito species and vertebrate species involved in the theoretical transmission of Rift Valley fever virus in the United States. PLoS Negl Trop Dis. 2014 Sep 11;8(9):e3163. http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003163 http://www.ncbi.nlm.nih.gov/pubmed/25211133?tool=bestpractice.com 裂谷热病毒可导致流产和幼畜死亡（最常见于绵羊、山羊和牛）。而在人类中的暴发通常与人直接接触牲畜有关（家畜流行病暴发）。[9]Golnar AJ, Turell MJ, LaBeaud AD, et al. Predicting the mosquito species and vertebrate species involved in the theoretical transmission of Rift Valley fever virus in the United States. PLoS Negl Trop Dis. 2014 Sep 11;8(9):e3163. http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003163 http://www.ncbi.nlm.nih.gov/pubmed/25211133?tool=bestpractice.com 然而，除了大规模暴发之外，裂谷热病毒给人类带来的地方性传播风险仍然是流行病学的一个重大空白。[10]Gerken KN, LaBeaud AD, Mandi H, et al. Paving the way for human vaccination against Rift Valley fever virus: a systematic literature review of RVFV epidemiology from 1999 to 2021. PLoS Negl Trop Dis. 2022 Jan 24;16(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8812886 http://www.ncbi.nlm.nih.gov/pubmed/35073355?tool=bestpractice.com

BMJ talk medicine podcast: Rift valley fever - recognise, refer, and report, with Professor Clayton Wiley Opens in new window