甲型禽流感 (H7N9) 病毒感染

这种流行病在地域上一直集中在中国，并且与受感染的家禽暴露有关。

对公共健康造成的风险较低；然而，这种病毒的流行潜力值得关注。根据病例群的研究，此疾病的传播限于人与人之间，但没有关于病毒持续传播的证据。

常规诊疗的感染预防和控制措施包括标准预防措施、飞沫和接触预防措施。建议在从事产生气溶胶的操作时，使用防颗粒物口罩。

在实验室确诊感染的住院患者中，累积病死率高达约 40%。

推荐使用呼吸道样本的逆转录聚合酶链反应作为诊断测试。

治疗包括支持性治疗、专门的重症监护管理和神经氨酸酶抑制剂用药。

甲型禽流感病毒通常局限于禽鸟，但也会感染其他哺乳动物，并且一些病毒可跨越物种屏障，在人类中产生散发感染。高致病性禽流感 (HPAI) A(H5N1) 病毒能够在禽鸟、人类和其他哺乳动物中引起严重的多系统疾病。[1]Writing Committee of the Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus; Abdel-Ghafar AN, Chotpitayasunondh T, Gao Z, et al. Update on avian influenza A (H5N1) virus infection in humans. N Engl J Med. 2008 Jan 17;358(3):261-73. https://www.nejm.org/doi/10.1056/NEJMra0707279 http://www.ncbi.nlm.nih.gov/pubmed/18199865?tool=bestpractice.com 直到 2017 年，禽鸟中的亚洲谱系 A(H7N9) 病毒感染仅与无症状感染或轻度疾病（表征为低致病性禽流感；LPAI）相关。2017 年 2 月，中华人民共和国（以下简称中国）首次报道了亚洲谱系 HPAI A(H7N9) 病毒的检测情况，其样本来源于人类病例、家禽及其环境。[2]World Health Organization. Human infection with avian influenza A(H7N9) virus – China. February 2017 [internet publication]. http://www.who.int/csr/don/27-february-2017-ah7n9-china/en/ [3]Yang JR, Liu MT. Human infection caused by an avian influenza A (H7N9) virus with a polybasic cleavage site in Taiwan, 2017. J Formos Med Assoc. 2017 Mar;116(3):210-2. https://www.jfma-online.com/article/S0929-6646(17)30149-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/28259506?tool=bestpractice.com 无论在禽鸟中的致病性评估如何，亚洲谱系 LPAI A(H7N9) 病毒通常会在受感染人类中引发严重疾病。[4]Yu H, Cowling BJ, Feng L, et al. Human infection with avian influenza A H7N9 virus: an assessment of clinical severity. Lancet. 2013 Jul 13;382(9887):138-45. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801178/

继 2013 年 3 月在中国东部检测到人类亚洲谱系 LPAI A(H7N9) 病毒感染后，在从中国活动物市场获得的家禽和环境样本中检测到与人类病例分离株基因上相似的 A(H7N9) 病毒。[5]Chen Y, Liang W, Yang S, et al. Human infections with the emerging avian influenza A H7N9 virus from wet market poultry: clinical analysis and characterisation of viral genome. Lancet. 2013 Jun 1;381(9881):1916-25. http://www.ncbi.nlm.nih.gov/pubmed/23623390?tool=bestpractice.com [6]Yu X, Jin T, Cui Y, et al. Influenza H7N9 and H9N2 viruses: coexistence in poultry linked to human H7N9 infection and genome characteristics. J Virol. 2014 Mar;88(6):3423-31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957952/ http://www.ncbi.nlm.nih.gov/pubmed/24403589?tool=bestpractice.com  根据对彼此孤立的一群群人类感染（其中动物源型传播被视为不可能）的研究，亚洲谱系 LPAI A(H7N9) 病毒可在人与人之间传播，但传播似乎有限，且不持续。[3]Yang JR, Liu MT. Human infection caused by an avian influenza A (H7N9) virus with a polybasic cleavage site in Taiwan, 2017. J Formos Med Assoc. 2017 Mar;116(3):210-2. https://www.jfma-online.com/article/S0929-6646(17)30149-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/28259506?tool=bestpractice.com [7]Li Q, Zhou L, Zhou M, et al. Epidemiology of human infections with avian influenza A(H7N9) virus in China. N Engl J Med. 2014 Feb 6;370(6):520-32. https://www.nejm.org/doi/10.1056/NEJMoa1304617 http://www.ncbi.nlm.nih.gov/pubmed/23614499?tool=bestpractice.com [8]Qi X, Qian YH, Bao CJ, et al. Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation. BMJ. 2013 Aug 6;347:f4752. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805478/ http://www.ncbi.nlm.nih.gov/pubmed/23920350?tool=bestpractice.com [9]Xiang N, Iuliano AD, Zhang Y, et al. Comparison of the first three waves of avian influenza A(H7N9) virus circulation in the mainland of the People's Republic of China. BMC Infect Dis. 2016 Dec 5;16(1):734. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139097/ http://www.ncbi.nlm.nih.gov/pubmed/27919225?tool=bestpractice.com  已有针对亚洲谱系 LPAI A(H7N9) 病毒的院内传播报道，包括患者与医护人员，患者与患者之间的传播。[10]Farooqui A, Liu W, Zeng T, et al. Probable hospital cluster of H7N9 influenza infection. N Engl J Med. 2016 Feb 11;374(6):596-8. https://www.nejm.org/doi/10.1056/NEJMc1505359 http://www.ncbi.nlm.nih.gov/pubmed/26863372?tool=bestpractice.com [11]Fang CF, Ma MJ, Zhan BD, et al. Nosocomial transmission of avian influenza A (H7N9) virus in China: epidemiological investigation. BMJ. 2015 Nov 19;351:h5765. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4652199/ http://www.ncbi.nlm.nih.gov/pubmed/26586515?tool=bestpractice.com [12]Chen H, Liu S, Liu J, et al. Nosocomial co-transmission of avian influenza A(H7N9) and A(H1N1)pdm09 viruses between 2 patients with hematologic disorders. Emerg Infect Dis. 2016 Apr;22(4):598-607. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4806937/ http://www.ncbi.nlm.nih.gov/pubmed/26982379?tool=bestpractice.com