a 䍞फᆊि⫳Ϣ⌕㸠⮙ᄺⷨお᠔ˈ䍞फ⊇ݙᏖDŽ
b 䍞फि⫳䚼乘䰆एᄺৌˈ䍞फ⊇ݙᏖDŽ
ᡩ〓᮹ᳳ˖2014ᑈ4᳜30᮹˗থ㸼᮹ᳳ˖2014ᑈ11᳜18᮹ doi: 10.5365/wpsar.2014.5.4.2.006
2 003 ᑈˈ A(H5N1) 催㟈⮙ᗻ⾑⌕ᛳ⮙↦ϰफѮ ݡߎ⦄ˈᑊϨᆊ⾑Ёᣕ㓁ᑓ⊯ᄬ[1]DŽ
㟇ⳂࠡᏆᲈথ䍋⾑䯈 A(H5N1) ⾑⌕ᛳ⭿ᚙˈ ᑊথ⫳њҢ⾑ࠄҎⱘ᳝䰤Ӵ᪁ˈԚᇮϡᯢ⹂থ⫳ᣕ㓁 ҎӴҎⱘ┰亢䰽DŽ✊㗠 A(H5N1) ⾑⌕ᛳ⮙↦ⱘᣕ㓁 বᓖ䘫ӴḋᗻҸҎᢙᖻˈЎҙҙϾ⇼䝌ⱘ ব࣪֓䎇ҹՓ⮙↦㦋ᕫ䲾䉖䯈Ӵ᪁ⱘ㛑ˈࡴњ A(H5N1) ⾑⌕ᛳ⮙↦⌕㸠ⱘ࿕㚕
[2–4]DŽ
㟇 2014 ᑈ 7 ᳜ ˈ 䍞 फ Ꮖ ਞ 127՟ Ҏ ᛳ ᶧ A(H5N1)⾑⌕ᛳ⮙՟ˈ݊Ё63Ҏ⅏ѵDŽ㞾2003ᑈ䍞 फ佪ߎ⦄A(H5N1)⾑⌕ᛳҹᴹˈЏ㽕᳝3Ͼ䈅㋏ⱘ A(H5N1)⾑⌕ᛳ⮙↦⌕㸠ϨϢҎᛳᶧ⮙՟Ⳍ݇ˈߚ߿
Ўclade 1ǃclade 2.3.4clade 2.3.2.1
[1,5]DŽϢ⮙ǃ⅏
ᆊ⾑㾺ϔⳈ㹿䅸ЎᰃҎᛳᶧA(H5N1)⾑⌕ᛳ⮙↦ⱘ
ॅ䰽㋴ˈᏆ䆕ᯢ⌏⾑ᏖഎᰃA(H5N1)⾑⌕ᛳ⮙↦Ӵ ᪁ⱘ䞡㽕എ᠔
[6,7]DŽ2001ᑈ⊇ݙᇍ200ৡ⌏⾑ᏖഎҢ ϮҎਬpoultry market workersˈㅔ⿄PMWsᓔሩⱘϔ 乍㸔⏙ᄺ䇗ᶹথ⦄ˈ4%ⱘⷨおᇍ䈵᳝A(H5N1)⾑⌕
ᛳ⮙↦⡍ᓖᗻ㸔⏙ᡫԧ
[8]ˈᦤ⼎ᅬᮍ⹂䅸ⱘ佪՟Ҏ ᛳᶧ$(H5N1)⾑⌕ᛳ⮙՟ПࠡᏆᄬA(H5N1)⾑⌕ᛳ⮙
↦ⱘҎ䯈ᛳᶧ
[9]DŽℸ⭿ᚙ䇗ᶹЁ䖬থ⦄᳝᮴⮛⢊
ᛳᶧ㗙䕏⮛⮙՟
[9–11]DŽ⋄ǃ᷀ඨᆼॄሐг᳒
㓐ড়ᗻᲈথ䇗ᶹЁᓔሩ䖛ҎᛳᶧA(H5N1)⾑⌕ᛳ㸔⏙
ᄺ䇗ᶹˈҹ䆘Ԅ݊Јᑞǃ⌕㸠⮙ᄺ㸔⏙ᄺㄝᮍ䴶ⱘ
⡍ᕕDŽ
2011 ᑈ䍞फ࣫䚼⌏⾑ᏖഎҢϮҎਬ A(H5N1)
⾑⌕ᛳ⮙↦㸔⏙ᄺ䇗ᶹ
Tham Chi Dung
a, Pham Ngoc Dinh
a, Vu Sinh Nam
b, Luong Minh Tan
a, Nguyen Le Khanh Hang
a, Le Thi Thanh
aLe Quynh Mai
a䗮䆃㗙˖ Le Quynh Mai (e-mail: [email protected] [email protected])DŽ
Ў䆘Ԅ PMWs ⱘ A(H5N1) ⾑⌕ᛳ⮙↦ᲈ䴆∈ᑇᰃ
৺থ⫳њᬍবˈ៥ӀѢ 2011 ᑈ䍞फ࣫䚼ⱘ 3 Ͼⳕӑ ᇍ PMWs ᓔሩ њ A(H5N1) ⾑⌕ᛳ⮙↦㸔⏙ᄺ䇗ᶹDŽ
ᴤ᭭Ϣᮍ⊩
ᢑḋঞⷨおᮍḜ
䍞फ࣫䚼ⱘ⊇ݙᏖǃᑇⳕǃ ⏙࣪ⳕˈᇍ 5 Ͼ⌏⾑
Ꮦഎⱘ៤ᑈҢϮҎਬᓔሩ῾ᮁ䴶㸔⏙ᄺ䇗ᶹDŽѢ 2001 ᑈ⊇ݙ PMWs 㸔⏙ᄺ䇗ᶹ
[9]ⱘ A(H5N1) ⾑⌕ᛳ⮙
↦㸔⏙ᡫԧ䰇ᗻ⥛ 4%(95%CI: 2.45–5.55) ᴹԄㅫḋᴀ 䞣DŽ㗗㰥ࠄৃ㛑ᄬϡড়ⷨおᇍ䈵ϡড়Ḑᷛᴀˈ ᴀⷨおḋᴀ䞣⹂ᅮЎ 600 ҎDŽ
ᴀⷨおЁ⌏⾑Ꮦഎⱘ㒇ܹᴵӊЎ˖᮹ᐌ⌏⾑䫔ଂ
Ҏਬ䍙䖛 100 ҎˈԡѢජᏖˈϨ᠔ජᏖߎ⦄䖛Ҏ ᛳᶧ A(H5N1) ⾑⌕ᛳᅲ偠ᅸ⹂䆞⮙՟DŽഄᮍᬓᑰⱘ
ᬃᣕϟˈ 3 ϾⳕᏖ᳝݅Ͼ⌏⾑Ꮦഎৃկ䗝ᢽˈ᳔㒜䱣 ᴎ䗝পњ 5 ϾDŽⷨおᇍ䈵䳔ヺড়ϟ߫ᴵӊ˖ᑈ啘 18 ቕ ҹϞˈᰃ⌏⾑ࣙᣀ∈⾑䫔ଂଚᆄᴔҎਬˈ⌏⾑
ᏖഎᎹᯊ䯈䍙䖛 6 Ͼ᳜DŽ៥ӀϔϾᏖഎϔϾᏖഎഄ
ࢳⷨおᇍ䈵ˈⳈ㟇㦋ᕫ䎇᭄䞣ⱘখϢ㗙DŽ
䞛⫼䯂ो䇗ᶹᬊ䲚ҎষᄺֵᙃҹঞA(H5N1)⾑⌕
ᛳ⮙↦ᲈ䴆ⱘ┰㘠Ϯॅ䰽㋴ˈব䞣ࣙᣀᑈ啘ǃᗻ
WHOᇍҎᛳᶧ A(H5N1)⾑⌕ᛳ⮙՟㸔⏙ᄺẔ⌟
ᅲ偠ᅸ⹂䆞ⱘ߸ᅮᷛޚЎ˖থ⮙14ৢ䞛䲚ⱘऩӑ㸔
⏙ HHIⓈᑺ>160ঞMNⓈᑺ>80
[14]DŽԚ䖭ϔ߸ᅮᷛ
ޚᇍ㸔⏙ᄺ䇗ᶹⷨおϡ䗖⫼ˈЎⷨおᇍ䈵ᑊ䴲⭥Ԑ
⮙՟DŽᅲ䰙Ϟˈ⌕ᛳ㸔⏙⌕㸠⮙ᄺᷛޚ࣪㘨ⲳᇮࠊ ᅮߎA(H5N1)⾑⌕ᛳ⮙↦㸔⏙ᄺẔ⌟ⱘ䰇ᗻᷛޚ
[7]DŽ
ᴀⷨおЁˈHHIⓈᑺı80ঞ01Ⓢᑺı20े㹿⹂ᅮ Ў A(H5N1)⾑⌕ᛳ⮙↦㸔⏙ᡫԧ䰇ᗻDŽҹ᳔催㸔⏙⿔
䞞ᑺ᠔ᇍᑨⱘ⮙↦䈅㋏Ў㸔⏙ᡫԧ䰇ᗻᷛᴀⱘ䈅㋏
[13]
DŽ
ᴀⷨおᮍḜ䗮䖛њ䍞फᆊि⫳Ϣ⌕㸠⮙ᄺⷨお ᠔ᴎᵘᅵᶹྨਬӮⱘᅵᡍDŽ᠔᳝ⷨおᇍ䈵ഛㅒ㕆к䴶 ⶹᚙৠᛣкDŽ
㒧ᵰ
ⷨおҎ㕸⡍ᕕ
2011 ᑈ 9–12 ᳜ 䞛 䲚 ࠄ 607 ৡ PMWs ⱘ 㸔 ⏙ ᷛ ᴀ DŽ
݊Ёˈ 305 ӑ 50.3% 䞛䲚㞾⊇ݙᏖˈ 169 ӑ 27.8%
䞛䲚㞾ᑇⳕˈ 133 ӑ 21.9% 䞛䲚㞾⏙࣪ⳕDŽⷨ
おᇍ䈵⌏⾑ᏖഎⱘᑇഛᎹᑈ䰤Ў 7.7 ᑈ 95%CI:
7.1–8.2 ˈ᳔ⷁЎ 6 Ͼ᳜ˈ᳔䭓Ў 36 ᑈDŽ
ⷨ お ᇍ 䈵 ⱘ ᑇ ഛ ᑈ 啘 Ў 42.3 ቕ 95%CI:41.4–
43.2 ˈ᳔ᇣᑈ啘Ў 18 ቕˈ᳔ᑈ啘Ў 74 ቕDŽ 214 Ҏ 35.3% Ў⬋ᗻDŽ㑺ϝߚПѠ 62.6% Ў⌏⾑䫔ଂ
ᆄᴔҎਬˈ݊ԭ 37.4% Ў 但ݏǃ䖤䕧݊ҪҎਬ ݑएǃৌᴎǃ㖑↯ᬊ䲚Ҏਬǃ⏙⋫ҎਬǃᏖഎㅵ⧚Ҏ ਬDŽ 79 Ҏ 13.1% ᳝᜶ᗻ⸔ᗻ⮒⮙催㸔य़ǃ㊪ሓ
⮙ǃ㙱♢DŽ 555 Ҏ 91.4% ᳝催ЁҹϞᄺग़㸼 1 DŽ
㸔⏙H5
ᡫԧ䰇ᗻ⥛37Ҏ㸔⏙A(H5N1)⾑⌕ᛳ⮙↦ᡫԧ䰇ᗻˈᘏ䰇ᗻ⥛Ў 6.1%95% CI: 4.6–8.3DŽ݊Ёˈ24ҎЎclade 2.3.4ˈ 2ҎЎclade 2.3.2.1ˈ11ҎЎclade 2.3.4clade 2.3.2.1
⏋ ড়
㸼2 DŽ ⊇ ݙ Ꮦ 䰇 ᗻ ⥛ Ў 7.2% 95%CI:4.3–
10.1 ˈ ᑇ ⳕ Ў5.3% 95%CI:1.9–8.7 ˈ ⏙ ࣪ ⳕ Ў 4.5%95%CI0.9–8.0 ˈ Ꮒ ᓖ ᮴ 㒳 䅵 ᄺ ᛣ Н P = 0.49㸼1DŽ
25–34 ቕᑈ啘㒘䰇ᗻ⥛᳔催 8.9% 95% CI: 3.8–
13.9 ˈ Ԛ 4 Ͼ ᑈ 啘 㒘 䯈 ⱘ 䰇 ᗻ ⥛ Ꮒ ᓖ ᮴ 㒳 䅵 ᄺ ᛣ Н P=0.46 DŽ 㒘 䯈 ᗻ ߿ P=0.99 ǃ ᬭ 㚆 ∈ ᑇ
P=0.48 ǃ᮶ᕔ⮙ P=0.55 ⱘ䰇ᗻ⥛Ꮒᓖг᮴
㒳 䅵 ᄺ ᛣ Н
㸼1 DŽ ᆊ ⾑ ᆄ ᴔ 䫔 ଂ Ҏ ਬ ⱘ 䰇 ᗻ ⥛ 8.2% 催Ѣ݊ҪҢϮҎਬ 2.6% ˈԚᏂᓖ᮴㒳䅵ᄺᛣ Н P=0.06 㸼 1 DŽ
߿ǃᬭ㚆㒣ग़ǃ᮶ᕔ⮙ǃ᠔ⳕӑǃ㘠Ϯǃᆊ⾑Ⳍ
݇㘠Ϯᲈ䴆亢䰽DŽᇍ᠔᳝ⷨおᇍ䈵䖯㸠䴶ᇍ䴶䆓䇜DŽ Փ⫼EpiData v3.1ᔩ᭄ܹˈSTATA v11䖯㸠᭄ߚ ᵤDŽ乥⥛䅵ㅫপ95%ৃֵऎ䯈DŽᇍ㸔⏙⌕㸠⥛䖯㸠
↨䕗ᯊˈབ䘛㾖⌟ؐᇣѢ5ˈ䞛⫼PearsonवᮍẔ偠
Fisher㊒⹂Ẕ偠DŽᑇഛؐⱘ↨䕗䞛⫼WẔ偠ˈẔ偠∈ޚ α=0.05DŽ
Ў⹂ᅮA(H5N1)⾑⌕ᛳ⮙↦ⱘ㸔⏙ᡫԧⓈᑺˈ䞛 䲚↣Ͼⷨおᇍ䈵5ml䴭㛝㸔DŽ㸔ᷛᴀ䞛䲚ৢֱᄬѢ4°C ބⲦˈ24–48ᇣᯊݙ㹿≑䔺䖤䗕㟇ԡѢ⊇ݙⱘ䍞फ
ᆊि⫳Ϣ⌕㸠⮙ᄺⷨお᠔ᆊ⌕ᛳЁᖗDŽ
ܼ㸔ᷛᴀ⾏ᖗ 2500 rpm ˈ 15 ߚ䩳ৢপ㸔⏙ˈᇚ 㸔⏙ߚ㺙ৢټᄬѢ −70 °C ބㆅᕙẔDŽ
㸔⏙ᄺẔ⌟
䍞 फ ᆊ ि ⫳ Ϣ ⌕ 㸠 ⮙ ᄺ ⷨ お ᠔ ˈ ձ ✻ 㕢 C D C ⱘ Ẕ ⌟ ᮍ Ḝ ˈ 䞛 ⫼ 偀 㸔 ޱ ᡥ ࠊ 䆩 偠 h o r s e haemagglutination inhibition assayˈㅔ⿄HHIᖂ䞣 Ё䆩偠microneutralization assayˈㅔ⿄MNᇍ㸔⏙
䖯㸠Ẕ⌟DŽ⬅ѢA(H5N1)⾑⌕ᛳ⮙↦ⱘᡫԧḋᗻৃ
㛑Ӯᕅડ⡍ᓖᗻᡫԧẔ⌟䆩偠ⱘ♉ᬣᑺˈℸᇚ䍞फ 2004ᑈҹᴹ⌕㸠ⱘ3Ͼ䈅㋏ⱘA(H5N1)⾑⌕ᛳ⮙↦ഛ
⫼ѢẔ⌟DŽ䖭3Ͼ䈅㋏ⱘA(H5N1)⾑⌕ᛳ⮙↦᷾ߚ⾏㞾 RT-PCRẔ⌟䰇ᗻⱘ䍞फ⮙՟ˈ݊Ёclade 1Ў2005ᑈ ߚ⾏ࠄⱘA/Viet Nam/HN30408/2005ˈclade 2.3.4Ў 2007ᑈߚ⾏ࠄⱘA/Viet Nam/HN31244/2007ˈclade 2.3.2.1Ў2011ᑈߚ⾏ࠄⱘA/Viet Nam/CM32/2011DŽ
⬅Ѣ⾑㉏Ҏ㉏⮙↦ⱘ㟈⮙┰ⶹˈ᠔᳝⍝ঞ⌏⮙↦
ⱘẔ⌟ഛࡼ⠽⫳⠽ᅝܼ3㑻ҹঞ⫳⠽ᅝܼ㑻ᅲ偠ᅸ 䖯㸠DŽ
HHI 䆩偠ᣝ WHO 㤤
[12]Փ⫼㒣ফԧ⸈ണ䝊໘⧚䖛 ⱘখ㗗ᡫ㸔⏙DŽ㸔⏙ᷛᴀܜ⫼ 8 Ͼ㸔ޱ㋴ऩԡⱘ⮙↦
1% ⱘ偀㑶㒚㚲䖯㸠 10 ס䖲㓁⿔䞞DŽ᠔᳝⮙↦Փ⫼ࠡ
⫼ 1% ⱘϭݙ䝃♁⌏DŽࡴܹ偀㑶㒚㚲 60 ߚ䩳ৢ䇏প HHI
Ⓢᑺˈҹᓩ䍋ޱ䲚ᅠܼᡥࠊⱘ᳔催㸔⏙⿔䞞ᑺⱘצ᭄
Ў HHI ⓈᑺDŽҹ䰈ᗻᇍ✻㸔⏙خЎ䋼ˈϢ偀㑶㒚㚲
⏋ড়ৢਜ䴲ޱ䲚⢊ᗕᯊे䅸Ў䆩偠᳝ᬜDŽᇍ HHI 䆩偠 Ё᳔Ԣ⿔䞞⌧ᑺ (1:10) Ў䰈ᗻ㒧ᵰⱘᷛᴀҹঞ HHI Ⓢᑺ ı 40 ⱘᷛᴀˈ⫼01䆩偠Ẕ⌟ 3 Ͼ A(H5N1) ⾑⌕ᛳ⮙↦䈅
㋏DŽ01䆩偠ᣝ:+2ⱘᮍḜ
[12,13]Փ⫼ 100 ס TCID
50ⱘ⌏⮙
↦DŽ⮙↦ܜҹ :10 Ⓢᑺ䍋ྟ䖯㸠ϸס䖲㓁⿔䞞ⱘ㸔
⏙Ёݏˈݡ MDCK 㒚㚲㕢 ATCC ⱘ Madin-Darby
⢀ 㚒 㒚 㚲 Ё ݏ 䖛 ˈ ✊ ৢ ⫼ 䝊 㘨 ܡ ⭿ 䰘 䆩 偠 enzyme-linked immunosorbent assay ˈㅔ⿄ ELISA Ẕ
⌟⌕ᛳḌ㲟ⱑˈ䖯㸠⮙↦ᅮ䞣DŽҹ䗴៤ᛳᶧޣᇥ 50%
ҹϞⱘ᳔催㸔⏙⿔䞞ᑺצ᭄Ў MN ⓈᑺDŽ
䅼䆎
ᴀⷨおথ⦄ৡ6.1%PMWs᳝A(H5N1)⾑⌕ᛳ clade 2.3.4clade 2.3.2.1⮙↦㸔⏙ᡫԧˈ䖭ϸϾ䈅
㋏ᰃ䍞फ࣫䚼2005–2013ᑈⱘӬ⌕㸠᷾
[15–17]DŽ 2003ᑈ㟇2005ᑈϞञᑈˈ䍞फг᳝clade 1⌕㸠
[18]ˈ Ԛᴀⷨおথ⦄clade 1⮙↦㸔⏙ᡫԧ䰇ᗻⱘPMWsDŽ 䆹㒧ᵰߎТᛣ᭭ˈЎϔѯҢϮҎਬclade 1⌕㸠ᳳ
䯈Ꮖ㒣⌏⾑ᏖഎᎹDŽᴀⷨお᠔䗝পⱘPMWsᴹ㞾
⊇ݙᏖǃᑇⳕ⏙࣪ⳕˈ䖭3Ͼⳕӑ㞾2004ᑈҹ ᴹഛਞ՟ҎᛳᶧA(H5N1)⾑⌕ᛳ⮙՟
[6,18]DŽሑㅵ
2004 ᑈ 䍞 फ ⋄ ᓔ ሩ ⱘ ϔ ѯ ⷨ お ᇚ 㾺 ع ᒋ ᆊ⾑Ў A(H5N1)⾑⌕ᛳ⮙↦ᲈ䴆ⱘॅ䰽㋴
[6]ˈ Ԛ 2001ᑈ ⊇ ݙ ⱘ ϔ 乍 ⷨ お থ ⦄ 4%ⱘ PMWs ᳝ A(H5N1)⾑⌕ᛳ⮙↦clade A/Goose/Viet Nam/113/2001 ⱘ㸔⏙ᡫԧ
[8]DŽA(H5N1)⾑⌕ᛳ⮙↦䍞फعᒋⱘ吁 ᄤЁӴ᪁
[1]ˈ㸼ᯢᲈ䴆Ѣعᒋᆊ⾑ⱘҎ㕸гᄬᛳᶧ A(H5N1)⾑⌕ᛳ⮙↦ⱘ┰亢䰽DŽ
ⷨ お Ҏ 㕸 ⌏ ⾑ Ꮦ എ ⱘ ᑇ ഛ Ꮉ ᑈ 䰤 Ў 7.7 ᑈ 95%CI:7.1–8.2 ˈ᳔ⷁЎ 6 Ͼ᳜ˈ᳔䭓Ў 36 ᑈDŽ݊Ё ϔѯ PMWs ৃ㛑᳒ᲈ䴆Ѣ clade 1 ⮙↦DŽ 11 Ҏৠᯊ
㸼
1. 2011
ᑈ䍞फ࣫䚼A(H5N1) PMWs
⾑⌕ᛳ⮙↦㸔⏙ᡫԧ䰇ᗻҎ㕸⡍ᕕn = 607
Ҏ⡍ᕕ 䰇ᗻ᭄ᘏ᭄ % 95% CI pؐ
ⷨおഄऎ
⊇ݙᏖ 22/305 7.2 4.3–10.1
ᑇⳕ 9/169 5.3 1.9–8.7 0.49
⏙࣪ⳕ 6/133 4.5 0.9–8.0
ᑈ啘㒘
̢ቕ 1/31 3.2 0.0–9.8
̢ቕ 11/124 8.9 3.8–13.9 0.46
̢ቕ 9/185 4.9 1.7–8.0
ቕঞҹϞ 16/267 6.0 3.1–8.9
ᗻ߿
⬋ 13/214 6.1 2.8–9.3
ཇ 24/393 6.1 3.7–8.5 0.99
㘠Ϯ
䫔ଂᆄᴔ 31/380 8.2 5.4–10.9
݊Ҫ 6/227 2.6 0.5–4.7 0.06
᳔催ᄺग़
催Ёঞᄺ 35/555 6.3 4.3–8.3 ᇣᄺঞ߱Ё 2/52 3.9 0.0–9.3 0.48
᮶ᕔ⮙᜶ᗻ⸔ᗻ⮒⮙ 6/79 7.6 1.6–13.6
ਞ᳝᜶ᗻ⸔ᗻ⮒⮙ 31/528 5.9 3.9–7.9 0.55
CI, ৃֵऎ䯈DŽ
*但ݏҎਬǃ䖤䕧Ҏਬǃݑएǃৌᴎǃ㖑↯ᬊ䲚Ҏਬǃ⏙⋫ҎਬǃᏖഎㅵ⧚ҎਬDŽ
㸼
2. 2011
ᑈ䍞फ࣫䚼A(H5N1)
⾑⌕ᛳ⮙↦㸔⏙ᡫԧ䰇ᗻҎ㕸ⱘ⮙↦䈅㋏ⳕӑߚᏗⷨおഄऎ 䰇ᗻ᭄ᘏ᭄
䰇ᗻ᭄
䰇ᗻⱒߚ↨%
Clade 1 Clade 2.3.4 Clade 2.3.2.1 Clades 2.3.4
2.3.2.1⏋ড়
⊇ݙᏖ 22/305 0 13 2 7 7.2
ᑇⳕ 9/169 0 6 0 3 5.3
⏙࣪ⳕ 6/133 0 5 0 1 4.5
ড়䅵 37/607 0 24 2 11 6.1
ሑㅵᄬҹϞሔ䰤ᗻˈᴀⷨおҡ㸼ᯢ䍞फ࣫䚼 ⱘPMWsЁ᳝6.1%ⱘҢϮҎਬ᳝A(H5N1)⾑⌕ᛳ⮙
↦⡍ᓖᗻ㸔⏙ᡫԧDŽA(H5N1)⾑⌕ᛳ⮙↦䍞फᣕ㓁 ᄬᑊϡᮁবᓖˈ䳔㽕ܼ㣗ೈݙᓔሩܼ䴶ⱘҎ䯈
⾑䯈ⲥ⌟ҹঞৢ㓁ⱘPMWsⷨおˈҹ䆘Ԅ䍞फ⾑㉏ᇚ A(H5N1)⾑⌕ᛳ⮙↦Ӵ᪁㒭Ҏⱘ亢䰽DŽ
߽Ⲟކさ
⬇DŽ
䞥
᮴DŽ
㟈䇶ᛳ䇶⊇ݙᏖǃᑇⳕǃ⏙࣪ⳕ乘䰆एᄺЁᖗDŽᛳ䇶䍞 फि⫳䚼䍞फ⾑⌕ᛳҎ⌕ᛳࠊϢޚ乍ⳂЎᴀⷨ
おᦤկ㒣䌍䌘ࡽDŽ
ᛳ䇶䍞फ⮒⮙乘䰆ࠊЁᖗࠡӏᅬਬDavid Dennis ᇍᴀ〓ӊ䖯㸠㓪䕥DŽ
ᓩ⫼ᴀ᭛ഄഔ˖
Tham DC et al. Seroprevalence survey of avian influenza A(H5N1) virus among live poultry market workers in nothern Viet Nam, 2011. Western Pacific Surveillance and Response Journal, 2014, 5(4):21–26. doi:10.5365/
wpsar.2014.5.2.006
খ㗗᭛⤂
1. Takakuwa H et al. Possible circulation of H5N1 avian influenza viruses in healthy ducks on farms in northern Vietnam.
Microbiology and Immunology, 2010, 54:58–62. doi:10.1111/
j.1348-0421.2009.00170.x pmid:20055944
2. Herfst S et al. Airborne transmission of influenza A/H5N1 virus between ferrets. Science, 2012, 336:1534–1541. doi:10.1126/
science.1213362 pmid:22723413
3. Viruses AI, World Health Organization Global Influenza Program Surveillance Network. Evolution of H5N1 avian influenza viruses in Asia. Emerging Infectious Diseases, 2005, 11:1515–1521.
doi:10.3201/eid1110.050644 pmid:16318689
4. Beigel JH et al.Writing Committee of the World Health Organization (WHO) Consultation on Human Influenza A/H5. Avian influenza A(H5N1) infection in humans. New England Journal of Medicine, 2005, 353:1374–1385. doi:10.1056/NEJMra052211 pmid:16192482
5. Wan X et al. Evolution of highly pathogenic H5N1 avian influenza viruses in Viet Nam between 2001 and 2007. PLoS ONE, 2008, 3:1–12. doi:10.1371/journal.pone.0003462
6. Dinh PN et al; World Health Organization/Global Outbreak Alert and Response Network Avian Influenza Investigation Team in
᳝clade 2.3.4clade 2.3.2.1㸔⏙ᡫԧˈৃ㛑ᰃ⬅ѢѸ ঝডᑨǃ݅ৠᛳᶧݡᛳᶧ᠔㟈ˈЎ2010ᑈৠᯊᄬ
clade 2.3.4clade 2.3.2.1⮙↦ⱘ⌕㸠
[12]DŽ
ᴀⷨおথ⦄ˈ 3 Ͼഄ⧚ԡ㕂ϡৠⱘⷨおഄऎⱘ䰇 ᗻ⥛Ꮒᓖ᮴㒳䅵ᄺᛣНˈ㸼ᯢ䖭ѯഄऎⱘ PMWs Ꮉ
ᴵӊ㘠ϮдᛃⳌԐDŽᴀⷨおЁ⊇ݙ PMWs ⱘ䰇ᗻ⥛
7.2% 䕗 2001 ᑈⱘⷨお㒧ᵰ (4.0%) ᳝᠔Ϟछˈৃ㛑 ᰃ⬅Ѣ 2003 ᑈᑩҹᴹ䍞फߎ⦄ A(H5N1) ⾑⌕ᛳ⮙↦ⱘ Ӵ᪁
[15]DŽᴀⷨおথ⦄ˈ⌏⾑ᆄᴔ䫔ଂҎਬ䕗݊ҪҢ ϮҎਬⱘ䰇ᗻ⥛催ˈ䖭ϢЁǃ⋄ᄳࡴᢝⱘⷨ
おϔ㟈ˈ㸼ᯢҢџⳈϢ⌏⾑㾺ⱘᎹҎਬ᳝
ᴎӮᲈ䴆Ѣ A(H5N1) ⾑⌕ᛳ⮙↦
[9,15]DŽ 2010 ᑈ䍞फϔ 乍⌏⾑Ꮦഎ䇗ᶹথ⦄ˈ 3.3% ⱘᆊ⾑ᷛᴀ㒣 RT-PCR Ẕ
⌟Ў A(H5N1) ⾑⌕ᛳ⮙↦䰇ᗻ㒣Ϣ䍞फ⾑⌕ᛳҎ⌕
ᛳࠊϢޚ乍Ⳃⱘ John Weaver ≳䗮㦋ᕫDŽ 2006 ᑈ 䍞फ࣫䚼ϔ乍ᇍعᒋ吁ᄤⱘ䇗ᶹথ⦄ˈሑㅵعᒋ吁 ᄤⱘઑᣁᄤ⊘Ⅺ㜨ᣁᄤЁẔߎ A(H5N1) ⾑⌕ᛳ⮙
↦ˈԚ㸔⏙ᄺẔ⌟থ⦄䖭ѯعᒋ吁ᄤᏆᛳᶧ A(H5N1)
⾑⌕ᛳ⮙↦Ϩ㸼⦄ߎӏԩᓖᐌ⮛⢊
[11]DŽᴀⷨお
ᑈ啘㒘 PMWs Ёഛথ⦄᳝ A(H5N1) ⾑⌕ᛳ⮙↦ᡫԧ ⱘҢϮҎਬˈᦤ⼎ PMWs ᳝ᖙ㽕䞛পԽ᠈ϾҎ䰆ᡸ㺙
ǃ⾡⭿㢫ㄝ乘䰆ᮑDŽ
ᴀⷨおЁᇍA(H5N1)⾑⌕ᛳ⮙↦㸔⏙ᡫԧ䰇ᗻⱘ
߸ᅮᷛޚWHO߸ᅮᷛޚⱘ⸔Ϟ䖯㸠њׂᬍDŽWHO ⱘ߸ᅮᷛޚᰃЎњᇍ⭥Ԑ⮙՟䖯㸠䖯ϔℹ⹂䅸ˈ䆹ᷛ
ޚᇍѢ㸔⏙ᄺⲥ⌟ⷨおᴹ䇈ᅲ⫼ᗻ♉ᬣᑺϡˈ
Ўᲈ䴆ѢA(H5N1)⾑⌕ᛳ⮙↦6–12Ͼ᳜ৢ⡍ᓖᗻᡫԧ
Ⓢᑺህᓔྟϟ䰡⫮㟇Ӯ⍜༅
[20]DŽᴀⷨおᇚHHIı80ঞ MNı20Ў㸔⏙ᡫԧ䰇ᗻⱘ߸ᅮᷛޚˈЎ៤Ҏⱘ MN䆩偠♉ᬣᑺϟ䰡ˈԢѢ80%
[21]ˈ㗠খϢᴀⷨおⱘ PMWsᑈ啘ഛѢ18ቕDŽ᳝ⷨお㸼ᯢ偀㑶㒚㚲HHI䆩偠
ৃ䴴ᗻ催ˈϢMN䆩偠᳝㡃དⱘϔ㟈ᗻ
[22]DŽᴀⷨおⱘ
߸ᅮᷛޚৃ㛑Ӯ催ԄⷨおҎ㕸ⱘ㸔⏙ᡫԧ䰇ᗻ⥛ˈᑨ
ᇮẔߎA(H5N1)⾑⌕ᛳ⮙↦ⱘഄऎ䗝পᇍ✻Ҏ㕸 ᓔሩ㸔⏙ᄺ䇗ᶹⷨおˈᇍ䆹ᷛޚ䖯㸠偠䆕DŽ᳝ᖙ㽕䖯 ϔℹᓔሩA(H5N1)⾑⌕ᛳ⮙↦㸔⏙ᄺ䇗ᶹ䗖⫼ᷛޚⱘ
ⷨお
[7]DŽ
⬅Ѣ PMWs ϡϔᅮ㛑ޚ⹂ಲᖚᕜ䭓ᯊ䯈ⱘ㘠Ϯᲈ 䴆ᚙމˈᬙᴀⷨお㘠Ϯᲈ䴆ਞᮍ䴶ৃ㛑Ӯᄬϔ ѯߚ㉏䫭䇃DŽⷨおᇍ䈵ᲈ䴆ᳳݙ䖬ৃ㛑Ңџ⾡⾑
㉏Ⳍ݇㘠ϮDŽᴀⷨおথ⦄ˈ䍞फ࣫䚼 6.1% ⱘ PMWs
᳝ A(H5N1) ⾑⌕ᛳ⮙↦㸔⏙ᡫԧˈԚ䖭ϔ㒧ᵰᑊϡ㛑
㟇䍞फ᠔᳝ PMWs DŽᬊ䲚ⱘ⌕㸠⮙ᄺֵᙃབ ϾҎ䰆ᡸ㺙ǃ㾺ᯊ䯈ǃ⌕ᛳ⭿㢫⾡䆌Ӯ᳝
ᐂࡽDŽབᵰ㒇ܹᇍ✻Ҏ㕸Ϣ PMWs ৠϔϾᏖഎᎹ
ⱘ㬀㦰ǃ∈ᵰǃ⍋剰䫔ଂҎਬᓔሩ䖯ϔℹⱘ䱣䆓ⷨ
おˈⷨお㒧ᵰᇚӮ᳝䇈᳡DŽ
Vietnam. Preventive Veterinary Medicine, 2012, 103:192–200.
doi:10.1016/j.prevetmed.2011.09.014 pmid:21974815 15. Le QM et al. Pathogenicity of highly pathogenic avian H5N1
influenza A viruses isolated f`rom humans between 2003 and 2008 in northern Vietnam. Journal of General Virology, 2010, 91:2485–
2490. doi:10.1099/vir.0.021659-0 pmid:20592108
16. Muramoto Y et al. Molecular characterization of the hemagglutinin and neuraminidase genes of H5N1 influenza A viruses isolated from poultry in Vietnam from 2004 to 2005. Journal of Veterinary Medical Science, 2006, 68:527–531. doi:10.1292/jvms.68.527 pmid:16757902
17. Nguyen TD et al. Multiple sublineages of influenza A virus (H5N1), Vietnam, 2005–2007. Emerging Infectious Diseases, 2008, 14:632–636. doi:10.3201/eid1404.071343 pmid:18394281
18. Long NT et al. Recent avian influenza virus A/H5N1 evolution in vaccinated and unvaccinated poultry from farms in Southern Viet Nam, January-March 2010. Transbound Emerging Diseases, 2011, 58:537–543. doi:10.1111/j.1865- 1682.2011.01229.x
19. Van NT et al. The H5N1 vaccination trial in Viet Nam – Phase 3, 2011 – 2013 [unpublished].
20. Rowe T et al. Detection of antibody to avian influenza A (H5N1) virus in human serum by using a combination of serologic assays. Journal of Clinical Microbiology, 1999, 37:937–943.
pmid:10074505
21. Kayali G et al. Testing human sera for antibodies against avian influenza viruses: horse RBC hemagglutination inhibition vs. microneutralization assays. Journal of Clinical Virology, 2008, 43:73–78. doi:10.1016/j.jcv.2008.04.013 pmid:18571465
Vietnam. Risk factors for human infection with avian influenza A(H5N1), Vietnam, 2004. [Internet]. Emerging Infectious Diseases, 2006, 12:1841–1847. doi:10.3201/eid1212.060829 pmid:17326934
7. Schultsz C et al. Prevalence of antibodies against avian influenza A (H5N1) virus among cullers and poultry workers in Ho Chi Minh City, 2005. PLoS ONE, 2009, 4:e7948. doi:10.1371/journal.
pone.0007948 pmid:19956765
8. Uyeki TM et al. Seroprevalence of antibodies to avian influenza A(H5) and A(H9) Viruses among Market Poultry Workers, Ha Noi, Viet Nam, 2001. PLoS One, 2012,7(8):e43948. doi:10.1371/
journal.pone.0043948 pmid: 22928049
9. Liem NT et al. Clinical features of human influenza A(H5N1) infection in Vietnam: 2004–2006. Clinical Infectious Diseases, 2009, 48:1639–1646. doi:10.1086/599031 pmid:19435433
10. Le MQ et al. Subclinical avian influenza A(H5N1) virus infection in human, Vietnam. Emerging Infectious Diseases, 2013, 19:1674–
1677. doi:10.3201/eid1910.130730 pmid:24047510 11. Shinya K et al. Subclinical brain injury caused by H5N1 influenza
virus infection. Journal of Virology, 2011, 85:5202–5207.
doi:10.1128/JVI.00239-11 pmid:21389133
12. Recommendations and laboratory procedures for detection of avian influenza A(H5N1) virus in specimens from suspected human cases. Geneva, World Health Organization, 2007:1–28.
13. Dejpichai R et al. Seroprevalence of antibodies to avian influenza virus A(H5N1) among residents of villages with human cases, Thailand, 2005. Emerging Infectious Diseases, 2009, 15:756–
760. doi:10.3201/eid1505.080316 pmid:19402962
14. Takakuwa H et al. Molecular epidemiology of avian influenza viruses circulating among healthy poultry flocks in farms in northern
