DAC DI^M CUM A (H1N1) NAM 2009

TAP CHf NGHieN CCPU Y HQC

DAC DI^M CUM A (H1N1) NAM 2009

Thdn Mgnh Hiing, Nguyin Van Kinh Trwdng Dai hpc Y Hd Ndi Vims A (H1N1) la tdc nhdn gdy dpi dich cum ndm 2009 trdn todn ciu nhung ehwa cd dw lidu diy du vi tac nhan gay bpnh nay. Nghien cuv dwac thwc hidn nhim md td ddc diim Idm sdng vd thdi gian thdi trii' virus d bpnh nhdn nhidm cum A (H1N1). Kit qud cho thiy, bdnh cum A (H1N1) gdp dcd2 gidi, dd tudi mic bpnh trung binh 24,4 ±2,5 tudi, tridu chdng Idm sdng hay gdp Id sdt (100%), ho khan (44,7%), chiy nwdc mui (28,9%), dau hpng (26,3%), dau diu (21,1%). Thdi gian thdi tm- vims tmng binh Id 6,74 ± 2,79 ngdy Bieu hipn lam sdng cua cum A (H1N1) nghdo ndn, thdi gian thanh thdi virus mudn vi vdy cin cd cdc gidi phdp hpn chi sw Idy lan cua virus.

Tu khoa: Vi rut cum A (H1N1), thdi tru vi rut

I. DAT

V A N

Dt

Tu cudi thdng 3 ndm 2009, djch ciim mdi xult hifn, b i t ngudn tip 2 tre em tgi Mexico sau dd lan sang Hoa Ky, Canada vd nhanh chdng lan ra todn t h i gidi. Do tdc d f Idy lan vd nguy hilm eiia loai virus cum ndy, kha ndng lay lan manh, trge tilp tu ngudi sang ngudi tren pham vi toan c l u , ngdy 11 thdng 6/2009, Td chuc Y t l T h i gidi da ndng c l p bdo dpng djch cum nay len c l p dp 6, bdo dfng mft dai djch mdi xult hifn. Theo Td chuc Y t l T h i gidi, dai djch ndm 2009 Id mdt biln chiing mdi ciid virus ciim H1N1, cdn dugc goi Id cum A (H1N1) [4]. Ngodi kha nang Idy lan nhanh vd ty If tu- vong cao, thi nhu-ng hilu bilt v l chiing virus Ciim A(H1N1) cdn r i t han c h l . Do vdy, phdn tich ddc dilm lam sdng, cQng nhu thdi gian thai tru ciia loai virus ndy trdn ca t h i ngudi nhilm, ed y nghTa r i t quan trpng trong vifc Cham sdc vd dilu trj bfnh, ddc bift Id gdp phdn cho cdng tdc dg phdng djch bfnh. VI vfy muc tieu nghien cuu nham: Md ta ddc dilm Idm sdng vd thdi gian thai tru virus d bfnh nhan nhilm cum A (H1N1).

II.

D 6 I

TUgNG VA PHUONG

PHAP 1. Ddi t u g n g

Gdm 38 bfnh nhdn, dugc chin dodn xdc djnh nhilm virus ciim A (H1N1) bing kT thuft PCR, dugc dilu trj nfi tru tai bfnh vifn Bfnh nhift ddi Trung uang trong 2 thdng diu cua vg djch (thdng 6 vd 7/2009).

Tidu chuan chpn bfnh nhdn:

Bfnh nhdn nhdp vifn vdi hfi chung ciim, khdng phdn bift tudi vd gidi tfnh.

Bfnh pham djch hlu hpng duang tfnh vdi cum A (H1N1), bing xet nghifm PCR.

Tidu chuln loai tru: bfnh nhan cd benh nhilm triing kdm theo, hodc cd cdc bfnh ca dja (nhu ddi du-dng, benh ly gan, than...).

2. Phuang phdp

Thilt k l : Nghien cuu tiln cuu md ta. Bfnh nhdn dugc chpn vdo nghien cuu theo phudng phdp chpn m i u thufn tifn.

Bfnh nhdn tham gia nghidn cuu dugc ddnh gid v l mft sd chi sd djch t l , Idm sdng, Idmncdc xdt nghifm phgc vu chin dodn, dilu tri. Bfnh nhdn cd xdt nghifm PCR duang tfnh vdi cum A (H1N1) dugc dilu tri mdi dgt 5 ngdy bing Tamiflu 150mg/ngdy cho din khi xet nghifm virus trd v l dm tinh.

Khdo sdt thdi gian thai trg vi rut tren dudng hd hip bing xdt nghifm PCR: Bfnh phim cum A (H1N1) dugc lly bing tdm bdng

TCNCYH 77 (6)-2011 25

TAP CHl NGHIEN CLFU Y HQC

vd khuln, ngody djch hlu, hpng. Xdt nghifm dugc lly tgi cdc thdi dilm: Khi nhfp vifn vd cdc ngdy thg 3, thg 5, thg 7 vd thg 10 cua b$nh (cho din khi xdt nghifm virus trd v l dm tinh).

Xdt nghifm PCR cum dugc Idm tai phdng sinh hpc phdn tu-, thufc dan vj Nghidn cu-u Idm sdng Trudng Oai hpc Oxford tgi Bfnh vidn Bdnh Nhidt ddi Trung uang

3. Thu thfp sd lifu: Bing mau bfnh ^ nghidn cO-u thilt k l sin.

4. Phdn tich sd lifu: Bing phin min SPSS 16.0 vd cdc thuft todn ung dgng.

III. K^TQUA

Trong thdi gian nghidn ciPU, 38 bfnh nhSr nhilm ciim A (H1N1) thda mdn tidu chuln v^

dugc chpn vdo nghidn ciPu Kit qua nhu sau:

Bdng 1. Dfc d i l m djch t l hgc Dfc dilm

Gid^i tinh Nam NO

n 20

18

% 52.6 47.4 Nhdm tudi (ndm)

<20 20 30 3 0 - 4 0 4 0 - 5 0 5 0 - 6 0

16 10 5 4 3

42,1 26.3 13.2 10,5 7.9

Nghi nghifp

Cdnbf

Hoc sinh. Sinh vidn Khdch du lich

Khde (trd em, nghi tg do...) Cd tiln si> tilp xuc

13 12 4 9 14

34,2 31,9 10.5 23,7 36,8

Bfnh nhdn nghidn ciPU cd thdi gian rftidp vifn trung binh Id 0,97 ±1,15 ngdy (sdm nhit la ngdy diu ciia sdt, mufn nhit 3 ngdy). Ngudi nhilm cum A (H1N1) gfp diu cd 2 gidi vd d tatca cdc lua tudi, trong dd gdp nhilu nhit d nhdm tudi dudi 20 tudi (chilm 41,2%). Bfnh gdp d nhieu ngdnh nghi khde nhau, hay gdp d nhdm hpc sinh. sinh vidn. 36,8% sd bfnh nhdn ed tiln sii- tilp xiic vdi ngudi nhilm A (H1N1) trudc dd (bdng 1).

Trifu Chung Idm sdng hay gdp Id sdt (100%), cdc diu hifu khde nhu ho khan, chay nudc mOi, dau hpng vd dau diu ft gfp han (bing 2).

26 TCNCYH 77 (6)-2011

TAP CHf NGHI§N C(yU Y HQC Bang 2. Dac d i l m lam sang ciia nhdm nghien cii'u

Lam sang Sdt

Ho khan

Chiy nudc mui Dau hpng Dau d i u

Thdi gian (ngdy)

< 5 5 - 7 7 - 1 0 10-13

Thdi gian thai tru virus trung

n 38 17 11 10 8

Bdng 3. Thdi gian thdi trip vi

binh:

n % 14 36,8 12 31,6 7 18,4 5 13,2

riit

6,74 ± 2,79 ngdy (sdm nhat 3 ngdy.

% 100 44,7 28,9 26,3 21,1

Ty If tich luy (%) 36,8 68,4 86,7 100 mufn nhat 13 ngdy).

IV. BAN LUAN

38 bfnh nhdn d i u tien trong vu djch cJm A (H1N1), dugc dilu tri bing thudc Tamiflu lilu 150mg/ngdy. Bfnh nhdn nhilm ciim A (H1N1) phan bd ddu d ca 2 gidi (nam chilm 52,6% vd nu- chilm 47,4%), gdp d mpi lua tudi vdi dp tudi trung binh Id 24,4 ± 2,5 tudi, nhd nhit Id 1,8 tudi vd Idn tudi nhit Id 53 tudi (bang 1).

Ddi tugng m i c bfnh tdp trung ehii y l u Id hpc sinh, sinh vien va cdn bd dang tham gia cdng tdc. Cdc nghien cuu v l bfnh nhdn cum A (H1N1) tgi Singapore [3] vd Trung qudc [5]

vdo cung thdi gian nghien cuu ciia chung tdi, khi dai djch b i t ddu xay ra tren todn c l u (ndm 2009), cung cd k i t qua tuang tg. Yu nhdn xdt 54% sd bfnh nhan la nam gidi vd df tudi trung binh la 20 tudi [5], vd theo Ling d f tudi trung binh Id 26 tudi [3]. Ndi chung, cdc kit qua nghidn cuu d i u cho thiy bfnh nhdn nhilm cum A (H1N1) tdp chung chu y l u d

lua tudi tre, dang tham gia hoc tfp, lao dfng.

v l bilu hifn Idm sang, 100% bfnh nhan cd bilu hifn sdt d cdc muc df khac nhau, vdi sd ngdy cd sdt trung binh Id 3,21 ± 0,26 ngdy.

Tuy nhien cdc bilu hifn khde chi gap vdi tin xult thlp, nhu ho khan (44,7%), ehly nudc mui (28,9%), dau hong (26,3%) vd dau ddu (21,1%). Cdc kit qua nghien cuu lam sdng v l ciim A (H1N1) trong viing Chdu A - T h d i Binh Duang cung d i u nhdn thiy mdc du tan xult cdc d i u hifu cd khde nhau theo tiiy tung tdc gia, nhung bilu hifn Idm sdng cua cum A (H1N1) r i t nghdo ndn [2, 3, 5]. Theo chiing tdi, bilu hifn Idm sdng cua ciim A (H1N1) tuang tg nhu djch ciim miia v i n thudng xay ra tgi Vift Nam.

T i t c l cdc bfnh nhdn trong nghidn cuu ndy d i u dugc dilu tri bing Tamiflu ngay tu khi nhdp vifn (thdi gian nhdp vifn trung binh k l tu khi sdt Id 0,97 ±1,15 ngdy). Kit qua v l thdi gian thai trg virus trung binh Id 6,74 ±

TCNCYH 77 (6)-2011 27

TAP CHf NGHIEN CLPU Y HQC

2,79 ngdy, sdm nhit Id 3 ngdy, mufn nhit Id 13 ngdy tinh tii- khi khdi phdt sdt. Cdc k i t qud nghidn cuu tgi M9 vd cdc nudc khde trong viing d i u du-a ra kit lufn virus ciim A (H1N1) cd thdi gian thdi tru tu 1- 13 ngdy [1], sau 7 ngdy vin cdn 37% duang tinh [3] vd thdi gian thdi tru trung binh Id 06 ngdy [1, 2, 3, 5] tu-ang tg nhu kit qud cua chiing tdi.

V. K^T LUAN

Qua kit qua nghidn cuu 38 bfnh nhdn nhilm virus ciim A (H1N1), trong d i u vg djch 2009, tgi bfnh vifn Bfnh Nhift ddi Trung uang, chung tdi riit ra k i t lufn:

Nhilm ciim A (H1N1) gdp c l 2 gidi, d t i t d cdc lua tudi, trong dd dudi 20 tudi chilm 41.2% vd 36,8% bfnh nhdn cd t i l n sii- tilp xiic.

Cdc bilu hifn Idm sdng hay gdp Id sdt (100%), ho khan (44,7%), ehly nudc mOi (28,9%), dau hong (26,3%), dau d i u (21,1%).

Thdi gian thai tru virus trung binh Id 6,74 ± 2,79 ngdy, sdm nhat Id 3 ngdy, mufn nhat Id 13 ngdy.

TAI

Lieu THAM

KHAO

1. Bhattaral, A., Villanueva, J., Palekar, R.S et al (2011). Viral shedding duration of pandemic influenza A H1N1 virus during an elementary school outbreak-Pennsylvania, May-June 2009. Clin Infect Dis, 52 Suppl 1:

S102-8.

2. JIa, N., Gao, Y., Suo, J.J., et al (2011).

Viral shedding in Chinese young adults with mild 2009 H1N1 influenza. Chin Med J (Engl), 124(10): 1576-9

3. Ling, L.M., Chow, A.L., Lye, D.C et al (2010). Effects of early oseltamivir therapy on viral shedding in 2009 pandemic influenza A (H1N1) virus infection. Clin Infect Dis, 50 (7):

963-9.

4. World Health Organization (2009).

Pandemb (H1N1) 2009 update 100. Weekly

update, http://www.who.int/csr/

don/2010 05 14/en/index.html.

5. Yu, H., Liao, Q., Yuan, Y et al (2010).

Effectiveness of oseltamivir on disease pro- gression and viral RNA shedding in patients with mild pandemic 2009 influenza A H1N1 opportunistic retrospective study of medical charts in China. BMJ. 341: e4779.

Summary

CLINICAL CHARACTERISTIC OF INFLUENZA A/H1N1 VIRUS IN 2009

Influenza virus A(H1N1) was agent of the Influenza pandemic in the world in 2009. However, the database of this virus was unknown. The study was conducted to describe clinical manifesta- tions and viral shedding in A(H1N1) patientc. The results show that, the presentation of influenza A(H1N1) is similar in man and woman. The median age was 24.4 ± 2.5 years old. Fever occurred in 100%, cough in 44.7%, rhinorrhea in 28.9%, sore throat in 26.3%, headache in 21.1%. The mean duration of viral shedding from illness onset was day 6.74 ± 2.79 days. The clinical manifes- tafions in avian influenza A(H1N1) are poor. Shedding time was long so we need to find out a so- lution for the virus transmission.

Key word: Influenza A(H1N1), viral shedding

28 TCNCYH 77 (6) - 2011