TAC NHAN VI RUT GAY HOI CHU'NG CUM TRONG CONG DONG TAI XA CAM SON, HUYEN C A M GIANG, TJNH HAI DU'ONG, 2009-2010.
Nguyen Thj Thu'dng, ThSm Chi Dung, Tran Thj Mai Hu^ng, Nguyen Tran Hien \k Kiyosu Taniguchi*
Vien Ve sinh Dich ti Trung uffng, Hd Ngi
* Vien Qudc gia cdc Benh truyen nhiem, Nhtit Bdn
TOM TAT:
Nghien ciru mo ta dac 6\hm dich t l hoc Hoi chirng ciim (HCC) ket hgp voi xac dinh tac nhan vi riit bIng cac xet nghiem sinh hgc phan tir dugc tiln hanh tai xa Clim Son, Huyen C i m Giang, tinh Hai Duong trong 12 thang (4/2009-3/2010), Kit qua nghien ciru cho thay ty le duong tinh chung voi mot trong cac tac nhan vi riit gay HCC g mirc cao, chiim 62.9% (34/54), trong do vi riit cum A/HI NI dai dich chiim ty le cao nhit (53,7%), CO su CO mat ciia vi rut ciim A thong thuong, vi riit ciim B va hRSV, khong phat hien dirge b^t cir truong hgp nao nhilm hMPVva vi rut ciim gia clmA/H5N1, Ngoai ra, nghien ciru da phat hien coronavirus NL63, mot vi riit moi dugc phat hien g i n day, la nguyen nhan gay ra mot vu dich viem duong ho hip tai xa d m Son vao thang 8-9/2009, Cac tac nhan vi riit xuat hien nhilu vao khoang miia thu dong (tii' thang 9 din thang 12), chiim 34,8%, tiip theo la thang 8/2009 (13,0%), Kit qua nghien ciru cung d p cac b^ng chirng khoa hpc ve su luu hanh ciia cac tac nhan gay HCC tai cong dong, tu' do goi y cac bien phap phong chong theo mua chiln luge tiem chiing v^c xin du phong cac tac nhan hgp ly, gop phan nang cao nang lu'c giam sat thuc dia HCC cho cac can bo Y te cua xa Cam Son, huyen C i m Giang
Tir khoa: Tac nhan vi riit, Hpi chirng ciim, xa Cam Son, cong dong
I. DAT VAN DE cac chucmg trinh can thiep xii gitim stit | I |. Vi rut niix tliucmi: hoat ddiui theo mua. xiitit hicn 1 ldi cluing cum (I ICC) lii tinh irting x iem
dudng hd htip do cac loai vi rut. x i khuiin giix
nhieu nluit xiio liic giao miia xii mua dong. Vi rut Clim C thircViui chi litix ra ciic benh cum nil ra vdi cac bidu hien lam simg nhu sol, dau diiu. ,^,^^ i^^^^ ^|^^,^ ^1^,. |^|^^-,,^^ ^^. ^,.,-,^, ^.|^^,.|,, |,^,^, dau CO', dau hgng ... cd thd dan den viem phdi j ^ , , ^ ,.,,^,^„ ,,3 j^,^„ ^^ pi^^o ^^^ ,j^,a ,^„l^icp ^uu nting xii tu vong neu khdng dugc phat hicn ^^,,, y^.^^^.^,^ ^^^^ Pl^5n„ ^.j, i<^jcm sotit benh tat xii xu ly kjp thdi. Cd khoang 200 vi rut khde Hoa Ky (CDC 2008-2009). 4 tac nhtin chinh nhau cd the giix ra HCC, phd bien nhiit ki cac giiy ra HCC bao gcim vi rut d i m ,A (Innuen/a vi rill rhino, Cimi A, Cum B, a ciim.... Cd 3 A). Cum B (Influen/a B). x i nil hgp bao dudng gidng vi lilt cum (Cum A. B. C) trong dd x i nit hd hap a ngudi (human Respiratorx S> ncitial Clim A va B la nguyen nhan phd bien giix djch Virus - RSV) vti xi riit gax x icm phdi a ngucVi lien quan ddn dudng hd htip, day la ttic nhan (human Mctapneumovirus - hMPV) |2|. Vi rut quan trgng xii thu hut htiu hdi sir quan tam cua ciim A/1 UN 1. hMPV. hRSV cd thd liix benh cho
file gia: Nguxdn fhj fhucmg
Dja chi: Vien Vc sinh Dich te frung uong. 1 ^'-ec-xanh. llii Ndi Dien thoai: 1 84-4-82 1-3241
l-nuiil: kitthuong24 c; xalioo.com
Tap chi Y hgc du phong. Tap XX, so 10 (118) 67
ngudi true tidp qua dudng hd hap hoac ngudi miic benh qua tiep xuc vc'ri gia ctim nhiem vi nit Clim A/I 15N1. Bao cao sd 112 cua fd chirc Y td The gidi (WI 10). tinh ddn ngay 01 /08/2010. da cd 214 qudc gia va viing lanh thd ghi nhan cd ca benh dirong tinh vdi ciim A/HINI, trong dd cd 18.499 tru'dng hgp da tu vong [3]. Tinh den ngay 19/03/2010. Viet Nam da ghi nhan 11.214 trudng hgp dugc chan doan xac dinh phdng thi nghiem. trong dd cd 58 ca tu vong. Djch ciim gia ciim A/1I5N1 a ngudi ltd Viet Nam tinh den ngiix 30/08/2010 da xay ra d 36/61 tinh.
thiinh phd xcri 119 trudng hgp mac va 59 tu vong. ty Ic chct/mac 49,6%) [4]. (2004) nghien ciru tai nhieu bang cua iic cho thiiy ciim la tiic nhan chinh gay ra HCC, ben canh cac tac nhan vi rill khtic nhu hgp btio hd hap (hRSV). rhino- virus, adcnox irus. a ciim (parainfluen/a viruses), SARS (human coronavirus) vti giin day la hMPV (human mctapneumovirus) ciing ducTc phiit hien lii tiic nhiin trong ctic vu djch HCC [5]. Nguyen nhan gax nhiem triing dudng hd hap cap tinh (ARI) khac nhau theo khu vuc dia ly dan cir.
Vi rill a ciim lii ttic nhiin chinh gay ARI trong quan thd diin cu tai Georgia, Hoa Ky, chidin 12,6%, tiep theo la adenovirus (11,2%o). ciim A (7,3%), vti RSV (6%). 'frong khi vdi quan the tie em. chi cd ii cum vii RSV la t<ic nhiin chinh giiy ra ARI |6|.
Vien Vc sinh Dich te 'frung uong phdi hirp vd'i Vien Cac benh truydn nhiem va nhiet dd'i Qudc gia, Nhat Ban thuc hien nghien ciru xac djnh tac nhan gay HCC tai cgng ddng (xa Ciim Son. huxen Cam Giang, tinh Iltii Duong) trong 12 thiing (tu thiing 4/2009-3/2010).
Nghidn cuu sc cung cap cac bang chimg khoa hgc hd trg viec quan ly va phat trien cac chien luge giam sat, kiem soat thich hgp va ngan ngira sir lax truyen cua benh dich va nham giam thieu nhirng ganh nang benh tat do hgi cluina ciim aav ra.
II. PHUONG PIIAP N ( ; i l I E N C l l i
Ddi tugng nghidn cuu ki cdc Iruivng hop mac HCC cu tni tai xti Ctim Scui. huxen Ciim Gitmg. tinh Hai Duong td thting 4 2009 den thang 3/2010 (12 thting). frong do. ddi tircrng nghien cuu phai dap ung tieu chuim lira chgn bao gdm mgi lira tudi, cti hai gidi, diicyc cluin doan lam siing mac fICC bao gdm (1) Cd trieu chirng scit tu 38" C tra ien. xti (2) Mcit hoiic cac tieu chuan sau: ho. htit hoi. sd miii. xet nghiem dirong iinh xc'ii ttic nhiin gtix ra HCC.
va (3) Khdng cd bat cir chan dotin xtic djnh luio khiic). ddng y tham gia nghien ciru. ddng x cho liiy djch ngoax hgng bting ttim bdng. tham gia phdng van true tiep. Cdng cu nghidn ciru tai thuc dja la bd can hdi dung siin. Ddi tugng nghien cuu dugc dieu tra vien lii>' djch nuii hgng bting tam bdng polxester chuyen dung, mdi ngircri dugc liiy benh phiim bting 2 ttim bdng vd triing bang each dua ttim bdng viio Id mui (cti hai Id miii) theo chieu song song vdi vdm hgng, giir 2-3 giay, sau dd rut nhe nhiing, vira riit vira xoay. Vd'i dich hau hgng, yeu cau benh nhtin lui mieng. can bg y td lay nuiu xtit vii xoay iihc;
ttim bdng noi tdn thuong 2 thanh ben va thanh sau hgng. Xac djnh chat lugng lay benh phiim bang each quan stit sc thay cd vet benh phiim biim dinh x ao tiim bdng. Sau khi Itiy nuiu, cho tam bdng vao dug nhua vd triing cd niip xotiy dung san mdi trudng van chuyen va bao quan vi nit. van chat dng dung mdi trirdng cd chira tiim bdng. giir d 4"C, sau dd chuyen ve Phdng thi nghiem tai frung tam Y tc Du phdng tinh trong cung ngay da bao qutin lau diii. Vdi tre nhd dudi 15 tudi, diing loai ttim bdng chuyen dung nhi khoa.
Sau khi lay mau, can bd y tc didn day du thdng tin vao phieu lay mau benh pham. Phieu nay dugc luu tai frung tiim Y te Du phdng tinh Hai Duong (trong may tinh) va ban in dugc de trong tiii ni-lon (tiii zip) dd gui kem mau
xe phdng thi nghiem cua Vien Ve sinh Djch te frung uong. Cac thdng tin cua mau benh pham gdm hg tdn. nam sinh. dja chi. dien thoai. loai benh pham. ngtiy lay benh pham. sd benh phiim. chan doan lam sang....(.xem them chi tiet d phieu lay benh pham), cd chu ky cua ngudi lay benh pham va cd dau co' quan. Cac dng benh pham dugc bao quan lanh va tuan thii nguyen tiic it nhat 2 - 3 lan bgc va van ehuxdn ve Phdng thi nghiem cua Trung tam Y te Du phdng tinh, dugc btio quan d -80"C tai dax den khi dugc chuyen vd Vien Ve sinh Djch te frung irong de lam xet nghiem. Qua trinh xu ly benh pham tuiin thu nghiem ngat ctic quy djnh xd an loan sinh hgc trong xir ly benh pham mirc dd nguy hiem ciip 2 va 3 (neu nghi do xi nit Clim A ddc lire cao) cua fd chirc Y tc fhe gidi.
Dam btio tiit ca cac mau benh pham dugc xu ly trong hd an loan sinh hgc cap 2, trong phdng thi nghiem an loan sinh hgc ctip 2. frudc tien.
benh pham dugc chia ra 2 dng vd trung nho xa giil ci -80"C, sau khi xir ly benh pham, tien hanh tach chiet acid ribonucleic (ARN) theo thudng quy ciia nhii stin xuat (Qiagen). lam thir nghiem phien mil ngirgc vii khuech dai doan gien dich phtit hicn ciing luc 04 tac nhiin gay benh (RT- PCR multiplex) vti khang djnh biing PCR don mdi (I lemi-nested PCR monoplex) la hRSVtx'p A vii B (human Respiratory Syncitial Virus - hRSV A/B), vi nit cum A/H3N2. cum A/H IN 1, vi nit Clim B vii hMPV (human metapneumo- xirus) theo thucTng quy cua Vien Ve sinh Djch te frung ucrng. Mdt sd trudng hgp dac bict nhu djch nghi cum rd rang, nhung cti 4 tac nhan tren deu tim tinh thi se tien hiinh xiic djnh nguxen nhtin khac, vi du vi rut cum A/H IN 1 dai dich sc dugc tien hanh chan doan bang phat hien cac doan gien dn dinh ma hda cac protein M, HA, va NA bang phan irng khudch dai djnh lugng true tiep (real-time R1-PCR faqMan).
Mdi phan ung khuech dai (monoplex hax multiplex) deu cd kem 2 chirng am tinh (dugc
cho vao trudc va sau khi xet nghiem mau).
xd it nhat la 1 mau chirng duong tinh. Chung diro'ng tinh la cdc gam chuiin ARN ddng nhtit va tinh khiet da dugc san xuat bang phuong phap phidn ma /;; vitro vdi 10'' (hRSV. Intlu- enza A, hMPV) va 10'(Inllucnza B) ban sao ARN cho mdi phtm ung de dam bao do nhax cimg nhu khdng chd hicn tugng iim tinh gia cua phan irng. Cac chirng dirong x a tiin tinh cd vai trd lam mau ngi kidm cho quii trinh kiem soat chat lugng cua cac ky thuat xet nghiem.
dam bao kdt qua nghien cuu cd do tin cax cao.
foim bd qua trinh thuc hien phan ung xd ket qua xet nghiem deu dugc luu hd so trong cap tai lieu rieng bict, de trong td cd khda. bao mat thdng tin cho ddi ttrcmg tham gia nghien ciru.
Ciic thdng tin phiin tich dam bao tin danh. Ket qua nghien cdu ducjc giu bi mtit. chi phuc xu cho muc dich nghien cdu nax. C'kc ket luan vii klugen nghj ap dung cho quan thd, khdng su dung cho tung ca the.
III. KET QUA VA BAN LUAN
Tac nhan gay ra HCC tai xa Cam Son.
huyen Ciim Giiing, tinh Hai Duong trong 12 thang (4/2009-3/2010) da dirge .xtic djnh bSng cac xet nghiem phdng thi nghiem. Xii Cam Son la 1 trong 19 xa cua huyen Cam Giang dugc lira chgn la didm thu thap cac mau benh pham trong nghien ciru nay, vi theo sd lieu giam sat thudng xuydn djch td hgc ciia 24 benh truyen nhiem qudc gia cho thay xii Cam Son cd ty Ic mac HCC cao nhat trong huyen Cam Giang trong 5 nam gan day. Ddng thdi. xa cd didu kien thuan Igi vd giao thdng, thuan tien cho vice lax mau.
bao quan va van chuyen mau benh pham dap irng cac tieu chuan co' ban vd an loan sinh hgc eua Vien Ve sinh Dich te frung uong. Ngoai ra, he thdng y te cua xa boat ddng rat cd hieu qua, giam sat djch td chat che. thu thap sd lieu day du, chinh xac va dung thdi gian.
Tap chi Y hgc du phong. Tap XX, so 10 (118) 69
Tdng sd cd 1.358 mac fICC tai huxen Cam Giang. Ridng xa Cam Son ghi nhan 121 trudng hgp. ty le hien mac la 5,1%. Tx le nax cao hon so xdi ty le hicn mac chung loan bg huyen (1.1%) xa cao nhat so vdi 18 .xii cdn lai cua huxen. Mac du khdng cd day du thdng tin vd su bien ddng cua dan cu tai xa. nhung ket qua so bg cho thax ty le hicn mac HCC tai xa Cam Son cao ban so vdi cac xa khac cd thd la do boat ddng giam sat djnh ky va chu dgng cua xa thuc hien tdt hon.
Trong 12 thang didu tra (4/2009-3/2010).
cd 54 miiu benh pham dugc thu thiip liim xet nghiem xac djnh tac nhan vi rut ga> ra HCC o ngirdi tai xaCain Son. chiem 44,6%o (54/121 )so vd'i sd trudng hgp mac HCC tai xa. do han che ve thdi gian va kinh phi xet nghiem. Man benh phiim Iti dich ngotix hgng cua ctic benh nhiin mtic HCC. Sd miiti dugc phiin bd ddu eho cac thang. uu tien liix' miiu vao ngtiy diiu tutin vdi sd lircrng trung binh mdi thang tir 4-5 mau/tluing hax 1 nuiu'tuiin. lux nhien. thuc tc cho thax cd nhicui thimg (thiing 4/2009. thiing 1-2/2010).
khdng thu thiip dugc miiu benh phtim do khdng cd benh nhan, phiit hien benh nhtin quii mudn (sau 7 ngax tir khi cd trieu chung liim simg diiu tien), benh nhiin da het ciic trieu chirng hoitc dti chuyen tdi tuyen cao hon (benh vien tinh. trung uong) hoiic khdiui ddnii v cho miiu. Do dd. sd
lugng mau da ducyc \k bd sung x tio ctic thang cd sd mac cao. dac bict lii ctic thang dmh d\ch (thang 8-9/2009 xa thting 12/2009). Vice phim bd sd lugng m^u thu thtip theo thimg ddng deu se cho ket qua xet nghiem cd tinh did dicn xe thdi gian. mua dich va dja du. V>o dd. ket qua nghidn cuu gdp phan phan iinh thuc irang cua HCC X ii sir luu hanh cua ctic ttic nluin x i rut gtix benh cho loan bd cdng dcing cua khdng chi xti Cam Son ma cdn cho ca huyen Ctim Giang.
Ket qua xet nghiem cho thtix mtiu dircrc thu thap nhieu nluit Iti viio mua djch. btit dtiu lit thting 8-12/2009 x ii cao nhat Iti thting 9/2009 (15 mau), chiem 28.3%. i\i> nhien, .sd lucmg miiu cua miia djch niim 2009 ciing bj tinh hircrng bcVi dai djch cum A/H IN 1. 1 irong img, ty le duong tinh vd'i ctic tiic nhan gay I ICC cao nhat vao thang 9/2009 xa thang 12/2009 (34.8%o). tiep theo lii thang 8/2009 (13.0%)). d i m A. diic biet lii ctim A/HIN1 dai dich. cum B. hRSV Iti ciic ttic nhtin vi nit chinh ducrc phtit hien trong nghien cuu niix (Bang I). Ngoiii ra. trong xu djch xidm duiiiig hd hiip ciip tinh lai xii Ctim Scrn thting 8/2009.
sau khi dti loai trir 4 ttic nhiin chinh cua nghien ciru niix. chimg tdi da tien himh xiic djnh ngux dn nhan gtix benh do vi rut khtic nhu coronuvirus.
udenoviriis. bocuvirus giiy benh o' ngudi Ket qua xet nghiem dti khiing dinh cd 2 mtiu duong tinh xcri coronuvirus NI.63.
Bang 1. Ty le % mlu thu thap, m l u du-cng tinh va cac tac nhan gay HCC theo thang tai xa Cim Sen, Cim Giang, Hai Du-cng (4/2009-3/2010).
TT
1 2 3 4 5 6 7 8 9 10 11 12
Thai gian (thang)
Thang 4/2009 Thang 5/2009 Thang 6/2009 Thang 7/2009 Thang 8/2009 Thang 9/2009 Thang 10/2009 Thang 11/2009 Thang 12/2009 Thang 1/2010 Thang 2/2010 Thang 3/2010 T6ng so
S6 mau
0 2 1 4
7 15
0 10
8 0 0 7 54
Ty le % mau thu thap
0,0%
3,7%
1,9%
7,4%) 13,0%) 27,8%
0,0%
18,5%) 14,8%o 0,0%
0,0%
13,0%
100,0%
So mau (+)
0 1 1 2 3 8 0 9 8 0 0 2 34
Ty le % mau (+) theo thang
0,0%
2,9%
2,9%
5,9%
8,8%o 23,5%.
0,0%) 26,5%o 23,5%o 0,0%o 0,0%o 5,9%o 100,0%o
Tac nhan
1 Cum B 1 Ciim A 2 coronavirus NL63 3 Ciim A/HI NI dai dich 8 Ciim A/HI NI dai dich
9 Ciim A/HIN dai dich 8 Ciim A/H I N dai dich
1 C i i m / V H I N dai dich 1 hRSV
Ghi ehii: ( i J ' ket qua xet nghiem duong linh
Bang 1 cho thay khdng thu thtip dugc mau benh pham nao trong thang 4/2009.
thang bat dau tridn khai nghien cuu tai thuc dia cd the do ctic boat ddng giam sat tai thuc dja dura di vao nc ndp, chua dn dinh. khdng cd benh nhtin 1 ICC trong thiing nay. iit thang 5-7/2009. thu thiip ducrc 7 mau. Sd mau phan bd theo thang dao ddng tir 1-3 mau/thang nen chimg tdi khdng tien hanh kiem djnh thdng kc sir khde bict. fu thang 8-12/2009. cd sd benh phiim cao nhat do dtiy la miia djch (mua thu ddng). mua luu hanh cac benh vidm nhiem dtrcVng hd luip tiii khu x ire mien Bac Viet Nam.
mdi trucVim tir nhien x ii didu kien khi hau. nhiet
do rat thich hgp de cac ttic nhan giiy fICC phtit tridn, luu hanh va gay benh o' ngudi. Ddng thd'i. thd'i diem nay triing vdi thdi diem xay ra dai djch cum A/I I IN 1 tai mien Bac Viet Nam.
•f uong tir thang 4/2009. thang 1 -2/2010 khdng thu thap dugc mau benh phiim. Ket qua cd thd bj anh hudng ciia mdt sd yen td lien quan den van hda dja phuong, vi du djp Tet Nguxdn Dan xa cac Le Hdi mua xuan, cho nen sd ngudi den kh.im benh thudng it hon so vdi binh thudng.
fhiing 3/2010, sd lirgng mau tang Idn 13.0%.
Sir tang dot bidn ve sd lugng mau dugc lax xdt nghiem lien quan vice lay bd sung cua dieu tra xien cho thans, 1 vii 2/2010. Nsihien cdu da cd Tap chi Y hgc du phong. Tap XX, so 10 (118) 71
gang khdng chd phan bd deu sd mau theo thang.
do dd sd lieu nay mac dii cd co mau nhd. thang dk\ tien (4/2009) va thdng cuoi ciing (3/2010) cua dgt didu tra chiu nhieu anh hudng cua cac yeu to khach quan. tuy nhien ket qua vtin dam bao tinh gia trj va dai dien cho quan the theo thdi gian cua xa Ciim Son ndi rieng va huyen Cam Gitmg ndi chung.
fong sd 54 mau benh pham dugc xet nghiem bdng ky thuat RT- PCR multiplex va khing djnh lai bang ky thuat Hemi-nested monoplex. Cd 34 mau phat hien cd vat lieu di
truydn cua cac tac nhiin xi rut. chiem 62.'-'%- Trong dd.vi rut cum A chiem 88.200(30 nuiu).
rieng vi rut cum A/H IN 1 chiem 85.3%. Khdng cd mau duang tinh vdi vi nit cum A/I I5N1 Vi cd mau nghidn cuu nhd, trdn qux md xii nen khdng the tien himh nghidn cuu phim tich tiic nhan vi nit dong nhiem vdi vi nit cum did djch A/H IN 1. Nghien ciru nay phtit hien duy nhtit mdt mail duong tinh vdi vi rut cum B (2,9%o) va mdt mau duong tinh vdi hRSV (2,9%).
Khdng pluit hien trudng hcrp niio duong tinh vdi hMPV (Bang 2).
Bang 2. Ty le % cac loai tac nhan gay HCC trong so mau xet nghiem dirang tinh tai xa Cam Sen, huyen C i m Giang, Hai Du-ang (4/2009-3/2010) (N=34).
STT Tac nhan Wlau dirang tinh Ty le %
Vi rut ciim A A/H1N1
Ciim B hRSV hMPV CoV NL63
30 29 1 1 0 2
88,2%) 85,3%o 2,9%o 2,9%
0,0%
5,9%
T6ng so 34 100,0
Vu djch xiem dudng hd hiip xtiy ra tai xa Cam Son xao thang 8-9/2009, da ghi nhan 60 trudng hgp mac. trong dd lay dugc 22 miiu benh pham de xet nghiem tim 4 tac nhan vi rut chinh cua nghien ciru nay, tuy nhien ket qua deu am tinh. Day la vu djch nghi ngd do cum, nen cac xet nghiem sang Ige bd sung da dirge tidn himh nhiim phat hien cac tac nhan vi nit khac. Ket qua cho thay cd 2 mau duo'ng tinh vdi coronavirus NL63 (Hinh 1). Day la mdt loai vi nit mdi dugc phat hien trong nhiing niim gan dtiy X'a cimg hg vdi coronavirus OC43, 229E, SARS vaHKUl.
fy Ic hicn mtic cua HCC thay ddi tuy theo ttic nluin gay benh. Nghien cuu cua Nguyen
fran Hien. Pham Nggc Dinh, fham Chi Diing va cdng su (2002-2005) vd viem dircVng hd hap cap (ARI) tai tinh fhai Binh thtiy rang nguyen nhan gay ARI khac nhau theo khu vuc dja ly va dan cu |7J. 'fai Georgia, Hoa Ky. ti cum la tdc nhan chinh chiem 12.6%). tiep theo la adenovi- rus (11.2%), ciim A (7.3%)), va RSV (6%,). Den vdi quan the trd em. a ciim va RSV la ttic nhan chinh gay ra ARI |2|. fy Ic nuic cao neu tdc nhan la vi riit cum miia nhu ciim miia A/I 11N1, ciim A. Clim B. Vi du, ty Ic mac o mirc rdt cao
dircrc bao cao vdo khoang 20-70%) xdi ciim .\' chi a qux md xa. sd lugng nuiu han che nen ket HIN I dai djch fax Ban Nha. 1918-1919. ciim qua cd thd se cd khac bict neu co cd nuiu km chau d (1957-1958). nhung cd ty Ic tu xong hem. Ket qua khdng cho phep tidn hanh pluin tht^i ttr 1/10.000 den 1/2.000. Ngircrc lai. mdt tich ddng nhiem gitia cac lac nhiin \i rul. lux sd tdc nhan cd tx le mtic thap. nhung tx Ic chet nhien birc'rc diiu cd the phan anh ducrc su luu mac o' mirc cao, vi du ciim gia cam A/115N1. hdnh cua cdc tdc nhan la xj riit giix HCC tiii hRSV. hMPV | 8 | . Nhu vay. kdt qua cua nghien cgng ddng cua cdc hux en khu x uc mien Bac.
ciru na_\' cd kdt qua tuong tir nhu cdc nghien
ciru tru'dc day. Ndi cdch khde. tx Ic hicn mac ' ' • KL I LUAN cua mdt tdc nhan cd thd tiing cao hon neu trung
xdi miia djch xa nhat la dai djch. cu the ty Ic hicn nuic vi nit ciim A/I UN I dai dich cao ho'n so xdi cdc tdc nhdn khde.
fodn bd qud trinh tir luc sdng Icic lam sang, lax benh pluim. dien phieu dieu tra. xtin chuyen va bao quan man tir thuc dja xd phdng thi nghiem. qud trinh xet nghiem. phdn tich ket qua theo tlurcTng qux chuan cua Vien Vc sinh Djch te frung ucrng. C^d cdc chirng ARN tieu chuan dimg Idm man ndi kiem cluing dam bao chat luong. dd tin ctiy cua nghien ciru (gid trj ndi suy). Qua trinh Id) mau tuan thu chat che cac quy djnh hicn hdnh ciia I'd chirc Y td The gicVi ve an toan sinh hcic va y dire trong nghien cuu X sinh. Nghien ciru da ino' rdng phtim x i sang lc)c de pluit hien nguxen nluin gax djch ngoai 4 tdc nluin nghien ciru chinh thirc. Dax la nghien cuu dau lidn tai Vict Nam sang Igc xi nit gax' I ICC ltd cgng ddng. cd su phdi hcyp
^i^ra nidni sdt dich td xd xet nuhiem sinh hoc
Cdc hotit ddng chuxen mdn xa quan ly hd SO' cua nghidn ciru luix deu tuan tlur cdc qux djnh cua qudn ly chat lircrng phdng thi nghiem xd cdc quy djnh cua an loan sinh hgc cua \icn v e sinh Djch te frung u'cmg x a Id chirc \^ te
fhe gic'ri nen sd lieu cua nghien cuu cd dd tin Ciix cao. fx Ic ducmg linh cluing la 63.0%. Cd 3 lac nhan chinh gax ra I ICC dugc lim tluix Id X i nit ciim A. irong dd ciim A/H IN 1 dai djch chiem Ix Ic cao nhdt (53.7%). cum B va hRSV.
khdng phdt hien diicic bat cu trudng hgp ndo bj nuic xi rut ciim A/115N I x a hMPV. Diic bict.
nghien ciru da phdt hien coronavirus NI.63 la nguxen nhan cua mdt vu djch nghi ciim l;ii xa Cam Son. Day la mgi xi rut nuri dtroc phdt hicn giin day. fdc nluin xuat hicn nhieu xao dmh miia dich (thimg 9-12). chiem 34.8%.
tiep theo Id thdng 8/2009 (13.0%). Chu kx xuat hien cua HCC goi x cac bicn phdp kiem sodt va phdng chdng cdc lac nhan. chien lucre I . . . . , - - , - , ,^ ,. tiem chimii vac xin hop Iv theo miia xd theo phan tu xac duih tac nhan gax benh. Do do. ^
lde nluin lidx benh.
ket qua ddp irng cdc gid tri x e khoa hgc. Idm ccr SO' de so sdnh xcri cdc nghien ciru cd diic diem luong ttr nlurng khdng dircyc lidn hanh tai cdng ddng. Nghien cuu ndx ciing gdp pluin ndng cao nting lire ve gidm sdt. ky thutil kiy benh pham.
phdng van benh nhan I ICC cho cdc cdn bd y td cua xa Cam Son. Ben canh. sd lieu cua nghien cuu ducTc thu tluip. lam sach x a kiem soat chat die dam bao mang tinh dai dicn xd cd gia tri ngoai sux.
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UNICl-f X idn tro.
VIRAL CAUSES OF INFLUENZA-LIKE ILLNESS IN CAM SON COMMUNE, CAM GIANG DISTRICT, HAI DUONG PROVINCE, 2009-2010.
Nguyen 'Ihi Thuong, Tham Chi Dung, 'Iran Thi Mai Hung, Nguyen Tran Hicn and Kiyosu 'Liniguchi*
.National Institute of Hygiene and Epidemiology, Hanoi
* National Insthute of Infectious Diseases, Japan
Abstract: A cross-sectional studx on one acute respiratory infection outbreak during Innucnza-likc Illness (11.1) xvith laboratory Augu.st and September of 2009. Viral agents conlirmalion of ihe viral causes by the mo-
lecular biologx techniques xvas conducted in Cam Son commune. Cam Giang district, llai Duong pioxincc for 12 months (April 2009- March 2010). fhe results indicated that overall rate of positixc throat and nose sxxab samples is high (62.9%). xxhile pandemic inlluenza x irus A/H IN 1 accounted for the major cause of ILl (53.7%). the study also found the presence of seasonal inlluenza A. B and hRSV. but absence of hMPV and ax ian inlluenza virus AdlSNl.
In particular, coronax irus Nk63. a ncxx xirus
often actixate and cause the disease during the annual autumn-xx inter period (September to December), comprised of 34.8% and then August (13.0%)). Ihc research provides the significant evidence to understand the circula- tion of X iruses to cause 11.1. fhe xiral causes, therefore, helps recommend relexant vaccina- tion strategics, and strengthen the surveillance sxstcm. the health care system c;ipacilies on 11.1 control and prcxcnlion at commune lexcl.
Key words: viral causes, innnenza-likc strain, xvas found to be the possible ctiologx of illness. Cam Son commune. comii,,inc level