湖北省首例人感染H5N6禽流感病例流行病学调查

Epidemiological on the first human case with avian influenza A （H5N6） virus in Hubei Province

目的对湖北省首例人感染H5N6禽流感病例的流行病学资料进行分析，探讨病例发现过程、调查处理措施、实验室检测方法，为防控人感染H5N6禽流感疫情提供依据。方法采用描述性流行病学方法，分析湖北省首例人感染H5N6禽流感病例诊治过程、密切接触者信息，开展现场流行病学调查，并采集病例、密切接触者、活禽市场外环境标本进行实验室检测分析。结果患者2016年4月9日发病，体温40℃，有活禽市场暴露史。发病早期采集的下呼吸道标本（痰液、气管分泌液）为H5N6禽流感病毒核酸阳性，而上呼吸道标本H5N6禽流感病毒核酸检测均为阴性。患者无外出史和H5N6禽流感病例接触史。患者经两个月的治疗痊愈出院。密切接触者58人均未出现发热和呼吸道感染症状。采集病例经常路过的两家活禽市场和一家土鸡专卖店外环境标本共36份，其中检出H5N6禽流感病毒核酸11份，阳性率为30．56％。结论该病例为湖北省首例人感染H5N6禽流感病例，属本地感染的散发病例，未出现人传人。传播途径可能为：活禽市场通过禽-环境-人的途径传播。在病例诊断中，下呼吸道标本（尤其是痰液、气管分泌液）具有重要意义。另外，尽早应用奥司他韦对病例的成功救治起到了重要的作用。

Objective To analyze the epidemiological, diagnostic and clinical data of the first human case with avian influenza （H5N6） virus in Hubei Province for better understanding of measures in the prevention and control of human avian influenza in the future. Methods The diagnostic data and clinical treatment process of the case, as well as the data of closed contacts were analyzed by descriptive epidemiological methods. The epidemiological survey for the sources of infection was carried out, and the samples of the case, close contacts and environmental samples from the live poultry market were collected and were tested by laboratory detection methods. Results On April 9^th, 2016, the patient developed fever with the highest body temperature of 40℃. He had a history of exposure to live poultry. The lower respiratory tract samples of the case were positive for the nucleic acid of avian influenza A （H5N6） virus. However, the specimens from upper respiratory tract were negative. The patients had no history of travelling or closely contacting with avian influenza patients. After two months of treatment, the patient recovered and discharged from the hospital. No fever or respiratory infection sign was observed from the 58 close contacts. Eleven samples out of 36 samples collected from two livestock markets and one chicken shop where the patient usually passed by were positive for nucleic acid of avian influenza A （H5N6） virus with a positive rate of 30.56%, Conclusions This was the first local human case with avian influenza A （H5N6） virus infection in Hubei Province. No human-to-human transmission was found. This investigation showed that the possible transmission route was birds-environment-human. The lower respiratory tract samples have their significance on case diagnosis. Meanwhile, earlier treatment with Oseltamivir played an essential role in the recovery of the case.