I.
To ensure the health of all employees, prevention and control of blood contact and infected with disease.
II. Scope of application
This procedure applies to all employees. (First aiders, security guards and others who may come into contact with the injured
Special attention).
III. Responsibilities
The EHS Committee is responsible for the awareness and handling of blood-borne diseases.
IV. Working Procedures
4.1 First aiders are required to wear disposable gloves when operating.
4.2 Security guards, dormitory managers and other personnel assisting in first aid need to rinse their hands or other exposed parts with plenty of water afterwards.
4. 3 blood-stained medical waste should not be discarded arbitrarily, and regularly sent to the hospital for destruction.
4.4 Educate employees to pay attention to personal hygiene and develop good living habits to prevent diseases.
4. 5 Local epidemic prevention stations and hospitals telephone numbers:
V. Related knowledge
5.1 AIDS transmission channels and prevention methods
5.1.1 Definition and description
AIDS medical name: "Acquired Immunodeficiency Syndrome", the acronym "AIDS", is caused by the human body infected with Human Immunodeficiency Virus, namely, the human immunodeficiency virus (HIV) caused by the immune deficiency syndrome.
Most people infected with HIV remain healthy and live for years with no symptoms or only mild illness. Even when they look healthy and feel healthy themselves, they are still able to transmit HIV to others and remain infectious for life.
HIV is strictly host-specific and can infect humans and cause AIDS. Under experimental conditions, HIV-1 infects chimpanzees and HIV-2 infects rhesus monkeys, resulting in pathologic hemorrhagic disease and seropositivity, but does not cause disease in animals. The virus can be isolated from peripheral blood, semen, breast milk, cerebrospinal fluid, saliva, tears, and other body fluids of HIV-infected individuals, but there are no reports of HIV infection through tears, saliva, or juices. HIV is generally transmitted through blood, semen, and body fluids,
5.1.2 Routes of Transmission
(1) Sexual transmission, which occurs through sexual activity among homosexual men and heterosexuals, and through artificial insemination.
(1) sexual transmission, through sexual intercourse between men who have sex with men and between heterosexuals, and also through artificial insemination;
(2) blood transmission, through the acceptance of blood or organs donated by HIV-infected people, the use of HIV-contaminated blood dye products, or the use of injecting needles with HIV-infected people ****, in addition, the occupational risk of HIV infection of medical personnel and laboratory workers who are in contact with the body fluids of HIV-infected people or HIV cultures;
(3) transmission, through sexual intercourse between men who have sex with men and between heterosexuals;
(3) Mother-to-child transmission, in which HIV-infected mothers can transmit HIV to their newborns in utero or during labor and delivery (Connor, 1997). Otherwise, there is no need to be overly sensitive or fearful about the fact that human-to-human contact does not cause HIV transmission.5.1.3 How to prevent AIDS
5.1.3.1
AIDS is a serious infectious disease with a high mortality rate, for which there is no cure, but which can be prevented. HIV is mainly found in the blood, semen, vaginal secretions, breast milk and other body fluids of infected people, so it is transmitted through three ways: sexual contact, blood and mother-to-child transmission. It takes five to ten years for most infected people to become sick, and they usually die within two to three years of the onset of the disease. People living with HIV and AIDS will not get infected through daily life and work contacts (such as shaking hands, hugging, ****eating together, ****tools, office tools, etc.). HIV will not be transmitted through public ****facilities such as toilet seats, telephones, food and beverage bureaus, bedding, swimming pools or public ****bathrooms, or through coughs, sneezes, mosquito bites, and other means. Cleanliness and sexual morality are fundamental measures to prevent sexual transmission of HIV.
5.1.3.2 In view of the different modes of transmission, scientists suggest that the following measures should be taken:
(1) Prevention of sexual transmission of AIDS
Cleanness and self-love, maintaining faithful and single sexual relations;
Correct use of condoms when engaging in risky sex;
Treatment of sexually transmitted diseases in a timely manner.
(2) Preventing blood transmission of AIDS;
Not using untested blood and blood products;
Not taking drugs or using needles with other people;
Avoiding unnecessary blood transfusions, injections, unsafe dental extractions and cosmetic treatments that don't have strictly sterilized instruments;
Piercing of the ears or the body, tattooing, needle sticking, or any kind of invasive puncture therapy. or any procedure that involves invasive piercing of the skin, carry a certain risk of HIV transmission.
(3) Prevention of mother-to-child transmission
Pregnant women who are infected with the virus can transmit the virus to their fetus or newborn baby through pregnancy, childbirth and breastfeeding, with a chance of about 15 to 40 percent. The HIV virus can be transmitted during pregnancy, childbirth or breastfeeding after the birth of a child. If a pregnant woman suspects that she is infected with HIV, she should seek medical advice as soon as possible to make appropriate arrangements, and she should not breastfeed her baby to minimize the chance of infection.
a. HIV-infected women should avoid pregnancy, and if they become pregnant, they should have an abortion.
b. The use of antiretroviral drugs before and after delivery can reduce the chance of mother-to-child transmission.
c. Artificial feeding can also reduce the risk of HIV infection.
5.2 Prevention of atypical pneumonia
5.2.1 Definition and brief description
Severe Acute Respiratory Syndrome (SARS) (formerly known as Atypical Pneumonia) has become a worldwide epidemic. According to WHO statistics, as of April 14, the number of SARS cases in the world had reached a total of 3169 cases and 144 deaths in 21 countries***. In particular, China (1,418 cases, 64 deaths) and Hong Kong (1,190 cases, 47 deaths) have the highest number of cases.
This is a syndrome, not a specific diagnosis, and other causes of pneumonia, as well as adult-onset respiratory distress syndrome, need to be screened for and ruled out.
The cases of SARS that have been detected so far are mainly through droplet transmission, and most of the infected people are relatives who have had close contact with the cases, as well as health care workers who are responsible for caring for the patients. The main symptoms are fever, dry cough, headache, muscle pain, and respiratory symptoms.
5.2.2 Clinical manifestations of SARS
According to the WHO bulletin, the clinical manifestations of SARS are as follows: the majority of cases occur between the ages of 25 and 70 years, with a very small number of patients younger than 15 years. The incubation period is usually 2 to 7 days, but can be as long as 10 days. The illness is usually preceded by a fever (>38°C), usually hot, sometimes with chills and shivering; it is sometimes accompanied by other symptoms, including headache, lethargy and muscle pain. Some patients may develop mild respiratory symptoms. There is usually no rash and no neurologic or gastrointestinal symptoms, but some patients develop diarrhea with the fever, and the lower respiratory phase begins in 3 to 7 days with a dry cough without sputum or with low oxygen levels due to respiratory distress. In 10-20% of patients, the respiratory problems are severe enough to require intubation and use of a respirator. The lethality rate for those who meet the current World Health Organization definition of a probable and suspected case of SARS is about 4 percent.
The risk of transmission during the incubation period (2 to 10 days) and the first days of illness (1 to 2 days) is fairly low. The risk of infection is greatest when symptoms are fully present (lower respiratory phase), especially when there is a severe cough, shortness of breath, and hypoxia.
Ninety percent of patients have influenza-like symptoms for about 6 to 7 days during the illness, after which they recover completely.
5.2.3 How SARS is spread
a. Aerosol route
The CDC's chief medical officer, Dr. Julie Gerberding, said that most of the cases, in fact, were contracted through contact with sick people in their homes or direct contact between health care workers and infected people or their bodily fluids. This means that SARS is transmitted through droplets of mucus or other bodily fluids," said Dr. Julie Gerberding, the CDC's officer-in-charge. It is very difficult to recognize droplets, which must be in close proximity and have a range of dispersal. To be safe, the CDC recommends that healthcare workers and others wear masks when in close contact with patients, and that suspected SARS patients be isolated according to treatment guidelines. Currently, cases of the disease are primarily acquired through close contact with people who have been infected with SARS. Close contact means handling or exposure to the patient's body secretions (nasal mucus, urine, feces).
b. Air-borne
Possible conduit of transmission, which is only different from droplet transmission as described above.
c. Fecal-oral route
Possible conduit of transmission, which may be closely related to the transmission of the Amoy Gardens community case in Hong Kong.
5.2.4 Etiology of SARS
The CDC (Centers for Disease Control) in the United States has indicated that a "coronavirus" was isolated in cell culture, but that its characteristics differed significantly from the other three known genera of the Coronaviridae family, and that it would probably need to be categorized as a fourth genus. The virus was also present in lung and kidney tissues of non-recovering patients, and the "absence" and "presence" of antibodies were confirmed in three patients from whom serum was available in the acute and recovering phases, respectively. This evidence strongly supports the hypothesis that the new coronavirus is the causative agent of SARS.
The SARS storm has swept across the world, and since it has been confirmed that the coronavirus mutation is the cause of the problem, parents should understand that the SARS disease will increase or decrease in severity depending on the degree of mutation of the coronavirus. At present, the Department of Health has already requested the U.S. to test the control viruses, so that as long as the gene sequencing is completed and compared, the correct diagnosis will be made for the patients suspected of being infected in order to eliminate the panic of the SARS disease. A few days ago, the U.S. CDC has completed the sequencing of the gene profile of the SARS virus.
The coronavirus has about 20,000 to 27,000 pairs of genomes, and the Department of Health used 400 pairs of genomes as a "primer" and found that the SARS coronavirus is different from the common human coronavirus, with a degree of mutation of 30% to 40%, while the U.S. report said that the degree of mutation is up to 50% to 60%.
5.2.5 Diagnostic methods for SARS
SARS is an emerging infectious disease, and its diagnosis is based on a combination of epidemiologic, clinical, and laboratory test data, rather than a single test result.
1. Chest X-ray:
Chest X-ray may be normal during the prodromal symptoms of fever or even throughout the course of the disease. However, in most patients, the respiratory period is characterized by a progression from an early localized infiltrate to a more generalized, patchy, interstitial infiltrate, and in some patients with advanced SARS, partial parenchymalization may be seen on chest radiography.
2. Laboratory tests:
Lymphocyte counts are usually decreased early in the course of the disease, and overall white blood cell counts are usually normal or decreased. At the height of respiratory disease, more than half of patients will have leukopenia and thrombocytopenia, or normal but slightly low platelet counts (50,000-100,000/microliter).
Till now, there is no test method to confirm SARS cases worldwide, and from the test results of SARS cases at home and abroad, some of the cases show the coexistence of multiple pathogens, so it is not appropriate to use the results of coronavirus molecular testing as a basis for judging a "confirmed case" or for preventive and curative measures, until the causative mechanism has been fully understood. The results of the molecular testing of coronaviruses should not be used as a basis for determining "definite cases" and preventive measures.
5.2.6 Treatment of SARS
The vast majority of cases (96%) pass through the observation period without respiratory complications and recover completely. Treatment includes a variety of antibiotics for the treatment of known bacterial SARS. In many areas, treatment also includes antiviral agents such as oseltamivir or ribavirin, oral or intravenous steroids, and has been used in conjunction with ribavirin and other antimicrobial agents, and the use of immunoglobulin has been documented in Taiwan. However, to date, the most effective treatment has not been found.
The mortality rate is about 4%, especially in people over 40 years of age or with underlying medical conditions (e.g., coronary artery disease, diabetes mellitus, asthma, and chronic lung disease).
5.2.7 Persons to be quarantined and precautions to be taken
Only persons who have been in contact with SARS patients should be quarantined at home, even if they are not symptomatic. They should be isolated at home from the first day of exposure until the tenth day.
The following precautions should be taken during home isolation:
*Stay at home, do not leave the premises and do not let anyone visit you. Members of your household do not need to be quarantined unless a member of your household has been diagnosed with SARS infection.
＊Wear a mask when you are in the same room as another member of your family.
＊Change your mask as instructed; no member of your household is required to wear a mask.
＊Do not use personal items such as towels, cups or cutlery with others***.
*Wash your hands frequently.
＊Sleep in separate rooms.
＊Measure your temperature with your own thermometer twice a day for ten days. Do not use the thermometer with other members of the household***.
＊Call the Department of Health immediately if any member of the family has a fever (over 38°C or 100.4°F), muscle aches, is very tired, has a dry cough, has shortness of breath, has a severe headache, or feels sick.
5.3 Avian Influenza
5.3.1 Definition and Description
Avian Influenza is an acute infectious disease caused by the avian influenza virus, which is also capable of infecting human beings. Symptoms of infection are mainly characterized by high fever, coughing, runny nose, and myalgia, most of which are accompanied by severe pneumonia, and in severe cases, heart, kidney, and other multiple organ failure leading to death, and the case fatality rate is very high. This disease can be transmitted through the digestive tract, respiratory tract, skin damage and conjunctiva and other ways, people and vehicle traffic is an important factor in the spread of the disease.
5.3.2 Common Symptoms
The symptoms of avian influenza vary according to the species of infected birds, age, sex, degree of co-infection, viral virulence and environmental factors, etc., and are mainly manifested as respiratory, gastrointestinal, reproductive or neurological abnormalities.
Common symptoms include depression, reduced feed consumption, and lethargy; increased nesting in hens and decreased egg production; mild to severe respiratory symptoms, including coughing, sneezing, and profuse tearing; edema of the head and face; neurological disorders; and diarrhea.
Any of these symptoms may occur alone or in different combinations. Sometimes the outbreak of disease is so rapid that chickens are found dead when there are no visible symptoms.
Also, the morbidity and mortality of avian influenza varies widely, depending on the species and strain of bird as well as age, environment, and co-infections, with the usual picture of high morbidity and low mortality. In highly pathogenic virus infections, morbidity and mortality can be as high as 100 percent.
The incubation period of avian influenza ranges from a few hours to a few days, and its length is related to the pathogenicity of the virus, the dose of the infecting virus, the route of infection, and the species of the infected bird.
5.3.3 Main routes of transmission of avian influenza
1. According to WHO, feces is the main channel of transmission of avian influenza.
2. The World Health Organization (WHO) said on 16 November that avian influenza, which has killed at least four people in Vietnam, is spread mainly through poultry feces, not cooked meat.
3. The WHO said the H5N1 strain of bird flu in the feces of sick chickens is airborne and carried by the wind, AFP reported. Chickens placed in narrow cages stacked one on top of the other can easily spread bird flu through their feces. Chicken keepers are also at risk of inhaling the virus. However, WHO spokesman Fadl? Shayb said it was almost impossible to get sick from eating cooked sick chicken meat. "The virus is cooked to death," he quoted a WHO expert as saying. He emphasized that cooking the chicken before plucking it would also destroy the virus.
4. WHO warned that people are equally at risk no matter what kind of sick chicken they come into contact with. Only a small number of infected poultry survive, and those that do will excrete virus-laden feces for at least 10 days.
5. The World Health Organization (WHO) released a report on the investigation of avian influenza viruses on the 15th, saying that the causative viruses of avian influenza in Japan, South Korea, and Vietnam are all H5N1 influenza A viruses.
5.3.4 Symptoms of the disease
After humans suffer from avian influenza, the incubation period is generally less than 7 days, the early symptoms and other influenza is very similar to the main manifestations of fever, runny nose, nasal congestion, coughing, sore throat, headache, general malaise, some patients can be nausea, abdominal pain, diarrhea, dilute watery stools and other gastrointestinal symptoms, some patients can be seen conjunctivitis, the majority of the body temperature persisted in 39 degrees Celsius or more, some patients chest Some patients may also have unilateral or bilateral pneumonia on chest X-ray, and a few patients may have pleural effusion. Most of the patients are cured well without sequelae, but a few patients, especially those who are older and too late for treatment, will rapidly develop progressive pneumonia, acute respiratory distress syndrome, pulmonary hemorrhage, pleural effusion, pancytopenia, renal failure, septic shock, and Reye's syndrome and other complications and death. Experts recommend that patients should seek medical attention as soon as the above symptoms occur, and once suspected of H5N1 virus infection, should be hospitalized immediately to isolate and report the outbreak, to prevent the deterioration of the condition and the spread of infection.
5.3.5 Susceptible populations
■Highest risk groups: those in close contact with birds with avian influenza
Special protection is required for workers in close contact with poultry infected with avian influenza. The special protection requirements are to wear normal overalls, a protective jacket (isolation suit), a protective mask, medical disposable latex gloves, and boots or sterilizable protective footwear.
The World Health Organization also recommends that these personnel be vaccinated against influenza in a timely manner, and thoroughly disinfect and wash their hands before and after work.
■Sub-high-risk groups: people who occasionally come into contact with birds
Besides the above groups, there are also many people who like to keep pets such as wild fowl, pigeons and birds. In the current period of avian influenza pandemic, in order to be safe, the first thing you should do is to minimize contact with pet birds. If it is not possible to minimize, attention should be paid to disinfection, and cages should be disinfected regularly; if one's hands come into contact with live birds or are soiled by bird secretions, they should be washed thoroughly with soap and water, and preferably properly disinfected as well.
If flu-like symptoms develop within 7 days of exposure, it is important to seek medical attention and tell medical personnel the history of exposure so that it can be handled properly.
Family tips for a complete manual to combat bird flu
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Fourteen ways to disinfect against bird flu
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■High-risk groups: those who have frequent contact with poultry
People who have frequent and close contact with live poultry, including those engaged in breeding, sorting, transportation, sales, slaughtering work and disposal of dead poultry, as well as professionals who carry out final disinfection of the premises concerned. These personnel should wear protective clothing, masks, timely vaccination against influenza, thorough disinfection before and after work, hand washing, etc.; to avoid direct contact with sick birds and their excreta and secretions.
Experts suggest: more intake of vitamin C and other foods and drugs that help improve immunity, and appropriate physical exercise, can enhance the body's resistance to the virus.
The onset of avian influenza is so rapid that many poultry die before they can see any symptoms. Therefore, if you suspect that their own chickens, ducks, or found that the sudden death of poultry for unknown reasons, should be reported as soon as possible to the Department of Animal Epidemiology, by them to diagnose and take the necessary measures such as disinfection.
■ Can the virus be transmitted from person to person?
Once the bird flu virus is recombined with a human virus, it could theoretically be transmitted from person to person. At that point, the virus would become a human virus, as if it were a flu virus.
One biological feature of the recombination of the two viruses is that the bird flu virus mutated in the first place. But bird flu is still a brand-new virus for humans, and to what extent it will mutate as it spreads is anyone's guess. Professor Shi Guangfeng, chief physician of the Department of Infectious Diseases at Huashan Hospital affiliated with Fudan University and vice chairman of the Infectious Diseases and Parasitic Diseases Committee of the Shanghai Medical Association, said that if all medical practitioners remain profoundly vigilant and pay attention to the development of the disease, it will not be impossible to find a pattern of epidemics and prevention and treatment methods.
■ ■ The case fatality rate of people with avian influenza
In 1997, Hong Kong's H5N1 avian influenza virus infection led to the illness of 18 people, of whom 6 died; Vietnam has been confirmed since October this year, there have been 8 cases of confirmed diagnosis, 6 deaths, in addition to the 2 deaths of suspected cases. The death rate is as high as 80%, much higher than that of SARS patients. According to the statistics of the World Health Organization (WHO), in 2003, more than 8 000 people in more than 30 countries and regions were infected with the SARS virus, and more than 700 of them died, with a case-fatality rate of only about 9%. Avian influenza has caused a great threat to human beings, for which we recommend, in particular, the following protective measures for reference:
5.3.6 The World Health Organization recommended protective programs
(1) Use of protective equipment: poultry slaughter, transportation should use protective clothing, rubber gloves, N95 mask (if there is no N95 mask, should use a standard surgical mask), eye protection, and rubber boots.
(2) Hand washing: All close contacts of infected birds should wash their hands frequently with soap.
(3) Disinfection: the environment of the poultry slaughtering premises should be disinfected, and the slaughterers and transporters of poultry should disinfect their hands afterwards.
(4) Surveillance: All persons exposed to diseased chickens or monitored farms should be closely monitored by the local health department. In addition, poultry slaughterers, other persons involved, and members of their families should be monitored. These persons should promptly report respiratory distress, cold symptoms, or symptoms of eye infection to their health care provider. People at high risk of influenza, such as those over 60 years old and those with coronary heart disease or lung disease should avoid contact with sick chickens.
(5) Collection: Whole blood specimens, viscera, etc. of sick poultry should be collected for isolation of possible new viruses.
■General public: those who do not come into contact with birds
The chances of the general public being infected with avian influenza are negligible. Judging from the spread of avian influenza, it is mainly prevalent among birds, so people should not panic about this disease. Avian flu can be completely controlled to a minimum through strict sterilization, isolation, blockade and effective preventive measures.
Since there is no corresponding vaccine and winter and spring seasons are the high incidence of acute respiratory diseases, experts reminded the public that a healthy lifestyle is very important to prevent the disease.
■To prevent bird flu, the first treatment of human influenza
While "human influenza" and "bird flu" is not exactly the same thing, but once the virus between the two genetic conversion, resulting in a new type of influenza viruses, there will be a massive outbreak of Influenza. Controlling human influenza and minimizing the chance of genetic recombination with avian influenza viruses can reduce the chance of human illness, and September-November is the golden time for vaccination. Keywords: Recommended Vaccination Population
People in units with poor ventilation and relatively high concentrations of people should be vaccinated. In addition, workers in nursing homes, elderly care centers, and child care facilities, service industry workers, and those who travel frequently on business or at home and abroad are among those recommended for vaccination.
Keywords: key vaccination population
Infants and young children aged 6-35 months; elderly people over 60 years old; patients with chronic diseases; staff of health care institutions, especially front-line staff; elementary school students and kindergarten children. Children, the elderly and people with chronic diseases in the family, this part of the population in the late stage of influenza infection is prone to serious complications such as pneumonia, myocarditis, otitis media, and even life-threatening. Healthcare workers also belong to the key vaccination population.
Keywords: contraindication vaccination population
Egg allergy or chronic diseases are in acute episodes of people, acute infectious diseases, mental illness, severe epilepsy and schizophrenia, as well as pregnant women and patients with fever is best not to inject. Injections for infants need to be judged by a doctor first. People with severe allergies should not be vaccinated; inactivated whole-virus vaccines should not be used in children under 12 years of age.
5.4 Causes, symptoms and treatment of dengue fever
5.4.1 Overview
Dengue fever is an acute infectious disease caused by dengue virus and transmitted by Aedes mosquitoes. Clinical features are acute onset, high fever, generalized muscle, bone marrow and joint pain, extreme fatigue, some patients may have rash, bleeding tendency and lymph node enlargement.
The disease was discovered in 1779 in Cairo, Egypt, Jakarta, Indonesia, and Philadelphia, U.S.A., and was named Arthritis Fever and Fracture Fever according to the symptoms. 1869 by the Royal College of Physicians in London, U.K., the disease was named Dengue Fever. 20 centuries, dengue fever in the world has occurred in many pandemics, with millions of cases. It has been endemic in Southeast Asia. In 1978, dengue fever became endemic in Guangdong, and type IV dengue virus was isolated. Since then, in 1979, 1980, 1985, small epidemics in the isolation of Ⅰ, Ⅱ, Ⅲ type of virus.
5.4.2 Etiology
Source of infection: patients and latently infected people are the main sources of infection, and no healthy carriers have been found. Patients have significant viremia from 6 to 8 hours before the onset of the disease to day 6 of the disease course, which can infect the biting Aedes mosquito. During the epidemic, the number of mild patients was 10 times that of typical patients, and the number of latently infected people was 1/3 of the population, which may be an important source of infection. Monkeys in the jungle mountainous areas and certain domestic animals in the city, although there is serologic evidence of infection with dengue virus, have not yet been able to be identified as a source of infection.
Transmission vector: Aedes aegypti mosquitoes, known 12 kinds of Aedes aegypti mosquitoes can spread the disease, but the most important is Aedes aegypti and Aedes albopictus. Guangdong and Guangxi are mostly transmitted by Aedes albopictus, while Aedes aegypti dominates the Leizhou Peninsula, coastal Guangxi, Hainan Province and Southeast Asia. Aedes aegypti mosquitoes as long as there is infectious liquid contact once, you can get infected, the virus replicates in the mosquito body 8 - 14 days after the infectious, infectious period of up to 174 days. Infectious Aedes aegypti mosquitoes bite the human body, the virus will be transmitted to people. Dengue virus particles were detected in the ovaries of captured Aedes mosquitoes, and it was hypothesized that Aedes mosquitoes may be the storage host of the virus.
Population susceptibility: general susceptibility in newly infected areas. in the 1980 epidemic in guangdong, the minimum age of 3 months, the maximum age of 86 years old, but with the highest incidence of young adults. In endemic areas, residents over 20 years of age, 100% in the serum can be detected anti-dengue virus neutralizing antibodies, and thus the onset of the disease is mostly children.
5.4.3 Symptoms
I. Typical Dengue Fever
(1) Typical Dengue Fever
1. All patients have fever. The onset of the disease is rapid, first chills, followed by a rapid increase in body temperature, up to 40 ℃ within 24 hours. Generally lasts 5 ~ 7d, and then suddenly drop to normal, the heat pattern is irregular, some cases in the third to five d temperature dropped to normal, 1 day later and then rise, known as the bimodal fever or saddle-type fever. In children, the onset of the disease is slower and the degree of fever is lower.
2. Systemic toxemia symptoms Fever is accompanied by systemic symptoms, such as headache, lumbago, especially bone and joint pain is severe, like fracture or broken bone, severe cases affect the activities, but the appearance of no redness and swelling. Digestive symptoms may include decreased appetite, nausea, vomiting, abdominal pain, diarrhea. The pulse rate increases in the early stages and slows down in the later stages. In severe cases, fatigue and weakness are in a state of exhaustion.
3. Rash appears in the course of 3 to 6 days, maculopapular rash or measles-like rash, there are also scarlet fever-like rash, red rash, and in severe cases, it becomes a hemorrhagic rash. The rash is distributed over the whole body, limbs, trunk and head and face, mostly itchy, and lasts for 5-7 days. There is no desquamation and hyperpigmentation after the rash recedes.
4. Bleeding 25～50% of cases have different degrees of bleeding, such as gum bleeding, epistaxis, gastrointestinal bleeding, hemoptysis, hematuria and so on.
5. Other Most cases have superficial lymph node enlargement. About 1/4 cases have liver enlargement and ALT elevation, individual cases may have jaundice and positive bundle arm test.
(2) Mild dengue fever, manifestations similar to influenza, short-term fever, mild body pain, scarce or no rash, often with superficial lymph node enlargement. Because of atypical symptoms, it is easy to misdiagnose or miss the rash.
(C) heavy dengue fever early with all the manifestations of typical dengue fever, but suddenly worsened in 3 to 5 days of the disease, severe headache, vomiting, delirium, coma, convulsions, sweating, blood pressure plummeted, cervical ankylosis, pupil dilatation and other meningoencephalitis manifestations. Some cases manifested as gastrointestinal hemorrhage and hemorrhagic shock.
Two, dengue hemorrhagic fever: divided into two types that is, the milder dengue hemorrhagic fever and the more severe dengue shock syndrome .
(I) Dengue hemorrhagic fever Begins to manifest as typical dengue fever. Fever, myalgia, lumbago, but bone and joint pain is not significant, while bleeding tendency is severe, such as epistaxis, vomiting blood, hemoptysis, urine blood, stool blood. Often there are more than two organs bleeding heavily, bleeding volume is more than 100 ml. blood concentration, red blood cell pressure volume increased by more than 20%, platelet count <100 × 109 / L. Some cases of bleeding volume is small, but the bleeding site is located in the brain, heart, adrenal glands and other important organs and life-threatening.
(2) Dengue shock syndrome has the typical manifestations of dengue fever; during the course of the disease or after the fever subsides, the condition suddenly worsens, with obvious bleeding tendency accompanied by peripheral circulatory failure. Performance of wet and cold skin, fast and weak pulse, progressive narrowing of pulse pressure difference, blood pressure drops or even undetectable, irritability, lethargy, coma and so on. The condition is dangerous, if not timely rescue, can die within 4 to 6 hours.
5.4.4 Examination
Blood routine examination The leukocytes decreased after the disease, and decreased to the low point (2×109/L) in the 4th to 5th d. It returned to normal 1 week after the fever subsided, and the categorized neutrophils decreased, and the lymphocytes increased relatively. Toxic granules and left shift of nuclei were seen. thrombocytopenia was seen in 1/4 to 3/4 of cases, down to 13×109/L.
Urine and cerebrospinal fluid may be mildly abnormal in some cases.
Serological tests commonly used are complement binding test, erythrocyte agglutination inhibition test and neutralization test. Single serum complement binding test potency more than 1:32, erythrocyte agglutination inhibition test potency more than 1:1280 has diagnostic significance. The diagnosis can be confirmed if the antibody potency of double serum in the recovery phase is more than 4 times higher than that in the acute phase. Neutralization test is highly specific, but difficult to operate, neutralization index more than 50 is positive.
5.4.5 Treatment
I. General treatment In the acute stage, bed rest should be provided, fluid or semi-fluid diet should be given, and isolation should be carried out until the fever has completely subsided in the ward with anti-mosquito equipment, and it is not easy to go down to the ground prematurely to prevent the condition from worsening. Keep the skin and mouth clean.
II. Symptomatic treatment
(1) High fever should be based on physical hypothermia. Alcohol rubbing should be avoided in patients with obvious bleeding symptoms. Antipyretic and analgesic agents are not ideal for reducing fever in this disease and can induce hemolysis in patients with G-6PD deficiency, and should be used with caution. For patients with severe symptoms of toxicity, small doses of adrenocorticotropic hormone can be used for a short period of time, such as oral prednisone 5mg 3 times/day.
(2) Maintaining water-electricity balance For those with profuse sweating or diarrhea, patients should be encouraged to take oral rehydration solution; for patients with frequent vomiting, inability to eat or dehydration, and blood volume insufficiency, intravenous fluids should be given in a timely manner; however, patients should be highly vigilant against the reaction of fluids that may aggravate the condition and lead to meningoencephalitis-type cases.
(3) Those who have bleeding tendency can use antiemetic drugs such as Anluo blood, hemostatic minerals, vitamin C and K, etc. For cases of hemorrhage, they should be fed into the bloodstream. For cases of hemorrhage, fresh whole blood or platelets should be imported, large doses of vitamin K1 intravenously, oral Yunnan Baiyao, etc., severe upper gastrointestinal hemorrhage can be oral mephedrone.
(4) Shock cases should be rapidly transfused to expand blood volume, and the addition of plasma and plasma substitute, combined with DIC patients, should not be transfused whole blood to avoid blood concentration.
(E) cerebral cases should be promptly selected 20% mannitol 250 to 500 ml, rapid intravenous injection, while intravenous dexamethasone, in order to reduce intracranial pressure, to prevent cerebral herniation.