I. Scope of application
This scheme is suitable for the prevention and control of human infection with H7N9 avian influenza in medical and health institutions at this stage, and will be updated in time according to the deepening understanding of the disease and the changes of epidemic situation.
Second, the discovery and reporting of cases.
(A) the definition of the case
1. For the definitions of suspected cases and confirmed cases of human infection with H7N9 avian influenza, please refer to the Diagnostic and Treatment Plan for Human Infection with H7N9 Avian Influenza (Second Edition) 20 13 (Wei Power Generation [20 13] 17).
2. Cluster case refers to two or more confirmed or suspected cases of H7N9 avian influenza (at least 1 confirmed case in the cluster case) found in a small area (such as a family or a community) within 7 days, suggesting that there may be interpersonal transmission or people infected by the same exposure. ?
(2) Discovery and report
All kinds of medical institutions at all levels should ask about the exposure history of poultry or live poultry market in influenza-like cases, with emphasis on personnel engaged in live poultry breeding, slaughtering, sales, transportation and other industries. Suspected cases and confirmed cases of human infection with H7N9 avian influenza should be reported directly through China Disease Surveillance Information Management System within 24 hours and 2 hours respectively. The reported disease category is "Human Infected with H7N9 Avian Influenza" in "Other Infectious Diseases". Medical institutions that do not have the conditions for direct online reporting should report to the local county-level CDC by the fastest means of communication (telephone, fax, etc.). ) and send an infectious disease report card, and the county-level CDC will report directly to the network immediately after receiving the report.
Three. Epidemiological investigation, sampling and detection of cases
(1) epidemiological investigation
After receiving the confirmed cases of human infection with H7N9 avian influenza reported by medical institutions within their jurisdiction, the county-level CDC conducted an investigation according to the epidemiological investigation plan of human infection with H7N9 avian influenza formulated by China CDC.
For a single case, the investigation contents mainly include the basic situation of the case, the onset process, clinical manifestations, laboratory examination, diagnosis and prognosis, the family and home environment of the case, exposure history, close contacts and so on. For poultry breeding or trading places that may expose cases, environmental samples such as poultry droppings and cage swabs should be collected for pathogen detection. When necessary, organize active case search according to the investigation.
For clustered cases, on the basis of the above work, the suspected cases should be investigated immediately, and the exposure history and epidemiological relationship between cases should be investigated emphatically, and the viruses isolated from cases and environmental samples should be analyzed for homology to judge whether there is interpersonal transmission or infection due to * * *.
(2) Specimen collection, transportation and laboratory testing
When medical staff suspect that the patient is infected with H7N9 avian influenza virus, they should collect upper and lower respiratory tract samples (especially lower respiratory tract samples), acute phase serum within 7 days of onset and serum 2-4 weeks from acute phase serum collection as soon as possible.
Medical institutions that have the conditions to carry out nucleic acid detection should carry out H7N9 virus nucleic acid detection on respiratory specimens, make case diagnosis, and guide the early application of antiviral drugs; Medical institutions that do not have the conditions to carry out nucleic acid detection should use rapid antigen detection reagents to carry out influenza A virus antigen detection as soon as possible, and send positive samples of influenza A virus antigen detection to the local influenza surveillance network laboratory to further carry out H7N9 virus nucleic acid detection. Specimen collection, packaging, transportation, etc. Should be strictly in accordance with the "Regulations on the transportation management of highly pathogenic microorganisms (viruses) that can infect human beings" (Order No.45 of the Ministry of Health) and other biosafety related regulations. Network laboratories with BSL-3 biosafety conditions immediately carry out virus isolation and send the isolated virus to the National Influenza Center in time as required; Network laboratories that have not carried out virus isolation should send the original samples of H7 nucleic acid positive cases to the National Influenza Center in time as required.
The serum samples collected by medical institutions are sent to the local influenza surveillance network laboratory, and the local network laboratory sends the serum samples to the provincial CDC and the National Influenza Center for antibody testing.
For specific operation points, please refer to the strategy of specimen collection and laboratory detection of human infected H7N9 avian influenza virus formulated by China CDC.
Four. Information report
All kinds of medical institutions at all levels and relevant personnel should fill in the infectious disease report card according to the regulations after discovering the suspected or confirmed cases of human infection with H7N9 avian influenza, and report it directly through the network of China disease surveillance information management system. For confirmed cases, the medical institutions reporting cases should also fill in the patient's condition change information daily through the information management system of human infection with H7N9 avian influenza, and fill in the Questionnaire of Human Infection with H7N9 Avian Influenza-Clinical Part online within 24 hours after discharge or death (see the Epidemiological Investigation Plan of Human Infection with H7N9 Avian Influenza for details). For death cases, it is necessary to fill in the relevant contents of the death medical certificate carefully and report it directly through the network through the death registration report information system. After completing the preliminary investigation, the county-level CDC in the jurisdiction should fill in the Questionnaire on Human Infection with H7N9 Avian Influenza-Epidemiology (see the Epidemiological Investigation Plan on Human Infection with H7N9 Avian Influenza for details) online, and supplement and improve the information of the questionnaire in time according to the investigation progress, and update the medical observation of close contacts daily.
If the case that has been directly reported through the network is transferred to the hospital for treatment, the medical institution that transferred the case shall input the case transfer information through the information management system of human infection with H7N9 avian influenza. Medical institutions that receive cases should inquire and verify case information through the above system, and enter case treatment.
Once the cluster case is diagnosed, it should be reported directly through the network through the public health emergency reporting management information system within 2 hours, and make a progress report and a closing report in time according to the progress of the incident.
When carrying out laboratory tests, the CDC should input the specimen information and test results into the China Influenza Surveillance Information System in time.
Verb (abbreviation of verb) case management and infection prevention
Medical institutions should refer to the Technical Guide for Hospital Infection Prevention and Control of Human Infected with H7N9 Avian Influenza (20 13 Edition) (Wei Power Generation [2065438+03] No.6) and implement measures such as patient isolation, hospital infection prevention and control, and medical personnel protection.
When carrying out epidemiological investigation and sample collection, the personnel of disease control institutions shall do a good job in personal protection, and guide the poultry-involved practitioners and the disposal personnel of infected poultry to do a good job in personal protection.
Six, suspicious exposure and close contact management
(1) Management of suspected exposure
Suspicious exposure refers to people who are exposed to poultry and the environment that are positive for H7N9 avian influenza virus and have not taken effective protection during exposure.
County health (health and family planning) administrative departments shall, jointly with relevant departments of agriculture, industry and commerce, transportation and so on. Inform the health of the suspected exposed persons, instruct them to seek medical advice in time when they have symptoms of acute respiratory infection such as fever (underarm temperature ≥37.5℃) and cough, and actively inform them of contact with poultry.
(2) Management of close contacts
Close contacts refer to medical personnel who have not taken effective protective measures during the diagnosis and treatment of suspected or confirmed cases or their families who have taken care of the patients; Persons who had lived together or had other close contact with patients before the onset of suspected or confirmed cases 1 day to isolation treatment or before death; Or other personnel who need to be managed as close contacts as judged by the on-site investigators. County-level health (health and family planning) administrative departments organize follow-up and medical observation of close contacts, and take temperature 1 time every morning and evening to find out whether there are symptoms of acute respiratory infection. Body temperature measurement can be carried out by close contacts themselves or by medical and health institutions. The medical observation period is 7 days after the last exposure or contact with cases without effective protection.
Once close contacts have symptoms of acute respiratory infection such as fever (underarm temperature ≥37.5℃) and cough, they will be immediately transferred to local designated medical institutions for diagnosis, report and treatment. When close contacts have acute respiratory symptoms, they should also collect their throat swabs and send them to the local influenza surveillance network laboratory for testing.
Seven. Intensive surveillance of influenza-like cases
Counties (districts) with confirmed cases of human infection with H7N9 avian influenza should carry out intensive monitoring for 2 weeks after the case is confirmed. All secondary and above medical institutions should collect respiratory tract samples from emergency patients who meet the definition of influenza-like cases and hospitalized patients with severe acute respiratory infection in time, ask about the exposure history, and carry out relevant tests according to the strategy of sample collection and laboratory detection of human infection with H7N9 avian influenza virus formulated by China CDC. Each medical institution collects and reports the total number of influenza-like cases, the total number of inpatients with severe acute respiratory infection, the number of samples, the number of people tested in our hospital, the number of people sent to disease control institutions for testing, the number of positive cases and positive results every week. The specific reporting method refers to the relevant technical requirements of the enhanced monitoring information report issued by China CDC. All localities can appropriately expand the monitoring scope and time according to the work situation.
In areas where there are no cases of human infection with H7N9 avian influenza, the monitoring intensity should be improved on the basis of previous influenza-like cases. In 20 13, the number of samples collected and tested has increased. Hospitals in southern province collect 20 samples of influenza-like cases and cases related to human infection with H7N9 avian influenza every week, 20 samples in northern province from April to September, and 20 samples in 10- March of the following year, and send them to the local influenza surveillance network laboratory for testing.
Eight, timely carry out epidemic research.
Health (health and family planning) administrative departments at all levels should promptly organize experts to judge the epidemic situation according to the epidemic situation of human infection with H7N9 avian influenza, pathogen monitoring and research progress. When the emergency standard is reached, the corresponding emergency response mechanism shall be started in time according to the relevant plan, and the response shall be terminated in accordance with the relevant provisions.
Nine, do a good job in health education.
All localities should actively carry out public opinion monitoring, focus on hot issues of public and social concern, actively do a good job in epidemic prevention and control knowledge publicity and risk communication, guide and promote the public to develop good health habits, especially to strengthen health education and risk communication for people engaged in live poultry breeding, slaughtering, trafficking, transportation and other industries.
Ten, strengthen the training and supervision and inspection of medical personnel.
Medical and health institutions should carry out training in the discovery and reporting of human cases infected with H7N9 avian influenza, epidemiological investigation, specimen collection, laboratory testing, case management, infection prevention and control, risk communication and other contents.
Health (health and family planning) administrative departments at all levels are responsible for organizing supervision and inspection of prevention and control work within their respective jurisdictions, and handling problems in a timely manner when found.
Eleven, vigorously carry out patriotic health campaign.
Ivy at all levels should give full play to the role of deliberation and coordination, strengthen organization, management, supervision and inspection, mobilize the masses and grass-roots units in combination with the activities of creating sanitary towns, and carry out in-depth centralized rectification actions of urban and rural environmental sanitation. Efforts should be made to strengthen the health management of farmers' markets and solve the outstanding health problems existing in live poultry sales and slaughter.