Cm gia cm (Avian influenza) Gii thiu chung thiu *AI (bnh Cm gia cm hoc Cm g) l mt bnh truyn nhim gy ra bi virus

cm typ A *Virus cm typ A gy bnh cho cc loi gia cm, d c m, ng vt c v khp th gii, c th ly sang ng cho ngi *Virus cm gia cm thuc h Orthomyxovirus, c dng hnh cu hoc xon, ng knh trung bnh ca ht xon, ng virus t 80 120nm. VR c v bc *VR c mang 2 khng nguyn chnh l hemagglutinin (HA) v neuraminidase (NA) *Nhn ARN c cha 8 on m ho cho 10 protein khc nhau: HA, NA, NP, M1, M2, PB1, PB2, PA, cha on NS1 v NS2 *Thnh phn ho hc ca virus : ARN 0,8-1%, 5-8% carbohydrate, 20% lipid v 70% protein Cn bnh bnh *Phn loi serotype virus cm ch yu da vo cc phn ng huyt thanh hc ca cc protein (ch yu l NP v M1), gm 3 loi : A, B v C *Ring virus cm typ A cn phn subtype da vo HA (gm 16 loi) v NA (gm 9 loi) *Virus cm A thng c t bin gen, to ra subtype mi th t *Drift (tri dt): l loi t bin ca khng nguyn HA hoc/v NA lm thay i nh tnh khng loi t hoc/v i nguyn , gy ra cc v dch nh hng nm, vacxin cn thay i cho ph hp c i *Shift (di chuyn): l s ti t hp gia 2 on gen ca 2 virus cm ng nhim vo 1 t bo to gia on ca ng ra khng nguyn HA v NA hon ton mi, gy ra cc v i dch i *Danh php : vic t tn cho virus cm c quy nh cht ch nh sau : typ (A, B hoc C), ngun gc vic nh hoc vt ch (tr ngi), a l, s chng (nu c), nm phn lp virus v ring cm A phi ch r ngi), a (nu lp subtype H v N *V d : A/g ty/Anh/ 79 (H7N7) *Tnh cht nui cy : *Tim vo xoang niu m phi g 9-11 ngy tui *Mi trng t bo x phi g, thn ch Madin-Darby (MDCK-Madin-Darby Canine Kidney cells), trng thn (MDCK-Madin-Darby cells), gy bnh tch t bo *G (Gallus gallus domesticus), g ty, vt, chut (Mus musculus) *Cc ch s xc nh HPAI : nh *Sau 10 ngy tim 0,2ml nc trng virus pha long 1/10 vo tnh mch g 4-6 tun tui phi lm cht nc 75-100% g th nghim (cht 6-8/tng s 8 g TN); IVPI > 1,2 *Virus H5 hoc H7 khng tho mn iu kin 1, nhng trnh t aa ca HA gn vi ca HPAI iu kin trnh *Virus gy cht 1-5/tng s 8 g TN v pht trin tt trn mi trng t bo x phi g khng c tt trng Trypsin Trypsin *Virus cm c chia thnh 4 nhm cn c vo t l gy cht, triu chng lm sng, bnh tch c *Virus c c lc cao (highly virulent) : gm cc virus HP H5 hoc H7 AI gy bnh cho g, t l c gy cht cao vi cc triu chng th hin hu ht cc c quan, trong c triu chng thn ht quan, triu kinh v h tun hon. T l m v t l cht c th ln n 100% n *Virus c c lc va (moderately virulent) : t l gy cht t 5-97% g con, g . Bnh tch c . Bnh c trng thng gp ng h hp, sinh sn, thn hoc ty. Bnh nng hn nu nh k pht thng ng nng n k virus hoc vi khun gy bnh khc *Virus c c lc thp (mildly virulent) : t l gy cht thp (<5%), c triu chng nh ng h c ng hp v gim t l *Virus khng c c lc (avirulent) : gm cc chng virus khng gy ra dch cm vi cc triu c chng lm sng v khng gy cht g Sc khng ca virus : Sc *V c v bc lipid nn virus cm d b bt hot bi cc cht nh formaldehyde, natri hypochlorite cht 5,25%, axit long , xut 2%c long 2% *Virus khng bn vi nhit , nhit 56-60C virus b mt c tnh trong vi pht; 100C nhit , nhit 56-60 mt c 100 virus b cht ngay. Virus trong nc niu ca phi g bo tn c vi tun 4C; -70C c nc tn c 4 -70 th bo qun virus lu di *Virus tn ti trng mi trng pH ti u t 6,5-7,9. Trong mi trng axit kh nng gy ti trng ti t mi trng

nhim gim nhanh hn trong mi trng kim. im ng in ca virus tng ng vi pH = nhim gim trng i in ca 5,3 *Ngoi t nhin, virus c th sng 105 ngy trong dch tit (ma ng), trong phn: 30-35 ngy tit 4C v 7 ngy 20C. Tht t lnh virus tn ti c 23 ngy 20 Tht ti c Truyn nhim hc Truyn *Phn b dch bnh : *Virus cm phn b khp th gii trong cc loi gia cm , d cm, ng vt c v cm, ng *Loi vt mc bnh : tt c cc loi gia cm nh g, g ty, vt, ngan, ngng, chim ct, iu, chim cnh, cm vt, ngng, iu, chim hoang d u mn cm vi bnh *Virus cm cn gy bnh ng h hp chn, hi cu, c voi, ngi bnh ng cu, ngi *Phn lp c virus t ln (H1N1 v H1N2), chn, chut, th lp c *Phng thc truyn ly Phng thc *Khi gia cm b bnh, virus nhn ln trong ng h hp, tiu ho, tit niu, sinh dc. S truyn ly bnh, ng bnh theo 2 phng thc trc tip v gin tip bnh thc *Trc tip :do con vt mn cm tip xc vi con vt mc bnh thng qua cc ht kh dung c bi tit ht c t ng h hp ng *Gin tip qua phn, thc n v nc ung b nhim hoc qua dng c chn nui, phng tin vn thc nc tin chuyn, cn trng c *Bnh ch yu truyn ngang, cha c du hiu chng minh bnh c th truyn dc (tuy nhin ngi truyn du dc ng ta chng minh trng g bnh c virus) *Chim hoang d c kh nng mang mm bnh v gieo rc mm bnh khp ni, l ngun gc gy mm v khp ngun ra cc trn dch cm g qua cc nm dch *Bnh c th xy ra trn gia cm mi la tui *T l mc bnh v t l cht khc nhau tu thuc vo loi vt mc bnh, la tui mc b nh v c lc ca c virus *HPAI t l cht rt cao (50-89%), c th ln n 100% n Triu chng Triu *Thi gian bnh t 3 14 ngy *Triu chng ph thuc vo rt nhiu yu t : c lc VR, tui g, tnh bit, mi trng (mt , nht c bit, trng (mt , nht , nh sng, thnh phn khng kh c), ch dinh dng, s bi nhim cc VK v VR khc dng, *Quan st thy gia cm cht t ngt, t l cht c th n 100% trong vi ngy cht t n *C cc triu chng ng h hp : th kh kh, vy m, chy nc mi, chy nc mt, kh th ng chy nc chy nc *T l gim *Triu chng thn kinh : chuynh chong, run ry *Km n, km vn ng, x lng, cnh x v ng, *Mo, ym sng, hoi t; c nhiu im xut huyt ym hoi nhiu im *C triu chng vim mng kt, a chy (phn trng long hoc trng xanh) *Vt v thu cm khc b nhim VR t biu hin triu chng (nu c : vim xoang, vim m mt, vim mt, ng h hp) ng Triu chng Triu *G x lng, x cnh *Mo, ym sng, tm bm Bnh tch *Bnh gy ra bi virus c c lc thp thy c bnh tch nh ng h hp, vim xoang cata, i khi bi c ng hp, c dch r vim, hoc keo nhy c si huyt hoc m dch *C trng hp ph kh qun do dch thm xut trng *Vim xoang bng Vim *Vim rut cata hoc c si huyt *Bung trng b vim xut huyt, trng non dp v, ng dn trng vim c dch thm xut *Bnh gy ra do cc chng virus c c lc cao thy chng c *Mi b vim tt *Mo ym thm tm, sng dy ln, xut huyt im v hoi t. Khi ct i mo hoc ym thy chng ym xut huyt im ct hoc thy

c mu vng xm, ng nh nh gelatin *M mt v mt ph n, u sng to n, *Xut huyt di da : chn, k mng chn v mt s vng khc nh lng, i huyt di *Xc g bo nhng tht thm v kh tht *Xut huyt v hoi t gan, lch, thn *G : *D dy tuyn, van hi manh trng, nim mc hu mn b vim xut huyt t cata n fibrin rt nng n nng (nhng khng xut huyt nh ng tuyn nh bnh Newcastle) xut nh tuyn bnh *Tu teo, dn do mt nc mt nc *Hoi t c tim v vim c tim, tim bi trong dch thm xut mu vng dch *Vim dnh phc mc v ti kh *Xut huyt di da v c vng i, ngc huyt d ngc *Xut huyt m bng, m bao tim v m mng treo rut *Xut huyt nim mc kh qun v trong kh qun thng cha nhiu m, di qun thng nhiu m, *Ngan, vt : *Mt trong hai l phi lun b vim, xut huyt nng, b gan ho, khi b vo nc th phi bnh b nc chm *Tim bi trong dch thm xut mu vng v b xut huyt im nng dch im *Xut huyt bn trong lng ngc *ng rut cha rt t thc n ng thc Chn on Ch *Ly bnh phm : *Phn lp mm bnh Phn *Gia cm sng : dch kh qun, trc trng hoc phn dch *Gia cm cht : t chc hoc phn *Chn on huyt thanh hc Ch huyt *Huyt thanh Huyt *Phn lp mm bnh Phn *Tim vo phi g 9-11 ngy tui , nui cy trong 4-7 ngy, theo di v *Lm phn ng HA chng minh s c mt ca VR *Xc nh subtype bng khng th c hiu nh c *Xc nh c lc ca VR cn c vo ch s IVPI g 4-8 tun tui c ca c *Phn ng huyt thanh hc Phn *ELISA : ELISA *Xc nh c tt c khng th ca AI, khng phn bit c subtype c bit c *Ch thch hp vi khng th ca g v g ty *Trong vng 1 tun sau khi nhim, ch xc nh c s mu c *AGID (agar gel immunodiffusion test) (agar *Khng xc nh c subtype Khng c *Trong vng 1 tun sau khi nhim, ch xc nh c s mu c *Phn ng huyt thanh hc *HI *L phn ng HTH c hiu ng c *nh c KN H c *Hiu gi HI dng tnh ko di hn ELISA v AGID Hiu *L phn ng chun cho tt c cc mu bnh phm ca gia cm *IFT (Immunofluoresence test) *C th xc nh c KN N c *C th s dng xc nh KT sinh ra do tim vacxin ng chng dng ng *RT PCR (Reverse-transcription polymerase chain reaction) (Reverse-transcription *Cho php xc nh VR vi s lng rt nh nh lng *Khng nh chc chn subtype H5 v H7 cn c vo primer c hiu Khng nh chn c c Cm ngi ngi *H5N1 - severe

*1997 Hong Kong: 18 cases; 6 deaths *2004 Vietnam and Thailand: 45 cases; 32 deaths (30 December 2004) *H9N2 - mild *1999 Hong Kong: 2 cases (mild) *2003 Hong Kong: 1 case (mild) *H7N7 - mild *2003 Netherlands: 89 cases; 1 death *2004 Canada: 2 cases Tnh hnh nhim AI ngi ngi Cm ngi - Triu chng ngi *St cao >38C km theo mt hoc cc triu chng sau: *Ho khan *Kh th *Nhim trng ng h hp Nhim ng *Vim hng, au nhc c hng, nh *Bin chng: *Vim phi, suy h hp, try tim mch, vim no cp, suy mt s chc nng khc. chc *Tt c u c th dn ti t vong. u *Phng bnh: - Tim vcxin phng cm type A (cho ngi gi v tr em 5-12 tui) phng cm ngi - Trnh tip xc vi ngi c du hiu nhim trng ng h hp (ho, vim hng, ht hi, s mi...) vi ngi nhim ng ht s Ra tay thng xuyn Ra thng - Khi tip xc vi gia cm, cn mc qun o bo h che kn, gng tay st trng bng cao su, khu bng khu trang t tiu chun N95, knh mt, ng cao su. t Tamiflu: l thuc duy nht hin nay c tin c kh nng phng v tr cm g. Phi dng thuc hin c phng ngay trong 2 ngy k t khi c biu hin bnh l u tin, theo s rt ngn triu chng cn 1,5 bnh s ngy. Nu bnh tin trin xa hn, thuc khng cn tc dng. Tamiflu cha c kim chng trin thuc dng. c ngi b bnh tim v phi mn tnh hoc suy thn. ngi *Phc iu tr ca B Y t cho php dng 3 loi thuc khng virus l Oseltamivir (Tamiflu), iu Amantadine v Ribavirin. *Hai loi thuc u tin c tc dng c ch s xm nhp ca virus vo t bo ng h hp, v th cn thuc u ng cn c dng sm trong vng 48 gi sau khi khi pht bnh. Loi thuc th 3 c tc dng hn ch s tng c hp ht virus trong t bo *Cc thuc ny ch gp phn hn ch mc nng ca bnh ch khng phi l thuc c tr. Do , mc thuc c tr. cn pht hin sm v p dng cc bin php iu tr tng hp ti cc c s chuyn khoa. bin iu ti s *iu tr sm s mang li li ch lm sng ln nht. Liu oseltamivir c ph chun hin nay iu Liu c hin iu tr sm cho nhng trng hp nh l: iu *Tr em: t 15kg tr xung: 30mg x 2 ln/ngy x 5 ngy * T trn 15 kg n 23 kg: 45mg x 2 ln/ngy x 5 ngy n * T trn 23kg n 40 kg: 60mg x 2 ln/ngy x 5 ngy n * T 40 kg tr ln: 75mg x 2 ln/ngy x 5 ngy *Ngi ln: 75mg x 2 ln/ngy x 5 ngy *Liu cao hn (150mg x 2 ln/ngy ngi ln) v thi gian di hn (t 7 10 ngy) ang c xem xt c cho nhng trng hp nng hn, nhng cn nghin cu thm. Kim sot bnh Kim *Cm bun bn vi cc nc xy ra bnh HPAI nc *Cm vn chuyn gia cm, khoanh vng xung quanh khu vc dch v tin hnh tiu hu gia cm bnh *Tuyn truyn, nng cao nhn thc cho ngi chn nui gia cm v nhn dn v bnh cm gia cm, ngi cm bin php ngn chn bnh xm nhp, ly lan bin chn *Hin ti, vacxin cm gia cm c php s dng ti Vit Nam gm: Vacxin cht chng H5N2 ca hng cm c

Intervet (H Lan), vacxin cht chng H5N2 v H5N1 ca Trung Quc. Vic cung ng vacxin cm gia cm theo k hoch, khng bn vacxin t do trn th trng. trng. *Thi gian tim phng: Tim giai on 1 t nm 2005 n 2006. on n *Ch tim phng, liu lng liu lng * a) i vi g: i vi vacxin cht chng H5N2 ca hng Intervet (H Lan) v Trung Quc, tim ln i vi i ln u t 8 ngy tui tr ln, tim ln 2 cch ln u 4 tun v sau 6 thng tim nhc li. n u tun c l nh * b) i vi vt: i vi vacxin cht chng H5N1 ca Trung Quc, tim ln u t 15 ngy tui tr ln, i vt: i ln u tim ln 2 cch ln u 3 tun v sau 4 thng tim nhc li. ln u * c) Liu lng s dng v cch bo qun theo hng dn ca nh sn xut vc xin. Liu lng qun hng *i vi gia cm tim phng vacxin, ch c s dng tht gia cm sau khi tim t nht 28 ngy. cm c