一起无防护禽肉加工引起人感染H7N9禽流感病毒的流行病学调查  

A case of human infection with highly pathogenic avian influenza A （H7N9） virus through poultry processing without protection measure

作　　者：马钰[1] 张周斌[1] 曹蓝[1] 陆剑云[1] 李魁彪[1] 苏文哲[1] 李铁钢[1] 杨智聪[1] 王鸣[1] Ma Yu;Zhang Zhoubin;Cao Lan;Lu Jianyun;Li Kuibiao;Su Wenzhe;Li Tiegang;Yang Zhicong;Wang Ming(Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou 510440, China)

机构地区：[1]广州市疾病预防控制中心,510440

出　　处：《中华流行病学杂志》2018年第6期799-804,共6页Chinese Journal of Epidemiology

基　　金：广东省医学科学技术研究基金（A2016056）;广州市科技计划（21707010451）

摘　　要：目的分析1例人感染高致病性H7N9禽流感病例的感染模式及病原变异情况，为禽流感防控提供依据。方法采用流行病学方法调查病例可疑暴露史及感染途径，追踪调查病例病情进展；使用核酸检测、病毒分离、基因测序及进化分析等技术对采集的相关标本展开病原学分析。结果病例无活禽接触史，发病前一周在狭小通风不畅厨房内不带手套加工烹饪光鸡；病例下呼吸道提取物、病家剩余冷冻光鸡表面涂抹标本、活禽来源市场环境标本均检出高度同源的H7N9禽流感病毒，且均在HA基因的裂解位点出现多个碱性氨基酸（PEVPKRKRTAR／GL）插入的突变。结论无防护禽肉操作是“禽一人”传播模式下的重要感染方式之一，现行的活禽限售区防控措施效果有限，应尽快推进规模化标准养殖，实现活禽全城限售、集中屠宰、冰鲜上市。Objective To investigate the infection pattern and etiological characteristics of a case of human infection with highly pathogenic avian influenza A （H7N9） virus and provide evidence for the prevention and control of human infection with highly pathogenic avian influenza virus. Methods Epidemiological investigation was conducted to explore the case＇ s exposure history, infection route and disease progression. Samples collected from the patient, environments and poultry were tested by using real time reverse transcriptase-polymerase chain reaction （RT-PCR）. Virus isolation, genome sequencing and phylogenetic analysis were conducted for positive samples. Results The case had no live poultry contact history, but had a history of pulled chicken processing without taking protection measure in an unventilated kitchen before the onset. Samples collected from the patient＇ s lower respiratory tract, the remaining frozen chicken meat and the live poultry market were all influenza A （H7N9） virus positive. The isolated viruses from these positive samples were highly homogenous. An insertion which lead to the addition of multiple basic amino acid residues （PEVPKRKRTAR/GL） was found at the HA cleavage site, suggesting that this virus might be highly pathogenic. Conclusions Live poultry processing without protection measure is an important infection mode of ＂poultry to human＂ transmission of avian influenza viruses. Due to the limitation of protection measures in live poultry markets in Guangzhou, it is necessary to promote the standardized large scale poultry fanning, the complete restriction of live poultry sales and centralized poultry slaughtering as well as ice fresh sale.

关 键 词：H7N9禽流感 流行病学 同源性分析 

分 类 号：R181.3[医药卫生—流行病学] R511.7[医药卫生—公共卫生与预防医学]