Definition Human highly pathogenic avian influenza is an acute respiratory infection in humans caused by some strains of certain subtypes of avian influenza viruses, such as H5N1 and H7N7, and the most recent avian influenza is an acute respiratory infection caused by H7N9. Disease Introduction In recent years, the H5N1 avian influenza virus has been spreading around the world, causing human morbidity, and it is speculated that this virus may evolve into a virus that can cause a human influenza pandemic through genetic reassortment or mutation, so human highly pathogenic avian influenza caused by H5N1 avian influenza virus infection has become the focus of global attention. China’s Prevention and Control of Infectious Diseases Act classifies it as a category B infectious disease, but implements category A management, which means that in the event of an outbreak, preventive and control measures for category A infectious diseases are taken. According to the results of investigations into cases of H5N1 subtype infection, the incubation period is generally 1-7 days, usually 2-4 days. The most recent avian influenza caused in the country is caused by H7N9. Pathogen (avian influenza virus) The avian influenza virus (AIV) is an influenza A virus. Influenza viruses belong to the orthomyxovirus family of RNA viruses, and are divided into three types: A, B, and C. Among them, influenza A viruses are mostly found in birds, and some subtypes can also infect various mammals such as pigs, horses, seals and whales, as well as humans; influenza B and C viruses are seen in the infection of seals and pigs, respectively. Avian influenza viruses, single-stranded negative-stranded RNA, are currently classified into 16 H subtypes (H1-H16) and 9 N subtypes (N1-N9) based on the antigenicity of their outer membrane hemagglutinin (H)/ and neuraminidase (N) proteins. The main subtypes of avian influenza viruses infecting humans are H5N1, H9N2, and H7N7, among which patients infected with H5N1 are seriously ill and have a high mortality rate. Recently spreading in the country is the H7N9 avian influenza virus. Previous studies have shown that strains of avian influenza viruses that were originally low pathogenic (H5N2, H7N7, H9N2) can become highly pathogenic strains (H5N1) by rapid mutation of the epidemic among birds in 6 to 9 months. Epidemiology (1) Source of infection (— human and avian patients) The source of infection is mainly poultry such as chickens, ducks and geese, especially chickens, who are suffering from avian influenza or carrying the avian influenza virus; wild birds play an important role in the natural spread of avian influenza, and human infection with highly pathogenic avian influenza. (2) Transmission routes (- respiratory) Transmission routes are mainly through the respiratory tract, but also through close contact with infected birds and their secretions, excretions, virus-contaminated objects and water, as well as direct laboratory exposure to viral strains are infected. There is no conclusive evidence of human-to-human transmission, but there have been some cases of aggregated occurrence. (3) Susceptible people (— mostly not susceptible) Due to the genus barrier, humans are mostly not susceptible to the avian influenza virus. However, there is a general lack of antibodies to the avian influenza virus and no specific resistance. Any age has the possibility of being infected, but generally speaking, children under 12 years of age have a higher incidence and are sicker. People in close contact with unexplained dead poultry or poultry infected with or suspected of being infected with avian influenza are the high-risk group. Clinical manifestations (— fever, soreness and general discomfort) Different subtypes of avian influenza virus infecting humans can cause different clinical symptoms. Patients infected with H9N2 subtype usually have only mild symptoms of upper respiratory tract infection, and some patients do not even have any symptoms; patients infected with H7N7 subtype mainly show conjunctivitis; patients with severe disease are usually infected with H5N1 subtype virus. Patients have an acute onset and early presentation is similar to that of common influenza. The fever is mainly febrile, with body temperature mostly persisting above 39°C. It may be accompanied by runny nose, nasal congestion, cough, sore throat, headache, muscle aches and general malaise. Some patients may have gastrointestinal symptoms such as nausea, abdominal pain, diarrhea, and loose watery stools. A few severely ill patients may have neuropsychiatric abnormalities such as headache, delirium, and agitation. Almost all patients have pneumonia with obvious clinical manifestations. Acute lung injury, acute respiratory distress syndrome (ARDS), pulmonary hemorrhage, pleural effusion, complete blood cytopenia, multi-organ failure, shock and Reye’s syndrome may occur as complications. Sepsis can occur secondary to bacterial infection. Severe patients may have solid pulmonary signs and other laboratory tests 1. General examination Peripheral blood picture: Total white blood cell count is generally not high or reduced. In severe cases, there is a decrease in total white blood cells and lymphocytes, and a decrease in platelets. Urine routine: a significant proportion of patients (about 40%) have moderate to large amount of proteinuria (1-3g/L). Serum enzymology: The vast majority of patients with severe H5N1 infection (80%-100%) showed abnormal liver and myocardial enzymology. 2, virus isolation from the patient’s respiratory specimens (such as nasopharyngeal secretions, oral gargle fluid. Tracheal aspirate or respiratory epithelial cells) to isolate the avian influenza virus. 3, virus antigen and gene detection Take the patient’s respiratory specimens using immunofluorescence (or enzyme-linked immunoassay) to detect influenza A virus nucleoprotein antigen (NP) or matrix protein (M1), avian influenza virus H subtype antigen. RT-PCR can also be used to detect avian influenza virus subtype-specific H antigen gene. 4.Serology-specific antibody test A 4-fold or higher increase in antibody titer of double serum avian influenza virus subtype strains in the early stage of disease onset and recovery period can help retrospective diagnosis. Diagnosis Classification of cases and diagnostic criteria Human cases of highly pathogenic avian influenza can be classified as medical observation cases, suspected cases, clinical diagnosis cases and confirmed cases. 1.Medical observation cases Those with a history of epidemiological exposure and influenza-like clinical manifestations within 1 week. For those diagnosed as medical observation cases, medical institutions should promptly report to the local disease prevention and control agencies and put them under 7d medical observation. 2.Suspected cases Those who have a history of epidemiological exposure and clinical manifestations, and whose respiratory secretions or related tissue specimens are positive for M1 or NP antigens or positive for the nucleic acids encoding them. 3.Clinically diagnosed cases Those who are diagnosed as suspected cases but cannot obtain further evidence of clinical test specimens or laboratory tests and have a history of common contact with them are diagnosed as confirmed cases and can exclude other diagnoses. 4.Confirmed cases with epidemiological contact history and clinical manifestations, specific viruses isolated from the patient’s respiratory secretion specimens or related tissue specimens, or by other methods, positive avian influenza virus subtype-specific antigen or nucleic acid examination, or a 4-fold or higher increase in antibody titers to the subtype strain of avian influenza virus in both the early onset and recovery period of the double serum. In cases where the epidemiological history is not known, the diagnosis of a confirmed case can be made on the basis of clinical manifestations, ancillary examinations and laboratory findings, especially if the specific virus is isolated from the patient’s respiratory secretions or relevant tissue specimens, or by other methods, if the avian influenza virus subtype-specific antigen or nucleic acid test is positive, or if the antibody titers of both serum avian influenza virus subtype strains increase fourfold or more during the early onset and recovery periods. Differential diagnosis: Human HPAI infection should be clinically differentiated from influenza, common cold, bacterial pneumonia, infectious atypical pneumonia, cytomegalovirus pneumonia, Chlamydia pneumonia, Mycoplasma pneumoniae pneumonia, Legionella pneumonia, pneumonic epidemic hemorrhagic fever, etc. The differential diagnosis is mainly based on pathogenic examination. Treatment Strong antiviral treatment based on isolation and symptomatic, supportive treatment of patients. (1) Western medicine treatment Anti-influenza virus western medicine drugs are 1, neuraminidase inhibitors Oseltamivir (Tamiflu) is a new anti-influenza virus drugs, laboratory research has shown that it has inhibitory effect on avian influenza virus H5N1 and H9N2. 2, ion channel M2 blockers Amantadine (Amantadine) and amantadine (Rimantadine) can inhibit the replication of avian influenza virus strains, early application may help to stop the development of the disease, reduce the disease and improve the prognosis. 3, the use of interferon to interfere with the replication of the virus in the body. 4, the use of drugs that increase immunity in combination, the treatment of many viral infections is more satisfactory. 5, the treatment of proteinuria Proteinuria treatment can (2) Chinese medicine treatment Chinese medicine antiviral effect is often better, can be used in conjunction with the use of Western medicine with the use of Chinese medicine treatment. The main symptoms are: fever, chills, sore throat, headache, muscle and joint pains, cough, little phlegm, white fur, floating and slippery pulse. Pathogenesis: Toxic evil attacking the lung guard, causing the lung guard to contain evil and the lung to lose its propagation and descent. Treatment: Clearing heat and detoxifying the toxin, promoting the lung to penetrate the evil. Basic formula and dosage: Chai Hu 10g Radix Scutellaria Baicalensis 12g Roasted Ephedra 6g Fried Almonds 10g Silver Flower 10g Forsythia 15g Burdock 15g Qiang Wei 10g Radix Rehmanniae 15g Radix Glycyrrhiza Uralensis 6g Addition and subtraction: If the cough is severe, add roasted loquat leaf and zhebei mu; if nausea and vomiting, add bamboo rhizome and sage leaf. (2) Poison offending the lung and stomach Symptoms: fever, or chills, headache, muscle and joint pain, nausea, vomiting, diarrhea, abdominal pain, white and greasy tongue coating, floating and slippery pulse. Pathogenesis: Poison offends the lung and stomach, dampness is contained within, and the stomach and intestines are out of harmony. Treatment: Clearing heat and detoxification, dispelling dampness and harmonizing the stomach. Basic formula and dosage: Pueraria lobata 20g Radix Scutellariae 10g Radix Scutellariae 6g Fritillariae 30g Cangjiao 10g Patchouli 10g Radix Panax notoginseng 10g Radix Phellodendron 6g Forsythia 15g Radix Angelicae 10g Radix Bupleurum 20g Addition and subtraction: if abdominal pain is severe, add fried white peony and roasted licorice; if cough is severe, add fried almond and cicada molasses. (3) Congestion of the lung by toxic evil Main symptoms: high fever, cough with little phlegm, chest tightness, shortness of breath and shortness of breath, or palpitation, restlessness, or even delirium, purple lips, dark red tongue, yellow or grayish fur, and fine pulse. Pathogenesis: severe toxin congestion of the lung, loss of lung circulation and lowering, hence high fever and cough; phlegm stagnation in the lung, hence purple lips, shortness of breath and shortness of breath. Treatment: Clearing heat and dipping the lung, resolving toxins and stasis. Zhi Mu 10g, Zhe Bei Mu 10g, Scape Drabble 15g, Mulberry Bark 15g, Dandelion 15g, Cao He Che 10g, Red Peony 10g, Dang Pi 10g, Addition and subtraction: For hyperthermia, trance, or even delirium, add Angong Niu Huang Wan, or use Qing Kai Ling Injection, Phlegm Fever Clear Injection, or Fishy Herb Injection; for cyanosis of the mouth and lips, add Astragalus, Panax notoginseng, Angelicae tail; for constipation, add Sheng Da Huang, Mannite. (4) Internal closure and external detachment Main symptoms: high fever or low fever, cough, breath-holding and shortness of breath, lack of warmth in the hands and feet or cold extremities, cold sweat, cyanosis of the lips and nails, sunken pulse or weak pulse to extinguish. Pathogenesis: Internal trapping of evil toxins, loss of qi, loss of yang and exhaustion of yin. Treatment: Promoting the righteousness and consolidating the detachment. Basic formula and reference dose: 15g Radix et Rhizoma Ginseng, 15g Radix Macrocephala, 10g Fructus Schisandrae, 10g Radix Phellodendron, 10g Radix Ginger, 30g Cornu Cervi Pantotrichum, 6g Radix Glycyrrhiza Uralensis, plus or minus: if sweating is very profuse, add Calcined Longmu; if phlegm is abundant, with phlegm in the throat and greasy coating, add Golden Buckwheat, Suhexiang Pill, Monkey Jujube San. Injections can be used to wake up the brain Jing injection, raw pulse injection, ginseng injection, ginseng injection, blood BJ injection, etc. 2, the application of proprietary Chinese medicine: pay attention to the identification of the use of oral Chinese medicine or injection, can be used in conjunction with Chinese medicine soup. (1) Clearing the heat from the surface: use Lianhua Qingfei capsule, Chai Yin oral liquid, Yinhuang granules, etc. (2) Clearing heat and removing toxins: Shuanghuanglian oral liquid, clearing heat and removing toxins oral liquid (or granules), fishy grass injection, Shuanghuanglian powder injection, etc. can be used. (3) Clearing heat and removing blood stasis: An Gong Niu Huang Wan (or capsule), Qing Kai Ling Oral Liquid (or capsule), Qing Kai Ling Injection, Awakening Brain Pure Injection, Phlegm Fever Clear Injection, Blood Bi Jing Injection, etc. can be used. (4) Clearing heat and dispelling dampness: Huo Xiang Zheng Qi Pills (or capsules), Ge Gen Scutellaria Micro Pills, etc. can be used. (5) Cough and phlegm relieving class: Bitter sweet punch, phlegm fever clear injection, throat date san, expectorant spirit, etc. (6) Benefit qi and consolidate deficiency: raw vein injection, ginseng and wheat injection, ginseng and sperm injection, etc. can be used. Treatment with Chinese medicine can follow the method of dialectical treatment to identify the evidence. Fever in the early stage of the disease is treated with Yin Qiao San plus reduction, or heat or thirst Sha Shen Mai Men Dong Tang. You can also use some Chinese medicines, such as Wu Yiling’s Lotus Qing Wen capsule orally, you can also use Yin Chai granules and other Chinese medicines to carry out treatment. 3, the treatment of acupuncture moxibustion can be used milli-needle acupuncture foot three miles, hand three miles, Neiguan, Sanyinjiao, moderate twisting, can be urgent out of the needle, but also can stay needle, once a day or 2-3 times. Acupuncture is effective in treating the lungs. Moxibustion can be used depending on the situation. Prognosis: Patients without serious complications and underlying diseases have a good prognosis. Prevention: The key to preventing and treating human HPAI is to achieve “four early”, which means early detection, early reporting, early isolation and early treatment of the disease. Prevention of highly pathogenic avian influenza, do not travel to infected areas, do not contact with live birds, pay attention to disease prevention and attention to high temperature killing. Editor’s comment: 1, human highly pathogenic avian influenza is a respiratory infectious disease caused by a virus, the first use of antiviral drugs for treatment. 2, human highly pathogenic avian influenza due to respiratory infections in addition to hand washing, you can add water to wash the nostrils, you can use tap water to rinse the nostrils oral cavity several times, especially if the nostrils are not comfortable, or as soon as possible after contact with suspected patients. 3, treatment of avian influenza methods and strategies: When patients with upper respiratory tract infections visit the clinic after testing found that there may be viral infections can use powerful antiviral treatment, there are bacterial infections, in addition to the corresponding effective antibacterial agents can be used, in short, antiviral do not delay the time. According to relevant data, acupuncture treatment, for fibrosis of the lungs, petrification effect is good, the mechanism is that acupuncture improves the energy state of some structural protein molecules in the lungs so that harmful substances are not easily deposited in the lungs.