H1N1 fever duration 3 days
Posted on November 7, 2009
Filed Under H1N1 Symptoms & Diagnosis | Leave a Comment
Moderator: The media reporter friends, Influenza A H1N1 influenza prevention and control of media briefing has now begun. The first to introduce what we have invited three experts who are the China Disease Prevention and Control Center for Disease Control and Emergency Response Office of the Director FENG Zi-jian, Beijing Children’s Hospital, Shen Ying, vice president of Chaoyang Hospital, Cao Zhi, the new director of Respiratory physician, for three Experts busy schedule to attend our Lash, face to face answers to reporters about influenza prevention and control of Influenza A H1N1 issues.
The main theme of today’s briefing for around two aspects: one is the Influenza A H1N1 influenza epidemic monitoring and reporting problems, two cases of medical treatment on the issue. Welcome to a reporter’s question below.
A reporter’s question: I have just seen from the unit before the manuscript of an international newspaper that is now a stream of deaths are two extremes, one is a small, one is old, while the WHO statistics are young adults, the two somewhat contradictory I do not know the crowd is now characterized by a flow of cases there is no new interpretation of?
In the treatment program, on the treatment of severe cases should be given Tamiflu and other anti-viral treatment, persistent high fever for two or three days to determine when cases of severe disease, so we doubt, to determine the future re-treatment for severe cases is equal to miss the most good treatment of the period, how to answer?
Cao Zhi New: China is now the severe cases and deaths is also small, we now sum up the characteristics is not necessarily a universal law, combined with the global circumstances. Because the flu is a new influenza, it and previous outbreaks in a number of different, reflected in a feature found in severe cases, the traditional high-risk groups for influenza, is down with the flu are likely to become heavy to those who do not currently able to cover all of the A flow characteristics of high-risk groups, a very important aspect is the traditional high risk of influenza is mainly the elderly, children, people with basic diseases, such as pregnant women, who remains a stream of high-risk groups did not find these people got a flow is particularly light. But there is one exception, the influenza A H1N1 influenza, a number of young people, the original in good health, got sick even after heavy, there may even be death, this phenomenon abroad, who died of severe cases of people and more countries are prominent, China seems to have this phenomenon, this issue should be analyzed so that young people get sick, there are some heavy, will die, which may reflect more of this disease is a new strain, so the general population is not immune barrier, but fortunately the yes, from the current domestic data, where young people got sick after the weight change, and even lead to death is very, very rare phenomenon, compared to about 50,000 cases of confirmed cases died inside the numbers, lower than the proportion of foreign much more. Domestic data also needs to summarize all of this may be a new strain of the virus is somewhat related to some special people who may be very sensitive to physical.
Follow-up: In the past, WHO has been saying that people die young adults is a major, after such a long time, there is no change?
Cao Zhi, the new: There have been published or the death of the foreign population is young.
FENG Zi-jian: Part of the reason is that the current number of cases in children and young adults and more severe, and so the corresponding number of deaths was also high. Number of cases in this age group more than the current stage of view, except, of course, and characteristics of pathogenicity of the virus may have relationship, we can also see old young adults the chance of infection is not high. Now schools are more outbreaks in schools this environment, methods and other environmental exposure is different, children in the school environment, a long contact time, contact proximity, frequency high. The present case, the susceptibility of various age groups is similar, because the exposure to different opportunities, it makes a high incidence of this group, the corresponding number of severe also come up. If we look at the incidence of severe cases account for the proportion of all ages, young people are not necessarily the highest.
Shen Ying: On the Influenza A H1N1 influenza virus is characterized by: the universal susceptible populations, spread fast, but most patients are light, only a few patients with severe or even critically ill patients. For the mild patients, we advocate a good rest, drink plenty of water, symptomatic treatment, because the main symptoms of mild patients in the first three days, fever in 38.5 degrees below the therapeutic effects of Chinese medicine is better. For critically ill patients, one is severe, one is critically ill patients, patients with severe and persistent high fever, severe cough, phlegm, chest tightness, lips purple, and even sanity some changes, such as restlessness, convulsions, severe nausea, vomiting, there is the clinical manifestation of pneumonia, some patients that there are chronic diseases, on this basis and then got a stream prone to complications. For critically ill patients, we advocate that antiviral therapy. For critically ill patients, mainly divided into two types, one is respiratory failure type, one is shock-type, complicated by multiple organ failure, need for intensive care for emergency medical treatment. We are now advocating to strengthen the early identification of critically ill patients, early diagnosis, early treatment, according to foreign and domestic experience, the former two or three days is very important, this is a window period, during which patients were observed such a situation, it is necessary immediately to the hospital for treatment .
Cao Zhi New: Why did you say is possible for three days without fever patients? This is statistics, not an expert slap your head and say Shibuguosan. Is because our survey of 1054 cases of early domestic A flow of patient information, it is important that we have to statistical variation of body temperature of these patients, the figure is: when the incidence of the third day, these patients, the average temperature is 37 degrees, 3 days Basically, both within the burned back down. Therefore, we feel that from the point of view mean that the vast majority of patients improve within 72 hours, and if 72 hours is not good, very few of these groups, it may be a potential critically ill patients. So, to say the number is a three-day fever more than 1000 cases of pre-basis for. These people for three days, the average temperature is 37 degrees, but not measured once a day, sometimes high sometimes low, the highest mean temperature was 37.5 degrees, is also very close to normal, this is our time to do 7-8 months statistics.
A reporter’s question: when these patients will have a high fever is dangerous?
Shen Ying: Most patients with mild will not have a very high fever, most of them are 38.5 degrees below the symptomatic treatment on it.
Q: What are the measures?
Shen Ying: drink plenty of water, plenty of rest, eat a little anti-fever medicine and heat-clearing and detoxifying Chinese medicine.
A reporter’s question: has any information to say that my first two days 80% of the influenza A stream of cases, it was projected that 80% of our patient is a cold stream, there is no basis for this figure? The disease and seasonal influenza the same? Will not be repeated too?
FENG Zi-jian: We can say 80% of influenza-like illness is an indicator of the monitoring system. A stream in the wake of the Ministry of Health expanded across the country this monitoring system, there are currently more than 500 hospitals is the sentinel surveillance system to monitor how do? So that the pediatric medical institutions and medical report of two numbers, an influenza-like illness within a week the number of treatment, while at the same time period, the total attendance is the total number, and then we calculate the treatment of influenza-like cases in the proportion of the total , this ratio change is to reflect strength of an influenza pandemic is an important indicator of the prevailing international practice of influenza surveillance.
At the same time, we are also part of the patients suffering from influenza-like illness pharyngeal test sub-samples collected and sent to laboratories to do HIV testing. Currently, we have collected the specimens, an average of more than 30% can detect influenza viruses, of which 80% are mostly influenza A H1N1 influenza virus, while 20% are mostly seasonal A 3 (H3N2) influenza . A stream in the absence of this figure is also the constant fluctuations in the time to pop the season will be high, sometimes seasonal H1N1 high, sometimes influenza H3N2 is high, and sometimes the B-type high. In early September, when positive for influenza A H1N1 influenza detection rate was only 30% to 80% now, it is estimated this figure will go up. The United States is now close to 100% of the Influenza A H1N1 influenza. 30% were positive, and the remaining 70% may be the other can lead to influenza-like illness, influenza-like illness is not very specific must be the flu, a lot can lead to influenza-like illness, such as a fever to 38 degrees, there are one or two respiratory tract symptoms, or the whole body symptoms of pain, we called the influenza-like illness, and some other respiratory pathogens, can have such clinical manifestations, is a clinical syndrome. And our laboratory and testing the sensitivity of the quality, will affect to the first 30% of the figure. In any case, at the technical level of stable conditions, this 80% or that they 20% Ye Hao, we can more sensitive reflection of Influenza A H1N1 or any influenza virus subtypes of influenza caused by the level of activity.
Cao new: For example, I am now a fever, cough, sore throat, I said I have a 80% probability of influenza A H1N1 flu, right?
FENG Zi-jian: No, it should be said that 30% of the probability of influenza, 30% where 80% may be a stream. So, it is best not to do that because I do not know that we are really testing the accuracy of how high, which also involves the timing of sampling, sample the quality of high or low, will be affected, so we can not simply multiply 80 by 30% % to calculate the number of patients. In a period of time, sampling and monitoring of the level of quality there are no major changes in circumstances, we can analyze the trend in this figure, but it can not accurately be used to estimate influenza-like illness a person entitled to how much the probability of Influenza A H1N1 influenza.
Follow-up: This 30%, 80% of the ratio is high compared with previous years do?
FENG Zi-jian: Over the past two months, influenza-like illness the proportion of the total attendance is now rising rapidly, the prevalence in previous years, the level of the peak season, only about 2%, and now has reached 9%.
Shen Ying: We have a week of pre-hospital fever of influenza-like illness accounted for 60% of the crowd.
FENG Zi-jian: Of course not the case throughout the South and the North are not the same.
A reporter’s question: There is now not possible to a general mistaken for Influenza H1N1 influenza flu? What is the probability? Influenza A H1N1 influenza virus, the probability that the number of missed diagnosis?
FENG Zi-jian: At present, a stream has been widespread in China, now no longer required for each patient by the disease control agency to take individual isolation, most important thing is to persuade the patient self-isolation, the patient can not do more to individual isolation. Therefore, we do not require medical institutions and disease control agencies have carried out for each laboratory diagnosis of suspected cases. First, there is no need, and second, we do not have such a large detection capability. We are now on the laboratory diagnosis of severe requirement is emphasis on diagnosis. Severe diagnosis of two meanings, one is to guide clinical anti-viral treatment, can quickly make a diagnosis, to guide the use of Tamiflu drug may be more accurate. Second, this is the disease we have to monitor the virulence of the virus suspected cases of change in a very important opportunity, and we see this disease in the performance of this person than heavier, that is not due to changes in virulence of the virus causing it? For all laboratory surveillance in all countries can not do.
A reporter’s question: This can not do because of capacity or financial problems?
Cao Zhi New: there is an important number to consider, more than 1000 cases of patients indicates that 3 days when the temperature only 37 degrees, if taking into account the actual situation, more than 1000 cases are sent to the clinic, and three days to finish the test results, which more than 1000 individuals have been better. This does not and arithmetic, let us find it more than 1000 individuals inside the critically ill patients, these critically ill patients, once there are signs of immediate submission is positive to give specific treatment. On the one hand to measure, however, on the other hand is generally not meaningful to measure, out-patient now have this situation, we make a phone call, with the patient and said, you are a flow of positive results that my patients are better.
A reporter’s question: Some symptomatic treatment, and eat anti-fever drugs, or drink water break self-healing, and also all right by.
FENG Zi-jian: This is the latest most in need of publicity. Now all levels of disease control agencies are working quickly to advance vaccine, we hope to bring the vaccine produced in the shortest possible time, hitting the people who most need protection. But, after all, a limited number, but also require the production cycle can not look at the place. With our country’s enormous size of the population compared to the number of vaccines is still inadequate. In this way, the public’s personal prevention is vital. Just as the reporter said, if there is a flu-like symptoms, or symptoms of acute upper respiratory infection, fever, coughing, sneezing, etc., to rest at home, work and other symptoms disappeared later. To do this, all social organizations must meet the unit’s leadership needs to understand this point, be able to support, be able to take some measures to encourage employees to sick leave, sick continued to work at this time is not worth promoting. This helps to prevent the whole society, but also help prevent the spread of their units and outbreaks. In the popular peak season, all units should do this to encourage people to rest at home sick, the symptoms disappeared 24 hours later to go to work, which is slowing the spread of the whole community is very helpful. Secondly, the right to prevent a flow in an outbreak of collective units also play a role, and this is evidence, and the international community is to do so.
Second, the rest due to illness in the family who pay attention to the spread within the family, especially the need to protect high-risk family members, such as the chronically ill, small children, very old elderly, pregnant women, are needed special protection because they occurred at high risk of severe, it is necessary to avoid as much as possible so that they can become infected.
Patients also go out as much as possible to reduce non-essential, if necessary, go out, for example to the hospital for treatment, to take the bus, go to the supermarket to buy things, this time to wear a mask, it is necessary to protect others, this is what every a civic responsibility. If you do not wear a mask, this time you cough, sneeze, we should cover mouth and nose, use paper towels, clothes blocked, do not splash directly into the front of others.
Other healthy people, usually a very important point, but also very simple and effective way is to wash their hands. Hand-washing is a very effective measure. Wash their hands, does not require very complicated, is to use soap or hand sanitizer, if not, the direct use of tap water rinse is also effective. Usual, if able to do so, bring a bottle of disposable alcohol, squeeze hands, rub what you can. Is very simple, many supermarkets have to sell, very useful, especially the common Yaogen others who come into contact, such as sales, bus conductor, etc., preferably with a bottle of hand, which are helpful to prevent infection, to also help reduce family communication and reduce the outbreak of the unit has also helped, of course, the individual will benefit.
A reporter’s question: Influenza A H1N1 influenza immunity is not too time there is it?
FENG Zi-jian: prevalence of subtype of influenza a few months time, there is no infection found to be infected later.
A reporter’s question: after the infected have no antibodies in serum?
FENG Zi-jian: Several countries have already done a serological survey, popular in areas experiencing high levels of human antibody. Because it will be played after the vaccine has a high antibody, let alone natural infection.
A reporter’s question: For instance, today I am the first day of fever, is needed immediately to a hospital, or a high fever a few days later Zaiqu treatment? Because if they are to the hospital for treatment, it may not actually infected with a flow of a stream.
Cao Zhi New: see who developed fever, if it is an age of two dolls, 70-year-old, are pregnant women, or people with asthma, we do not deny, we should immediately go to the hospital, the so-called high-risk groups symptoms, it is necessary the first time to the doctor. In other words, thirty or forty years old, twenty to thirty years old, able-bodied, made a fire, temporarily look is good, so there are two advantages, one may not be what the flu, and second, even a stream, According to our statistics, the typical patient, within three or four days like up, as you said, had nothing to do, go to the hospital cross-infection may occur again. From another perspective, if the non-high risk of influenza at home and look at the short period of time, we can greatly alleviate the current pressure on hospitals, so that you can free up more medical resources to treat critically ill patients, was already on the people are good, but it there is a premise must be able-bodied non-high-risk groups.
Shen Ying: If the spirit of good, high fever, difficulty breathing, or go to hospital. If you go to the hospital, regardless of to see what disease should wear a mask, this is also a good preventive measure a flow of cross-infection.
A reporter’s question: do normal people need to wear a mask?
Shen Ying: Normal wear in public places may not, if we should wear to the hospital.
A reporter’s question: If we usually take the subway, people are crowded together, the need to wear a mask then?
Shen Ying: wear better.
A reporter’s question: I have two experts in the hospital referred to in the hospital for fever patients do not have sample test. If so, some patients with influenza A H1N1 influenza is not detected and the network reported. Please tell us the health sector is now a weekly briefing of the Influenza A H1N1 influenza epidemic, the figures were obtained from the channels, from the perspective of surveillance, notification of this figure, what considerations?
FENG Zi-jian: Now we are no longer required for each cases of laboratory-confirmed patients with fever have done. We call for each case of an outbreak of respiratory disease should be investigated and laboratory diagnosis. At present, the communication network of direct reporting system, the reported cases of such major categories: First, a stream of cases involved in outbreaks, and second, to conduct sentinel surveillance of confirmed cases, three cases of severe disease is diagnosed, in addition, there are a number of laboratory-confirmed sporadic cases. A large number of patients without laboratory-confirmed no further report. Currently more than 50,000 the number of reported cases, in fact, only May 11 since the first case, a small fraction of the total number of cases, we can not use this number to estimate the total number of infections and the number of cases, it should be and the actual figures were far worse.
We now look at using this system since the number of outbreaks, but a trend analysis, trend monitoring, and we use it as a reporting platform, to observe the number of critically ill patients occur. We ask each one critically ill patients found that as much as possible, of course, is not necessarily able to do it and every doctor’s judgments, alertness related, he suspected that the patient is a stream, perhaps I would do testing, if there is no doubt the patient clinical is a stream, it may no do so, may miss, of course, we hope that each of patients with severe A flow through our surveillance system reported that up, let us grasp the severe change in the trend of variation of the virus to make an early warning.
On the intensity of epidemics of influenza-like illness and the proportion of the total cases of HIV positive rate of surveillance has been basically to meet the strength of our observation epidemic needs.
A reporter’s question: Now from the children’s hospital admissions of the circumstances, adolescents, children, disease is characterized by the crowd like? Is currently the focus of prevention and control of the school, the school surveillance is how to do it? Is a separate system or integrated into the network of direct reporting years?
Shen Ying: From our observations in the hospital, from October 23 sick children began to fever outpatient clinic there is a sudden peak, night fever child treatment than in the past an increase of 35% or so. A large proportion of 6-12 year-olds mainly school-age children may be due to the aggregation, the weather turns cold, the air circulation is not very good, causing a variety of reasons such a small outbreak. Our hospital received 10 cases of severe patients, in one case critically ill patients, and now have eased after emergency treatment. We monitored around more than 600 cases of influenza-like patients, which were 60% of a stream.
A reporter’s question: how monitoring is carried out in schools? Today, China’s prevention and control of schools will introduce new policies or new approaches?
FENG Zi-jian: The new policy’s future to be jointly issued by the Ministry of Health and the Ministry of Education in recent days, there may be promulgated. On school outbreak prevention technologies, there are several points I would like to emphasize: First, if there is influenza-like illness or acute febrile symptoms of infection, we should rest at home and not come back to school, to rest a few days, good again, so that This is the prevention of dissemination in schools and outbreaks have a good effect, must give the school, to parents in clear terms.
Shen Ying: This is particularly important because there are many parents fear their children off the course, have come to the hospital be certified worry your child classes.
FENG Zi-jian: Personally, I believe that in the case of no drug control, fever, coughing, sneezing, sore throat and the symptoms disappeared after 24 hours, can be used as criteria for students to resume classes. First, it is easy to grasp, the relevant departments or were time-bound, it seems that 7 days. In addition, during school hours, if the student appeared fever respiratory symptoms, the teachers have to hurry to send their children out of the classroom, he was sent home as soon as possible. Boarding school can do some arrangements to have such symptoms of segregation of students, such as separate living quarters, and isolated from other students, this right to prevent a flow of an outbreak in the school environment is helpful, to be completely it is impossible to avoid the disease, but it can prevent a large-scale disease. In addition, we must educate students so that students can wash their hands, and the schools to find a way to facilitate the conditions for students to wash their hands, we find ways to take active measures in schools, but also conducive to the prevention of a stream. Prevention is concerned, the school can do something, and if students consciously report that they are not comfortable with, parents and consciously put the incidence of children at home and can not do, the school adopted the approach is also used to examine morning newly made possible.
Shen Ying: Gun-type thermometer in cold weather regardless of the circumstances, may use, now many schools have to use thermometers, between classes but also out of the ventilation.
FENG Zi-jian: do this, the school will be conducive to the prevention of outbreaks.
A reporter’s question: Now there is a contradiction heating period, ventilation and everyone feel cold, it would easily cold, but not ventilation does not help the air circulation.
Shen Ying: Yes, regular ventilation, not always open the window.
FENG Zi-jian: In the context I just said, the school suspended the measures taken by the main judge should be based on whether the number of sick children has made the normal teaching activities can not proceed, if only half of children were sick, and even class, which is unrealistic The. Of course, the Ministry of Education has a similar document provides the initial set is 30%, if 30% of students can not come to class tomorrow, it can be closed. To grasp the timing of closure measures, minimizing the impact on teaching and learning activities.
A reporter’s question: Recently, the epidemic developed rapidly, the current to cause greater pressure on medical and health institutions, said Beijing Children’s Hospital, a few thousand cases a day admissions. According to the prevention and control strategies should focus on key sectors to strengthen the severe treatment, the current epidemic situation and the treatment situation, Cao doctor for treatment of mild cases are there any suggestions?
Shen Ying: All public health events, such as infectious diseases, child certainly is the first attack, because his own health reasons, the development of more perfect, resistance is weak, this group also has clusters of features, so that children are the first incidence of a a common new rule. From the 23, Beijing has two major children’s hospital after the sudden peak of the Beijing Municipal Health Bureau, respond rapidly, immediately launched emergency plans, there are two main measures, first of all, Beijing has 103 all pediatric health care resources hospitals in all 24-hour treatment, Children’s Hospital is open 24 hours all year round, but most of Pediatrics are not open 24 hours this regard, we would like to thank the media, media propaganda quickly, the publicity in the media, parents and the nearest medical care, to the We divert a lot of patients, so we reduced the patient load 8000,7000,6000, and now down to 5000, gave us a lot of pressure to ease the same time, we have adopted the measure, all the doctors, nurses, whether in vacation or In school, all returned to working at the hospital. We believe that, if it is mild patients, the nearest treatment is the best approach, because children still go to a doctor for treatment under the guidance of a doctor a reasonable observation, pairs of children, this is the treatment and prevention of influenza A relatively good approach.
A reporter’s question: You have just said that 5,000 people a day at Children’s Hospital is the heat do?
Shen Ying: October 23 to seek treatment for medical patients are more than 5,000, the total number of patients nearly 9000, and now has dropped to 5000-6000 the total number of patients, medical patients are more than 3,000. CDC reports A total number of patients has not been reduced flow, we reduce the number of hospital cases, mainly due to the Beijing Municipal Government and the Health Bureau of the emergency measures, the city has 103 pediatric hospitals in 24-hour pediatric outpatient triage of fever sick child relationship.
Moderator: That concludes today’s Lash, Thank you.
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