2019 Novel Coronavirus-Important Information for Clinicians (2020/02/05)+中文摘要轉譯

依美國CDC標準,當患者出現下表情形時,應依通報個案,評估SARS-CoV-2感染可能性。

臨床特徵   流行病學風險
發燒或下呼吸道疾病(如,咳嗽或呼吸急促) 任何人,包括醫療人員,在過去14天內,與確診患者有接觸史。
發燒且下呼吸道疾病(如,咳嗽或呼吸急促) 過去14天內有湖北旅遊史
發燒且下呼吸道疾病(如,咳嗽或呼吸急促),需要住院者 過去14天內有中國旅遊史
若通報個案確診,醫療人員應立刻通知單位內感染科團隊及當地衛生主管機關。

因目前為流感季節,醫師應檢測其他呼吸道感染源,並評估開立克流感等藥物之必要性。若病患感染冠狀病毒機率不高,則不須戴口罩;若病患高度懷疑感染SARS-CoV-2,則應立刻戴上口罩,而醫護人員則應戴N95口罩。治療藥物方面,Lopinavir/ritonavir在之前SARS及MERS的治療中可能有效,而Remdesvir在一位美國患者身上似乎有效。

目前因沒有疫苗及抗病毒藥物,基本公衛手段,如生病時在家、洗手、及咳嗽禮節(如,打噴嚏或咳嗽時遮住鼻口),為控制疾病傳播最有效的方法。

(國衛院莊淑鈞博士整理)

 

In early December 2019 a patient was diagnosed with an unusual pneumonia in the city of Wuhan, China. By December 31 the World Health Organization (WHO) regional office in Beijing had received notification of a cluster of patients with pneumonia of unknown cause from the same city.1 Wuhan, the capital city of Hubei Province in central China, is the nation’s seventh largest city, with a population of 11 million people. Over the next few days, researchers at the Wuhan Institute of Virology performed metagenomics analysis using next-generation sequencing from a sample collected from a bronchoalveolar lavage and identified a novel coronavirus as the potential etiology. They called it novel coronavirus 2019 (nCoV-2019).2 The US Centers for Disease Control and Prevention (CDC) refers to it as 2019 novel coronavirus (2019-nCoV).3

As of February 4, 2020, more than 20 000 cases of 2019-nCoV have been reported, 98.9% of them in China, and the outbreak is linked to more than 400 deaths. As the epidemic is evolving and the situation is rapidly changing, up-to-date reliable information on the number of cases and recommendations on management of cases and preventive interventions can be found at various sites, including the webpage developed by the CDC.3 Currently the number of infections outside of China remains small (approximately 180), but cases have been detected in 26 countries, including 11 cases in the United States.

While it is unclear how many people are truly infected, a modeling study suggests that as of January 25, 2020, 75 815 individuals have been infected in Wuhan alone.4 The authors calculated the basic reproductive number (the number of cases one infected individual generates), R0, of this outbreak to be 2.68 (95% CI, 2.47-2.86) and that the epidemic is doubling every 6.4 days. Because of extensive travel between China and cities like Bangkok, Hong Kong, Singapore, Tokyo, and Taipei, these locations have identified the majority of cases outside of mainland China. As testing becomes more frequent, the true number of cases and the full spectrum of disease will become more clear. However, for now, it appears that compared with the other 2 zoonotic coronaviruses that occurred in the last 20 years (severe acute respiratory syndrome [SARS] in 2002 and Middle East respiratory syndrome [MERS] in 2012), 2019-nCoV seems to have greater infectivity (eg, a higher R0) and a lower case fatality rate.1

Author: Carlos del Rio, Preeti N. Malani

Link: https://jamanetwork.com/journals/jama/fullarticle/2760782