(2020/02/08)What to do next to control the 2019-nCoV epidemic? +中文摘要轉譯

整理近期新冠病毒的基礎與臨床研究,闡釋其臨床意義與影響。

新型冠狀病毒附著於下呼吸道,並於此增生,導致下呼吸道損傷。主要有三種臨床症狀:上呼吸道輕微症狀、肺炎(無生命危險)、急性呼吸窘迫之嚴重肺炎;後者開始7~8天症狀較為輕微,之後快速惡化至需要維生器材的輔助。目前傳播途徑與感冒及流感類似,如打噴嚏、咳嗽、或直接接觸感染者之分泌物。糞口傳染的途徑未被證實,但曾於SARS流行時發生過。依目前證據,新冠肺炎可能流感化,會在老人及多重慢性病者(如,糖尿病、肺部疾病、及其他慢性疾病)造成重症。醫療工作者及照顧者是感染的高危險群,長照機構居民若感染,可能併發重症,醫療相關院所須做好感控。

新冠病毒目前無疫苗及抗病毒藥物。如社區傳染擴大並擴及多國,WHO建議及以下措施:

  1. 監測流行病學參數、公衛措施的效率、及公眾的接受度。
  2. 持續評估、加強溝通,提供一般民眾及高危險民眾保護自己的可行措施,包括,症狀的辨認及清楚描述尋求治療的方式。
  3. 持續對中國感染源的控制。
  4. 盡速研究病毒相關資訊,如,傳染力、傳播方式、病程,並通報WHO。
  5. 主動監測可能的感染源。
  6. 增加醫療系統的抗壓力。因目前亦為流感季節,醫療系統需預期嚴重感染及老人及高危險族群之病程。
  7. 如果社區感染確定,則須考慮減少大型活動,尤其當接觸者追蹤變得沒有效率、費力,且浪費資源時。
  8. 建立血清學資料,以估計目前及之前的感染率。
  9. 持續研究感染源,以提供未來冠狀病毒感染的預防。

(國衛院郭書辰醫師及莊淑鈞博士整理)

The 2019 novel coronavirus (2019-nCoV) infection can lead to acute resolved or fatal pneumonia. On the basis of knowledge of other coronaviruses, the main route of human-to-human transmission of 2019-nCoV is probably through respiratory droplets. As of Feb 4, 2020, statistical data show that the outbreak constitutes an epidemic threat in China, where the exponential increase in patients has reached 20 438 confirmed cases, with 2788 (13·64%) patients in critical condition and 425 (2·08%) deaths; 23 214 additional suspected cases have also been identified so far. The most affected city, Wuhan, and related regions in Hubei province of China have reported 13 522 confirmed patients (66·16% of total cases) and 414 deaths from 2019 nCoV infection (97·41% of total deaths in China). 632 patients with confirmed infection have recovered and have been discharged from hospital. However, the downward turning point for new cases of infection has not been observed yet (figure). Notably, 159 confirmed cases have been reported in 23 other countries beyond China, including Japan, Thailand, Singapore, South Korea, Australia, the USA, Malaysia, and Germany. Because of the seriousness of this outbreak, WHO declared it a public health emergency of international concern on Jan 30, 2020, followed by the USA announcing a public health emergency on Jan 31, 2020.

Author: Fu-Sheng Wang, Chao Zhang

Link: https://marlin-prod.literatumonline.com/pb-assets/Lancet/pdfs/S0140673620303007.pdf