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目的:对桐乡市2013年以来报告的5例人感染H7N9禽流感死亡病例进行流行特征分析,为进一步科学防控提供依据。方法:对确诊病例和病例的密切接触者进行个案调查,对病例的呼吸道标本进行人感染H7N9禽流感病毒核酸检测。结果:2013年以来桐乡市共确诊人感染H7N9禽流感病例6例,死亡5例,病死率83.3%;均为散发病例;其中死亡的5例病例男性4例,女性1例,年龄中位数68岁(58~77岁),发病到就诊时间中位数3d(0~5d),发病到确诊时间中位数5d(5~13d),发病到服用达菲抗病毒治疗时间中位数6d(1~8d),发病到死亡时间中位数28d(4~76d),5例死亡病例均有慢性基础性疾病,3/5病例首诊均在乡镇级以下医疗机构就诊。结论:患有慢性基础性疾病的中老年是人感染H7N9禽流感的高危人群,就诊延误、就诊医疗机构不规范、误诊、用药不及时等是危重患者死亡的重要因素。病例均有接触暴露史,人传人可能性不大。
OBJECTIVE: To analyze the epidemiological characteristics of five human deaths from H7N9 bird flu reported in Tongxiang since 2013, and provide a basis for further scientific prevention and control. Methods: To investigate the close contacts of confirmed cases and cases and to detect the nucleic acid of human H7N9 avian influenza virus in respiratory samples. Results: Six cases of H7N9 bird flu were diagnosed in Tongxiang since 2013, with 5 deaths and a mortality rate of 83.3%. All of them were sporadic cases. Among them, 5 cases were dead in 4 males and 1 females, the median age 68 years old (58-77 years old), the median time from onset to treatment was 3d (0-5d), the median time to diagnosis was 5d (5-13d), the median time to take Tamiflu antiviral therapy was 6d (1 ~ 8d). The median time from onset to death was 28d (ranged from 4 to 76 days). All 5 deaths had chronic basic diseases, and 3 of 5 patients were referred to medical institutions below township level for the first time. Conclusion: Middle-aged and elderly patients with chronic underlying diseases are at high risk of H7N9 avian influenza infection. Delay in treatment, irregular medical treatment, misdiagnosis and medication are important factors in the death of critically ill patients. All cases have exposure history, human transmission is unlikely.