The ministry of health issued by the general office of the base hole Ken, heat prevention and control technology guide (2012 edition) "notice

        All provinces, autonomous regions, municipalities directly under the central government health TingJu, xinjiang production and construction corps health bureau, China's disease prevention and control center:

        In June 2008, ministry issued the base hole Ken, heat prevention and control technology guide (for trial implementation) "(who do emergency hair [2008] no. 109), to prevent and control base hole Ken and heat which has played a positive role. In order to adapt to the current our country base hole Ken and thermal epidemic situation, combined with practical experience in recent years, prevention and control, guidance to all further base hole Ken, heat prevention and treatment work, to protect people's health, our organization has formulated the "base hole Ken, heat prevention and control technology guide (2012). Hereby printed and distributed to you (electronic from the ministry of health web site), please connecting with the working practice, seriously implement. This guidance issued by the, the base hole Ken, heat prevention and control technology guide (for trial implementation) shall be repealed simultaneously.

General office of the ministry of health

October 30, 2012

Base hole Ken, heat prevention and control technology guide

(2012 edition)

        Base hole Ken and hot (Chikungunya Fever, CHIKF) is a kind of infected with base hole Ken and virus causes by Fever, joint pain/arthritis, skin rash as the main clinical manifestation of viral diseases, mainly through the aedes albopictus captured and aedes mosquitoes spread. The disease although case fatality rate is very low, but in mosquito-borne densities areas easy to form large-scale outbreak and pop.

        As a guide to further around the base hole Ken, heat prevention and control work, in our 2008 issued by the base hole Ken, heat prevention and control technology guide (try out) "basis, technical guidelines are formulated.

        A, disease overview

        (a) etiology.

        Base hole Ken and virus (Chikungunya virus, CHIKV), belongs to the membrane virus KeJia virus genera, virus diameter about 60 ~ 70 nm, envelope. Genome for single strands are chain RNA, the length of about 11-12 KB; One serotype, can divide three genotypes, i.e., west Africa type, medium - east - cape type and Asian. Viruses can be in Vero, C6/36, BHK - 21 and HeLa cells in culture breeding and produce lesions. Virus is not acid, not heat-resisting, 56 ℃ 30 minutes inactivated, 70% ethanol, 1% sodium hypochlorite, grease solvent, peroxyacetic acid and disinfectant and ultraviolet irradiation all can kill virus.

        (2) epidemiology.

        1. The source of infection.

        Patients, recessive infection is the main source for the spread of the disease. Non-human primate animal is the host.

        2. Transmission way.

        The disease is mainly through the media aedes mosquito bites propagation.

        3. The crowd susceptibility and immunity.

        The crowd to base hole Ken and virus common susceptibility. People were infected with the virus can obtain the lasting immunity.

        4. Media.

        Aedes albopictus captured and aedes aegypti is the disease is the major media. Aedes albopictus captured and aedes aegypti mainly breed in relatively clean container water, the general in the daytime bite people, activity peak after sunrise and sunset 2 hours before two hours.

        Aedes in bite viremia issue of people or animals, virus in the mosquito breeding body and get to the salivary gland hyperplasia inside, the 2 to 10 days of the incubation period to spread the virus. Mosquito in the virus can survive for a long time, even a lifetime with poison.

        5. Infect period.

        Patients in the day to 7 days have infectivity.

        6. Distribution.

        Base hole Ken and heat with the geographical distribution of media aedes geographical distribution related, in sub-saharan Africa, southeast Asia, and the Indian Ocean islands, west Pacific tropical or subtropical area is local popular.

        According to the world health organization (WHO) reported that in recent years, Africa and southeast Asia often occur base hole Ken and hot outbreak and pop. In 2006, the maldives, Mauritius, Madagascar, seychelles, French reunion island, Malaysia, Indonesia and India and other countries and regions have reported base hole Ken and thermal outbreak, among them, the French reunion island in the pathogenesis of number up to 270000 people, accounts for about 40% of the local population, India the report suspected cases more than 1.39 million, the incidence of parts of more than 45%. 2008-2009 years, Thailand, Singapore, India, Malaysia reported base hole Ken and thermal epidemic; In 2010, India, Indonesia, Vietnam and China all have base hole Ken and thermal epidemic situation report. France and the United States and other countries not popular input cased being found.

        7. The seasonal characteristics.

        The season with local media aedes season growth and relevant. In the tropical and subtropical regions, base hole Ken and hot all the year round all can come on.

        (3) the main clinical manifestation.

        Incubation period 1 to 12 days, usually 3 to 7 days.

        Fever, joint pain/arthritis, skin rash is the typical clinical manifestations of the disease. The main symptoms are urgent up high fever, joint pain, joint swelling, maculopapule, may be associated with headache, nausea, vomiting, NaCha, abdominal pain and so on gastrointestinal symptoms, photophobia, conjunctival congestion or bleeding symptoms. Acute symptoms usually lasts for 5 to 7 days. Skin rash in facial or limbs stretch side. Joint pain often expression to wander the gender aches, involvement of the multiple joints, to attack small joint (such as knuckle) see more, Joint pain often associated with fever symptoms appear, sustainable days or months. Some patients may appear as a persistent joint pain. A few patients can appear bleeding, encephalitis, myelitis and serious complications leading to death.

        Second, epidemic prevention and control classification and regional assignment

        (a) input cased.

        Refers to the first 12 days to a base hole Ken and heat flow done countries or regions of cases.

        (2) the local infections.

        Refers to the first 12 days did not leave this area (county/district as the unit), or not to a base hole Ken and heat flow done countries or regions of cases.

        (3) farm.

        Farm is refers to the base hole Ken and thermal patient and recessive infected areas of activity, can cause the infection around the area. Usually in infected domicile or the neighboring some household, infections, such as the work site activity places as the center, according to the mosquito-borne range of activity delimit radius within 100 feet of space scope, usually as a disease treatment of core area. A case can be infected more than designated farm.

        (4) warning area.

        Warning area refers to when there is a base hole Ken and thermal epidemic, according to the base hole Ken and thermal patients, recessive infection and mosquito-borne and source of infection or media activities, combined with epidemiological survey results may be defined the spread of the virus risk area. Usually in core area of around 500 - meter radius area as epidemic disposal warning area. Rural farm general with surrounding natural village, tuen, or necessary in administrative villages and township, town as early warning area. In the city general with around farm some street, residents' committees or street as early warning area.

        Three, discovery and report

        All kinds of medical institutions at all levels found fever, joint pain and/or rash patients, should be detailed knowledge of the patient's history of epidemiology (travel history or people around the situation), consider the diagnosis, timely sampling inspection.

        All kinds of medical institutions at all levels found the hole Ken and thermal suspected, clinical diagnosis or confirmed cases, within 24 hours through the national disease monitoring information report management system for network straight, the report disease category select "other infectious disease", such as for input cases must be in the remarks column indicate the source area.

        Composition of emergent public health events, it shall, within 2 hours of the people's government at or above the county level within the administrative department of public health reports. Upon receipt of the report of the public health administrative department shall, within 2 hours of indrawn people's governments at the corresponding levels report, and at the same time through the emergent public health event information report management system to the ministry of health report.

        Health administrative departments at all levels and the local entry-exit inspection and quarantine agencies to establish information communication and the exchange mechanism, timely grasp the local port input cases related information, and prevent the occurrence of for input cases lead to local propagation.

        Four, laboratory testing

        At all levels of disease prevention and control institutions and medical agencies found suspicious cases, carefully according to the base hole Ken and thermal laboratory detection scheme "(appendix 1) specimen collection, storage, transportation and laboratory detection.

        Local laboratory unconditional test, should be timely to the superior CDC testing.

        Five, the case management and occupational protection

        Base hole Ken and heat treatment of the cases are mainly take suit, support and comprehensive treatment. Cases of acute period must take measures to prevent mosquito isolation measures, anti-mosquito isolation period from the date of not less than 7 days, and should continue to fever symptoms subsided. Severe cases should be hospitalized.

        For case management, based on the medical institution shall carry out mosquitoes anti-mosquito measures to prevent nosocomial infection. Medical and health technical personnel to carry out diagnosis and treatment in and epidemiological investigation when, should adopt standard protection and anti-mosquito protection measures.

        Six, epidemiological investigation

        In institution of disease prevention and control from epidemic situation report, must immediately organize professional personnel in accordance with the base hole Ken and thermal epidemiological survey plan "(attachment 2) launch investigation, clear infection site, search suspect case, evaluate the risk of an infection and popular.

        Found that the local infection epidemic, must carry out active cases search and mosquito-borne emergency monitoring and evaluation, analysis epidemic dynamic, evaluate popular trend, timely put forward some control measures.

        In all cases and send out the instructions of the outbreak cases, starting cases, serious illness, death cases and to find out the epidemic nature and the scope affected need and determine the investigation object, according to the base hole Ken and thermal epidemiological case questionnaire "(attachment 2 of appendix 1) carry on the detailed case study. Epidemic nature confirmed cases happened can use "base hole Ken and thermal household survey registration form" (attachment 2 of schedule 2) collect briefly epidemiological information.

        Seven, prevention and control measures

        There is no base hole Ken and thermal vaccine. Control aedes medium density, completes the anti-mosquito mosquito killer work is prevention and control base hole Ken and heat the most basic and most important measures.

        (a) the preventive measures.

        1. To strengthen health education, popularize the prevention knowledge.

        (1) the guidance anti-mosquito mosquito killer.

        In a base hole Ken and hot popular risk areas, to take various effective form to straightaway way to carry out health education activities. Propaganda points include: basic hole Ken and heat by aedes mosquitoes (commonly known as tinea mosquito or flower mosquito) bite spread; Aedes in the bucket, such as basin water container breeding; Clear water, turn basin fall tank, clear the mosquito breeding sites can prevent base hole Ken and hot popular; In case of epidemic areas to wear long sleeve clothes, can besmear mosquito repellent to prevent mosquito bites.

        (2) tip tourists overseas infection prevention.

        All health institutions to assist tourism departments to base hole Ken and hot popular area of the tourists and tour guide propaganda education, especially to southeast Asia, South Asia and Africa popular area of the tourists, awareness, to prevent infection in overseas base hole Ken and heat. Inform visitors once appear suspicious symptoms, should be active to see a doctor and will travel history told the doctor.

        2. Strengthen the medical personnel training, improve disease recognition ability.

        Medical staff to carry out diagnosis and treatment knowledge training, improve disease diagnosis and recognition ability. The key areas should be in every popular season before the start of a grassroots medical staff base hole Ken and heat related knowledge of intensive training, strengthen the base hole Ken and thermal understanding, discover in time and report suspected base hole Ken and hot cases.

        (3) strengthen media aedes density monitoring, carries out the mosquito killer measures.

        Disease control department should carry out community-based mosquito-borne density monitoring or survey, including aedes species, density and seasonal regression etc; Find mosquito-borne density on the high side, timely relevant units in clearing mosquito breeding sites and preventive mosquito killer work.

        (4) to carry out patriotic sanitation campaign, the comprehensive clear mosquito breeding sites.

        Existing popular risk region should actively do patriotic sanitation campaign, do a good job in indoor and outdoor environment health, clear mosquito breeding sites, etc.

        5. Strengthen information communication, well integrated zone.

        Department of health and the inspection and quarantine, tourism and other departments to establish defense mechanism, and timely reporting information and coordinating epidemic disposal work.

        (2) epidemic control measures.

        Epidemic control measures include: case management, case investigation, case search, publicity and education, mosquito-borne density investigation, mosquito killer and effect evaluation, etc.

        1. Input venereal disease cases of control measures

        Input cased prevention and control of key is find out patients viremia period (onset 7 days) of the activity place, according to the mosquito medium density and spread risk assessment results, adopt specific measures to control the spread of the virus, mainly including the following several aspects:

        (1) to carry out epidemiological investigation and risk assessment.

        Found the hole Ken and hot cases, should be carried out as soon as possible epidemiological investigation, find out the source of infection and disease patients before and after activities; To carry out case search and farm mosquito-borne density investigation, evaluation spread risk.

        (2) the scene of the farm organization and coordination and communication.

        According to epidemiological survey and spreading risk assessment delimit the epidemic point, the epidemic occurred shall notify the villages and towns (street) government (office), completes the organization carries out the base hole Ken and thermal control coordination work, implement the anti-mosquito mosquito killer drugs and material reserve and transfer, adopt to kill mosquitoes, clear mosquito-borne nidus and carry out the public education etc.

        (3) to carry out case search.

        Find input cases, should be tracking have common exposure of people's health condition, may jointly debunker should as far as possible draw blood cleared.

        (4) the epidemic situation, strengthen the departments.

        Find input cases should be reported as soon as possible or related areas of institution of disease prevention and control by the superior to the relevant regions bulletin, bulletin content should include: name, patient morbidity and diagnosis situation, main stroke, Tours or reception unit name and related contact way, etc.

        Through the cases in CDC after notified, should be based on cases stay date and infect period, evaluate the local spread risk, and carry out the corresponding prevention and control work.

        2. Local disease control measures.

        Found that the local infection epidemic, should be in well on the basis of case management, focusing on the following work:

        (1) strengthening leadership, suggest epidemic situation as soon as possible the local people's government established base hole Ken and thermal epidemic control leading group and implement the prevention and control work.

        (2) carry out epidemiological investigation, the core area and early warning zone, formulate corresponding prevention and control strategy. In the core area to carry out to kill into mosquito, cleaning mosquito breeding sites for the focus of the comprehensive prevention and control measures. The early warning to the crowd, actively carry out heating with arthralgia wait for a symptom of emergency monitoring work.

        (3) media monitoring and performance evaluation.

        In the core requirements in every 3 days one mining diagram index survey work, every 4 days to carry out one into mosquito density investigation, request as soon as possible mining diagram index and induced mosquito lure egg index control in 5 below. In the early warning area requirements once a week mosquito-borne larva and into mosquito density investigation, makes every effort will mining diagram index and induced mosquito lure egg index control in 5 below.

        (4) to carry out popular factor investigation, evaluate epidemic diffusion risk.

        In carry out epidemiological survey at the same time, detailed farm and the collection of early warning of natural ecology, population and living conditions, floating population characteristics, environment and sanitation facilities, topography and geomorphology, air temperature, rainfall, and disease and dissemination of relevant information, analysis of local natural factors and social factors influence the spread of disease, evaluate epidemic diffusion risk. According to the epidemic situation assessment results, timely adjustment prevention and control strategy.

        (5) completes the risk communication.

        In accordance with the regulations in accordance with the timely publicize the epidemic information, fully arouse the masses, and carry out clear aedes nidus as the main contents of the patriotic health campaign.

        (3) epidemic termination decision.

        Finally a case after the occurrence of 39 days (7 days viremia period + 20 days mosquito-borne life + 12 days of incubation period) no new cases, and core mining diagram index for two weeks less than 5, can think this epidemic termination.

        Accessories: 1. Base hole Ken and thermal laboratory detection scheme

                                2. Base hole Ken and thermal epidemiological survey plan