General office of the national health and family planning commission concerning the village card virus disease diagnosis and treatment scheme (2nd edition) in 2016

The national health and family planning commission of the People's Republic of China

The 2016-03-30

Countries who do medical letter [2016] no. 259

Provinces, autonomous regions and municipalities directly under the central government health and family planning commission, the xinjiang production and construction corps health bureau:

Recently, the report village card virus infections country has increasing trend. As of March 8, 2016, at least in Africa, Asia, Europe and America has 55 countries village CARDS evidence of the spread of the virus, the most serious epidemic in Brazil. On February 9, 2016 in jiangxi province in China found the first imported cases, 11 March 2016 JCP imported cases, 13 cases were found. To do a good job in village card virus disease medical treatment related by experts in the relevant reference to the world health organization guidelines and summarizing the relevant domestic cases of medical experience, on the basis of revising perfect scheme of village card virus disease diagnosis and treatment, forming the village card virus disease diagnosis and treatment plan version 2 (2016) "(which can be downloaded from the national health and family planning commission web site). Hereby printed and distributed to you, please refer to execution.

Around the family planning administrative department of public health, especially with the outbreak occurred port district family planning department of public health personnel exchanges, to continue to prepare for village card virus epidemic prevention and control and medical treatment work, keep communication with port health quarantine and transportation departments and linkage, ensure the prevention and control measures put in place. Must strengthen the case management, accomplish early discovery, early diagnosis, early treatment, in accordance with the relevant therapeutic regimen for patients with standard medical services, to do a good job of anti-mosquito isolated cases. Strengthen medical personnel training, improve the village card virus disease early recognition and diagnosis and treatment ability. With the spread of disease distribution of mosquito-borne province should strengthen environmental health regulation, according to the situation of mosquito-borne monitoring work timely and effective to carry out the mosquito, reduce the risk of mosquito-borne diseases spread.

Touch: national health and family planning commission medical administration hospital authority XiaoKui, rui-rong hu

Contact phone: 010-68791885, 68791887

The true: 010-68792963

Mail box: bmaylzyc@163.com

General office of national health and family planning commission

On March 17, 2016

Village card virus disease diagnosis and treatment plan

Version 2 (2016)

Village card Zika virus disease is caused by village card virus a self-limited acute infectious diseases, is mainly transmitted by aedes mosquitoes. Clinical characteristics are mainly rash, fever, joint pain or conjunctivitis, rarely cause death. The world health organization (WHO) believe that the newborn microcephaly, guillain-barre syndrome (gillan - the barre syndrome) may be associated with village card virus infection.

Village card virus disease mainly in tropical and subtropical regions in the world. In 1952, in the human body in Uganda and Tanzania isolated the virus. Since then, many countries have reported sporadic cases. In 2007, for the first time in the western Pacific countries Micronesia island village chapel card virus outbreaks. As of March 8, 2016, at least in Africa, Asia, Europe and America has 55 countries village CARDS evidence of the spread of the virus, the most serious epidemic in Brazil. On February 9, 2016 in jiangxi province in China found the first imported cases, 11 March 2016 JCP imported cases, 13 cases were found.

A, etiology,

Card is a mosquito-borne viruses village, for the first time in 1947 in Uganda found in rhesus monkeys. Yellow virus flavivirus genus, for single strand RNA virus is chain, 40-70 nm in diameter, envelope, contains 10794 nucleotides, encoding 3419 amino acids. According to the genotype don't classified as African and Asian, the popular for Asian America.

Village card virus resistance is unknown, but yellow virus of the genus generally no acid, no heat. 60 ℃ for 30 minutes can be inactivated, 70% ethanol, 0.5% sodium hypochlorite, disinfectants, such as grease solvent, peracetic acid and ultraviolet irradiation can be inactivated.

Second, the epidemiology characteristics

(a) infection.

Patients and asymptomatic infections and village card virus nonhuman primates is the likely source for the spread of the disease.

(2) the route of transmission.

Aedes mosquito with the virus is the main route of transmission of the disease. Media mainly aedes aegypti and aedes albopictus, Africa aedes and yellow head aedes mosquitoes can spread the virus. Through mother-to-child transmission (including childbirth and intrauterine infection), blood transmission and sexual transmission.

Virus disease duration generally within 10 days. In infected saliva, urine, semen village card virus RNA can be detected, and the duration is longer than the viremia. Can be detected in milk village card virus nucleic acid, but there is no neonatal infection through breastfeeding.

According to monitoring, our country related to village card virus to aedes species mainly aedes aegypti and aedes albopictus, including aedes aegypti mainly distributed in leizhou peninsula, hainan and guangdong province in xishuangbanna, yunnan province, dehong prefecture, lincang city, as well as parts of Taiwan; Aedes albopictus is widely distributed in China's liaoning, hebei, shanxi, shaanxi, gansu, sichuan, Tibet, south of the line and the general area.

(3) the population susceptibility.

People generally. Once infected village card virus may have immunity to infection again.

Three, clinical manifestation

Village card virus disease of the incubation period is generally 3 to 12 days. One village card after virus infection, only 20% of the onset of symptoms, and the symptom is lighter, main show is rash (mostly maculopapule), fever (mostly in the low-grade fever), and may be accompanied by the purulent conjunctivitis, muscle and joint pain, muscle weakness and a headache, a few patient can appear abdominal pain, nausea, diarrhea, mucosal ulcers, skin pruritus, etc. Symptoms for 2 to 7 days, the prognosis is good, illness and death cases are rare. Infant infection also can appear the nervous system, eye and hearing change.

Pregnant women village card virus infection can result in placental insufficiency, fetal intrauterine retarded, fetal intrauterine and newborn microcephaly, etc.

A village card virus infection related guillain-barre Syndrome (gillan - the Barre Syndrome, Guillain - wilkes-barre Syndrome) cases reported, but the causal relationship between them has not yet been set.

Fourth, laboratory examination

(a) general inspection.

Routine blood: some cases can have white cells and platelets.

(2) serologic test.

1. The village card virus IgM test: by using enzyme-linked immunosorbent (ELISA), immunofluorescence test, etc.

2. Village card virus neutralizing antibody detection: the plaque reduction neutralization test (PRNT) detecting blood neutralizing antibody. Try to collect the acute phase and convalescence double serum detection.

Village with fellow yellow card virus antibody virus of the genus dengue virus, yellow fever and west Nile virus antibodies have stronger cross reaction, prone to false positives, identification should be paid attention to at the time of diagnosis.

(3) the etiology examination.

1. The virus nucleic acid detection: using fluorescence quantitative rt-pcr test specimens of blood, urine, semen, saliva in the village card virus nucleic acid.

2. The virus antigen detection: using immunohistochemical method to detect virus antigen village card.

3. Viruses isolated culture: specimens can be vaccinated in mosquito source cells (C6/36) or mammalian cells (Vero) separation methods such as training, also the milk inside the mouse vaccination can be used for virus isolation.

Five, the diagnosis and differential diagnosis

(a) diagnosis basis.

According to the history of epidemiology, clinical manifestation and related laboratory synthetic judgment.

(2) the case definition.

1. The suspected cases: conform to the history of epidemiology and clinical manifestations of accordingly.

Epidemiological history (1) : 14 days before the onset of inner village case report card virus infection or epidemic areas to travel or live; Or contact with village card is confirmed or suspected, clinical diagnosis of virus disease.

(2) clinical manifestations: hard to explain with other reasons of fever, rash, joint pain or conjunctivitis, etc.

2. Clinical diagnosis cases, suspected cases and village card virus IgM antibody testing positive, at the same time out of dengue fever, Japanese encephalitis, and other common yellow virus infection.

3 confirmed cases, suspected cases or clinical diagnosis cases through laboratory testing in accordance with one of the following circumstances:

(1) village card test positive for virus nucleic acid.

(2) the virus isolated village card.

(3) recovery of serum village card virus neutralizing antibody Yang or the drop degree of the acute phase is more than 4 times, and exclusion of dengue fever, Japanese encephalitis, and other common yellow virus infection.

(3) of the differential diagnosis.

Need a differential diagnosis and the following diseases:

1. The main with dengue and chikungunya differential diagnosis.

2. Other: with tiny virus, rubella, measles, enterovirus and rickettsial disease phase identification.

Six, treatment,

(a) general treatment. Village card virus disease symptoms usually lighter, do not need to make a special treatment, with symptomatic treatment is given priority to, strengthen nutrition support. Avoid the use of aspirin before exclusion of dengue fever and other non-steroidal anti-inflammatory drugs.

(2) of symptomatic treatment.

1. High fever is not retreated patients can take antipyretic analgesics, such as acetaminophen, adult usage for 250-500 mg/time, 3 to 4 times daily, children's usage for 10 to 15 mg/kg/times, between 4 to 6 hours, no more than 4 times in 24 hours. Children should avoid the use of aspirin to prevent concurrent Reye's syndrome.

2. With joint pain patients can use ibuprofen, adult usage for 200-400 mg/times, 4 to 6 hours, children 5-10 mg/kg/time, 3 times a day.

3. Can use human recombinant interferon alpha when accompanied by conjunctivitis eye drops, 1 to 2 drops/eye drops, 4 times a day.

(3) the treatment of traditional Chinese medicine. The disease belongs to Chinese medicine ", the plague epidemic, rash "category, can consult" disease rash "treatment based on syndrome differentiation.

1. The evil who made table card.

Symptoms: rash, fever, bad cold, sore throat, muscle joints pain, or see a skin rash point vaguely, or flush on head and neck skin, red eyes tears. Red is the tip of the tongue edge, pulse number.

Treatment: heat nourish.

Basic syndromes: honeysuckle, forsythia, herba schizonepetae, radix paeoniae rubra, artemisinin, SSP, radix scutellariae, radix bupleuri.

Add and subtract, red eyes, chrysanthemum, selfheal. Skin rash appeared, a bit cohosh, radix arnebiae seu lithospermi; What hot, add plaster stone, rhizoma anemarrhenae.

Proprietary Chinese medicine, can choose heat-clearing and nourish the kind of proprietary Chinese medicine.

2. The evil yu camp gas card.

Symptoms: fever, thirst, rash point dense, violet red and headaches, joints pain. Visible red crimson tongue, pulse number.

Treatment: camp through evil.

Basic syndromes: radix rehmanniae, radix paeoniae rubra, cortex moutan, radix arnebiae seu lithospermi, honeysuckle, forsythia, cogongrass rhizome, artemisinin, Fried gardenia, haliotis.

Add and subtract, constipation, with raw rhubarb, acid-insoluble ash; What hot, add gypsum; What a headache, uncaria; Joint pain, the person that weigh with loose knot, ramulus mori.

Proprietary Chinese medicine, can choose pure camp through evil kind of proprietary Chinese medicine.

3. The qi and Yin deficiency syndrome.

Symptoms: fever, god weakness, dry mouth, less gas, macula fade, Dr. Visible red tongue, less moss, pulse is fine.

Treatment: qi and nourishing Yin.

Basic syndromes: coastal glehnia root, dwarf lilyturf, yam, fructus schisandrae, radix trichosanthis, herba lophatheri, cogongrass rhizome, malt.

Chinese medicines, proprietary Chinese medicine, qi and optional classes.

(4) the other.

Village card virus to infection of pregnant women, it is recommended that regular prenatal, every 3-4 weeks monitoring fetal growth and development.

Seven, discharge standard

Comprehensive evaluation of hospitalized patients outcome situation to determine the discharge time. Suggestions in discharge shall meet the following conditions:

1. The temperature is normal, clinical symptoms disappeared.

2. Blood nucleic acid detection 2 consecutive negative (more than 24 hours); Do not have the nucleic acid testing conditions, duration of not less than 10 days.

Eight, prevention,

There is currently no vaccine to prevent, the best way to prevent is to prevent mosquito bites. Recommendations for pregnancy and pregnancy women carefully to village card virus epidemic areas.

Patients and asymptomatic infections should implement effective anti-mosquito isolation measures more than 10 days, four weeks to avoid blood donation, such as sexual behavior should be 2-3 months to use condoms.