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About the yellow fever prevention and control plan (2016 edition)

 

The 2016-04-22 national health and population and family planning commission of the People's Republic of China

Countries who do CDC letter [2016] no. 382

 

Provinces, autonomous regions and municipalities directly under the central government health and family planning commission, the xinjiang production and construction corps health bureau, the entry-exit inspection and quarantine bureau directly under, the Chinese center for disease control and prevention:

Yellow fever is mainly in the tropical regions of South America and Africa, China has confirmed on March 12, 2016, the first imported cases. Because our country has personnel exchanges with the endemic countries/regions, an importation risk persist. Yellow fever for further prevention and control work, to protect people's life safety and health, national health and family planning commission and the gaqsiq shall formulate the "yellow fever prevention and control schemes (2016 edition)" (which can be downloaded from the national health and family planning commission website www.nhfpc.gov.cn). Hereby printed and distributed to you, please refer to execution.

General office of national health and family planning commission Quality supervision, inspection and quarantine office

On April 15, 2016

Yellow fever prevention and control plan

(2016)

Yellow Fever (Yellow Fever) is a kind of made by Yellow Fever virus spread by mosquito bites of acute infectious diseases, is one of quarantine infectious diseases in our country. The main clinical fever, jaundice, bleeding, etc. The disease is mainly popular in the tropical regions of South America and Africa. In our country was confirmed on March 12, 2016, the first imported cases. With the endemic countries/regions have personnel exchanges, cases enter our country risks persist. To do a good job in the prevention and control of yellow fever in China formulates this plan.

An overview, disease

(a) etiology.

Yellow Fever Virus (Yellow Fever Virus get) for single strand RNA Virus is chain, belong to the Yellow Virus (Flaviviridae) Yellow Virus genera (Flavivirus). Virus particles are spherical, 40-60 nm in diameter, outer lipid membrane, the surface have a spine, the length of the genome of about 11 KB.

Yellow fever virus is only one serotype, according to the characteristics of the virus genome sequence can be divided into multiple genotypes. The virus can be with for the yellow virus of the genus dengue virus, village card virus, such as west Nile virus serological cross reactions occur.

Yellow fever virus is addicted to internal organs such as liver, kidney, heart, and primates) and the characteristics of the perineural (mice).

Yellow fever virus external resistance is weak, 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.

(2) of epidemiology.

1. The source of infection

According to the propagation mode, yellow fever is mainly divided into urban and jungle. The main source for the spread of city type patients and recessive infection, especially in patients within 5 days of stroke onset. The main source for the spread of jungle monkeys and other nonhuman primates, separation to the virus in the blood of infected animals.

2. The route of transmission

Mosquito-borne transmission is the main route of transmission of yellow fever virus.

Mosquito-borne by biting yellow fever virus infection of infected people or animals, again through the bites will spread of the virus. Different kinds of aedes mosquitoes and hasten blood can spread the virus.

At present there are mainly two types of transmission mode:

Urban yellow fever: in person - mosquito-borne - cycle. In the ever popular area, the main medium for aedes aegypti. If infected the virus into densely populated areas, low immunization coverage, and the region has the aedes mosquitoes survive, aedes mosquito infected bite again after healthy people, infection can lead to crowd. At present, the main yellow fever this way lead to the outbreak of the crowd. Laboratory studies have shown that white mosquito aedes mosquitoes may also has the capability of transmission.

Forest type (or jungle) yellow fever: in nonhuman primates - mosquito-borne - way cycle of non-human primates. Mosquito species in the tropical rain forest, media is more complex, including Africa aedes mosquito, aedes Simpson, hasten blood, evil spirit are threshold, aedes albopictus and aedes mosquitoes, etc. Because the human into the jungle were mosquitoes bite and infection.

3. The population susceptibility

For yellow fever virus generally susceptible crowd. After infection or vaccination may obtain lasting immunity, have been found infected again.

4. The incubation period and infected period

Incubation period (1) : general for 3-6 days, up to 14 days.

Patients with stage (2) infection: fever to within a short time before 3-5 days after the onset, can produce high levels of viremia. The longest 10 days after onset can detect virus in the blood.

5. The geographical and seasonal distribution

Yellow fever is mainly in the tropics of central and South America and Africa, each year 90% of reported cases in Africa. In the absence of the endemic in the country/region has a small amount of imported cases. Have input case report of our country, the local communication but not yet.

The disease in endemic areas all can happen all the year round, mosquito-borne active peak season. 3 - each year in South America and Africa, more cases of April.

(3) the clinical manifestations.

The disease clinical difference is very big, the illness from mild self-limited to lethal infection. Typical clinical course can be divided into the following four period.

1. The infection period

This period is the viremia stage, for 3 to 5 days.

Acute onset, chills, fever (up to 39 ℃ - 41 ℃), the whole body discomfort, headache, muscle pain, anorexia, nausea, vomiting, restlessness, irritability, dizziness, etc., but no specific symptoms.

Physical examination can be relatively slow pulse, the skin, conjunctiva and gum hyperaemia, phase change characteristic tongue (tongue tip red with white moss), etc.

2. Remission

Onset of 3 to 5 days later, the patient into remission, hypothermia, relieve symptoms. Most of the patients started to recover, but about 15% of patients within 48 hours the illness is aggravating, again into the poisoning.

Stage 3. Poisoning (liver and kidney damage)

This period is characterized by the illness is aggravating, again appear multiple organ damage, often involving the liver, kidney and blood system, etc. About 50% patients with stage into the poisoning of death.

From 4.

Recovery sustainable 2-4 weeks. Temperature dropped to normal, the symptoms gradually disappear, organ function gradually returned to normal. But fatigue symptoms last for several weeks. Jaundice and sustainable transaminase eleations for months. It is reported that patients in convalescence death, died of cardiac arrhythmias.

Second, the diagnosis and report

(a) diagnosis.

Medical institutions at various levels and of yellow fever should, in accordance with the diagnosis and treatment plan to do a good job of the diagnosis of related cases.

Provinces found the first yellow fever cases, by provincial family planning department of public health organization expert group, combined with the Chinese center for disease control and prevention check result, diagnosis. Severe cases, death cases and aggregation index case of epidemics and the specimens of initial cases shall be sent to the audit and testing the Chinese center for disease control and prevention.

(2) the report.

Medical institutions of various levels found suspected cases of yellow fever cases, clinical diagnosis or confirmed cases, should consult a class infectious diseases reporting requirements, through the national information system for disease surveillance network straight newspaper, reported disease categories, select the "yellow fever", "other infectious diseases" such as imported cases should be stated in the note column source region, a unified format for "foreign input/X country or region" or "domestic input/X X X province city county". Conforms to the national public health emergency information management report specification (try out) "requirements, shall be in accordance with the relevant provisions of the report.

Third, laboratory testing

In cases of blood specimens for laboratory related to the etiology and serological detection, on mosquito-borne specimen collection, packaging, transport and laboratory tests, the specific content see the yellow fever virus lab testing technology solutions (appendix 1).

Yellow fever virus belongs to a class of pathogens in our country. Virus isolation, culture and so on involved in the operation of live virus must in biosafety level 3 laboratory (BSL - 3); Infection without training materials operations in biosafety level (BSL - 2) laboratory, if there is a negative pressure biosafety laboratory (BSL - 2) class 2, suggest that in the negative pressure lab operation; Inactivated and non infectious materials can be in biosafety laboratory (BSL - 1) operation. Live virus in the animal experiments should be carried out in animal biosafety level 3 laboratory (ABSL - 3). All operations must be strictly in accordance with the regulations on the biological safety of pathogenic micro-organism laboratory management requirement of related regulations.

Fourth, epidemiological investigation

Institution of disease prevention and control, port inspection and quarantine organ, after receiving the case report shall immediately organize professional conduct investigation, analysis of source of infection, search suspected cases, assess the risk of further infection and popular.

Cases found that the local infection, should carry out active search and mosquito-borne emergency monitoring, analysis of the epidemic dynamics, assess the popular trend, timely targeted control measures are put forward.

Severe cases, death cases, aggregation index case of epidemics and initial cases, and find out the epidemic situation to determine the nature and scope of investigation, according to the yellow fever cases epidemiology investigation table (attachment 2) a detailed case study.

Five, the prevention and control measures

(a) to popular country/region to outbreak of personnel to carry out the immune prevention and health knowledge education.

Yellow fever vaccination for prevention. Attenuated yellow fever 17 d preparation of vaccine can prevent yellow fever virus infection. Vaccination within 10 days, more than 90% of the people can get effective immunity; Within 30 days, 99% of people can obtain effective immunity. For most travelers, inoculation agent 1 enough to provide lasting immune protection, even produce life-long protection, do not need to strengthen the immune. Advice to popular country/region to outbreak of personnel in accordance with the requirements for yellow fever vaccine instruction, implement active immunity.

Education to epidemic endemic countries/areas of the traveler to improve awareness and take anti-mosquito measures such as insect repellent, long-sleeved clothes, prevent infection and enter overseas yellow fever, once appear suspicious symptoms, should take the initiative to see a doctor and will travel history told the doctor.

(2) to strengthen the frontier health and quarantine, effectively reduce the input of risk.

The inspection and quarantine department should strengthen the from epidemic endemic countries/regions people entering the health and quarantine, researchers from epidemic endemic countries/regions must present valid certificate of inoculation against yellow fever. For staff without relevant certificates, epidemiological investigation and collecting samples, given health persons possessing tips and see a doctor, (which can be downloaded from the general administration of quality supervision, inspection and quarantine the health and quarantine and supervision business column) to follow the related content, leave the outbreak epidemic countries/regions within 6 days, self health monitoring, if appear suspicious symptoms, the doctor in time, and take the initiative to report travel history to accepts the medical staff. Completes the popular country/region from the entry of aircraft and other transportation and container, goods such as mosquito vector control measures.

Found after suspected cases, inspection and quarantine department shall timely notify the health, family planning branch jointly do the outbreak investigation and disposal.

(3) the case report and management.

Medical institutions at all levels found after suspected cases of yellow fever to report in time, make the family planning administrative department of health and disease prevention and control institutions grasp the epidemic as soon as possible and take necessary control measures. Season in the medium of aedes activity, medical institutions should be anti-mosquito isolated cases, at the same time, completes the nosocomial anti-mosquito mosquito mosquito vector control measures, etc. Cases of medical staff should do well in personal protection, avoid contact with blood and body fluids. Medical institutions secretions and excretions of cases should be strict disinfection treatment.

Cases of institution of disease prevention and control should be timely to carry out epidemiological investigation, case search, evaluate the spread risk.

Family planning department of public health found that after suspected cases, also should promptly notify the inspection and quarantine departments, in order to master the epidemic as early as possible and effective port of prevention and control measures.

(4) to carry out the mosquito-borne emergency monitoring and control.

Season in the medium of aedes activity, when yellow fever cases appeared, should immediately carry out emergency mosquito-borne monitoring, and control measures. Specific measures can see issued by the Chinese center for disease control and prevention of the dengue vector aedes mosquito monitoring and guide to the medium of dengue aedes control guide.

(5) improve the ability of yellow fever to detect and respond to.

Suggested that the conditional provincial center for disease control and prevention and the port city of center for disease control and prevention, port inspection and quarantine institutions to establish laboratory testing techniques and methods, techniques and reagents reserve.

Family planning departments should organize local health issued by the relevant technical plan, carry out technical training, improve the medical staff to the discovery of yellow fever, recognition ability, improve the outbreak of disease prevention and control of epidemiological investigation and disposal ability.

Attachment: 1. The yellow fever virus lab testing technology solutions

2. The yellow fever case survey of epidemiology

Attachment 1

Yellow fever virus lab testing technology solutions

Yellow Fever Virus (Yellow Fever Virus get) belong to the Yellow Virus (Flaviviridae) Yellow Virus genera (Flavivirus), spherical, diameter is about 40-60 nm, envelope. RNA genome for single strand is chain, the length of about 11 KB. Yellow fever virus is only one serotype, according to the characteristics of the virus genome sequence can be divided into multiple genotypes.

Detection methods include yellow fever virus nucleic acid detection, antibody detection and neutralizing antibody (IgM and IgG, etc.) and virus separation, etc. Yellow fever virus and virus belong to other viruses, such as dengue virus, huang village card virus, produce serological cross reactions such as west Nile virus, serological detection are prone to false positives.

A, test object

(a) suspected, clinical diagnosis and confirmed cases.

(2) the aedes mosquitoes and larvae.

Second, sample collection, preservation and transportation

(a) cases specimen collection.

In patients with suspected of yellow fever virus infection, blood, urine and saliva samples as soon as possible.

Blood specimen collection way: use a sterile vacuum drying tube, the acquisition of anticoagulant in patients with 5 ml, serum separation in time, separated into two different tube, save in the tube with screw cap, inside the washer cryopreserved, mark clear after cryopreservation, one tube for local biosafety level 2 laboratory testing, 1 tube used in the higher institution of disease prevention and control. For cases should be double blood samples as soon as possible, it is advisable to interval of 14 days between the two specimens, hospitalized cases can be on the day of admission and discharge a 1 day before the acquisition.

Urine specimen collection methods: urine samples of 10 ml, separated into two different tube, 5 ml, 15 ml centrifuge tube to keep sterile.

Saliva specimen collection methods: will spit saliva into 50 ml plastic tip at the end of the centrifugal tube, separated into two different tube, each 1 ml, save in the tube with screw cap, inside the washer cryopreserved after save.

(2) the mosquito-borne specimen collection.

Foci in the acquisition of aedes mosquitoes and larvae, classification identification, specimen information table, fill in the medium according to the gathering place of packaging of each tube 10-20.

(3) samples, shipping.

Such as specimens are able to carry out laboratory tests within 24 hours, samples should be stored in 2 ~ 8 ℃; Can not be timely detection of specimen should be kept at - 70 ℃ below as soon as possible.

Samples shipped using low temperature refrigerating transportation, avoid freezing and thawing, sample transport shall comply with the national biological safety regulations related to a class of pathogen.

Third, detection method

Detection methods include yellow fever virus nucleic acid detection, antibody detection and neutralizing antibody (IgM and IgG, etc.) and virus separation, etc. Yellow fever virus and yellow belong to other viruses have stronger serological cross reaction, easy to produce false positive.

To carry out the mosquito-borne yellow fever virus detection, mainly for the adult mosquitoes or captured aedes mosquito larvae for virus nucleic acid detection and separation.

(a) in clinical samples.

1. Detection of etiology

Etiology detection is mainly used in the acute phase of blood specimen, general think within 5 days of the detection positive rate is high.

(1) nucleic acid testing: fluorescence quantitative rt-pcr are main detection methods in the early diagnosis of yellow fever. Can use the Chinese center for disease control and prevention virus disease by fluorescence quantitative PCR reagents or other commercial kits for testing.

(2) the virus separation: within 4 days after onset virus separation, high success rate, but there are 14 days come on successful in deaths from liver tissue separation the report of the virus. Specimen administered in Vero cell separation culture, etc, with immunofluorescence method to detect nucleic acid or identification of the virus.

2. The serological detection

Yellow fever virus antibody with dengue virus, village card and west Nile virus yellow viruses have strong serological cross reaction, easy to produce false positive. At the same time, the judge should also be considered when ever vaccinated against yellow fever.

(1) the serum specific IgM antibody: within 1 week of specific IgM antibody can be detected virus, week 2 antibody levels to peak, 1 to 2 months after down, IgM antibody in the patient's body to last for years. Yellow fever virus IgM antibody with dengue virus, such as west Nile virus yellow virus has strong serological cross reaction, easy to produce false positive. IgM antibody capture method commonly used ELISA test. IgM antibody positive, such as the recent not vaccinated against yellow fever, the patient may be newly infected with yellow fever virus.

(2) the serum levels of specific IgG antibody: 1 week after onset specific IgG antibody can be detected virus, duration of years or even a lifetime. By adopting the method of ELISA, immunofluorescence test. Recovery in patients with serum IgG antibody positive transfer or drops relatively acute phase is more than 4 times and higher, and the exclusion of dengue, je, yellow and other common virus infection can be confirmed.

(3) the neutralizing antibodies: neutralizing antibody appeared in the disease after a week. By plaque reduction neutralization test of neutralizing antibody specificity is better. Recovery period in patients with serum neutralization antibody positive transfer or drops relatively acute stage is 4 times higher and above, other yellow after virus infection can be diagnosed.

3. The other samples

Urine and saliva samples available serum virus RNA extraction kit and specificity of detection reagent for nucleic acid detection, the result judgement with serum specimens, also can carry out the detection of specific antibodies. Such as in patients with liver tissue samples can be used immunohistochemical method to detect virus antigen, or grinding after virus specific nucleic acid detection and separation.

(2) medium samples.

1. The specimen processing

After the classification of aedes mosquitoes or larvae, according to the gathering place, every 10 to 20 for a grinding processing.

2. The virus nucleic acid detection

By rt-pcr method for yellow fever virus nucleic acid detection.

3. The virus separation

Positive specimens for viruses the virus nucleic acid separation.

Fourth, biological safety

Yellow fever virus belongs to a class of pathogens in our country. Virus isolation, culture and so on involved in the operation of live virus must in biosafety level 3 laboratory (BSL - 3); Infection without training materials operations in biosafety level (BSL - 2) laboratory, if there is a negative pressure biosafety laboratory (BSL - 2) class 2, suggest that in the negative pressure lab operation; Inactivated and non infectious materials can be in biosafety laboratory (BSL - 1) operation. Live virus in the animal experiments should be carried out in animal biosafety level 3 laboratory (ABSL - 3). All operations must be strictly in accordance with the regulations on the biological safety of pathogenic micro-organism laboratory management requirement of related regulations and personnel engaged in yellow fever virus related material lab operation should be according to the result of exposure to risk assessment, yellow fever vaccination when necessary.

Virus cultures transportation should meet the international civil aviation organization file "aviation safety transport of dangerous goods technical conditions" (Doc9284) class A infectious material packaging requirements, corresponding to the Numbers for UN2814; Without the culture of infectious materials transportation should meet the packaging requirements of class B infectious material, corresponding the UN Numbers for UN3373. Related transportation activities must be in accordance with the human to infect highly pathogenic pathogenic microbial species (drug), or sample transportation management regulations of the People's Republic of China (the original health ministry make 45), after examination and approval before implementation.

The attachment 2

Yellow fever case survey of epidemiology

One, the basic situation

(a) the patient name: ________________ contact phone: _____________________

Such as patient age < 14 years old, the parents name:.., contact phone number: _____________________

(2) gender: 1. 2. The male female

(3) age: _____ years old

(4) home address: (area/city) ____ ____ province city (city/area) ___ ___ county township (town)/street ___ village (neighborhood)

(5) work units: ________________________________________________

(6) occupation:

Childcare children 2. Scattered children 3. 4. Students teachers 5. Conservation nanny 6. Diet from personnel of course of study

7. Business services 8. 9. Medical workers 10. 11 of migrant workers. The farmers' 12. The nomads

14. 13. Yu (a ship) people cadre staff 15 former personnel 16. Housework unemployment 17. Other

(7) if the imported cases, please fill out the following content:

1. Nationality ________________________________

2. Where local entry:

3. The port of entry _____________________________. Entry time: on ______ _____ ______ years

4. (2) entry reasons: (1) the travel business with relatives to study (3) (4) (5) other ________________

5. After the entry into the area and residence time:

Place 1: ___________; Date:...... years _____ month solstice on _____ _____ ______ years

Place 2: ___________; Date:...... years _____ month solstice on _____ _____ ______ years

Second, the pathogenesis and clinical symptoms

(a) onset date: on......... years

(2) the starting symptoms: __________________________________________________

(3) the associated symptoms and signs:

1. The fever (38 ℃ above) : (1) there are (2) (3) is unknown

If yes, date: on solstice _____ _____ _____ _____ month, the highest temperature _____ ℃, or (not) detection.

2. Chill: (1) (2) (3) is unknown

3. The whole body discomfort: (1) (2) no (3) is unknown

4. Headache: (1) (2) (3) is unknown

5. Muscle pain: (1) there are (2) (3) is unknown

If there is any, location: ______________________________

6. Joint pain: (1) (2) (3) is unknown

Mainly affects joints (pops) : (1) the wrist 2) finger toe ankle (3) (4) (5) the knee

6. Elbow spinal pet-name ruby other 7) shoulder joint

7. Anorexia: (1) (2) (3) is unknown

8. Nausea: (1) (2) (3) is unknown

9. Vomiting: (1) (2) (3) is unknown

10. Upset: (1) (2) (3) is unknown

11. Dizzy: (1) (2) (3) is unknown

12. The face congestion: (1) there are (2) (3) is unknown

13. The conjunctival congestion: (1) there are (2) (3) is unknown

14. Bleeding symptoms: (1) there are (2) (3) is unknown

If you have any bleeding as (pops) :

1) gum bleeds conjunctival hemorrhage (2) nasal bleeding (3) (4) the hematemesis 5 hematochezia 6 hematuria 7) other

15. Flush on the face, neck: (1) there are (2) (3) is unknown

Three, doctor

Clinic date

Name of the hospital doctor

Whether in the hospital

The hospital date

note

Four, residence (a patient and his family) environmental factors associated with:

(a) using anti-mosquito device (pops) : (1) the nets (2) the mosquito-repellent incense (3) the screen door (4) (5) other mosquito agent:

(2) the water container types (pops) : (1) (2) the vase made of baked clay (3) (4) the pot dishes cylinder (5) the pond

(6) tree holes (7) (8) (9) the rockery miniascape bamboo pile

Other ________________ (10)

Five, the disease before and after the activity

(a) go out history:

1. Within 1 week before the onset of whether to have to go out (to leave the cities and counties and outbound travel) the history is: (1) (2) no

If no, skip to "(2) before and after the onset of the local activity"

If yes, location 1: ___________; Date: from ____ ____ _____ solstice year on _____ _____ _____

Place 2: ___________; Date: from ____ ____ _____ solstice year on _____ _____ _____

Place 3: ___________; Date: from ____ ____ _____ solstice year on _____ _____ _____

Returns the time (arrival time) : on _____ _____ _____ years

Peer group name (or travel agency name) : __________________

1: the field name telephone: ________________________ health: ____________ hold

2: the field name telephone: ________________________ health: ____________ hold

Field name 3: phone: ________________________ health: ____________ hold

Field name 4: phone: ________________________ health: ____________ hold

Field name 5: phone: ________________________ health: ____________ hold

2. During travel if there is a clear history of mosquito bites is: (1) (2) (3) is unknown

If so, the bite site is: location 1: alarm; Place 2:..,;

Place 3:..,

(2) before and after the onset of the main activities in the local) : (note column to fill in a specific location

The date of

In the home

Work units

park

Sports venues

market

The school

The hospital

other

note

Six, joint exposure to health

(a) any other family members has had the similar symptoms/contacts: (1) (2) (3) is unknown

(2) of the population in the home: ___, similar to the symptoms: ___ person;

(3) the work unit department number: ___, similar to the symptoms: ___ person;

Please send similar symptoms related to family members or colleagues to fill in the table below:

The name

With the patient

Relationship between

age

gender

The onset date

Clinic situation

The sampling

The date of

note

Seven, should be added other content:

Eight, note

(a) the blood routine examination

(2) the etiologic diagnostic testing

(3) the case diagnosis classification: this case belongs to the (imported cases, local)

Date of survey: on ______ ______ _______ years investigators: ________________