H1N1 – 全球关注的问题 H1N1 – A Global Concern

1. H1N1 – 全球关注的问题 H1N1 – A Global Concern 中国健康教育者协会第四届全国会议 首届中国健康促进与教育论坛 中国人民共和国 上海 Presentation to the 4th National Meeting of the China Association of Health Educators and The 1st Chinese Health Promotion and Education Forum Shanghai, Peoples Republic of China 十一月 19-20, 2009 Bruce R. Chelikowsky, R.S. 美国公共卫生服务部上校（退役） CAPT U.S. Public Health Service, Ret.

2. 新型甲型流感（H1N1） Novel Influenza A (H1N1) 美国政府已经宣布了美国的突发公共卫生事件新型甲型流感（H1N1）。 疾病控制和预防中心(CDC)回应的目标是减少传播和疾病的严重性，并提供信息以帮助医疗机构、公共卫生官员和公众应对这一紧急情况带来的挑战。 The United States Government has declared a public health emergency in the United States in response to novel Influenza A (H1N1). CDC’s response goals are to reduce transmission and illness severity, and provide information to help health care providers, public health officials, and the public address the challenges posed by this emergency.

3. 新型甲型流感（H1N1） (续) Novel Influenza A (continued) 2009年3月底和4月初，在美国加利福尼亚南部，靠近德克萨斯州瓜达卢佩县报告了第一例新型甲型流感病例。随后，美国其他各州和国际社会也相继报告了人感染猪流感病毒的病例。 In late March and early April 2009, cases of human infection with a novel H1N1 influenza virus were first reported in Southern California and near Guadalupe County, Texas. Other U.S. states have reported cases of swine flu infection in humans and cases have been reported internationally as well.

4. 新型甲型流感（H1N1） (续) Novel Influenza A (cont.) 在墨西哥与美国已经报告了由于 H1N1流感爆发而导致的死亡病例。 CDC预计发病数量和死亡人数还会增加。 Deaths associated with this outbreak of H1N1 influenza have been reported in Mexico and the United States. CDC expects the number of cases and deaths to increase.

5. 大流行水平Pandemic Levels 世界卫生组织使用了6个阶段方法易于纳入新建议和办法纳入现有国家备灾和应急计划。 The World Health Organization uses a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans.

6. 时间 (2009年7月22日起) Timeline (22 July 2009 onwards) 向世卫组织报告 2009年 H1N1大流行实验室确诊病例和死亡人数 Pandemic (H1N1) 2009 laboratory confirmed cases and number of deaths as reported to WHO Status as of: 18 October 2009

7. 大流行水平 (续) Pandemic Levels (cont.) • 第1-3 阶段 - 主要是动物感染, 少数人类感染 • 第4 阶段 - 持续的人际传播 • 第5-6 (大流行) 阶段- 普遍的人类感染 • 高峰以后 - 经常性事件的可能性 • 大流行以后 - 季节性疾病活动水平

8. 有什么症状？ What are the symptoms? 人感染猪流感后的症状与人类的普通流感症状类似，包括发烧、咳嗽、喉咙痛、全身酸痛、头痛、发冷和疲劳。腹泻和呕吐也已经在一些人中报告。 The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting.

9. 流感病毒如何传播？ How Influenza Viruses Spread • 主要通过飞沫 • Primarily through respiratory droplets • 咳嗽 Coughing • 打喷嚏 Sneezing • 接触飞沫、另一个人、或一个物体，然后不洗手就触摸黏膜（如口，鼻，眼） Touching respiratory droplets on self, another person, or an object, then touching mucus membranes (e.g., mouth, nose, eyes) without washing hands

10. 你能做些什么来保护自己？What can you do to protect yourself? 首先，最重要的：洗手。尽量保持良好的健康状况。充足的睡眠，体力活动，控制你的压力，多喝水，吃有营养的食物。尽量不要触摸的可能污染了流感病毒的物体。避免密切接触生病的人。 First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.

11. 如果我生病了应该怎么办？What should I do if I get sick? 如果您生病，你应该留在家中，避免与尽可能其他人接触。如果你生病和经验，这些警告标志的，寻求紧急医疗服务。 If you are sick, you should stay home and avoid contact with other people as much as possible. If you get sick and experience any of these warning signs, seek emergency medical care.

12. 如果我生病了应该怎么办？(续) What should I do if I get sick? (cont.)  儿童 In children: • 呼吸快速或困难 Fast breathing or trouble breathing • 蓝肤色 Bluish skin color • 不饮用足够的液体 Not drinking enough fluids • 没有或没有醒来互动 Not waking up or not interacting • 易怒，孩子不想举行 Irritable, the child does not want to be held • 类似流感的症状改善，但再回到发烧和严重咳嗽 Flu-like symptoms improve but then return with fever and worse cough • 发热皮疹 Fever with a rash

13. 如果我生病了应该怎么办？(续) What should I do if I get sick? (cont.) 成人 In adults: • 呼吸困难，呼吸急促 Difficulty breathing or shortness of breath • 疼痛或胸部或腹部压力 Pain or pressure in the chest or abdomen • 突然头晕 Sudden dizziness • 混乱 Confusion • 严重或持续呕吐 Severe or persistent vomiting

14. CDC预防和控制H1N1传播的措施 What is CDC doing now to prevent and control the spread of H1N1? 疾病预防控制中心工作非常密切地州和地方官员地区人类感染病例H1N1病毒感染已确定。 EpiAid队已经部署，许多其他流行病活动正在发生或planned.What是中华网现在所做的预防和控制H1N1病毒传播的？ CDC works very closely with state and local officials in areas where human cases of H1N1 infections have been identified. EpiAid teams have been deployed, and many other epidemiological activities are taking place or planned.

15. 准备大流行 Be prepared for a pandemic • 存储2的水和食品供应一周Store a 2-week supply of water and food • 商店至少有2个星期的供应不为每个家庭成员和宠物生鲜食品 Store at least a 2-week supply of food and non-perishable food for each family member and pet • 包括所有的药物和医疗用品（包括处方药和非处方药）Include all medications and health supplies (both prescription and non-prescription) • 保持紧急联络名单 Maintain an emergency contact list • 现在计划为学校关闭和停工 Plan now for school closing and work stoppages

16. 公共卫生准备 Public Health Preparedness 在改善卫生系统的能力，发现持续的过程，响应，恢复，并减轻恐怖主义和其他突发卫生事件的后果。 The continuous process of improving the health system’s capacity to detect, respond to, recover from, and mitigate the consequences of terrorism and other health emergencies.

17. 准备目标 Preparedness Goal 在所有社区人们将保护传染病，职业，环境和恐怖主义威胁 People in all communities will be protected from infectious, occupational, environmental, and terrorist threats

18. 卫生防护在一个小世界 Health Protection in a small world 要求 Requires: • 快速检测 Fast detection • 快速科学 Fast science • 快速和有效的沟通 Fast and effective communication • 快速和有效地融入 Fast and effective integration • 快速和有效的行动 Fast and effective action 全球化，连通性和速度Globalization, connectivity, and speed

19. 国家战略目标 National Strategy Goals • 停止，缓慢，或以其他方式限制对美国的流行病蔓延 Stop, slow, or otherwise limit spread of a pandemic to the US • 限制国内的蔓延，减轻疾病，痛苦和死亡 Limit domestic spread, and mitigate disease, suffering, and death • 保持基础设施和减轻影响经济和社会的正常运转 Sustain infrastructure and mitigate impact to economy and functioning of society

20. 社区减灾战略的关键因素 Key considerations forCommunity Mitigation Strategy • 社区减灾战略的关键因素 Voluntary restrictions preferred • 根据现有的最佳科学干预Interventions based on best available science • 公众参与至关重要 Public engagement crucial • 平衡个人利益和共同福祉 Balance individual benefit and common good • 规划应提前发生，以减少不良后果的策略 Planning should occur in advance to reduce adverse consequences of strategy

21. 如果流感爆发更严重，学校可能的策略Possible Strategies for schools if outbreak is more severe • 积极筛选 • Active Screening • 高风险的学生和工作人员留在家里High-risk students and staff members stay home • 虐待家庭成员与学生留在家中 Students with ill household members stay at home • 在学校增加人与人之间的距离 Increase distance between people at schools • 考虑预防学校解雇 Consider preventive school dismissals

22. Challenges to H1N1 Response Virus • Potential to change to be more deadly, less matched to vaccine, drug resistant Vaccine • Production and distribution (new, hard-to-reach groups) • 2-dose series recommended • Suspicion about vaccines inevitable/rumors about adverse events Public Health infrastructure • Decades of neglect Health care • Poor coordination • Lack of good information systems • Lack of prevention infrastructure or focus Coordination • Across government – federal/state/local • Across sectors

23. 展望未来Going Forward • 准备一场马拉松，不是短跑 Prepare for a marathon, not a sprint • 小心 Take care • 利用人才的跨机构Utilize talent from across agencies • 明智地部署工作人员，尽量减少你的广大公众健康影响工作Deploy staff wisely to minimize disruption of your broad public heath work

24. 总结 Summary • 很可能的案件，以及一些死亡的流感H1N1病毒，会继续发生。 • It is likely that cases, and some deaths, from H1N1 influenza will continue to occur. • 我们正面临另一流感大流行的风险增加，有所准备。 We are facing an increased risk for another flu pandemic, be prepared. • 我们必须共同努力，以限制和控制H1N1病毒流感的传播We must all work together to limit and control the transmission of H1N1 influenza. • 对于流感的H1N1病毒的爆发，请访问www.who.org或www.cdc.gov/h1n1flu最新的信息 For the most current information on the H1N1 influenza outbreak, visit www.who.org or www.cdc.gov/h1n1flu

25. 銘謝 Acknowledgements • 某些资料来源: 美国 疾病控制与预防中心/企业通信办公室 SOURCES OF MATERIAL Office of Enterprise Communication, Centers for Disease Control and Prevention 翻译只作参考Translation as reference only 陸錦霞, 美國公共衛生服務部上校 Astrid Szeto, MPH Captain, US Public Health Service