【转帖】美国CDC针对感染猪流感病毒治疗和预防的临时指南 中英文对照

Special Considerations for Children

针对儿童的特别声明

Aspirin or aspirin-containing products (e.g. bismuth subsalicylate – Pepto Bismol) should not be administered to any confirmed or suspected ill case of swine influenza A (H1N1) virus infection aged 18 years old and younger due to the risk of Reye syndrome. For relief of fever, other anti-pyretic medications are recommended such as acetaminophen or non steroidal anti-inflammatory drugs.

阿司匹林或含有阿司匹林的产品（例如碱式水杨酸铋 - Pepto Bismol）不能给18岁或18岁以下的感染A（H1N1）型猪流感病毒的确诊或可疑病患使用，它们可能引发瑞氏综合症。为了缓解发热症状可以使用其它退热药物，推荐对乙酰氨基酚或非甾体类抗炎药物。

Antiviral Resistance

病毒抗药性

This swine influenza A (H1N1) virus is sensitive (susceptible) to the neuraminidase inhibitor antiviral medications zanamivir and oseltamivir. It is resistant to the adamantane antiviral medications, amantadine and rimantadine.

A（H1N1）型猪流感病毒对神经胺酸酶抑制剂类（扎那米韦zanamivir和奥司他韦oseltamivir）抗病毒药物敏感，对金刚烷类（金刚烷胺amantadine和 金刚乙胺rimantadine）抗病毒药物具有抗药性。

Antiviral Treatment （Confirmed, Probable and Suspected Cases ）

抗病毒治疗（针对确诊，疑似和可疑病例）

Recommendations for use of antivirals may change as data on antiviral susceptibilities become available.

当对抗病毒药物敏感性测试的数据完成后，推荐使用的药物可能会变化。

Empiric antiviral treatment should be considered for confirmed, probable or suspected cases of swine influenza A (H1N1) virus infection. Treatment of hospitalized patients and patients at higher risk for influenza complications should be prioritized. Antiviral treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of symptoms. Evidence for benefits from treatment in studies of seasonal influenza is strongest when treatment is started within 48 hours of illness onset. However, some studies of treatment of seasonal influenza have indicated benefit, including reductions in mortality or duration of hospitalization even for patients whose treatment was started more than 48 hours after illness onset. Recommended duration of treatment is five days. Recommendations for use of antivirals may change as data on antiviral susceptibilities and effectiveness become available. Antiviral doses recommended for treatment of swine influenza A (H1N1) virus infection in adults or children 1 year of age or older are the same as those recommended for seasonal influenza (Table 1). Oseltamivir use for children < 1 year old was recently approved by the U.S. Food and Drug Administration (FDA) under an Emergency Use Authorization (EUA), and dosing for these children is age-based (Table 2).

对感染A（H1N1）型猪流感病毒的确诊、疑似和可疑病例可以考虑使用经验性抗病毒药物。对到医院就医和高危发生流感并发症的患者应优先医治。在病状发作后应尽早采用扎那米韦或奥司他韦进行抗病毒药物治疗。在季节性流感的研究中证明：在疾病发作后48小时内进行治疗效果最佳。然而，对季节性流感的一些研究发现，即使在病人的疾病发作48小时后开始治疗也有明显的好处，包括减小死亡率或缩短入院治疗时间。推荐的治疗时间是五天。在对抗病毒药物敏感性和有效性的测试数据完成后，推荐使用的药物可能变化。对于感染A（H1N1）型猪流感病毒的成年人、1岁或更大的儿童的抗病毒药物用量建议参见表1，这与季节性流感相同。最近美国食品药品管理局（FDA）批准基于紧急使用授权（EUA）可以对小于1岁的儿童使用抗病毒药物奥司他韦，具体用量参见表2。

Antiviral Chemoprophylaxis

抗病毒药物预防

For antiviral chemoprophylaxis of swine influenza A (H1N1) virus infection, either oseltamivir or zanamivir are recommended (Table 1). Duration of antiviral chemoprophylaxis post-exposure is 10 days after the last known exposure to an ill confirmed case of swine influenza A (H1N1) virus infection. For pre-exposure protection, chemoprophylaxis should be given during the potential exposure period and continued for 10 days after the last known exposure to an ill confirmed case of swine influenza A (H1N1) virus infection. Oseltamivir can also be used for chemoprophylaxis under the EUA (Table 3).

针对A（H1N1）型猪流感病毒的抗病毒药物预防，推荐使用扎那米韦或奥司他韦，用量参见表1。暴露后抗病毒药物预防的持续时间为10天，在最后已知暴露在一例确诊感染A（H1N1）型猪流感病毒的病人之后。奥司他韦也可以基于FDA紧急使用授权下用于药物预防，参见表3。

Antiviral chemoprophylaxis (pre-exposure or post-exposure) with either oseltamivir or zanamivir is recommended for the following individuals:

对下列人群，抗病毒药物预防（暴露前或暴露后）推荐使用奥司他韦或扎那米韦：

1.Household close contacts who are at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women) of a confirmed, probable or suspected case.

1、与具有高危流感并发症的确诊、疑似或可疑患者有家庭紧密接触的人（例如：有特定慢性疾病的人，65岁及以上老人，5岁以下儿童和孕妇）

2.School children who are at high-risk for complications of influenza (children with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed, probable, or suspected case.

2、与确诊、疑似或可疑患者有紧密接触（面对面）的学校儿童，流感并发症的高危人群（有特定慢性疾病的儿童）

3.Travelers to Mexico who are at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women).

3、到墨西哥的旅游者，流感并发症的高危人群（例如：有特定慢性疾病的人，65岁及以上老人，5岁以下儿童和孕妇）

4.Health care workers or public health workers who were not using appropriate personal protective equipment during close contact with an ill confirmed, probable, or suspect case of swine influenza A (H1N1) virus infection during the case’s infectious period.

4、与处于传染期的确诊、疑似或可疑的感染A（H1N1）型猪流感病毒患者紧密接触，并且未能正确采取个人保护装备的医疗机构工作人员或者公共医疗工作人员。

Pre-exposure antiviral chemoprophylaxis with either oseltamivir or zanamivir can be considered for the following:

对下列人群，暴露前抗病毒药物预防推荐使用奥司他韦或扎那米韦：

1.Any health care worker who is at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women) who is working in an area of the healthcare facility that contains patients with confirmed swine influenza A (H1N1) cases, or who is caring for patients with any acute febrile respiratory illness.

1、流感并发症的高危医疗工作者（例如：有特定慢性疾病的人，65岁及以上老人，5岁以下儿童和孕妇），其工作的医疗机构中有确诊的感染A（H1N1）型猪流感病毒患者，或者照顾急性发烧呼吸道疾病病人的医疗工作者

2.Non-high risk persons who are travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection.

2、到墨西哥旅行的非高危人群，工作地有确诊的感染A（H1N1）型猪流感病毒患者的第一报道人或边界工作者。

Table 1. Swine influenza antiviral medication dosing recommendations.

表1. 猪流感抗病毒药物治疗与预防的剂量参考

(Table extracted from IDSA guidelines for seasonal influenza .)

药物，人群
治疗
预防

奥司他韦(Oseltamivir)

成年人
每天两粒75mg胶囊，5天
每天一粒75mg胶囊

儿童（年龄12月或更大）体重
15kg或更轻
每天60mg分两次服用
每天30mg

15-23kg
每天90mg分两次服用
每天30mg

24-30kg
每天120mg分两次服用
每天60mg

大于30kg
每天150mg分两次服用
每天75mg

扎那米韦(Zanamivir)

成年人
每次吸入2*5mg（共10mg），每天两次
每次吸入2*5mg（共10mg），每天一次

儿童
每次吸入2*5mg（共10mg），每天两次（7岁及以上）
每次吸入2*5mg（共10mg），每天一次（5岁及以上）






Children Under 1 Year of Age

1岁以下儿童

Children under one year of age are at high risk for complications from seasonal human influenza virus infections. The characteristics of human infections with swine H1N1 viruses are still being studied, and it is not known whether infants are at higher risk for complications associated with swine H1N1 infection compared to older children and adults. Limited safety data on the use of oseltamivir (or zanamivir) are available from children less than one year of age, and oseltamivir is not licensed for use in children less than 1 year of age. Available data come from use of oseltamivir for treatment of seasonal influenza. These data suggest that severe adverse events are rare, and the Infectious Diseases Society of America recently noted, with regard to use of oseltamivir in children young than 1 year old with seasonal influenza, that "…limited retrospective data on the safety and efficacy of oseltamivir in this young age group have not demonstrated age-specific drug-attributable toxicities to date." (See IDSA guidelines for seasonal influenza .)

1岁以下儿童是季节性人类流感并发症高危人群。人类感染H1N1猪流感病毒的特征仍在研究中，目前还不知道婴儿相对于年纪大的儿童和成年人来说，是否是与H1N1猪流感病毒相关并发症的更高位人群。对婴儿使用奥司他韦或扎那米韦的安全数据相对于1岁的儿童更少，而且奥司他韦不允许用于1岁以下儿童。现有数据来自使用奥司他韦治疗季节性流感，这些数据建议严重的副作用很少，最近美国传染病协会表示，对1岁以下儿童采用奥司他韦治疗季节性流感“对于年幼的人群，有限的安全有效地使用奥司他韦的回顾数据表明，目前没有证明有与年龄相关的药物毒性”。

Because infants typically have high rates of morbidity and mortality from influenza, infants with swine influenza A (H1N1) influenza infections may benefit from treatment using oseltamivir.

因为婴儿对流感有很高的发病率和死亡率，所有对感染A（H1N1）型猪流感病毒的婴儿使用奥司他韦可能会有疗效。

Healthcare providers should be aware of the lack of data on safety and dosing when considering oseltamivir use in a seriously ill young infant with confirmed swine H1N1 influenza or who has been exposed to a confirmed swine H1N1 case, and carefully monitor infants for adverse events when oseltamivir is used.

医护人员应该知道：由于安全数据和剂量的缺乏，当考虑使用奥司他韦治疗确诊感染A（H1N1）型猪流感病毒的危重婴儿时，用药后要谨慎监测其对婴儿的副作用。



Table 2. Dosing recommendations for antiviral treatment of children younger than 1 year using oseltamivir.

Age
Recommended treatment dose for 5 days

<3 months
12 mg twice daily

3-5 months
20 mg twice daily

6-11 months
25 mg twice daily




表2. 1岁以下儿童采用奥司他韦进行抗病毒药物治疗的剂量参考

年龄
5天推荐治疗剂量

小于3个月
12mg，每天两次

3-5个月
20mg，每天两次

6-11个月
25mg，每天两次






Table 3. Dosing recommendations for antiviral chemoprophylaxis of children younger than 1 year using oseltamivir.

Age
Recommended prophylaxis dose for 10 days

<3 months
Not recommended unless situation judged

critical due to limited data on use in this age group

3-5 months
20 mg once daily

6-11 months
25 mg once daily






表3. 1岁以下儿童采用奥司他韦进行抗病毒药物预防的剂量参考

年龄
10天推荐预防剂量

小于3个月
不推荐

3-5个月
20mg，每天一次

6-11个月
25mg，每天一次