成人の新型インフルエンザ 治療ガイドライン 第2版

1 2 2017 11 28 29 27270501 1 I. II. III. IV. V. VI. VII. VIII. IX. X. XI. XII. 2 III IV V VI VIII IX VII X XI IV 15 3 I A(H7N9)

2 ECMO 2009 35% ECMO 2015/16 83% 2009 AMED 2009 2010 A(H1N1)pdm09 2000 4 ECMO ECMO 1) 2013 2 A(H7N9) - 2) A(H7N9)

3 2013 2 5 1 2013 10 2014 3 28 2 400 ARDS 30 ECMO ECMO 25 3 ECMO A(H1N1)pdm09 A(H7N9) 1) Takeda S, Kotani T, Nakagawa S et al.

4 Extracorporeal membrane oxygenation for 2009 influenza A (H1N1) severe respiratory failure in Japan. J Anesth 2012; 26: 650-7 2) A (H7N9) 5 II. A A (H5N1) 1996 1997 2003 2017 9 27 16 A(H5N1) 860 454 53% WHO 1) A(H7N9) 2013 3 31 WHO 2017 9 27 1564 612 39% 2013 5 II-1 2016 5 1 4 1) 4 5 A(H7N9) A(H7N9)

5 2,6 2,3 A(H7N9) A(H7N9) 2) 3,4) 2015 2016 5 14 A(H5N6) (71%) 2009 4 A(H1N1) 2009 A(H1N1) 5) 2005 2009 A(H1) A(H1N1)pdm09 6) 6 2011 5 A(H3N2)v 7) 1990 2011 A(H1N1)pdm2009 2012 10 305 A(H3N2)v 8) 5% Rejmanek A HA 21 II-1 9) A II-1 7 11 CDC Influenza Risk Assessment Tool IRAT 8)

6 IRAT IRAT IRAT - - 2 2011 11 H3N2v 5 2012 2013 4 A(H7N9) 2013 4 A(H7N9) IRAT IRAT II 1 HA n=21 H1N1 H2N2 H3N1 H4N2 5N1 H6N1 H7N1 H8N4 H9N1 H10N2 H11N1 H12N3 H13N9 H1N2 H2N3 H3N2 H4N6 H5N2 H6N2 H7N2 H9N2 H10N4 H11N2 H12N4 H2N7 H3N3 H4N8 H5N3 H6N3 H7N3 H10N7 H11N6 H12N5 H2N8 H3N6 H5N8 H6N4 H7N7 H11N9 H2N9 H3N8 H5N9 H6N6 H7N8 H6N8 H7N9 HA 1 3 2 9)

7 8 A A 1) Influenza at the human-animal interface. Summary and assessment, 25 July to 27 September 2017. 2) Watanabe T, Kiso M, Fukuyama S, et al. Characterization of H7N9 influenza A viruses isolated from humans. Nature 2013; 501: 551-5 3) Imai M, Watanabe T, Kiso M, et al. A highly pathogenic avian H7N9 influenza virus isolated from a human is lethal in some ferrets infected via respiratory droplets. Cell Host & Microbe. 2017; 22:1-12 4) Shi J, Deng G, Kong H, et al. H7N9 virulent mutants detected in chickens in China pose an increased threat to humans.

8 Cell Res. 2017 :1-13 5) Novel swine-origin influenza A (H1N1) virus investigation team. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Eng J Med 2009; 361: 1-10 6) Shinde V, Bridge CB, Uyeki TM, et al. Triple-reassortant swine influenza A (H1) in human in the United States, 2005-2009. N Eng J Med 2009; 360: 2616-25 7) Lindstrom S, Garten R, Balish A, et al. Human infections with novel reassortant influenza A(H3N2)v viruses, United States, 2011. Emerg Infect Dis 2012; 18: 834-7 8) Jhung MA, Epperson S, Biggerstaff M, et al. Outbreak of variant influenza A(H3N2) virus in the United Staes. Clin Infect Dis. 2013; 57: 1703-12 9) Rejmanek D, Hosseini PR, Mazet JAK, et al.

9 Evolutionary dynamics and global diversity of influenza A virus. J Virol 2015; 89: 10993-1001 10) Trock SC, Burk SA, Cox NJ. Development of framework for assessing influenza virus pandemic risk. Emerg Infect Dis. 2015; 21: 1372-8 9 III. 1) 1. III 1 III 1 1) A A-1 A-2 A-1 2 A-2-1 A-2-2 B A 2.

10 III 2 IV VI 10 III 2 1) A A-1 1 600mg 3 A-1 A-2-1 A-2-2