10 3 pfu A B 2004/ FluA. Viral Shedding. Viral Shedding. Frank Houston Family Study 2005/

Transcription

1 56 pp pfu A B 2004/ Viral Shedding Frank Houston Family Study 12 4 A TEL FAX mitamura@eijuhp.com B A 2 37 A A FluA Viral Shedding / A B A B 67

2 ml pfu/ml 10 3 pfu/100 l A&B-N B 6

3 pp A r nestd RT-PCR 10 1 pfu pfu pfu B B B A B B 6 A B Viral Shedding 1 2 A 13 A mg/kg/day Shiraishi 15 M2

4 pfu/ml A/B pfu / OTC 2005/ CDC / A B 21 A 3.5vs A B 2004/2005 B A Boivin 24 A B real-time PCR A B 48 PCR 24 A H3N / Kiso A 50

5 pp A 66 33/5018 9/50 NA 25 4 Viral Shedding pfu/ml

6 a b 30 1 Frank AL, et al: Patterns of shedding of myxoviruses and paramyxoviruses in children J infect Dis 144: , Viral Shedding , A A , A B RT-PCR , The medical test journal 951 P AB Covalciuc KA, Webb KH, Carlson CA: Comparison of four clinical specimen types for detection of influenza A and B viruses by optical immunoassay (FLU OIA test) and cell culture methods. J Clin Microbiol 37:3971-4, Crumpacker C: Antiviral therapy. Fields virology. 4th ed. Knipe DM, Howley PM, eds. Lippincott Williams & Wilkins, Philadelphia , Shiraishi K, Mitamura K, Sakai-Tagawa Y, Goto H, Sugaya N, Kawaoka Y: High frequency of resistant viruses harboring different mutations in amantadine-

7 pp treated shildren with influenza. J Infect Dis 188:57-61, Bright RA, Medina MJ, Xu X, Perez-Oronoz G, Wallis TR, Davis XM, Povinelli L, Cox NJ, Klimov AI.: Incidence of adamantane resistance among influenza A (H3N2) viruses isolated worldwide from 1994 to 2005: a cause for concern. Lancet (9492): , Bright RA, Shay DK, Shu B, Cox NJ, Klimov AI.: Adamantane resistance among influenza A viruses isolated early during the influenza season in the United States. JAMA 295: , Centers for Disease Control and Prevention (CDC): High levels of adamantane resistance among influenza A (H3N2) viruses and interim guidelines for use of antiviral agents--united States, influenza season. MMWR 55:44-6, Moscona A: Neuraminidase inhibitors for influenza. N Engl J Med 353: , Whitley RJ, Hayden FG, Reisinger KS, Young N, Dutkowski R, Ipe D, Mills RG, Ward P.: Oral oseltamivir treatment of influenza in children. Pediatr Infect Dis J 20:127-3, A B oseltamivir Aoki FY, Macleod MD, Paggiaro P, Carewicz O, El Sawy A, Wat C, Griffiths M, Waalberg E, Ward P; IMPACT Study Group. Early administration of oral oseltamivir increases the benefits of influenza treatment. J Antimicrob Chemother. 51:123-9, Boivin G, Coulombe Z, Wat C: Quantification of the influenza virus load by real-time polymerase chain reaction in nasopharyngeal swabs of patients treated with oseltamivir. J Infecr Dis 188:578-80, Kiso M, Mitamur K, Sakai-Tagawa Y, Shiraishi K, Chiharu K, Kimura K, Hayden FG, Sugaya n, Kawaoka Y: Resistant influenza A viruses in children treated with oseltamivir : descriptive study. Lancet 364:759-65, Kirkbride HA, Watson J: Review of the use of neuraminidase inhibitors for prophylaxis of influenza. Commun Dis Public Health. 6:123-7, Harper SA, Fukuda K, Uyeki TM, Cox NJ, Bridges CB; Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention (CDC).: Prevention and control of influenza Recommendations of the advisory committee on immunization practices. MMWR July 29,2005/54(RR08); , Sato M, Hosoya m, Kato K, Suzuki H: Viral shedding in children with influenza virus infections treated with neuraminidase inhibitors. Pediatr Infect Dis J. 24: , Moscona A: Oseltamivir Resistance-Disabling our influenza defenses. NEJM 353; ,2005 Diagnosis and Treatment of influenza - Clinical Investigation on Viral Shedding in Children with Influenza Keiko MITAMURA 1), Norio SUGAYA 2) 1) Department of Pediatrics, Eiju General Hospital 2) Department of Pediatrics, Keiyu Hospital Children with influenza usually shed viruses from the several days before onset of clinical symptoms, and viruses are isolated for one or two weeks after onset. Point-of-care rapid diagnostic tests are useful to guide use of antiviral agents, appears over 90% sensitivity and specificity for influenza A with nasopharyngeal specimens compared with cell culture. The detection limits of these test kits are 10 3 pfu or over, so it is necessary to consider viral load in clinical specimens for diagnosis with these kits. Viral load are decreased after the start of antiviral agents, but influenza viruses are isolated in more than half of pediatric patients when fever get down, and resistant viruses are detected in some of these patients. It is very important for influenza control to investigate on viral shedding and resistant viruses.

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