Transcription

1 ١

2

3 !" # +& )* $ ) # ' & "( %&. ) #, )+ " & $ # $,# 10 (SARS) )% *% % '. &' ( % $ # ". # * +,.( ' )% *% % ' / 4 % /$ %& (. )% *% % %. MERS % SARS)..

4 ۴

5 ۵ SARS

6 . 10 ۶

7 ٧

8 ٢۴ ٢۴ September September ٢٠١٢ ٢٠١٢ % 2012 EMC ) ( MERS-CoV : 103 %48 (49) : ٨ 82 41) (

9 .( ) :!! ٩

10 60. ١٠

11 Hospital D patient from A Hospital C Hospital B transferred form A, HD unit: (st was admitted to A) HCW, family contact Hospital A patients HD unit healthcare acquired family contact sporadic patients ICU/wards HCW Hospital E patient from B family contact Hospital F patient from A

12 ١٢

13 A new cases ۴ ٣ Acquired in hospitals B, C, D, Hospital A٢Acquired ward Acquired in ICU, hospital A Acquired in dialysis unit, hospital A, hospital A١Acquired ward Community-acquired Number of ٢ ١ ٠ ١٣

14 .١.٢.٣.۴.۵.۶ ١۴

15 1391. (... ) ١۵

16 . ١۶

17 ١٧

18 MERS. ( ) MERS.. ١٨

19 MERS 103 ١٩

20 R٠ ١۵ ١۴ ١٣ ١٢ ١١ ١٠ ٩ ٨ ٧ ۶ ۵ ۴ ٣ SARS Smallpox ٢ ١ Influenza HIV ٩٠% موفقيت در ايزوله نمودن ٠ ٠% ٢٠% ۴٠% ۶٠% ٨٠% ١٠٠% θ.

21 ) ( 1000!!! ٢١

22 MERS. ٢٢

23 Mandell ٢٠١٣ A few cases with mild or asymptomatic infection have been identified. Symptoms are chills, cough, fever, dyspnea, myalgia and, less often, nausea and diarrhea. The majority of cases have been in patients with co-morbidities.

24 SYMPTOMS OF MERS-CoV INFECTION All of the laboratory confirmed cases have had respiratory disease as part of the illness, and most have had severe acute respiratory disease requiring hospitalization. Reported clinical features include acute respiratory distress syndrome (ARDS), renal failure requiring hemodialysis, consumptive coagulopathy, and pericarditis. Many patients have also had gastrointestinal symptoms including diarrhea during the course of their illness the course of their illness. One patient, who was immunocompromised, presented with fever, diarrhea and abdominal pain, but had no respiratory symptoms initially; pneumonia was identified incidentally on a radiograph. The National Institutes of Health has found that a combination of two antiviral drugs, ribavirin and interferon-alpha ٢b, can inhibit replication of the virus in cell cultures [Falzarano et al. Inhibition of novel human coronavirus-emc replication by a combination of interferon-alpha٢b and ribavirin. Scientific Reports ٢٠١٣, doi: ١٠.١٠٣٨/srep٠١۶٨۶]

25 INFECTION PREVENTION AND CONTROL Routine Practices: For all patients, at all times, in all healthcare settings including when performing a point-of-care risk assessment, and adherence to respiratory hygiene and hand hygiene. Contact and Droplet Precautions (should be implemented empirically): Wear gloves and a long-sleeved gown upon entering the patient's room, cubicle or designated bed space. Wear facial protection (surgical or procedure mask and eye protection, or face shield, or mask with visor attachment) t) when within two metres es of a patient t suspected or confirmed to have MERS-CoV infection. Airborne Precautions When performing aerosol-generating medical procedures (AGMPs). A respirator and face/eye protection should be used by all HCWs present in a room where an AGMP is being performed on a patient suspected or confirmed to have MERS-CoV infection. Whenever possible, AGMPs should be performed in an airborne infection isolation room. Airborne Precautions (including respirator and airborne infection isolation room) is the recommendation from the Centers for Disease Control (CDC) in the U.S.

26 ٢۶

27 IHR IHR. ٢٧

28 : 14 ) ( : ) ( ( ) ) ( ٢٨

29 : ٢٩

30 ) ) -1 ((ARDS) ( : 14 (cluster) l. ١..٢. (ICU).٣. ٣٠

31 14 ( ) ( ) Mers-CoV ( ) ) :. -2 ٣١

32 : PCR : PCR IHR ( ) ٣٢.

33 B. MERS. ٣٣

34 .١ ) :(.٢ :.٣ : 3 ).(.۴ :.. ٣۴

35 . ( ) :! :.. (BAL) :. ٣۵

36 FFP FFP٣. ٣۶

37 :(Bronchoalveolar lavage). 3 2 : از بيمار بخواهيد تا مقداری ا ب را در دهان غرغره نمايد و سپس با يک سرفه قوی و عميق ترشحات خلط عمقی خود را از گلو مستقيما به درون ظرف استريل و غيرقابل نشت (دارای درب پيچدار) بريزد. ٣٧

38 ٣٨

39 ٣٩

40 :.! 200 : 10 5 }. {.. ۴٠

41 . ( ) 4. ۴١

42 برای انتقال در مدت زمان کوتاه بايد نمونه تهيه شده را در درجه حرارت ٢ الی ٨ درجه سانتی گراد () نگهداری و در سريعترين زمان ممكن (در عرض ٢۴ نمود. ساعت)منتقل ترجيحا ٢۴ الی ٧٢ ساعت اگر در ارسال نمونه ممکن است تاخيری ايجاد گردد پس از تهيه نمونه ا نرا در اولين فرصت در سرمای منفی ٧٠ درجه سانتی گراد منجمد () نماي يد (در مورد سواب نياز به انجماد نيست) ۴٢

43 (IATA). ice-pack ( ) ice-pack ۴٣

44 . real-time RT-PCR ۴۴

45 . : -.١.٢.٣.۴ ۴۵

46 .١ : ) (ARDS) (DIC)... (.٢ 14 : ) ( ) ( ) (.٣ : ) ( : PCR } ) {(. ۴۶

47 14 ( ) ۴٧

48 .. FFP٣. ۴٨

49 IPC is not just about PPE VS VS ۴٩

50 ۵٠

51 بيماران قطعی يا محتمل. در غير اينصورت در اتاق انفرادی با تهويه کافی تحت درمان قرار گيرند. وقتی اتاق انفرادی برای بستری بيمار وجود ندارد بايد بين تخت او و ساير بيماران حداقل يک متر فاصله باشد.. :. ( ). 95 ۵١

52 : %1... %99.99 ۵٢

53 MERS.... ۵٣

54 + + ) :( ) (.(FFP٣ ).١..٢ ).٣. (.۴..١. ۵۴

55 . (). (portable ) (... ) ). 24. ۵۵

56 ... ۵۶

57 ۵٧