2006年世界衛生組織偶發性人類禽流感感染藥物治療建議指引

WHO Advice Guidelines for Pharmacological Management of Sporadic Human Infection with Avian Influenza A Virus

盤松青(Sung-Ching Pan) ； 張上淳(Shan-Chwen Chang)

《內科學誌》 19卷1期 (2008/02) Pp. 36-43

https://doi.org/10.6314/JIMT.2008.19(1).05

摘要

近年來A型禽流感(avian influenza A, H5N1)在家禽養殖業與野鳥間的快速傳遞，一直是可能造成人類禽流感大規模傳染的隱憂，即使各國已有儲備抗病毒藥物的共識，但是對於此些藥物的使用方法卻缺少實證性的指引，因此世界衛生組織於2006年3月結合國際上各相關領域的專家，以目前現有的證據擬定H5N1人類禽流感臨床治療準則，此份臨床治療率則是依每個建議的好處、壞處、以及花費成本等等因素針對不同族群、不同暴露環境做出強弱不同程度治療及預防用藥的建議。雖然因爲目前仍無針對H5N1禽流感的隨機臨床實驗，此份率則所能引用的證據力仍十分薄弱，但基於禽流感感染的嚴重性，指引強烈建議對證實或高度懷疑禽流感感染的個案應使用oseltamivir加以治療；基於相同的理由，指引亦強烈建議對禽流感高危險性暴露的個案應使用神經銨酶抑制劑(neuraminidase inhibitors)加以預防。要特別注意的是H5N1病毒有可能隨時會發生致病性或傳染性的改變，因此世界衛生組織也會依最新的疫情就指引內容進行更新。

關鍵字

禽流感 ； 治療指引

並列摘要

The influenza A virus, especially H5N1 virus strain, is one of today's leading public health concerns because it's high lethality. The mortality rate associated with infection with H5N1 influenza had ranged from 33% to more than 50% according to the first known outbreak in Hong Kong in 1997. Recent spread of H5N1 virus to wild birds and poultry has increased the treat of human infections with H5N1 virus worldwide. In February 2004, the WHO published interim clinical guidelines for the use of antivirals for H5N1 infection and updated in 2005, resulting in international agreement to stockpile antivirals for potential use. However, the evidence-based information for the use of these antiviral agents does not exist. Thus, WHO convened a rapid advice panel in Match, 2006 to provide evidence-based guidelines on the pharmacological management of human H5N1 infection. Even though the quality of the underlying evidence was rated very low since it was based on small case series of H5N1 patients and indirect evidence from the experience of seasonal influenza, the panel made strong recommendation to treat H5N1 patients with oseltamivir and to use neuraminidase inhibitors as chemoprophylaxis in high risk exposure populations because of the severity of the disease. But since the circumstances could change rapidly and emergence of novel avian influenza A virus or changes in the pathogenicity of H5N1 virus can happen, WHO will monitor this condition closely and update these guidelines accordingly.

並列關鍵字

Avian influenza ； Treatment guideline