豚インフルエンザ　撃退可能？

　産科医療のこれから
http://obgy.typepad.jp/blog/
で詳しいです。

　昨夜、県知事から医師会に通知が来て、以下のタイトルの文書を今朝、出勤して受け取りました。

　メキシコ・米国等におけるインフルエンザ様疾患に係る外来診察について（依頼）

　ある意味で、これから連休に入る医療機関の対応については”最悪の時期だ”というのが感想です。いいのは、会社、学校が休みで、ここでの感染拡大がとりあえずないということです。
　ただし、連休の旅行で全国津々浦々にウイルスがばら撒かれ、連休中に対応が準備されない状態で感染が爆発したら、恐ろしいものがあります。

　致死率はそう高くないようです。しかし、間違ったマスコミの報道により、Ｈ５Ｎ１の死亡率６０％という数字が一人歩きして、新型インフルエンザ流行の折には、退職するという看護師のアンケートがあるように医療関係者の腰が及び腰です。これがまずい結果をもたらす可能性があります。（医療関係者の戦意がこのところの医療問題で相当に落ちてますから）
　このレスのタイトルに対しての私の結論としては

１）すでに水際で止められるわけがない。（もう韓国まで来てる）
２）それほど死亡率が高いわけではないが治療を行わないと死亡する人間が出る。（普通のインフルエンザでも死ぬやつはいる）
３）タミフル、リレンザは今のところ有効
４）国内に侵入したら、一年以内にほとんどの国民が感染する。（感染と発症は違うことをよく理解してください）
５）発症率は”いつもの”インフルエンザの約２倍と考えている学者が多い

　ちなみに、昨日のうちに検査薬と抗インフルエンザ薬の発注を行いました。問屋にはもうなく、製造会社の在庫を抑えました。

　ほんとは戦いたくないんですけどね、門閉めてろう城したいのが本音です（生命保険の額も減らしてしまったし、、）
　致死率６０％のＨ５Ｎ１ならなに言われても、この地にいられなくなっても逃げちゃうかもしれませんが、、、
　でも、インフルエンザはいずれ感染をするという前提の下に、抗インフルエンザ薬を飲みまくりながら戦うしかないようです。

　これがわかりやすいんでは。
http://obgy.typepad.jp/blog/2008/12/post-cf45.html
ばらばらになってすみません。仕事しながらなもんで。

Ｈ５Ｎ１が新型インフルの最有力候補、しかもアジアが発生地になる、として騒いでいたことを綺麗さっぱり忘れてしまったかのような専門家（と称する人達）やマスコミの変身ぶりがおもしろいですね。カウンターパンチをもらったような気分です。それはともかく、診療の現場におけるルールの確立が急がれます。診療拒否はどこまでが許容されるのでしょうか。予防薬の配布はどのようなルールで実施されるのでしょうか。感染した医療者は労災扱いのなるのでしょうか。

No.4 ころちゃん様

メディアはともかく、専門家の認識としては「H5N1が最有力候補」というより「毒性の強いH5N1が新型化すると脅威なので厳重警戒が必要」だったと思います。そういう視点の報道がほとんどされなかったので、一般に前者のように受け止められていたのも無理はありませんが。

No.1 でも様
1)から5)まですべて同意です。
個人的に特に問題だと思うのは、政府もメディアも1)と4)の視点が全く欠けているように見えるところです。
水際作戦は、日本国内でのパンデミックをなるべく遅らせるという時間稼ぎとしては無意味ではないかもしれません。しかし、現時点でもっと注力すべきなのは、No.4でころちゃん様が指摘されているように「診療体制の確立」「備蓄されている治療薬の配布ルートの確立」だろうと考えます。

　http://www.mhlw.go.jp/bunya/kenkou/kekkaku-kansenshou04/02.html

新型インフルエンザに関するＱ＆Ａ
（保健所用：暫定版）4月28日

感染症の予防及び感染症の患者に対する医療に関する法律
（平成十年十月二日法律第百十四号）
最終改正：平成二〇年六月一八日法律第七三号

（国民の責務）
第４条 　国民は、感染症に関する正しい知識を持ち、その予防に必要な注意を払うよう努めるとともに、感染症の患者等の人権が損なわれることがないようにしなければならない。

普通のインフルエンザと同様の毒性らしいですね。トリのような強毒性ではなさそうなので、普通のインフルエンザの対応で問題ないはずですが、短期間に大量の感染者や疑いが出現すると医療機関側の対応能力の問題が露呈するのです。
　トンフル、日本上陸は連休明け後、あるいはその１－２週間後でしょうか。ぱらぱらと来るのなら大した事件にはならないのでしょうけど。

先生、　Swine influenza (Swine flu)の訳が　トンフル　なんですね。　　勉強に成りました。

いや、正式訳語でないので、おそらくネットスラングでしょう(^^;)

正式な訳は、Swineは分類学ですから。ブタ種。

トンフルですか。パンデミックになればタミフルの割付試験の絶好の機会になりそう。（単なるブラックジョークです）

検疫官の皆様の不眠不休での今の状況の確保をありがとうございます。過労死隣合わせの状況で有るにもかかわらず。ここにも大変なしわ寄せが来ていると思われます。
　

「国立感染症研究所」を詐称したブタインフルエンザ関連メールにご注意ください
平成２１年４月２８日

引用開始

ブタインフルエンザの流行に便乗して、「国立感染症研究所」を詐称したメールが送られているという情報が寄せられています。当該メールは、yahooメールを使用しており、発信者欄には”国立感染症研究所 ”とあります。発信元メールアドレスは、受信者のアドレスと同一である場合が多く、明らかに発信者を詐称した不審なメールです。メールには「ブタインフルエンザに関する知識.zip」等と題した添付ファイルが含まれています。当方のウイルスチェックソフトウェアで、この添付ファイルが不正プログラム（ウイルス等）として認知されております。添付ファイルを開くことで、メールを受けたパソコンへの不正侵入やシステム破壊のおそれがあり、注意が必要です。 以下のような「詐称メール」を受信された方々におかれましては、添付ファイルを開かずにメールごと削除なさるようお願いいたします。

不審メールの詳しい内容（例）
From: 国立感染症研究所
Subject:豚インフルエンザに注意！
添付ファイル名：ブタインフルエンザに関する知識.zip

皆様

豚インフルエンザの感染は拡大を続けている。メキシコ、米国、カナダ、スペインに続き、英国でも感染が確認された。世界が警戒を強めるなか、各国から次々と疑い例が報告されている。２８日には、韓国で疑い例が発生した。メキシコでは過去数週間にわたって流行が続いている可能性があり、「人間の往来が激しい現代では、日本にもすでに上陸している可能性がある」と指摘する専門家もいる。自分の身を守るために、豚インフルエンザに関する基礎知識を身につけましょう。

国立感染症研究所

--------------------------------------
Power up the Internet with Yahoo! Toolbar.
http://pr.mail.yahoo.co.jp/toolbar/

添付ファイルは不正プログラムの可能性があり、警戒が必要です。
国立感染症研究所では、 メールはすべて "nih.go.jp" のドメインから発信することとしており、 yahooから発信されることはありません。 また、公的なお知らせはすべてWebサイト上に公開され、 メールを用いたサービスは行っておりません。

なお、国立感染症研究所では第三者中継（発信元を隠すために、関係のない第三者のサーバを中継して発信する）されないメールサーバの設定や、ウィルス感染メールを発信しないようウィルス対策をするなどセキュリティにも十分配慮しておりますが、引き続き対策を強化していく考えです。

国立感染症研究所・情報セキュリティ委員会

引用終了

との事です。

モトケン先生。　真に申し訳ございません。

ttp://pr.mail.yahoo.co.jp/toolbar/ の記載分が、リンクしてしまいました。　リンクを解除をお願いも仕上げます。

不手際にて、お手数および大変なご迷惑をおけいたしました事、深くお詫び申し上げます。

素人としては、

・海外旅行に行った連中が帰ってきて、潜伏期間が過ぎる5月中旬がターニングポイント
・新型で免疫が完全じゃないから、感染するといつものインフルより発病しやすいかも。
・それ以外には、今のところ症状、治療法はいつものＡソ連型と変わんなさそう。
・「新型インフル」というと強毒性の鳥インフルを想定していたので、各方面の対策がアジャストできず妙にオーバー気味になってるんじゃ。
・マスコミさんが、第１号発生を狙ってど派手に報道するので、むしろ患者が名乗り出にくい状況を作ってしまってるんじゃないの。

と勝手な想像をしてます（＾＾；

主戦場のメキシコやアメリカはともかく、患者も発生してないのにここまで大騒ぎしてる国は他にないんじゃないかなあ・・・。

主順発生国の２カ国からの帰国者からもそれほど関係しないと思われます。以前から人の往来はありますので。

　封じ込めは、とあまり過敏に成らないほうが良いとおもいいます。

連休があければ、通常の暮らしになりますし。

○石鹸で手洗いをこまめに行う。手洗いは流水で行う。手洗いだけでなく、石けんで顔や頭髪を定期的に洗浄するのは予防に効果が大きいです。

　「咳エチケット」
○咳・くしゃみが出たら、他の人にうつさないためにマスクを着用しましょう。マスクをもっていない場合は、ティッシュなどで口と鼻を押さえ、他の人から顔をそむけて１ｍ以上離れましょう。
○鼻汁・痰などを含んだティッシュはすぐにゴミ箱に捨てましょう。
○咳をしている人にマスクの着用をお願いしましょう。

　
　セキ、くしゃみ、鼻水　等の症状のある時は、ガーゼタイプで無いマスクを使いましょう。

DS2・N95マスク等のより密閉性の高いマスクは不必要(息苦しいだけです。医療従事者へ供給の妨げになるだけです。)

※マスクを着用しているからといって、ウイルスの吸入を完全に予防できるわけではありません。

※マスクの装着は説明書をよく読んで、正しく着用しましょう。

いまだ、国内未発生　Aレベルある。

毎年起こるインフルエンザの対策を講じれば良いと思われますし。

　発病しても、タミフルが効くようですし。
現時点では、予防にタミフルを使う状況でないと思われます。

３８度以上の熱がある方など、心配な方は。
都道府県による新型インフルエンザ相談窓口へ電話相談してください。いきなり医師の所へ行かないでね。　http://www.mhlw.go.jp/kinkyu/kenkou/influenza/090430-02.html

神戸大学感染症内科　岩田健太郎 先生より

http://georgebest1969.cocolog-nifty.com/blog/2009/04/post-6163.html

研修医の皆さんへと成っていますが、一般の方が読まれても　ウイルスを理解できる内容でとおもわれます。

パンデミックになりかかった時点で発病者はもとより、健康体にも老いも若きもいっせいにタミフルまたはリレンザを同時に投与してみたらどうだろうか。ウィルスの増殖の場を無くせば数日間で一気に殲滅できるのじゃないか,なんて考えていたら、人から豚にも感染するらしいですね。豚に逃げ込むことができるとは敵もなかなかかしこい。

No.18 うらぶれ内科先生。
ヒトーヒトのみの感染症である、麻疹、風疹は、根気よくワクチン接種を続ければある程度は制御可能なような。先にこっちの方が。これさえもしようとしないのに。こんなときはワクチンて言うのね？。

No.16 じじい　　さま。

＞・マスコミさんが、第１号発生を狙ってど派手に報道するので、むしろ患者が名乗り出にくい状況を作ってしまってるんじゃないの。

こちら本当に心配されますよね。政府対応も問題有ると思います。　政府が公に発表しなければ良いだけですのに。　あそこまで、もれるとご本人ご家族の方も心労がですね。それでなくても不安であろうに。

感染症の予防及び感染症の患者に対する医療に関する法律
（平成十年十月二日法律第百十四号）
最終改正：平成二〇年六月一八日法律第七三号

（国民の責務）
第４条 　国民は、感染症に関する正しい知識を持ち、その予防に必要な注意を払うよう努めるとともに、感染症の患者等の人権が損なわれることがないようにしなければならない

これを、ないがしろにしていますよね。

omizo 様

実は、この感染者報道には、概ねの属性や地域、行動を報道することで、保健所調査の届かない接触（接近）者に、自身の接触（接近）の可能性を想起させ、軽微な発症時の受診や行動の抑制に向けた注意喚起の役割を期待することができるんですよね。だから全く情報を出さない訳にもいかないんです。

接触者が感染した場合でも、接触の認識が少しでもあれば、早期治療（タミフルが効く）が期待できますし、複次的な感染拡大の防止に少しでも繋がればという意味合いです。

ただ、前にも申し上げたとおり、本人が特定されその周辺への取材が殺到するなど、報道が過ぎれば、むしろ受診抑制に繋がる惧れもありますし、周囲からの人権侵害行動に繋がる惧れもある。つまり諸刃の剣という訳です。げにマスコミは難しい・・・。

じじい さま

　仰る通りに両刃の情報発信です。冷静な行動を望むとしか。　最初の確定者の情報発信は、冷静に受けてとめて行動していただきたいと願うばかりです。　押しかけれれた関連基幹側も支障をきたしかねませんでしょうし。

たまにROMってるものです。
H1N1トンフルだけならまだしも、ですが、東南アジア経由でH5N1トリフルと交配されるとヤバい気がするんですけどね…。
すでにヒト→ブタ感染も確認されているようですから。
(ソース失念しましたが)
最近はH5N1トリフルの動向は寡聞にて存じ上げませんが、流行こそしていないもののどこかで潜伏しているでしょうから、トンフルを契機に流行しないかが個人的に気になっているところです。
H1N1トンフルにしても2~4種類のウイルスの遺伝子が交配されてるんですよね？
行政の死角になってたりしないですかね…

呼吸器感染症についてはシロウト同然の泌尿器科医です。
撃退可能？というトピからははずれていないと思って質問およびコメントさせていただきます。もし仮に水際作戦が功を奏して、日本には持ち込まれず、世界中では流行が（多くの人が免疫を獲得して）終わった場合のことです。ソ連風邪、アジア風邪のようになって、後から世界的な流行を繰り返す可能性があるとしたら水際作戦はいつまで続けるのでしょうか？永遠に？
もしかしたら、水際作戦は意味のないことで、国民向けにやむなく（宣伝として）やっているだけなのではと思ってしまいます。それとも水際作戦でくい止めている間に全国民に予防接種を行ってという意図なのでしょうか？インフルエンザの性質（私が学生時代に習った知識とＴＶの聞きかじりの知識からですが）から考えるとそれもあまり意味があるようには思えないのですが。
世の中には対症療法しか方法がない病気は他にもたくさんあります。ウイルスに対する治療法は大変限られています。なるようにしかならない、と思います。なった患者が自分の抵抗力で病気を撃退するまで死なないように、早く元気になるようにすることは（医学の力で）できるかも知れません。
お前は新型インフルエンザ怖くないの？といわれたら、大変こわいとお答えします。ただ命の問題ではなく、営業停止と風評被害についてです。早い段階では私や家族、スタッフに感染者がでなければいいなと思っています。

本題から外れるのですが少し。
H5N1は、感染症の予防及び感染症の患者に対する医療に関する法律　から言えば、「二類感染症」に入り、入院勧告です、実質入院措置（強制入院？）です。第六条３「二類感染症」・五 　鳥インフルエンザ（病原体がインフルエンザウイルスＡ属インフルエンザＡウイルスであってその血清亜型がＨ五Ｎ一であるものに限る。第五項第七号において「鳥インフルエンザ（Ｈ五Ｎ一）」という。） は、５ 「四類感染症」七 　鳥インフルエンザ（鳥インフルエンザ（Ｈ五Ｎ一）を除く。） と違って別扱いです、H7N2,N3,N7。H9N2。などは、「四類感染症」として扱われます。

感染症関連は他にも沢山有りますので、特定（予測困難）の物のみに神経を尖らしても疲れるだけです。　既存のワクチンのある物を推進していった方が減らしていけると思います。

フルに関しては、トレンドは、A/H1亜種、A/H3亜種で毎年大変ですし。

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