1、新发传染病基孔肯雅热新发传染病基孔肯雅热研究概况研究概况主要内容Contentsv 一、前言一、前言IntroductionIntroductionv 二、全球流行概况二、全球流行概况v 三、三、CHIKCHIK主要传播媒介主要传播媒介v 四、最新研究结果四、最新研究结果一、前言一、前言Introduction基孔肯雅热（Chikungunya fever，CHIK）：单链正义RNA病毒A single strand positive sense RNA virus披膜病毒科披膜病毒科（Togaviridae）甲病毒属甲病毒属(Alphavirus)基孔肯雅病毒基孔肯雅病毒(Chikungun
2、ya virus，CHIKV)西西门门利克森林病毒利克森林病毒亚组亚组(Semliki forest，SF)临床症状p主要临床表现为发热、关节剧烈疼痛、皮疹和轻度出血体征，类似于流行性登革热(dengue fever，DF)。p该病起病急骤和关节剧烈疼痛，被迫采取弯曲体位，当地的土语形容这种姿势为“基孔肯雅”Kimakonde language meaning to become contorted(WHO,1985)。p1952年，它首次分离于坦桑尼亚（Tanzania）(Sourisseau et al.,2007)。p截至目前为止，还没有有效的疫苗或防制药剂。地理概况白纹伊蚊在法国流域分
3、布白纹伊蚊在法国流域分布Aedes albopictus distribution on the French Riviera意大利白纹伊蚊分布Distribuzione di Aedes albopictus in Italia per provincie nel 2000瑞士虫媒病毒分布瑞士虫媒病毒分布The distribution of oThe distribution of other arbovirus ther arbovirus around around SwitzerlandSwitzerland虫媒病毒虫媒病毒Arbovirusgenus Alphavirus,genu
4、s Alphavirus,family Togaviridaefamily TogaviridaeSindbis virus(SIN)In Europe Asia Australia South American Africa(Strauss&Strauss,1994)genus Flavivirus,family Flaviviridaegenus Phlebovirusgenus Phlebovirus,familyfamily BunyaviridaeBunyaviridaeYellow fever virus(YFV)Eg:Spain,Italy(Livorno),France(Sai
5、nt-Nazaire)and Portugal and so on(Vainio&Cutts,1998)Dengue fever virus virus(DFV)TropNetEurop:such as Israel and Dutch et al (Wichmann et al.,2003)Wset Nile virus(WNV)In western Mediterranean and southern Russia in 1962-64,Belarus and Ukraine in the 1970s and 1980s,Romania in 1996-97,Czechland in 19
6、97,and Italy in 1998)(Hublek&Halouzka,1999).In Italy,Portugal and other Mediterranean countries(Snchez-Seco et al.,2003).Toscana virus(TOSV)Sandfly fever virus(SFV)Rift Valley Fever virus(RVFV)2007年瑞士提契诺地区白纹伊蚊监测过程中阳性诱卵器数年瑞士提契诺地区白纹伊蚊监测过程中阳性诱卵器数Proportion of positive ovitraps checked during the monito
7、ring program on Ae.albopictus in Ticino,Switzerland,2007（Wymann等，等，2008）不含不含Chiasso地区地区(without Chiasso)Chiasso地区地区(in Chiasso)Fig.Sequencing strategy for CHIK genomic RNA by RTPCR.Boxes indicate the coding regions of non-structural and structural proteins.(Khan et al.,2002)CHIKV,全基因组全基因组complete ge
8、nome(NCBI:NCBI:NC_004162,11,826 nt11,826 nt)Nucleotide sequencing of the E1 Nucleotide sequencing of the E1 gene of CHIKV was used to gene of CHIKV was used to investigate the relatedness of the investigate the relatedness of the samples.samples.http:/www.ncbi.nlm.nih.gov/entrez/viewer.fcgi?db=nucco
9、re&id=27754751http:/www.ncbi.nlm.nih.gov/entrez/viewer.fcgi?db=nuccore&id=27754751CHIK Outbreaks The Globalization of Vectorborne Diseases ,past old geographicboundariesCharrel et al.2007-N Engl J Med二、全球二、全球CHIK分布概况分布概况(between 1952-2006)The distribution of CHIK around the world在地域分布上，在地域分布上，CHIKCH
10、IK主要经非洲主要经非洲传播至东南亚、传播至东南亚、欧洲与南美洲等欧洲与南美洲等国家。国家。基孔肯雅热：不再是第三世界疾基孔肯雅热：不再是第三世界疾病病Chikungunya:No Longer aThird World Disease-Science(Enserink,2007)Paper trail.The number of papers with“CHIK”in the titlehas risen from fewer than five per year before 2004 to more than70 in 2007.Emilia-Romagna多个国家多个国家CHIKCHI
11、K案例数案例数（February 2005 to April 2006February 2005 to April 2006）国家国家Country案例数案例数No.of cases疑似或确诊疑似或确诊Suspected(S)or confirmed(C)报道时间报道时间Reporting period印度洋与亚洲印度洋与亚洲Indian Ocean and Asia留尼旺岛Runion255 000S28 Feb 05 30 Apr 06马约特岛Mayotte5834S1 Jan 06 16 Apr 06塞舌尔Seychelles8818S1 Jan 06-26 Feb 06Seychell
12、es158S29 Mar 06 2 Apr 06科摩罗Comoros8C20 26 Mar 06 马达加斯加Madagascar2C6 12 Mar 06毛里求斯Mauritius60004800 S+1200 C1 Jan 06 5 Mar 06印度India 100 000SDec 05-23 Apr 06马来西亚Malaysia200S1 Jan 06-21 Apr 06欧洲欧洲Europe(imported cases)法国France307C1 Apr 05 28 Feb 06德国Germany17C1 Jan 06 21 Apr 06英国United Kingdom92 C+7 S
13、1 Dec 05 20 Apr 06比利时Belgium12CDec 05 26 Apr 06捷克Czech Republic1C1 Jan 06 20 Apr 06挪威Norway1C1 Jan 06 19 Apr 06欧洲监测欧洲监测Euro Surveillance,2006,11(5)http:/www.eurosurveillance.org/ew/2006/060511.asp#2 20072007年意大利年意大利CHIKCHIK暴发流行趋势图暴发流行趋势图Epidemic curve Distribution of dates of onset of symptoms for C
14、HIKV Epidemic curve Distribution of dates of onset of symptoms for CHIKV cases by presumed place of infectioncases by presumed place of infection（Rezza et al.,2007).CHIKVCHIKV疫源地及病例空间分布：疫源地及病例空间分布：A A：001515天；天；B B：045045天；天；C C：加权：加权cumulativelycumulatively；DD：RavennaRavenna省省 （Rezza et al.,2007).感
15、染感染CHIKVCHIKV病例特征病例特征白纹伊蚊活动与欧洲、美国和印度洋白纹伊蚊活动与欧洲、美国和印度洋CHIKCHIK暴发流行同步性分析暴发流行同步性分析Synchronisation of Aedes albopictus activity in Europe and the Synchronisation of Aedes albopictus activity in Europe and the USA and of Asian and Indian Oceans outbreaks.The arrow USA and of Asian and Indian Oceans outbr
16、eaks.The arrow indicates the date of return from India to Italy of the presumed indicates the date of return from India to Italy of the presumed index case of the Italian outbreak.index case of the Italian outbreak.三、CHIKV传播媒介CHIKV transmission of vector主要传播媒介：亚洲虎蚊Asian Tiger mosquito白纹伊蚊(Aedes albo
17、pitus，Diptera:Culicidae)和埃及伊蚊（Ae.Aegypti）。20世纪初期，白纹伊蚊起源于东南亚、西太平洋和印度洋岛屿，现已扩散到非洲、中东、欧洲和美洲(Gratz,2004)。传播方式传播方式Transmission modeTransmission mode美洲埃及伊蚊再度侵害状况美洲埃及伊蚊再度侵害状况Reinfestation of the Americas by Aedes aegypti 1930s1930s 1970s 1970s 2006s2006s*资料来源资料来源Source:美国美国CDC/PAHO主要传染源主要传染源u基孔肯雅病毒感染的主要传染源：
18、人和猴类。u在城市型疫源地中，病人和隐性感染者是主要传染源，病毒主要以人-蚊-人的方式传播。u在丛林型疫源地中，猴、猩猩等灵长目和野生动物是本病的主要传染源。病毒以灵长目动物-蚊-灵长目动物方式传播。媒介生物监测媒介生物监测The surveillance of vectorThe surveillance of vectorBG-Sentinel mosquito trap 四、最新研究结果Recent Results总总 结结蚊虫监测蚊虫监测(TropNetEurop)虫媒传染病专一引物设计传播媒介Ae.albopictus egg新型病毒探测(DFV,YFV,WNV,KRV实验室诊断实验室诊断(如如:医院医院)
