Insect-borne viruses (insect-borne viruses) refers to some of the natural odd source microorganisms through the bite of blood-sucking arthropods capture and cause human and animal diseases of good news, including different genomes of the virus family, such as flaviviruses (flaviviridae), flaviviruses (flavivirus), lentiviruses (togaviridae), a virus genus (Alphavirus), Bunyaviridae (bunyaviridae), reoviridae, and orthomyxoviridae (orthomyxoviridae). virus family (bunyaviridae), reoviridae, and orthomyxoviridae. Arthropod-borne viruses, which share the common characteristic of being able to be transmitted to new and close arthropods by biting and sucking blood in arthropod coast animals, after some kind of external incubation period, are monkeys, cicadas, white ridge, snails, moths, nagas, ants, to mosquitoes and other important animals. Birds, bats, primates and domestic animals are the most important vertebrate hosts.
Principle
The basic principle of prevention of arboviral infections is that the main source of infection during an epidemic of arboviral infections is the patient, so early detection and timely isolation of the patient is very important. Patients are most contagious from a few hours before to a few days after the onset of illness, and should be treated in a room with good mosquito control.
The basic principle of treatment for arboviral infections is that there is no specific drug treatment for arboviral infections, and the main treatment is symptomatic supportive therapy. Patients should be hospitalized, the room should have anti-mosquito, cooling equipment, should closely observe the condition, careful care, to prevent complications and sequelae, is important to improve the efficacy of treatment.
Operation method
Arbovirus prevention and treatment
Principle
The basic principle of prevention of arboviral infections is that the main source of infection during an epidemic of arboviral infections is the patient, so early detection and timely isolation of the patient is very important. Patients are most contagious from a few hours before to a few days after the onset of illness, and should be treated in a room with good mosquito control. The basic principle of treatment for arboviral infections is that there is no specific drug treatment for arboviral infections, and the main treatment is symptomatic supportive therapy. Patients should be hospitalized, the room should have anti-mosquito, cooling equipment, should closely observe the condition, careful care, to prevent complications and sequelae, is important to improve the efficacy of treatment.
Materials and Instruments
Equipment: adrenal glucocorticosteroids, diazepam, chloral hydrate, phenytoin sodium, amytal sodium Move -Prevention (i) Control of sources of infection The source of infection during the epidemic of insect-borne infectious diseases is mainly the patients, so it is very important to find and isolate the patients in time at an early stage. Patients are most contagious from a few hours before to a few days after the onset of the disease, at which time they should be treated in rooms with good anti-mosquito equipment. All departments should report suspected cases in a timely manner when they find them, so that the relevant departments can grasp the epidemic situation as early as possible and take necessary preventive and control measures. Disease control and inspection and quarantine personnel should carry out epidemiological investigations on suspected patients immediately upon discovery of cases or upon receipt of case reports, including investigation of travel history of suspected cases during the period of onset of the disease, history of mosquito bites, etc., investigation of close contacts and co-exposed persons, searching for sources of infection and suspected sites of infection, in order to determine the infected areas or outbreak sites, strengthen the monitoring of travelers from the infected areas, and direct the infected sites to take urgent measures such as spraying and removing the breeding grounds and other follow-up work. (ii) Cutting off the means of transmission 1. Anti-mosquito and anti-mosquito are fundamental measures to prevent mosquito-borne diseases. Improve environmental hygiene, fill up surrounding potholes, remove fecal sewage and stagnant water in a timely manner, manage water sources, and eliminate mosquito breeding grounds. Fighting. Smoke or medicate adult indoor mosquitoes. Strengthen personal awareness of mosquito prevention also helps the prevention of disease, in the peak time of mosquito activity to minimize the outing, when going out should wear long-sleeved clothes and pants, etc., in the mosquito places, sleeping should try to use mosquito nets. 2. Preventing the infestation of maids is one of the most important aspects of controlling encephalitis, and it is also the simplest and most feasible way to prevent the disease. Strengthen the measures to prevent and eliminate maidservants, can be divided into two aspects of work: (1) environmental protection: to create an environment that is not conducive to the activities of maidservants in order to achieve the purpose of preventing maidservants. For example, open up the road, clear the roadside weeds, to reduce the chances of people and animals to and from the maidservant infestation. Eliminate rodents that carry handmaiden larvae or cicada larvae. (2) Individual protection; workers who enter the forest area should wear protective clothing, insect cover, collar, cuffs and trouser legs tightly tied, in the exposed part of the body can be coated with potassium sulfide solution or high-quality insect repellent oil, can also be used to repel insect repellent oil coated with overalls. Avoid bringing the handmaiden back to the residence when returning from the field. (iii) Protecting susceptible people 1. Improve the disease resistance of the population by paying attention to balanced diet and nutrition, combining work and rest, and exercising appropriately to enhance physical fitness. 2. For those who travel to the infected area to carry out tourism health knowledge education, all departments should pay attention to do a good job in the daily public health education, disseminate and popularize the relevant prevention and treatment knowledge to the public, guide the public to take the correct preventive behaviors, and improve the prevention and protection ability of individuals and groups. Educate travelers to the infected area to raise awareness of prevention, to take mosquito repellent, long-sleeved clothing and other anti-mosquito measures to prevent infection and transfusion of yellow fever or West Nile fever outside the country, once suspected symptoms, should take the initiative to seek medical attention and travel history to inform the doctor. 3. Vaccination Vaccination is one of the means to prevent infection of insect-borne infectious diseases. (1) At present, injection of B-brain vaccine is effective and has a high protection rate. In endemic areas, the target group of vaccination is usually children above 6 months of age and below 10 years of age. In the first year, inactivated B brain vaccine needs to be injected twice, with an interval of 7~10 days, and then strengthened once a year; live attenuated vaccine is not divided into the initial immunization, and one injection is given every year until the age of 6 years, so that lasting immunity can be obtained. (2) Vaccination against attenuated yellow fever strain 17D can effectively prevent yellow fever virus infection. Antibodies appear 7-10 days after vaccination and last for at least 30-35 years. Active immunization is recommended for all people 9 months of age and older at real risk of exposure who live or travel to infected areas. (3) Universal vaccination of susceptible persons in cicada-borne encephalitis infected areas is the main measure to prevent handmaiden-borne encephalitis. Evaluation of the immunization effect should be strengthened after vaccination to ensure effective prevention of viral infection. The immunization should be repeated annually thereafter. (4) There is currently no prevention of dengue fever. Chikungunya fever and West Nile fever have mature vaccines. Specific vaccine development is in the experimental research stage, once successfully developed, will become an effective means of controlling these insect-borne infectious diseases. (iv) Strengthening health quarantine at the border to prevent the importation of diseases Health quarantine should be strengthened for incoming personnel from endemic areas, and personnel from yellow fever infected areas must present valid vaccination certificates. Once the port quarantine department found a suspected case, to inform the health department in a timely manner to do a good job in the investigation and treatment of the epidemic. Conditional inspection and quarantine departments and the CDC should establish insect-borne infectious disease laboratory testing techniques and methods, and make good technical and reagent reserves, to improve the detection of imported insect-borne infectious diseases and the ability to respond. There is no specific drug treatment for arbovirus infections, mainly symptomatic supportive treatment. Patients should be hospitalized, and the sick room should have anti-mosquito and cooling equipment. Close observation of the condition and careful nursing care should be taken to prevent complications and sequelae, which is of great significance to improve the efficacy of treatment.
1. General treatment: pay attention to diet and nutrition, supply enough water, preferably fluid or semi-fluid diet, fasting when frequent vomiting occurs, and intravenous rehydration with 5%~10% glucose saline or plasma, but need to pay attention to the balance of water, electrolytes and acid-base balance.
2. Symptomatic treatment
(1) Treatment of high fever; room temperature should be lowered to below 30℃. Patients with high fever can be cooled down by physical cooling or medication to keep the body temperature between 38~39℃ (anal temperature). High fever can generally be intramuscular anandamide, young children can use anandamide anal plug, avoid using excessive antipyretic drugs, so as not to cause dehydration due to profuse sweating. Adrenal glucocorticoids can inhibit the response of the body temperature center to the pyrogen, thus causing the body temperature to drop, and can be considered to be used in moderation. Prevention and treatment of hemorrhage, hypotensive shock; prevention and treatment of hepatic. Renal failure and secondary infections and various other complications. Small amounts of antipyretic and analgesic can be used for severe headache, but avoid aspirin and mehloprim (anti-inflammatory pain), which can cause bleeding. Antiemetic can be used metoclopramide (gastroenterology) 5-10mg orally or intramuscularly, and severe hiccups can be injected intramuscularly or static methylphenidate (Ritalin) 10-20mg and so on. Adrenocorticotropic hormone can be tried in those with myocardial damage, and oxygen inhalation can be given at the same time. For those with secondary bacterial infection or complicated malaria, give appropriate antimicrobials or antimalarials. Shock, DIC, uremia, heart failure, etc. should be treated accordingly.
(2) Treatment of convulsions; sedative and antispasmodic agents can be used, such as diazepam, chloral hydrate, phenytoin sodium, sodium amytal, etc.. Convulsions should be the cause of the corresponding measures: ① due to cerebral edema caused by the person, should be mainly dehydrated drug therapy, available 20% mannitol, in 20 ~ 30 minutes intravenous drip, if necessary, 4 ~ 6 hours repeat use. At the same time, can be combined with the use of acepromazine, adrenocorticotropic hormone, etc., in order to prevent the rebound after the application of dehydrating agents. ② If the brain cells are hypoxic due to the blockage of respiratory secretion and the difficulty of ventilation, oxygen should be given to keep the respiratory tract open, and tracheotomy and pressurized respiration should be carried out if necessary. ③ If it is caused by high temperature, it should be cooled down.
(3) Handling of respiratory disorder and respiratory failure: when deep coma patients have increased phlegm sound in the throat which affects respiration, the secretion can be attracted through the mouth or nasal cavity, and postural drainage and nebulized inhalation can be used to keep the respiratory tract unobstructed. If respiratory failure occurs due to cerebral edema and brain herniation, dehydration and adrenocorticotropic hormone can be given. Breath holding due to convulsions can be treated as convulsions. If spontaneous respiration stops due to pseudo medullary paralysis or medullary cerebral palsy, tracheotomy or intubation should be performed immediately, and a pressurized artificial respirator should be used. If spontaneous respiration exists, but the respiration is shallow and weak, respiratory stimulants such as sanguinarine, niclosamide, methylphenidate, and tamsulosin can be used (alternatively).
(4) Treatment of circulatory failure: circulatory failure caused by cerebral edema, cerebral hernia and other brain lesions, manifested by pallor, cold extremities, small pulse pressure, central respiratory failure, it is appropriate to use dehydration to reduce intracranial pressure. In case of cardiogenic heart failure, cardiotonic drugs, such as trichostatin C, should be added. If circulatory failure is caused by insufficient blood volume due to hyperthermia, coma, and excessive water loss, the main focus should be on volume expansion.
(5) Treatment of patients with fever with hemorrhage: patients with fever with hemorrhage should be treated with hemostasis. Replenishment of fluid and elimination of cerebral edema are the main points of treatment. Generic hemostatic agents such as phenol sulfacetamide. Carbazochrome or vitamin K intramuscularly, and give a large amount of vitamin C IV, plus Yunnan Baiyao or white pill orally. Local bleeding can be stopped by local hemostatic agents or local embolization. In case of excessive blood loss, whole blood transfusion should be given, but if the patient has hemoconcentration, isotonic fluids should be given before transfusion to prevent heart failure, shock and DIC, and fluids should be replenished according to the patient's need for fluid replacement in case of water loss due to hyperthermia, poor appetite, and vomiting. Patients with concurrent cerebral edema can be treated with artificial hibernation, dehydration therapy, or application of hormones.
(6) Treatment of shock syndrome: When dengue shock syndrome occurs, anti-shock treatment should be given in time, and attention should be paid to maintaining water-electrolyte balance. Patients with high fever need to use antipyretic and analgesic, but the use of sodium salicylate is contraindicated, which may lead to bleeding and acidosis. The condition should be closely observed to detect signs of shock as early as possible. Measurement of the patient's hematocrit is important to understand the degree of plasma extravasation. Intravenous fluid administration should be emphasized in cases of persistent high fever and positive hemoconcentration markers, and in cases of acidosis, attention should be paid to correcting water and electrolyte disorders. When shock occurs, attention should be paid to rapid fluid replacement, isotonic or semi-isotonic salt solution to increase the plasma volume, and give blood transfusion if necessary.
3. Adrenocorticotropic hormone and other treatments, adrenocorticotropic hormone has anti-inflammatory, antipyretic, reduce capillary permeability, protect the blood-brain barrier, reduce cerebral edema, inhibit the formation of immune complexes. Protecting the lysosomal membrane of cells and other effects, it can be applied to patients with severe diseases and early diagnosis. When the body temperature drops to 38 ℃ or above, the dosage can be gradually reduced for 2 days, and generally should not be more than 5~7 days. The symptoms may recur if the drug is stopped too soon, and complications may arise if the drug is used for too long.
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