鳥インフルエンザから新型インフルエンザ大流行へ

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1

2

3 H1 - H16 N1 - N9 Aquatic birds Poultry Humans Pigs Horses Aquatic mammals Cats Dogs Influenza Branch

4 ( )

5

6 1997 H5N1 18 6

7 H5N1 HPAI , , Feb. 2004, Chickens 6, 1 12 Jan.2004 Chickens 17 Feb,2004 Bantams, duck -3 Mar. 2004, Chickens -7 Mar.2004, Crows -10 Mar. 2004

8

9 H5N1

10

11 2005 1

12 Lombok, Indonesia, 2008

13 2006 3

14

15 Clade 1 Clade 2.1 Clade 2.2 Clade 2.3 Clade 0 10

16 ( Clade 2.2 Clade 2.3 Clade 1 Clade 2.1

17

18

19 Country 5) Total Azerbaijan (5) (5) Bangladesh (0) 0 1(0) Cambodia (4) 2 (2) 1 (1) 1 (0) 0 8 (7) China 1 (1) 0 8 (5) 13 (8) 5 (3) 4 (4) 7 (5) 38 (25) Djibouti (0) (1) Egypt (10) 25 (9) 8 (4) 2 (0) 53 (24) Indonesia (12) 56 (46) 42 (37) 24 (20) 2 (2) 143 (117) Iraq (2) (2) Laos (2) (2) Myanmar (0) (0) Nigeria (1) (1) Pakistan (1) (1) Thailand 0 17 (12) 5 (2) 3 (3) (17) Turkey (4) (4) Vietnam 3 (3) 29 (20) 61 (19) 0 8 (5) 6 (5) ) Total 4 (4) 46 (32) 97 (42) 116 (80) 88 (59) 44 (33) 11 (7) 407 (256)

20 .

21 H5N

22 2005

23

24 2-8 ( ) 7-15

25 Emerg. Infect. Dis. J. 2005

26 De Jong et al. Nature Med 2006

27 - NP ( /

28 α

29

30 ( ;

31

32

33

34 ( ) ( ) (

35 (Russian Flu Pandemic)

36

37 1918

38

39

40 - 8

41

42 (1) (3) (2)

43

44 α α

45 HA Clade Receptor binding Receptor site specificity Gln Leu Ser Ser α(2-3) Arg Glu Ser/Gly Gly α(2-6) A/goose/Guandong/1/96(H5N1) 3 Gln Leu Ser Ser α(2-3) A/Hong Kong/156/97(H5N1) 3 Gln Leu Ser Ser α(2-3) A/chicken/Vietnam/1/2004(H5N1) 1 Gln Leu Ser Ser α(2-3) A/Vietnam/1193/2004(H5N1) 1 Gln Leu Ser Ser α(2-3) A/Thailand/16/2004(H5N1) 1 Gln Leu Ser Ser α(2-3) A/duck/Cambodia/JP52A/2005(H5N1) 1 Gln Leu Ser Ser α(2-3) A/Vietnam/JPHN20408/2005(H5N1) 2-2 Gln Leu Ser Ser α(2-3) A/goose/Shantou/2086/2006(H5N1) 2-2 Arg Leu Gly Ser α(2-6) A/Turkey/15/2006(H5N1) 2-2 Arg Leu Gly Ser α(2-6) A/Egypt/2947/NAMRU2/2006(H5N1) 2-2 Arg Leu Gly Ser α(2-6) A/Indonesia/13/2006(H5N1) 2-1 Gln Leu Ser Ser α(2-3)

46

47 H5N1 HPAI

48

49 H3N8 H2N2 H2N2 H1N1 H5 H9 H6 H H3N2 H1N Russian Influenza H2N Old HK Influenza H3N Spanish Influenza H1N Asian Hong Kong Influenza Influenza H2N2 H3N2

50

51

52 ) vs. PQ RERRRRKR GL H5

53 HA1 HA2 Clade 0 A/ Hong Kong/ 258/ 97 A/ Hong Kong/ 156/ 97 PQ RERRRKKR PQ RERRRKKR GL GL Clade 1 A/ Viet Nam/ 1194/ 2004 PQ RERRRKKR GL Clade 2.1 A/ Indonesia/05/2006 PQ RESRRKKR GL A/ Indonesia/13/2006 PQ RESRRKKR GL Clade 2.2 A/ Turkey/12/2006 PQ GERRRKKR GL A/ Egypt/2616/NAMRU-3/2007 PQ GERRRRKR GL - - Clade 2.3 A/ Anhui/2/2005 PQ RE RRRKR GL - - A/ Myanmar/NIID-23/2008 PQ RERRRKKR GL - -

54 ) NS1 ; TNFα F92E or D S42P : TNFα PB2 ; E627K (4 36 PB1-F2 N66S 2

55 PB2 RNA (. PB1-F2 HA. HA NS PDZ

56

57 H5N1 H9N2 H7N(2,3,7) H6N1 H2N ~ ?

58

59

60 The big pandemic of 1918

61

62

63

64

65

66

67

68

69

70

71

72

73

74 )

75 )

76

77 ( (

78

79

80

81

82

83

84 Deaths Rates / 100,000 Population (Annual Basis) 1918 Death Rates: Philadelphia v St. Louis Philadelphia St. Louis /14/1918 9/21/1918 9/28/ /5/ /12/ /19/ /26/ /2/ /9/ /16/ /23/ /30/ /7/ /14/ /21/ /28/1918 Date Weekly mortality data provided by Marc Lipsitch (personal communication)

85 St. Louis *Estimated attack rate before interventions: 2.2% /9/ /9/ /9/ /10/5 1918/10/ /10/ /10/ /11/2 1918/11/9 1918/11/ /11/ /11/ /12/7 1918/12/ /12/ /12/28 Date *derived from mortality data using 2% CFR Death Rate / 100,000 Population (Annual Basis)

86 14000 Philadelphia *Estimated attack rate before interventions: 10.8% /14/18 9/21/18 9/28/18 10/5/18 10/12/18 10/19/18 10/26/18 11/2/18 11/9/18 11/16/18 11/23/18 11/30/18 12/7/18 12/14/18 12/21/18 12/28/18 Date *derived from mortality data using 2% CFR Death Rate / 100,000 Population (Annual Basis)

87

88 4

89 social distancing)

90 .

91

92 (Oseltamivir, Zanamivir) (Tamiflu) ( ) + (Relenza),

93

94 Clade 2.2 M2: L26I, S31N NA: H Y, S N Clade2

95

96 ICH E2B guideline

97

98 H5N1 VietNam/2004 Clade1 Clade2.1,Clade 2.2(, Clade2.3 1/2 8 Clade Pre-pandemic

99 Prepandemic

100

101

102 6 1 1

103 ?

104

105

106

107

108

109

110 PPE

111 2 ( ) (

112 ~6 4.8~ (4.4 trillion)

113

114

115

116

117

118

119 1. (

120

121

122 (BCP) Business Continuity Plan

123 P) M)

124 Business Continuation Plan,BCP)

125 ~2

126 1. ( 2. 3.

127 1. (

128

129

130

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