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季節性流感的臨床處理

香港醫學會傳染病顧問委員會對季節性流感的臨床處理提出以下建議：

於近日季節性流感流行期間，六歲以下兒童的住院率特別高。於二零一九年一月十二日一週，六歲以下兒童的住院率為 9.23(每一萬人口計) ，已超出近三年季節性流感高峰期錄得之最高入院率(近三年之最高入院率為6.18至9.07(每一萬人口計))。更出現一系列兒童嚴重流感個案，其中許多涉及流感相關的腦病變。

雖然接種流感疫苗有助預防流感和相關的腦病變，但疫苗需時兩週才能有效發揮作用，而幼兒於第一次接種流感疫苗時需要接種兩劑以確保對季節性流感產生足夠的免疫力。為了有效保護幼兒，香港醫學會傳染病顧問委員會建議對確診或疑似流感個案及早使用神經氨酸酶抑制劑進行治療。特別是在季節性流感流行期間，如在臨床上認為有需要，抗病毒藥物應盡早使用，無須等待化驗確診才開藥。雖然快速流感測試可能會出現假陰性結果，但它們有助決定在非典型個案中是否使用抗病毒藥物，尤其在父母對臨床診斷有懷疑的情況下。

鑑於先前有幾乎全部來自日本的報告提及兒童，特別是青少年，於感染流感及使用神經氨酸酶抑製劑期間發生精神紊亂症狀，香港醫學會傳染病顧問委員會諮詢了日本專家的最新意見和數據，顯示這些精神紊亂症狀主要與流感本身有關，他們亦認為盡早使用抗病毒藥物，包括神經氨酸酶抑製劑，可能有助於預防精神紊亂症狀及減低嚴重併發症。患有流感的幼兒和青少年，無論是否使用神經氨酸酶抑製劑，仍需接受觀察，以及早發現可能發生的精神紊亂症狀。

二零一九年一月二十一日

編輯備忘：

香港醫學會成立於一九二零年，旨在聯繫政府、各公立醫療機構、大學及私人執業的醫務工作者，交流意見，團結一心。醫學會致力將最新的醫療資訊及醫務發展傳遞與會員，提倡會員遵行專業操守，進而服務社會，維護民康。

PRESS

RELEASE

21 January 2019

Clinical management of seasonal influenza

The Advisory Committee on Communicable Diseases made the following recommendations in relation to the clinical management of seasonal influenza:

In the current seasonal influenza epidemic, the influenza admission rate was highest among children aged below six years. In the week ending 12 January 2019, it reached 9.23 per 10,000, exceeding the peak rate which ranged from 6.18 to 9.07 recorded in major influenza seasons in the past three years. A series of severe cases were also seen among young children, many of which involved influenza-associated encephalopathies.

While vaccination will help to prevent influenza and the associated encephalopathies, it takes two weeks to act and two doses are also needed for first influenza vaccination in young children.

To protect our young children from the current seasonal influenza epidemic, the Advisory Committee on Communicable Diseases recommends EARLY antiviral treatment of confirmed or suspected influenza with neuraminidase inhibitors. If clinically indicated, empirical antiviral treatment should be started as soon as possible. Laboratory confirmation of influenza virus infection is NOT necessary for the initiation of treatment, especially during seasonal influenza epidemic. While false negative results can occur with rapid flu tests, they may help to guide antiviral use in atypical cases, especially in case of doubt from parents. 

In view of previous reports, almost entirely from Japan, of neuropsychiatric events among children, especially young teenagers, with influenza and put on neuraminidase inhibitors, the Advisory Committee on Communicable Diseases of the Hong Kong Medical Association has obtained updated professional opinions and data from relevant expert sources in Japan. In their opinions, those neuropsychiatric events were mainly related to influenza itself and early use of antivirals, including neuraminidase inhibitors, may help to prevent them as well as other serious influenza complications. Observation is required for young children and teenagers with influenza, as neuropsychiatric events can occur irrespective of whether they are put on neuraminidase inhibitors.

Notes to editors:

The Hong Kong Medical Association, founded in 1920, aims to bring together Hong Kong's government, institutional, university and private medical practitioners for an effective exchange of views and co-ordination of efforts.  The foremost objective of the Association is to safeguard and promote public health.  The Association speaks collectively for its members and aims to keep its members abreast of medical ethics, issues and advances around the world.  In fulfilling these goals, the association hopes to better serve the people of Hong Kong.