文·本报记者 陈磊
医务工作人员正在为小学生接种甲型H1N1流感疫苗CFP/供图
■两会传声
甲流发病率高、重症病人多可能与打疫苗少有关。提醒市民，目前的普通流感疫苗对甲流是有一定效果的，一般疫苗只有一年的免疫期。——全国人大代表、中国工程院院士钟南山
健康档案的建立，可补充我国某些重大传染病和重大慢性疾病相关流行病学的数据，为重大疾病防控策略的制定和政府决策提供依据。——全国人大代表、吉林大学中日联谊医院内科教研室主任王江滨
8年前，我国遭遇到一种名叫SARS的传染病袭击，因毫无准备而付出了沉痛代价；而2009年，面对席卷全球的甲型H1N1流感疫情，中国成功地打了一场阻击战，向世界交出了令人满意的成绩。
6年期间，从SARS到甲型H1N1流感，从“遭遇战”到“阻击战”，中国传染病应急处置和综合防控能力的提升，正是“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项实施成效的一个缩影。
“通过‘艾滋病和病毒性肝炎等重大传染病防治’科技重大专项实施，我国建立了覆盖全国的跨部门、跨学科传染病防控支撑技术平台，实现了传染病应急处置能力由点到面的提升。”该专项技术总师侯云德院士日前在接受科技日报记者专访时表示，专项紧密结合医药卫生体制改革、传染病防控实践和战略性新兴产业发展需求，强化顶层设计，着力技术创新，创新组织实施机制，整合全国优势科技和产业资源，初步建立了具有举国体制特征的传染病防治科技支撑体系，突破了一批关键技术和产品，为有效降低“三病两率”（艾滋病、病毒性肝炎和结核病发病率、病死率）提供了重要支撑。
抓住传染病防控“牛鼻子”，降低“三病两率”
如何提高我国重大传染病以及新发突发传染病的诊、防、治的水平？“我们不可能面面俱到，而是要突出重点，结合我国严峻的传染病防控形势，加强顶层设计，选择三个‘难啃的骨头’进行攻关。”传染病专项总体组成员、中国医学科学院病原生物学研究所所长金奇说。
金奇所指的攻关重点就是艾滋病、病毒性肝炎和结核病。当前，我国传染病防控形势仍十分严峻。艾滋病毒感染人数估计超过70万，性传播成为主要传播途径，防控难度进一步加大；现有乙型肝炎病毒携带者和慢性肝炎患者近1亿，网络直报的发病人数仍居高不下，肝炎慢性化问题日趋严重；结核病年发病人数超过百万，耐多药结核的人数居世界前列；新发突发传染病不断涌现，对社会稳定和经济发展造成巨大威胁。
“传染病专项就是要抓住‘三病两率’这个‘牛鼻子’，在攻坚克难中形成技术体系、增强防控能力、锻炼创新队伍，带动我国传染病防治科技整体水平的提升。”科技部重大专项办公室赵清华处长说。
“防控传染病有3个渠道：控制传染源、切断传播途径和保护易感人群。”侯云德指出，根据当前的科技进展，目前采取的策略是：控制艾滋病以阻断传播途径为主，并对现有感染者开展积极治疗；控制乙型肝炎则以推广和改善疫苗免疫、减少易感人群为主，同时提高诊治水平；控制结核病以改进诊断技术，及时发现和治疗病人，控制传染源为主。目前，专项“十一五”计划目标已顺利实现。
金奇告诉记者，我国在艾滋病、病毒性肝炎、结核病研究上取得一批具有自主知识产权的阶段性成果,如初步建立符合国际标准并适合国情的人类免疫缺陷病毒（HIV）核酸血筛检测体系；采用国产一线药物治疗成人艾滋病；艾滋病疫苗临床试验顺利推进；重症乙型肝炎的临床治疗方案使病死率下降20%以上，乙肝免疫新策略将大幅降低新发感染率；成功研制系列结核病诊断产品，等等。
“特别值得一提的是，专项研究提出加大免疫剂量的乙型肝炎疫苗免疫新策略。”侯云德解释，通过研究发现乙肝疫苗10微克剂的免疫效果优于现在推行的5微克策略；又研制成功60微克高剂量疫苗，一针注射的效果达80%以上，初步解决了疫苗接种者免疫低/无应答的难题，有望大幅降低乙肝的新发感染率。该策略已被建议应用于“十二五”国家乙型肝炎防治规划。
全球率先规模使用疫苗，迎战甲型流感
还是把镜头拉回到2009年4月底。中国疾病预防控制控中心病毒病预防控制所、中国医学科学院病原生物学研究所等单位的工作人员正在紧张而有序地工作。世界卫生组织公布甲型H1N1流感病毒序列后，这些院所在72小时内就成功建立病毒核酸检测方法。4月29日,获得世界卫生组织推荐使用的核酸检测引物信息后，又迅速研制出人甲型H1N1病毒核酸检测试剂，在第一时间将该技术向全国推广，并援助了14个发展中国家和地区。
利用专项的技术平台和现场，定期监测了全国分离的约1000多个株病毒基因全序列，追踪其变异情况；通过对超过15万份血清的调查分析，了解人群感染情况，为国家在不同时期调整防控策略提供了科技支撑。与此同时，甲型H1N1流感疫苗的研究也紧锣密鼓的展开。2009年8月29日，卫生部部长陈竺向全球宣布，甲型H1N1l流感病毒疫苗可引起回忆性保护反应，对一般人群注射一针（15微克）就可获得足够的免疫力,而在此以前，国际上大多数科学家建议要注射2针。9月上旬，甲型H1N1流感疫苗完成13000余人的临床试验后批准上市，疫苗质量及安全性达到国际先进水平，使我国成为全球第一个成功研制并规模使用甲型H1N1流感疫苗的国家。
在这场与时间赛跑的战斗中，侯云德用“全球瞩目”来评价中国的成绩,有鉴于此,世界卫生组织在2010年正式将我国“国家流感中心”认定为流感国际参比实验室，这在发展中国家还是唯一的一个……科技，为科学有效防控甲流提供了强大的支撑。
“虽然甲型H1N1病毒有其特殊性，但基本规律我们是掌握的。这次是在充分准备的情况下迎接的一次突发公共卫生事件。”侯云德认为，在甲流联防联控方面，中国打了一场漂亮仗，体现出我国新发突发传染病应急处置和传染病综合防控能力的大幅跃升。
有备而战，心中不慌。侯云德说，专项集成全国优势资源，建立了覆盖全国的由14个网络实验室、77个合作实验室和240个哨点医院组成的传染病监测技术实验室网络，对发热伴呼吸道症状、发热伴腹泻、发热伴脑膜脑炎、发热伴出血和发热伴出疹五大症候群，约300个病原体进行了高通量监测检测，对12万多份样本的病原体检测结果进行了网络直报，初步了解各地区五大症候群病原体的分布情况和流行特点，提高了基层单位的传染病监测和疫情发现能力，在新发突发传染病监控上发挥了关键作用。
结合医药卫生体制改革，打造“民生工程”
“传染病防控也是一个民生工程。”侯云德告诉记者，专项建立了两个产学研用联盟，使疫苗、诊断试剂和设备等传染病防控技术在产业链上得到延伸发展，目前，已经获得批准证书和生产文号30个以上。
金奇也认为，传染病防控必须在政产学研结合的平台上才能得以发展。他说，我国已初步建立了具有举国体制特征的传染病防控科技支撑体系。其中，传染病监测技术平台有效促进了监测和检测技术由国家实验室向地方实验室的转移，实现监测能力由点到面的提升。
如何将这个民生专项与医药卫生体制改革、转化医学相结合？侯云德介绍，通过专项的顺利实施，在15个省、自治区、直辖市建立了传染病综合防治示范区和单病种现场，覆盖人口逾2000万，初步实现了各类防治资源和技术的区域性集中，开展大规模的流行病学研究，创建了传染病综合管理信息体系，获得了超过1000万人“三病两率”的科学基数，对高流行因素进行了初步分析，并利用专项及其他科技成果开展了综合干预研究，形成了科技和卫生工作的有机衔接。
金奇介绍，在这些区域内重点开展了基线调查、电子档案建立等基础性工作，加大了综合防控措施的实施力度。已经建立了涵盖三病的新型电子健康档案约1500万份，完成三病高危人群健康教育干预1600余万人次；对已感染人群实施综合防治干预工作约34万人次。
“上述工作与医疗卫生体制改革、转化医学理念的方向是一致的，也为建立‘重心下移、关口前移、依靠科技、预防为主’的传染病防治模式进行了有益的探索，为最终实现降低‘三病两率’目标奠定了坚实基础。”金奇说。
■数字说话
79%
艾滋病防治及疫苗研究取得重要进展。成功研发适合国情且符合国际标准的核酸血筛检测体系及第四代检测试剂盒，将检测窗口期从3周缩短到2周以内；成人艾滋病一线治疗方案付诸实施，显著降低治疗副作用，费用降低79%。建立“政产学研用”相结合的中国艾滋病疫苗联盟。疫苗临床试验顺利推进，初步验证了艾滋病疫苗的安全性。
20%
我国新生儿乙肝疫苗预防接种的持续实施使15岁以下儿童乙型肝炎病毒感染率和乙型肝炎发病率明显下降。提出加大免疫剂量的疫苗免疫新策略，我国60微克新型疫苗已批准投放市场。进一步优化了包括人工肝在内的重型乙肝治疗方案，使其病死率降低20%以上。十余种新型乙型或丙型肝炎诊断试剂获国家批准，其性能达到或超过国际主流产品水平。
45%
自主发现的肝癌早期诊断新标志物GPC3，将有效提高肝癌早期诊断准确率。抗原致敏的人树突状细胞瘤苗已完成Ⅱ期临床试验，与化疗结合对转移性肝癌的有效率达到45%。包括外科手术治疗在内的治疗手段不断发展，显著提高了乙肝相关性终末期肝病患者的存活率和生活质量。
60%
结核病缺乏有效诊断的局面得到初步改观。痰液中结核分枝杆菌的检出率由过去的25%提高到60%以上；结核和非结核分枝杆菌的快速鉴别诊断使鉴定时间由现在2—3月缩短至1—2天；分枝杆菌菌种鉴定和结核分枝杆菌耐药检测基因芯片等技术将检测时间由8周缩短到6小时，大大提高了结核病诊治水平。
20个
采用循证医学的方法开展多中心临床研究,筛选20多个中医、中西医结合治疗方案。结果显示，中医药治疗可有效调节免疫功能、提高抗病毒治疗效果、降低治疗毒副作用，明显改善生存质量、降低重型肝炎等病死率,并在耐药结核病治疗方面显示一定疗效，在甲型H1N1流感等新发突发传染病防治中发挥重要作用。建立了国内最大的传染病中医证候研究数据库，基本明确了证候的分布特点和辨证规范。构建了重大传染病中医证候生物学研究平台，利用系统生物学等先进技术方法研究重大传染病常见中医证候的生物学特征。
(科技日报)
艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复
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| 图示∶2010年12月即将出版的《中国特色医疗金鉴》登载的刘君主任及其机构 |
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From the "encounter" to "blocking action"
Published: 2011-03-13 | On: Chen Lei
http://www.stdaily.com 2011 年 03 月 13 日 Source: Journal of Science and Technology: Chen Lei
Chen Lei Wen reporter
Medical staff are the primary influenza A H1N1 influenza vaccine inoculation CFP / courtesy
■ sound transmission two
A flow of high incidence of severe patients in the vaccine may be less relevant. Reminded the public that the current flow of ordinary flu vaccine have a certain effect, the general immunity of the vaccine one year. - National People's Congress, Chinese Academy of Engineering academician Zhong Nanshan
The establishment of health records, can add some of the major infectious diseases of major chronic diseases and epidemiological data, disease prevention and control strategies for major development and provide the basis for government decision-making. - National People's Congress, China-Japan Friendship Hospital, Jilin University, Department of Internal Medicine Director GASTROENTEROLOGY
8 years ago, our country suffered an infectious disease called SARS hit, because not prepared to pay a painful price; and 2009, the face of the influenza A H1N1 influenza swept the world epidemic, China has successfully fought a check war, surrendered to the world with satisfactory results.
6 year period, from SARS to H1N1, from the "encounter" to "blocking action," the Chinese and comprehensive prevention and control of infectious disease emergency response capacity to enhance, is the "major infectious diseases such as AIDS and viral hepatitis prevention and control" the effectiveness of technology implementation of major projects in microcosm.
"By 'AIDS and viral hepatitis and other major infectious diseases' technology implementation of major projects, China has established a nationwide cross-sectoral, interdisciplinary infectious disease prevention and control of supporting technology platform, the infectious disease emergency response capacity to the surface from the point increase. "chief engineer of the special technology Hou Academy Science and Technology Daily reporter recently in an interview that the special medical and health system closely, infectious disease prevention and control practice and strategic development needs of new industries, strengthening the top-level design, focus on technological innovation, innovation organization and implementation mechanisms, integrated national science and technology and industrial resources advantage, initially established with the characteristics of infectious diseases nationwide system technology support system, breaking a number of key technologies and products, in order to reduce the "three two rates of disease" (HIV, viral hepatitis and tuberculosis incidence and mortality) provided important support.
Seize the prevention and control of infectious diseases, "Niu Bizi" and reduce the "two-three disease rate"
How to improve China's major infectious diseases and emerging infectious diseases, emergency clinics, prevention and treatment level? "We can not cover everything, but to focus, combined with prevention and control of severe infectious diseases situation, to strengthen top-level design, choice of three 'hard nut to crack' to tackle the problems." Disease specific overall group membership, the Chinese Academy of Medical Sciences pathogen Institute of Biology, JIN Qi said.
Jin Qi within the meaning of research focus is on AIDS, viral hepatitis and tuberculosis. At present, China is still very serious infectious disease prevention and control of the situation. HIV infection is estimated that over 70 million, sexual transmission as a major route of transmission, prevention and control more difficult to; existing hepatitis B virus carriers and patients with chronic hepatitis nearly 1 million, the number of network report the incidence remains high, growing problem of chronic hepatitis; the number of annual incidence of tuberculosis over a million, the number of MDR-TB highest in the world; emerging outbreaks of infectious diseases continue to emerge, social stability and economic development poses a great threat.
"Infectious disease special is to seize the 'three disease two rate' this 'Niu Bizi', formed in the tackle tough technical system, and enhance prevention and control capacity, exercise creative team, led infectious disease in China to enhance the overall level of science and technology." Science and Technology Director of the Office of Zhaoqing Hua Department said major projects.
"Prevention and control of communicable diseases are three channels: 控制传染源, cut off the transmission and protection of vulnerable populations." Hou pointed out that under the current technological progress, the current strategies adopted are: the control of AIDS by blocking the main route of transmission, and infected persons to carry out the existing active treatment; control the promotion and improvement of hepatitis B vaccine Zeyi reduce the susceptible population-based, while improving the diagnosis and treatment; control to improve the diagnosis of tuberculosis, timely detection and treatment of patients, 控制传染源 as Lord. Currently, the special "Eleventh Five-Year" Plan targets have been successfully achieved.
Jin Qi told reporters that China has AIDS, viral hepatitis, tuberculosis has made a number of initial results with independent intellectual property rights, as initially established in line with international standards and appropriate conditions of human immunodeficiency virus (HIV) nucleic acid blood screening test system ; use of domestic first-line therapy of adult AIDS; the smooth progress of HIV vaccine clinical trials; the clinical treatment of severe hepatitis B decreased by 20% of the mortality rate of hepatitis B immunization strategy is to substantially reduce the new infection rate of new hair; TB diagnostic products successfully developed series of and so on.
"It is particularly worth mentioning is that the specific research proposed to increase doses of hepatitis B vaccine immunization new strategy." Hou explained that by studying the dose of 10 micrograms of hepatitis B vaccine immunization is better than 5 micrograms strategy is implemented; and Development high dose of 60 micrograms a successful vaccine, the effect of a needle injection of more than 80%, has initially solved the immune vaccine recipients with low / no response problem, is expected to significantly reduce new-onset hepatitis B infection. The strategy has been proposed applied to the "second five" national hepatitis B prevention and control planning.
Scale use of the world's first vaccine against influenza
Or the lens back to the end of April 2009. Chinese Center for Disease Control and Prevention virus disease control prevention and control, the Chinese Academy of Medical Sciences, Institute of Parasitic and other units of the staff are intense but orderly work. World Health Organization Influenza A H1N1 influenza virus sequence, these institutions in the successful establishment within 72 hours of viral nucleic acid detection methods. April 29, the World Health Organization recommended the use of nucleic acid primer information, and quickly developed a human influenza A H1N1 virus nucleic acid detection kit, the first time the technology to promote the country, and assisted 14 developing countries and regions.
Using special technology platform and on-site, regular monitoring of the country about the separation of more than 1,000 strains of the virus gene sequences to track the variation; by sera of more than 150,000 survey analysis to understand the people infected with the situation for the country at different times prevention and control strategies to adjust to provide the scientific and technological support. At the same time, H1N1 influenza vaccine launched intense research. August 29, 2009, Health Minister Chen Zhu announced to the world, influenza virus vaccine can cause influenza H1N1l memories of the protective reaction of the general population of a needle injection (15 micrograms) can get enough immunity, and in the past , the majority of international scientists recommended to injection of 2 needles. In early September, H1N1 vaccine to complete clinical trials of more than 13,000 after the approval of listing of the quality and safety of the vaccine to reach the international advanced level, making China the world's first successfully developed and the scale of H1N1 influenza vaccines using influenza countries.
In this battle with a race against time, Hou with "global attention" to evaluate China's performance, view of this, the World Health Organization in 2010, formally of the "National Influenza Center," recognized as an international reference laboratory for influenza, which in developing countries is the only one ... ... technology to provide a flow of scientific and effective prevention and control of a powerful support.
"Although influenza A H1N1 virus has its particularity, but the basic rule that we are to master. This is the case in well-prepared to meet a public health emergency." Hou that the joint prevention and control in a stream, China fought a good fight, reflecting the burst of emerging infectious diseases and comprehensive prevention and control of emergency response capacity of a quantum leap.
Well prepared to fight, hearts do not panic. Hou said that the special advantages of an integrated national resources to establish a nationwide network of 14 laboratories, 77 laboratories and 240 co-sentinel hospital component of the infectious disease laboratory network monitoring technology, for fever and respiratory symptoms, fever and diarrhea, fever and meningoencephalitis, fever, bleeding and fever and rash associated with the five syndrome, about 300 high-throughput monitoring of pathogens were detected on more than 120,000 samples of the pathogen detection network report the results of a preliminary understanding of the Regional distribution of the five syndrome and prevalence of pathogens characteristic of the grass-roots units to improve communicable disease surveillance and outbreak found ability to control outbreaks of infectious diseases in the new issue played a key role.
Combination of medical and health system, to create "livelihood projects"
"Infectious disease prevention and control is a livelihood project." Hou told reporters that the establishment of two production and research with special alliance for vaccines, diagnostic reagents and equipment and other infectious diseases prevention and control technology in the development of the industry chain to be extended, at present, has received and production of the certificate of approval document number 30 or more.
Kynge also believe that infectious disease prevention and control must be combined in the Education and Research in order to develop the platform. He said that China has initially established a nationwide system features with the disease prevention and control technology support system. Among them, infectious disease surveillance and effective technology platform for the monitoring and detection technology to local laboratories by the National Laboratory for the transfer, implementation monitoring capabilities to the surface from the point of upgrading.
How will the livelihood of the people with special medical and health system, the combination of translational medicine? Hou introduction, through the smooth implementation of the special, in 15 provinces, autonomous regions and municipalities had established disease prevention and control demonstration areas and a single disease site, covering a population of more than 20 million, the initial realization of a variety of regional control of resources and technology focus to carry out large-scale epidemiological studies, to create a comprehensive management information system for infectious diseases, access to more than 1,000 people, "the two rates of the three diseases," the scientific base of the high prevalence of a preliminary analysis of the factors and use of special and other technology results of research carried out a comprehensive intervention to form the organic technology and health converge.
Jin Qi introduced in these areas focus on the baseline survey, electronic file creation and other infrastructure work, and increased efforts to implement comprehensive prevention and control measures. Three patients have been established covering the new electronic health records of about 1,500 million to complete the three patients at high risk of more than 1600 health education intervention million; of infected people has been the implementation of comprehensive prevention interventions, about 34 million.
"The work and health system reform, the concept of translational medicine in the same direction, but also for the establishment of 'center of gravity, before problems occur, relying on science and technology, prevention,' the infectious disease model a useful exploration for the final to achieve lower 'two-rate three patients' goals laid a solid foundation. "Kinch said.
■ The Numbers
79%
AIDS prevention and vaccine research has made important progress. Successfully developed international standards for conditions and nucleic acid blood screening test system and the fourth-generation test kit, the test window period from 3 weeks to 2 weeks or less; first-line treatment of adult AIDS implemented, significantly reduce the treatment side effects, cost 79% decrease. Establish a "government production and research with" a combination of Chinese AIDS vaccine alliance. Smooth progress of clinical trials of vaccines, the initial validation of the AIDS vaccine safety.
20%
Hepatitis B vaccination of infants continued implementation of the children under the age of 15 hepatitis B virus infection and hepatitis B incidence has declined markedly. Proposed increasing doses of vaccine immunity new strategy, China has approved 60 micrograms of new vaccines to market. Further optimized, including artificial liver treatment, including severe hepatitis B, making it more than 20% reduction in mortality. More than ten kinds of new diagnostic reagents for hepatitis B or C has been ratified, the performance of mainstream products meet or exceed international standards.
45%
Early diagnosis of hepatocellular carcinoma independently discovered a new marker of GPC3, will effectively improve the accuracy of early diagnosis of liver cancer. Antigen of human dendritic cell vaccine has completed Phase Ⅱ clinical trials, combination with chemotherapy for metastatic liver cancer with 45% efficiency. Including surgical treatment, including the continuous development of hepatitis B significantly improved end-stage liver disease related survival and quality of life.
60%
Lack of effective diagnosis of tuberculosis has been initially changed the situation. Mycobacterium tuberculosis in sputum past the detection rate of 25% to 60%; Mycobacterium tuberculosis and non-rapid differential diagnosis to identify the time from now shortened to 1-2 days, 2-3 months; points Chi bacteria Mycobacterium tuberculosis strain identification and detection of drug resistance gene chips and other technology to reduce detection time from 8 weeks to 6 hours, greatly improving the diagnosis and treatment of tuberculosis.
20
Evidence-based medicine approach with multi-center clinical studies conducted to screen more than 20 traditional Chinese medicine, Integrative Medicine program. The results showed that Chinese medicine treatment can regulate the immune function, improve the anti-viral treatment, reducing treatment side effects, improved quality of life and reduce mortality of severe hepatitis, and drug-resistant TB treatment showed some efficacy in influenza A H1N1 influenza and other emerging infectious disease emergencies play an important role. Established the largest infectious diseases research database Syndrome, defined the basic characteristics and distribution of syndrome differentiation specifications. Construction of a major infectious disease syndromes biology research platform, the use of advanced technology systems biology methods such as major infectious disease syndromes common biological characteristics.
(Science and Technology Daily)
