流感回归，知否，知否？应是疫苗正当时

进入冬季，流感如期汹涌而至，眼下正进入高峰季节，各大医院内科和儿科门急诊爆满，看病动辄排队数小时，就连小编昨天在门诊看的小朋友里面也有一半是确诊甲型流感阳性。数周前，四大天王之一的刘德华因流感而中途停止演唱会并入院治疗数天，取消了7场演唱会。说到流感， 有些人会说，“大惊小怪，流感不就是流行性强点的感冒吗！”; “小毛病，就是着凉了，喝点水睡一觉就好了！”；或者 “我身体健康抵抗力强着呢，不会得流感的！”。

其实不然，大家还记得去年流感季节在微信朋友圈流行的长文《流感下的北京中年》， 记录了作者李可的岳父感染流感病毒然后并发重症肺炎，发展到呼吸衰竭，用上了体外膜肺氧合（ECMO），历时29天最终还是阴阳两隔。无独有偶，去年一个急诊科医生也在个人微信公号上上分享了一个80岁老年人从流感发热到并发症死亡才13天的案例。

看到这里，是不是大家开始担惊受怕了，其实也没有必要为了个别重症病例而过分紧张。全国各地疾控都会对流感进行监测，可以及时动态地掌握流感的流行情况，给出预警。而且绝大多数为轻症，重症和死亡的病例较少，这也是为什么公众容易对流感有轻敌思想。那么在流感季节该怎么办？对于我们大众来说，了解流感的相关特点，学会正确有效地预防流感尤其重要，现在就让我们一起来看看吧！

流感是流感病毒引起的一种传染性强，传播很快的呼吸道疾病。流感的程度可以从轻度到重度，有些时候甚至可能致命。流感和普通感冒不同。流感通常起病很急，有以下的部分或全部症状：

• 发热

• 咳嗽

• 咽痛

• 鼻塞或流涕

• 全身肌肉关节酸痛

• 头痛

• 疲乏倦怠

• 有些人可能会有呕吐腹泻表现，不过更常见于儿童

Influenza Symptoms                           

Influenza is caused by flu viruses and it is a contagious respiratory illness. It can cause mild to severe illness, and sometimes can lead to death. Flu is different from a cold. Flu usually onset suddenly. People who are sick with flu often feel some or all of these symptoms:

• Fever

• Cough

• Sore throat

• Runny or stuffy nose

• Muscle or body aches

• Headaches

• Fatigue (tiredness)

• Some people may have vomiting and diarrhea, though this is more common in children than adults.

其实严重的不是流感本身，而是流感的各种并发症。

大多数流感可以在1-2周内痊愈，但是一部分患者会出现并发症，甚至会出现危及生命的结果。流感的并发症包括有鼻窦炎和中耳炎，而肺炎就属于相对严重的并发症了，可能是流感病毒单独引起的结果，或是流感病毒和细菌的合并感染。由流感引起的其他严重并发症还有心肌炎，脑炎，肌炎，横纹肌溶解，以及多器官功能衰竭（比如呼吸衰竭和肾衰竭）。流感病毒的呼吸道感染会触发机体过激的炎症反应，从而导致会危及生命的败血症。同时，流感病毒也会让机体的慢性疾病加重。例如，有哮喘病史的患者在流感时可能会发生哮喘急性发作；有慢性心脏疾病的患者可能因流感而加重。

Influenza Complications

Most people who get flu will recover in one to two weeks, but some people will develop complication, some of which can be life-threatening and result in death. Sinus and ear infections are complications of flu, while pneumonia is a serious flu complication that can result from either influenza virus infection alone or from co-infection of flu virus and bacteria. Other possible serious complications triggered by flu can include myocarditis, encephalitis, myositis, or rhabdomyolysis, and multi-organ failure (for example, respiratory and kidney failure). Flu virus infection of the respiratory tract can trigger an extreme inflammatory response in the body and can lead to sepsis, the body’s life-threatening response to infection. Flu also can make chronic medical problems worse. For example, people with asthma may experience asthma attacks while they have flu, and people with chronic heart disease may experience a worsening of this condition triggered by flu.

流感可以感染任何人，无论健康与否，年龄大小，任何人都有可能感染流感以及发生流感所引起的并发症，但是某些特定高危人群在罹患流感后会有相对更高的风险得流感的并发症，甚至导致重症流感。这些人群包括年龄65岁以上的老年人，5岁以下幼童特别是2岁以下的婴幼儿，孕妇，有特定慢性疾病的（比如哮喘，糖尿病或心肺疾病）任何年龄段人群。

People at High Risk of Serious Flu Complications

Anyone can get sick with flu (even healthy people), and serious problems related to flu can happen at any age, but some people are at high risk of developing serious flu-related complications if they get sick. This includes people 65 years and older, people of any age with certain chronic medical conditions (such as asthma, diabetes, or heart and lung disease), pregnant women and children younger than 5 years, but especially those younger than 2 years old.

儿童

• 呼吸频率快或呼吸困难

• 皮肤颜色青紫

• 不能摄入足够的液体

• 唤之不醒或没有反应

• 烦躁不安不愿意被大人抱着

• 流感的症状好转后发热又起伴有咳嗽加重

• 发热及出疹

成人

• 呼吸困难或气急

• 胸部或腹部疼痛或压迫感

• 突然发生的头昏

• 意识模糊

• 严重或持续性呕吐

• 流感的症状好转后发热又起伴有咳嗽加重

另外，除了以上的症状，在婴幼儿中出现下列表现中的任何一项，需要立即去急诊：

• 无法进食

• 呼吸有困难

• 哭时无泪

• 尿量比平时明显减少

Emergency warning signs of flu sickness

In children

• Fast breathing or trouble breathing

• Bluish skin color

• Not drinking enough fluids

• Not waking up or not interacting

• Being so irritable that the child does not want to be held

• Flu-like symptoms improve but then return with fever and worse cough

• Fever with a rash

In adults

• Difficulty breathing or shortness of breath

• Pain or pressure in the chest or abdomen

• Sudden dizziness

• Confusion

• Severe or persistent vomiting

• Flu-like symptoms that improve but then return with fever and worse cough

In addition to the signs above, go to emergency immediately if infant has any of these signs

• Being unable to eat

• Has trouble breathing

• Has no tears when crying

• Significantly fewer wet diapers than normal

流感疫苗！

流感疫苗！

流感疫苗！

重要的事情说三遍！

关于流感疫苗的接种，长期以来存在误区。有些人认为“流感是小病”，自己身体健康抵抗力强，没有接种疫苗的必要；或者认为“接种疫苗没啥用，打了针冬天照样感冒”。如同之前说得，流感的传染性极强，可以感染任何人，无论健康与否，年龄大小，任何人都有可能感染流感以及发生流感所引起的并发症。 有区别的是感染的机率可能与当时不同免疫力的人群而有所差别。

迄今为止，接种流感疫苗是预防流感及其并发症的最有效和最重要的手段，可以有效地减少流感及相关疾病，因病缺课和缺勤，医院就诊和住院负担，以及病死率。对流感高危人群予以疫苗接种可以降低重症流感的风险，所以尤为重要。再次重申，高危人群包括年龄65岁以上的老年人，5岁以下幼童特别是2岁以下的婴幼儿，孕妇，有特定慢性疾病的（比如哮喘，糖尿病或慢性心肺疾病，肝肾功能不全，免疫抑制疾病或免疫功能低下）任何年龄段人群。

另外，医务工作者，高危人群的看护人员和家庭成员接种流感疫苗也很重要，可以防止流感的传播。特别是现有的流感疫苗不适合给6月龄以下的小婴儿直接接种，通过给家庭成员和照顾者接种可以形成一道屏障，间接达到保护小婴儿的目的。

研究数据发现在即使注射流感疫苗后仍然中招了的病例中，疾病表现相对较轻。

为保证能在流感流行开始之前获得免疫保护，建议所有在6月龄以上的每个人在每年的十月底之前完成疫苗接种。通常接种流感疫苗2-4周后，可产生具有保护水平的抗体。如果是因为学习紧张，工作忙、没有疫苗或者没当回事等等原因没来得及接种，那么记得在整个流行季节都可以提供进行免疫接种， 以免在这个冬天裸奔在流感的威胁之下。

根据WHO推荐的2018－2019年度北半球的流感疫苗成分，我国今年批准上市的流感疫苗包括三价灭活疫苗和四价灭活疫苗，可以保护预测的最常见的3或4种流感病毒。三价疫苗含有H1N1,H3N2,以及一种B 型(Victoria系)。四价疫苗包括以上三种加上另一种B型（Yamagata系)。所以，四价疫苗的保护性更为全面，另外，四价和三价疫苗的安全性上没有差别。

《中华人民共和国药典》（2015版）就未将对鸡蛋过敏者作为流感疫苗接种禁忌。在2018年9月中国疾控中心发布的《中国流感疫苗预防接种技术指南（2018-2019）》上，也已经不将鸡蛋过敏作为禁忌症内容。美国CDC从2016年的指南也开始建议有鸡蛋过敏者，无论程度如何，都可以接种任何符合其年龄要求的流感疫苗，而且不需要留观30分钟观察过敏反应。

灭活流感疫苗与其它灭活疫苗及减毒活疫苗可同时在不同部位接种。

How To Preventive Influenza?

Flu vaccine

Get a flu vaccine is the most effective and most important step in protecting against influenza and its complications. Flu vaccination can reduce flu illnesses, missed work and school due to flu, doctors’ visits and hospitalizations, and death. Vaccination of high risk persons of serious flu complications is especially important to decrease their risk of severe flu illness. This includes young children, pregnant women, people with chronic health conditions like asthma, diabetes or heart and lung disease and people 65 years and older.

Vaccination also is important for health care workers, and other people who live with or care for high risk people to keep from spreading flu to them. Infants younger than 6 months are too young to be vaccinated. People who live with or care for infants should be vaccinated to establish a barrier for the protection from flu.

There are data to suggest that even if someone gets sick after vaccination, their illness may be milder.

To get immunity before flu season begins, it is recommended everyone 6 months of age and older should get a flu vaccine by the end of October. It takes about 2 to 4 weeks to developed effective immunity after vaccination. If not vaccinated due to various reasons, it is appropriate to get the shot any time during the flu season.

According to WHO recommendation for 2018-2019 year, there are three- component and four-component vaccines available in China that protecting against the 3 or 4 viruses that research suggests will be most common. Three-component vaccines contain an H3N2, an H1N1 and a B virus. Four component vaccines have an additional B virus component.

Regarding egg allergy and flu vaccination, CDC recommended that people with egg allergies no longer need to be observed for an allergic reaction for 30 minutes after receiving a flu vaccine. People with a history of egg allergy of any severity should receive any licensed, recommended, and age-appropriate influenza vaccine.

Influenza vaccine can be given with other inactivated or live vaccines, preferably in different limbs.

流感的日常预防

• 尽量避免与患者密切接触

• 罹患流感者要注意尽可能减少和限制与他人接触，居家休息，以防传染他人。

• 咳嗽和喷嚏时使用纸巾遮掩口鼻，然后丢弃纸巾并洗手。

• 经常使用肥皂和水洗手，如果没有，可使用含酒精的免洗洗手液。

• 避免用脏手直接接触口，鼻子和眼睛。

• 经常清洁消毒容易被细菌病毒污染的物品表面。

• 尽量少去人多聚集场所，避免接触呼吸道感染患者，注意戴口罩防止病毒通过空气飞沫传播。

• 增强免疫力：保持充足睡眠，每晚7.5-9小时；多运动，锻炼身体，一周3次，每次30分钟以上。

  
  

Everyday preventive steps

• Try to avoid close contact with sick people.

• While sick, limit contact with others as much as possible to keep from infecting them.

• Cover your nose and mouth with a tissue when you cough or sneeze. After using a tissue, throw it in the trash and wash your hands.

• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.

• Avoid touching your eyes, nose and mouth.

• Clean and disinfect surfaces and objects that may be contaminated with germs and virus.

• Avoid large crowds, limit contact with sick people. Wear face mask to prevent from getting flu.

• Strengthen your immune system: sleep at least seven and a half to nine hours per night and maintain a regular physical activity routine, at least 30 minutes, three times a week.