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    现在位置首页>?#38469;?#36164;料首页>行业动态>实验室动态>science专访墨西哥顶级流感实验室主管:墨西哥目前不需要支援

    science专访墨西哥顶级流感实验室主管:墨西哥目前不需要支援

    丁香园2009年5月13日 18:38 点击:1295

    墨西哥人现在表示,目前还不需要国际援助!

    微生物学家Alpuche领导的墨西哥实验室因该国爆发猪流感而成为众人关注的焦点,昨天Alpuche接受了science的独家专访。

    很多人都会问:墨西哥是否可能更早发现这次爆发,是否可能在爆发之前就将其消灭在萌芽阶段。Alpuche称此次爆发发生在病毒流行的季节,而且病毒可能并非源自墨西哥,这些令InDRE非常困惑。采访中,Alpuche还解释了为?#20301;?#36153;数周时间确定此次爆发同首个病例(一名来自veracruz州la lgloria的四岁男孩),此外,她还坦述了她所在实验室的局限性。

    InDRE已同加拿大公共卫生部、美国CDC密?#34892;?#20316;,确定猪流感病毒为此次爆发的罪魁祸首,墨西哥将继续与其合作检测剩余疑似病例的标本。到五月1日,墨西哥已经有156名确诊病例和9例死亡报告,多于世界其他任何一个国家。昨天公布的CDC发病?#36864;?#20129;周报显示墨西哥还发现1918名疑似病例,目前InDRE正忙于筛查其中真正的感染者。

    流感由两型病毒引起:A和B,此外还可区分为不同?#20999;停?#30001;位于病毒表面的血凝素和神经氨酸酶决定)。此次引发爆发的病毒是A型,HIN1。

    以下为采访内容

    科学杂志:请问?#38382;?#21457;现呼吸系统病例报告数出现异常的?

    Alpuche:四月七日,我们从the National Institute of Respiratory Disease 得知突然有很多健?#30340;?#36731;成人发生重症肺炎,于是我们立刻开始搜集数据,并对过去掌握的流感资料进行回顾性分析

    我们调查了1月以来流感监测的所有数据,并同以往流感流行期数据比较。当时还有传言称有的病例患的不是肺炎,可能是另一种呼吸道疾病,类似于流感。

    科学杂志:从对流感趋势的分析中你看出什么了吗?

    Alpuche:首先从分析结果我们发现全国?#27573;?#20869;仍有流感在发生,除了流感的流行期有所延长外,这和我们每年观察到的情况非常相似,之后我们分析了流感病毒的?#20999;停?#24471;到一个异常发现:此次流感流行期中有两个发病高峰,分别是去年11和12月,和今年2月,整个流感流行期中发现比往年更多的B型流感感染病例。

    科学杂志:但此发现与本次流行无关

    Alpuche:是的,同本次流行无关。这令我们很困惑。我们发现今年37%发病者感染的是B型病毒,而去年该比例只有15%。之后我们调阅了美国CDC流感监控系统中的数据,发现在美国也有类似的情形(流感流行期延长且主要为B型)。于是我们考虑这次发病应该流感有关,但同时我们仍?#36824;?#27880;那些肺炎病例。之后我们立刻回头调查流行期全国?#27573;?#20869;所有爆发资料,以确定是否同流感流行期延长或我们的其他发现有关。在墨西哥中部某些州如Tlaxcala州有一些小规模流感爆发,最后一次爆发在3月最后两周,地点是vercruz州,la gloria镇。

    科学杂志:为什么三月最后两周那次的爆发没有引起关注?

    Alpuche:它只是流感样的疾病,没有死亡和肺炎病例报告,国家流行病学调查人员对这次爆发也做了深入调查,veracruz州的卫生秘书在那次流行中做了很多有意义的工作。

    科学杂志:对鉴定?#20999;退?#20204;有多大能力?

    Alpuche:墨西哥实验室流感检测网络采用免疫荧光法进行筛查,主要是采用针对A/B型不同?#30446;?#20307;,这也是州卫生部门采用的方法。

    科学杂志:所以他们不能鉴定?#20999;停?#24517;须把样本送到你那

    Alpuche:是的,但不是立刻?#36864;停?#22240;为如果没发现什么异常,他们会等出现足够多的病例然后才将样本送到国家鉴定?#34892;摹?#36825;次流行有一个特殊之处,初发症状在感染4-5天后才出现,但是免疫荧光法的敏感性在感染超过72小?#26412;?#20250;变低,因此到出现症?#35789;贝?#22810;数鼻咽部采样检测结果?#38469;且?#24615;的。

    科学杂志:稍后你对la gloria 的样本进行了更多采集,是吗?

    Alpuche:在la gloria爆发的最后?#27426;问?#38388;,4月1日起开?#21152;?#20799;童出现症状,当地卫生人员在4月3日采集了样本,将其送到国家健康实验室,4号经过处理,到达?#19994;?#23454;验室是8号。

    科学杂志:哪些是阳性的?

    Alpuche:最后他们?#24739;?#23450;出3株流感病毒,一株为H3N2,另一株为A型,但这并不振奋人心,在?#19994;?#23454;验室,我们考虑最后一株可能是HI?#20999;停?#20294;并不确定,坦白的说,我们无法确定它的?#20999;停?#26368;后我们将其鉴定为B型。

    科学杂志:最后那株无法确定的的,你把它送到别的机构了吗,这株无法?#20013;?#30340;菌株引起你的关注吗?

    Alpuche:那时我们我们还没有得到关于加利福尼亚男孩身上分离出的无法?#20013;?#27969;感病毒的相关消息

    科学杂志:在加州监测框架下,如果你无法?#20013;停?#20320;应当把标本送到CDC。

    Alpuche:是的,我们是应该那么做,我们的协作单位是CDC,但我们有三个不同的样本累计期限。当我们发现第一株无法定型的病毒时,我们没有很担忧,因为那时,疫情已经在控制下了。

    科学杂志:4月12日,墨西哥按照《国际卫生条例》向泛美卫生组织通报了Veracruz地区流感样爆发的情况。最初,你们认为这些病例类似流感么?

    Alpuche:不,就像我们最初按照《国际卫生条例》所报告的那样,我们初期的想法是流感较强且时间延长,并不认为在Tlaxcala 和 Perote发生的这些病例有什么特别,认为仅仅是肺炎。但是后来,我们开始考虑这些病例不同寻常。

    科学杂志:4月17日,墨西哥开?#25216;?#22823;流感监控力度,是什么导致了这种变化?

    Alpuche?#20309;?#20204;获悉了一个单发病例通告:一名?#21152;?#31958;尿病37岁女性,死于呼吸道疾病和肺炎。这名死者四月4日出现症状,同perote的爆发没有一点联系。因为家属拒绝尸体解?#21097;?#25105;们获得的样本来自肺部活检。此外他们还全面调查了和这些死者接触的人,发现?#34892;?#21628;吸道症状,但没有死亡。这看起来没什么异常的,不是吗?#31354;?#20123;人被取样检测,流感病毒和其他病毒检测结果?#38469;且?#24615;的。

    科学杂志:就此您第一?#38382;嗆问?#32852;系Frank Plummer教授的?(加拿大公共卫生部微生物实验室主管)

    Alpuche?#20309;?月17日通过?#22987;?#32852;系他,他立刻回复了。他想知道更多信息,我们在18号进行了一次长谈。

    科学杂志:frank告诉我说他开始并没想到流感,他考虑可能是一种未知的病原。

    Alpuche:是这样,我们就此和plummer教授进行了?#33268;邸?#20107;实上,是我给他打的电话,我通过全球健康安全促进组织遇到他,我们之间?#33268;?#36807;很多合作,当我们开?#32487;致?#27969;行病学时,我们希望排除一切可以排除的因素。

    科学杂志:为什么你会联系他?

    Alpuche:加拿大有很多关于?#29616;?#21628;吸道疾病如SARS,以及未知病原方面的经验。

    科学杂志:4月21号MMWR报告了加州的两例猪流感,你是?#38382;?#30693;道的?

    Alpuche:CDC曾给我一个发布前稿,具体日子记不得了。

    科学杂志:什?#35789;?#20505;把标本送到加拿大和CDC的?

    Alpuche:4月21日,我同时向他们寻求帮助,CDC是我们WHO框架下的合作机构,他们经常帮助我们,进行质控,提供试剂,开展培?#25285;?#20256;递?#38469;酢?#20294;是想要给他们寄东西有点?#35759;取?#20174;美国获得运输的相关许可耗费了一些时间。

    科学杂志:你把标本送到加拿大,是不是也因为美国政府耽搁了样本运送?

    Alpuche:不是的,我送样本到CDC是因为它是我们的合作单位,我们应该这么做,我们一?#36125;覥DC得到帮助。

    科学杂志:但我认为美国政府应?#36125;?#36825;?#38382;录?#21560;取教?#25285;?#20320;的标本被耽搁了多久,为什么?

    Alpuche:其实只有一天,我不能说从墨西哥寄东西到美国比从加拿大寄东西到美国是否更难,老实说,我不能解释。

    科学杂志?#20309;?#24819;你?#27426;?#23545;这一延误很纠结。

    Alpuche:是的,但是我知道我将获得我们需要的帮助,而且我们得到了,这之间只有很小的差别。

    科学杂志:你什?#35789;?#20505;从Frank Plummer教授那里得到第一次反馈?

    Alpuche?#20309;?#20204;4月22日得到初步结果。Plummer那天下午3点收到标本,到午夜他给我打电话告诉我我们的样本感染的是A型流感病毒。我知道我送给他的那些标本中一部?#36136;茿型病毒。那一周,我们开始看到A型病毒流行,并开始转变B型病毒流行期延长的想法。

    科学杂志:你?#38382;?#24471;知他们是一?#20013;?#22411;猪流感病毒的?

    Alpuche?#20309;?#26159;4月23日下午从Frank Plummer教授那得知这是一种猪流感病毒,稍后的晚间,在包括CDC的Nancy博士和墨西哥专家参与的一次电话会议上,她给我们提供了23日到达CDC标本的初步检测结果?#20309;?#20204;爆发?#30446;?#33021;是猪流感。

    科学杂志:你对关于批评墨西哥没有做好足够的早期预警工作有何看法,现在墨西哥媒体和国际媒体都这?#27492;怠?/font>

    Alpuche:对任?#38382;?#24773;来说,能?#19994;教?#32618;羊总会得到安慰。这是一?#20013;?#30340;未知病毒,我们最近在诊断和流行病学调查方面已成熟了很多,当然还有不足之处。我们必须接受之一点。我们正在努力克服这些不足。我们与所有的卫生部门一道,尽我们所能以尽快对这一病毒进行鉴定。

    从一开始我们就积极同各?#28966;低ǎ?#24403;我收到Frank博士的确诊后,我立刻联系了Manricio博士,他立刻向Secretary Córdova 汇报

    科学杂志?#20309;业焦?#30340;许多墨西哥实验室?#38469;?#37117;很先进,是什么限制了你的实验室鉴定H1N1病毒,你们缺少哪些CDC和加拿大已有的条件?

    Alpuche:墨西哥唯一进行?#20999;?#26816;测的就是?#19994;?#23454;验室,我们可以进行测序和鉴定?#20999;停?#20294;是我们忙于处理流感样本和其他来自全国各地的标本,因此我们会比加拿大和美国滞后一些。

    科学杂志:是什么限制了你们分析病毒并对其测序?

    Alpuche:从这周开始,有来自CDC和加拿大的专家帮助我们建立适时荧光PCR?#38469;?#26469;检测HIN1病毒。

    科学杂志:你的实验室是墨西哥目前唯一采用RT-PCR?#38469;?#36827;行确诊试验的实验室吗?

    Alpuche:到现在为止是的,但是我们正在同CDC和加拿大一起培训来自墨西哥六个州的分子生物学人员,我们手头有两台RT-PCR仪,其中一台从公司借来的,并已经购买了十台,我们正夜以继日的工作以加快诊断。

    科学杂志:你们现在有多少样本等待检测?

    Alpuche::现在我们有大约1000个样本亟待检测,我们所有人员分为早中晚三班?#21482;?br />
    科学杂志:你们有1000个样本等待检测,但那里有2000名疑似病例。

    Alpuche:不是所有病例的标本都送到我们这里,我们手中的1000个样本也不?#38469;且?#20284;病例。

    科学杂志:你还在继续送样本到CDC和加拿大吗?


    Alpuche:是的,我们这周送了更多的样本到加拿大,我们刚刚我们这里的CDC人员一同安排运送更多标本到CDC,我们希望排除目前已经掌握的所有标本,?#28304;?#29702;新标本。

    科学杂志:许多墨西哥和国际媒体都在报道关于laglora和perote附近的养猪场,有很多间接甚至怀疑的?#26376;?/font>

    Alpuche:?#20309;?#19981;知道,现在谣言很多

    科学杂志:la gloria的男孩现在怎么样?

    Alpuche::病情很轻,不是什么大问题

    科学杂志:确定他是首发病例吗?

    Alpuche?#20309;?#20204;还不确定,根据首发症?#35789;?#38388;,他是第一例

    科学杂志:他是?#38382;?#21457;病的?

    Alpuche:四月1号

    科学杂志:还有很多说法称perote是疫源地,你相信吗?

    Alpuche: 我们问了perote当地农业部门,他们确定没有监测到任何动物疫情爆发,农场离la gloria还有80公里?#19969;?br />
    科学杂志:还很远

    Alpuche:远到对一个在那里工作的人往返很麻?#24120;?#20294;我们还在调查,我们正在做流行病学监测,但根据当地农业部门的陈述那里没有什么异常。

    科学杂志:granjas carroll有一例确诊病例是吗?

    Alpuche::目前我还不知道

    科学杂志:还有猜测说病毒起源于来自美国或其他地方到墨西哥的人,很可能是个移民,关于起?#35789;?#19968;个大养猪场的猜测是误导。

    Alpuche:有可能,我?#19988;?#26159;这么想的,我们需要更多证据,有趣的是,我们在调查oaxaca和perote的病例,这些地方移民很多。其他发病?#29616;?#22320;区如san luis potosi也是移民走?#21462;?#24456;难相信病毒是源自这个农场,但是我相信政府会?#27807;?#35843;查的。

    科学杂志:如果如你所说病毒源自其他地方而非墨西哥,是否有可能已经在当地被消灭,你是否认为病毒迁徙的?#34892;?#36807;快?

    Alpuche:考虑到正处在流感流行期末,可能会让人误以为是其他病毒,但病毒确实迁徙的很快。

    科学杂志:美国很早就监测到发病,但没能控制,它们称这种病毒更狡猾

    Alpuche::是的

    科学杂志:最后一个问题,你们每晚睡多久?

    Alpuche:最多两个小时

    科学杂志:已经两周这样了?

    Alpuche:是的,有时候我们睡两小时,还能来个半小时的小睡,靠咖啡提神

    科学杂志:你现在希望国际社会提供哪些帮助?

    Alpuche: 我们现在暂时不需要,如果我们需要我们我们会提出,但是现在,我们确实不需要。
     

    Exclusive: Interview With Head of Mexico's Top Swine Flu Lab

    By Jon Cohen
    ScienceNOW Daily News
    1 May 2009

    Microbiologist Celia Alpuche heads the laboratory in Mexico that has become ground zero for the country's outbreak of swine flu. Alpuche spoke to Science yesterday from her office at the Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE) in Mexico City.

    Many people have raised questions about whether Mexico could have detected this outbreak earlier and contained it before it spread elsewhere. But as Alpuche explains, InDRE had a confusing situation because the virus surfaced in the middle of flu season--and it may not have originated in Mexico anyway. Alpuche also sets the record straight about why it took several weeks to link the outbreak to the first case with symptoms, a 4-year-old boy from La Gloria in Veracruz state. And she frankly describes the limitations of her own lab.

    InDRE has worked closely with the Public Health Agency of Canada and the U.S. Centers for Disease Control and Prevention (CDC) to identify the virus as the cause of the outbreak, and Mexico continues to collaborate to test samples of suspected cases. As of 1 May, Mexico had 156 confirmed cases and nine deaths, more than any country in the world. Mexico has identified another 1918 suspected cases, as described in the CDC's Morbidity and Mortality Weekly Report yesterday, and InDRE is rushing to sort out how many are actually swine flu.

    Influenza is caused by two strains, A and B, and several different subtypes that are designated by the two proteins that stud the viral surface, hemagglutinin and neuraminidase, followed by a number. The outbreak is caused by an influenza A virus of the subtype H1N1.

    Science: There have been many questions about the origin and the timing. When was there an indication that there were an unusual number of respiratory cases?

    Alpuche: On April 7, we heard that the National Institute of Respiratory Disease was having unusually severe cases of pneumonia in young adults who were previously healthy. Immediately, we started to get the data around this cluster. We also started to do a retrospective analysis of the influenza data we had.

    We looked at all data that we had regarding influenza detection since January up to this month and also to compare to the past season of influenza. In addition to the unusual pneumonia, we started to have rumors there were other cases that were not pneumonia, it was like a respiratory disease, an influenza-like illness.

    Science: Did you see anything from your analysis of influenza trends that told you anything?

    Alpuche: The first thing that it told us is that we were still detecting influenza in the country, not just in Mexico City. It was pretty much the same as we see every year except it was a prolongation of the flu season. Then we analyzed the subtypes of the strains of influenza, and one of the unusual things we saw was that in this season, we had the first peak in the last part of November and December and another one in February. Over the season, we started having more influenza B than we had the year before.

    Science: Which had nothing to do with this outbreak.

    Alpuche: Nothing to do with this. It was very confusing. We found that 37% of cases were B and the year before we only found up to 15% were B. Then we looked at data that they have in the influenza surveillance system at CDC to see if were having something unusual. We saw also in United States something kind of similar--a prolonged period of influenza and increases of strain B. So we thought that we were having something related to influenza, and we were still concerned about the pneumonia cases. We went back immediately to look at all the influenza outbreaks we had in the country since the season started to see if this was more related to the prolonged influenza or there was something else we were seeing. We had small outbreaks in some states in the central part of Mexico, Tlaxcala, and then the last outbreak we had was in Veracruz state, in the town of La Gloria, near Perote. That was in the last 2 weeks of March.

    Science: Why didn't that trigger concern in the last 2 weeks of March?

    Alpuche: It was influenza-like illness, no fatalities and no pneumonia cases. This outbreak was deeply studied with state epidemiologists. The secretary of health of Veracruz did a wonderful job during the outbreak in the last 2 weeks of March.

    Science: What capability did they have for typing subtypes?

    Alpuche: The influenza, laboratory-based surveillance network in Mexico is using immunofluorescence--that's the screening test, and it's using antibodies against A and B. So that's what the public health state lab is doing.

    Science: So they don't have subtype tests and had to refer the samples to you?

    Alpuche: Yes. Not immediately, because if there's nothing unusual, they wait to get accumulated cases and then send to the national referral center. One of the interesting things in this outbreak is they were testing, but the onset of symptoms was after 4 or 5 days. The sensitivity of the immunofluorescence test is low after 72 hours. Most of the tests, which were nasopharyngeal swabs, were negative.

    Science: You later did more sampling from La Gloria, right?

    Alpuche: In the last part of the outbreak in La Gloria, children started having symptoms April 1. They took the samples April 3. They sent the samples to the public health state lab, and they were processed April 4. These arrived at my lab on April 8.

    Science: What were the positive ones?

    Alpuche: They only identified three influenza strains at the end of the period. One turned out be H3N2. The other was A, but it was not heartening. Here at our lab, we were considering that it could be H1, but it looked indeterminate. To be honest, we were not able to type it. And then we had a B.

    Science: The one that you weren't able to type, did you send that anywhere else? Were you concerned that you couldn't type it?

    Alpuche: At that moment, we didn't have any information about the untypeable A's that they saw in the California children.

    Science: In the surveillance program here in California, if you cannot type it, you send it on to CDC.

    Alpuche: That's what we do. Our collaboration center is CDC. We have three different deadlines to do the accumulation of samples to send to CDC during the season. When we had that first indeterminate strain from La Gloria, we were not worried. By that time, the outbreak was controlled.

    Science: On April 12, Mexico notified the Pan American Health Organization as per the International Health Regulations about the influenza-like outbreak in Veracruz. Initially, did you think these cases looked like influenza?

    Alpuche: No, our initial thinking, as we reported according to the International Health Regulations, was that we were having intensification and prolongation of the influenza period. We thought the outbreaks of Tlaxcala and Perote were nothing unusual in terms of the pneumonia. Those were later on, and then we started to consider that there was something unusual.

    Science: On 17 April, Mexico started to increase its surveillance for influenza. What triggered the switch to enhanced, active surveillance?

    Alpuche: We got a notification of an isolated case, a 37-year-old woman, diabetic, who died because of respiratory disease and pneumonia in Oaxaca. The woman had onset of symptoms April 4. There was no connection at all with Perote. We got samples, and it was a lung biopsy because the relatives didn't allow an autopsy. They intensively investigated the contacts around these deaths. They found some with respiratory diseases but no fatalities. Nothing unusual, okay? They were tested, and all were negative for influenza and other viruses.

    Science: When did you first contact Frank Plummer, head of the National Microbiology Lab at the Public Health Agency of Canada?

    Alpuche: I contacted him April 17 by e-mail, and he answered immediately. He wanted to know more about this, and we had a long conversation on Saturday, April 18.

    Science: Frank told me that he initially didn't think influenza. He thought it would be an unknown pathogen.

    Alpuche: Exactly. And we discussed that with Dr. Plummer. In fact, I was the one who called him because I'm the lab person. I met him through the Global Health Security Action Group. And we've been talking about different collaborations, and immediately when we began discussing this and the epidemiology, we wanted to rule out everything we could.

    Science: Why did you contact him?

    Alpuche: Canada had a lot of experience with the screening of the severe acute respiratory syndrome, SARS, of unknown pathogenesis.

    Science: When did you learn of the first two California cases of swine flu that were reported in the MMWR on April 21.

    Alpuche: CDC sent me a preprint. I'm not sure exactly when.

    Science: When were samples sent to Canada and CDC?

    Alpuche: April 21. We asked for help from both at same time. The CDC is my collaborating center in the WHO network. They always help us, doing quality assessment for us, giving us reagents, doing training, transferring technology. But to do shipping for both of them, it was kind of hard. It was a little delayed to get all the permission from the U.S.

    Science: Was your decision to send it to Canada also because U.S. authorities were holding up your samples?

    Alpuche: No, not at all. I sent these samples to the CDC because they are my collaboration center. That's the way to do it. We get all the help we need from the CDC.

    Science: But I think it's important for the United States to learn from this. How long were your samples held up and why?

    Alpuche: It was just 1 day difference. I cannot tell you if this is because it is more difficult to send things from Mexico to the U.S. instead of Canada. To be honest, I cannot explain that.

    Science: I imagine you were frustrated by the delay.

    Alpuche: Yeah, but we knew we were going to get the help that we needed, and we got it. It was just a small difference.

    Science: When did you first hear back from Frank Plummer about your samples?

    Alpuche: We got the preliminary results April 22. Dr. Plummer got the samples at 3:00 in the afternoon, and by midnight he was calling me to say we had influenza A. Some of the samples I sent him, we knew they were influenza A. That week, we started seeing the A's and we started to change our mind about this influenza B prolongation of the seasonal influenza.

    Science: When did you learn that they were positive for a new swine flu virus?

    Alpuche: I first learned that it was swine from Frank Plummer; that was in the afternoon of April 23. And later that night Dr. Nancy Cox [of CDC] in a teleconference we had with Mexican experts, we were discussing this and she gave us the preliminary results that we have some swine strains, the ones that just arrived that day at CDC.

    Science: What do you think of the criticism that Mexico didn't do enough earlier on to catch this? It's coming from both the Mexican press and the international press.

    Alpuche: There's always going to be something to find guilty people in everything. This is a new, unknown virus. We've been growing so much in terms of diagnostics and epidemiological surveillance lately. We still have limitations, that's for sure. We really need to accept that. And we're working very hard to overcome those limitations. We, along with all the health authorities, did everything possible to try to define this as soon as possible.

    We're working so hard to try and control this. And we were very open since the beginning. When I received the confirmation from Dr. Frank Plummer, I was immediately in contact with my superior Dr. Mauricio Hernández, and he spoke immediately with Secretary Córdova and he was basically open.

    Science: Many laboratories in Mexico City I've visited are very sophisticated. What are the limitations that prevented your lab from identifying the new H1N1? What did CDC and Canada have that you didn't have?

    Alpuche: The only place in Mexico doing subtyping is this lab here. We are able to sequence and subtype, but we are overwhelmed with samples of influenza and other things from all around the country. It's a little bit slower than in the U.S. or Canada.

    Science: But what were the limits in your lab to isolate the virus and sequence it?

    Alpuche: Since this week, we have experts from CDC and Canada helping us to set up a real-time PCR [polymerase chain reaction] technology to test for swine H1N1 directly.

    Science: Is your lab the only lab in the country at this point that can do the confirmatory test with the real-time PCR machines?

    Alpuche: At this point, yes, but we're working with CDC and Canada to train molecular biologists in different institutions in six different states in Mexico. We have two real-time PCR machines we were able to get immediately--we borrowed one from the company. And now we bought 10 more machines. We are working full-time to speed up the diagnostics.

    Science: How many samples do you have waiting to be tested?

    Alpuche: Right now, we have a backlog of around 1000 tests that we're rushing to do on time. We're having three shifts of people working, during the morning, afternoon, and overnight.

    Science: You have 1000 samples waiting to be tested, but there are nearly 2000 suspected cases.

    Alpuche: Not all of the cases that were tested at the hospitals had samples that were referred to us. And not all of the 1000 samples we have are suspected cases.

    Science: Are you still sending samples to CDC and Canada?

    Alpuche: Yes, we sent more samples to Canada this week, and we are just arranging with the person here from CDC to send more samples to CDC. We want to rule out all these samples we're holding so that we can keep going with the new ones.

    Science: A lot of Mexican press and now press outside of Mexico has written about La Gloria and the large pig farm in nearby Perote, Granjas Carroll. There are all these allegations and even conspiracy theories.

    Alpuche: I don't know, there are so many rumors.

    Science: What about the boy in La Gloria who has received so much attention?

    Alpuche: It was mild disease, no problem.

    Science: Is it accurate that he is the index case?

    Alpuche: We're not sure about that. By the onset of symptoms, he's the first we're seeing in our database, that's all.

    Science: What's the onset for him.

    Alpuche: April 1.

    Science: There have been all these stories of Perote as the epicenter, or the originator. Do you believe that?

    Alpuche: We've been asking agriculture authorities, and they ensured us that they didn't detect any problems with outbreaks with animals in these farms near Perote. And the farm is 80 kilometers from La Gloria.

    Science: So it's very far.

    Alpuche: Even far for a person working there to make the commute. But we are investigating that. We are doing epidemiological surveillance. And we asked the other authorities, and there was basically nothing wrong.

    Science: Is there a confirmed case in any employee of Granjas Carroll?

    Alpuche: Not that I know so far.

    Science: One of the theories is that this originated in the United States or elsewhere and a human came to Mexico, possibly a migrant. The assumption that it was a big pig farm could be very misleading.

    Alpuche: Could be. That's the same thought we have. We need more data to prove it. One of the interesting thing is, we're seeing these cases isolated in Oaxaca and Perote, they are well-known for migration. And also the other state that we're seeing several cases now during the active epidemic is San Luis Potosí, and it's like the corridor for migration. It's hard to believe that it's going to be associated with this farm, but I know that the authorities are thoroughly investigated it.

    Science: Do you think if this surfaced somewhere other than Mexico it would have been contained, or does influenza just move too quickly anyway?

    Alpuche: Considering it was the end of the season, maybe that confused the fact a little that something else could grow, but probably influenza moves too quickly anyway.

    Science: The United States detected cases very early, and the United States was not able to contain it. It tells me that the virus is smarter.

    Alpuche: Yes, that's for sure.

    Science: One last thing. How many hours a night are you sleeping.

    Alpuche: [laughter] At the most two.

    Science: This has been going on for 2 weeks now.

    Alpuche: Yeah, so some days we're getting 2 hours and then a nap of half an hour. And there's Latte. Double shots. Espresso.

    Science: Anything you need, anything right now from the international community?

    Alpuche: We're okay now in the way we're working, and our collaborators. But at some point if we need it for sure I'll ask. But now, we're okay.

    (来源: 丁香园 )


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