B Y T

------S: 439/Q-BYT

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
--------------H Ni, ngy 05 thng 02 nm 2016

QUYT NH
V VIC BAN HNH HNG DN CHN ON V IU TR BNH DO VI RT ZIKA
B TRNG B Y T
Cn c Ngh nh s 63/2012/N-CP ngy 31 thng 8 nm 2012 ca Chnh ph quy nh chc nng,
nhim v, quyn hn v c cu t chc B Y t;
Xt bin bn hp ngy 04/02/2016 ca Hi ng chuyn mn xy dng Hng dn chn on, iu tr
bnh do vi rt Zika;
Theo ngh ca Cc trng Cc Qun l Khm, cha bnh - B Y t,
QUYT NH:
iu 1. Ban hnh km theo Quyt nh ny Hng dn chn on v iu tr bnh do vi rt Zika.
iu 2. Quyt nh ny c hiu lc k t ngy k, ban hnh.
iu 3. Cc ng, b: Chnh Vn phng B; Cc trng Cc Qun l Khm, cha bnh; Chnh Thanh
tra B; cc V trng, Cc trng ca B Y t; Gim c cc bnh vin, vin c ging bnh trc
thuc B Y t; Gim c S Y t cc tnh, thnh ph trc thuc Trung ng; Th trng y t cc B,
ngnh; Th trng cc n v c lin quan chu trch nhim thi hnh Quyt nh ny./.

Ni nhn:
- Nh iu 3;
- B trng( bo co);
- Cc Th trng ( bit);
- Website B Y t, website Cc QLKCB;
- Lu: VT, KCB.

KT. B TRNG
TH TRNG

Nguyn Th Xuyn

HNG DN

CHN ON V IU TR BNH DO VI RT ZIKA

(Ban hnh km Quyt nh s 439/Q-BYT ngy 05 thng 02 nm 2016 ca B trng B Y t)
I. i cng
Nhim vi rt Zika l bnh truyn nhim cp tnh do mui Aedes truyn v c th gy dch. Vi rt Zika
thuc chi Flavivirus, h Flaviridae.
Bnh c pht hin trn kh Rhesus ti Uganda vo nm 1947 v pht hin trn ngi vo nm 1952
ti Uganda v Tanzania. Theo thng bo ca T chc Y t th gii, bnh do vi rt Zika hin ang din
bin phc tp v ly lan nhanh. Tnh n ngy 19 thng 1 nm 2016 c 27 quc gia v vng lnh th
ghi nhn cc trng hp mc bnh do vi rt Zika.
Hin nay Vit Nam cha ghi nhn ca bnh do vi rt Zika nhng bnh c nguy c xm nhp.
Bnh do vi rt Zika thng din bin lnh tnh, him gp nhng ca bnh nng v t vong. Vi rt Zika
c th gy hi chng no b tr sinh ra t nhng ngi m mc bnh trong thi k mang thai. n
nay, bnh cha c thuc iu tr c hiu v vc xin phng bnh.
II. Chn on:
1. Triu chng lm sng:
- Thi gian bnh t 3 n 12 ngy.
- Biu hin lm sng: T 60% n 80% cc trng hp nhim vi rt Zika khng c triu chng lm
sng.
Bnh thng khi pht t ngt vi cc triu chng:
+ St: bnh nhn thng st nh 37.5c n 38c
+ Ban dt sn trn da
+ au u, au mi c khp
+ Vim kt mc mt
+ C th c bin chng v thn kinh: Guillain Barre, vim no mng no, hoc hi chng no b tr
sinh ra t b m mc bnh trong thi k mang thai.
2. Cn lm sng:
- Huyt thanh chn on c th gip pht hin IgM t ngy th 4 sau khi xut hin triu chng. Tuy
nhin xt nghim ny c th dng tnh gi do phn ng cho vi cc flavivirus khc, nh vi rt
Dengue v Chikungunya....

- RT-PCR t bnh phm huyt thanh (hoc cc bnh phm khc nh nc tiu, dch no ty, dch i...)
c u tin la chn trong chn on xc nh nhim vi rt Zika.
Cn ch nh theo di siu m thai i vi ph n c thai nghi nhim vi rt Zika c th pht hin
bin chng no b thai nhi.
3. Chn on:
3.1. Chn on ca bnh nghi ng:
C yu t dch t (sinh sng ti hoc du lch ti vng c lu hnh dch do vi rt Zika trong vng 2
tun trc khi khi bnh)
C t nht 2 trong s cc triu chng lm sng nu trn, hoc c hi chng Guillain Barre hoc
trn siu m pht hin thai nhi c no nh hn bnh thng so vi pht trin ca thai nhi.
Khng xc nh c cc cn nguyn gy bnh khc (st xut huyt Dengue, Chikungunya...).
3.2. Chn on ca bnh xc nh:
- Ca bnh nghi ng v
- RT-PCR vi rt Zika dng tnh, v/hoc
- Phn ng huyt thanh (IgM) dng tnh vi vi rt Zika.
4. Chn on phn bit:
4.1. Cc cn nguyn vi rt:
- St xut huyt Dengue
- Chikungunya
- Rubella
- Si
- Enterovirus
- Adenovirus
4.2. Nhim vi khun v k sinh trng
- Bnh do Leptospira
- Bnh do Ricketsia

- Nhim lin cu nhm A.

III. iu tr
iu tr triu chng l chnh, bao gm:
- Ngh ngi.
- H st bng paracetamol. Khng s dng aspirin v cc thuc gim au NSAID (ibuprofen,
meloxicam, piroxicam...).
- Bi ph nc v in gii: ung nc oresol hoc nc si ngui, nc tri cy.
- V sinh mt bng dung dch nc mui sinh l NaCl 0.9%.
- Theo di cc biu hin tn thng thn kinh nh yu, lit c,...
- i vi ph n c thai cn hi chn vi chuyn khoa sn theo di bt thng v thai nhi:
+ Theo di siu m thai mi 2 tun mt ln pht hin sm tnh trng u nh hoc vi ha no thai
nhi.
+ Ph n c thai trn 15 tun b nhim vi rt Zika c th ch nh chc i lm xt nghim RT-PCR,
hoc ly mu cung rn lm xt nghim huyt thanh.
- Tr b d tt no b hoc c tin s m nhim vi rt Zika khi mang thai cn c theo di s pht trin
v tinh thn, vn ng, nh gi th lc v iu tr cc ri lon nh co git, ng kinh (nu c).
IV. Phng bnh:
- Hin cha c vc xin phng bnh.
- Bin php phng bnh tt nht hin nay l dit mui v phng trnh mui t.