本日の講演内容

みちのくウイルス塾

COVID-19とSARS-CoV-2（動物由来ウイルス感染症）• SARS• MERS• COVID-19

西條 政幸
札幌市保健福祉局・保健所医療政策担当部長
国立感染症研究所

名誉所員

仙台医療センター（仙台）2021年7月17日

新規ウイルス感染症
SARS流行の発見• 2002年11月：中国南部（広東省）の奇病（肺炎）• 2003年2月：ベトナムハノイにおける呼吸器感
染症様疾患の院内流行（French Hospital）• 2003年3月：Severe Acute Respiratory
Syndrome（SARS，重症急性呼吸器症候群）の命名（WHO）• 2003年5月：SARSに関する論文発表（N Engl J
Med）

Global spread of SARSSARS-outbreak identified after the last SARSoutbrak in 2002/2003•September 2003: Laboratory-associated SARSoutbreak in Singapore (1)•December 2003: Laboratory-associated SARSoutbreak in Taiwan (1)•December 2003-January 2004: SARS-outbreak in
Guandong province, China (4)•April 2004: Laboratory-associated outbreak inBeijing and Anhui province (9 patients, 1 died)

UrbaniTOR2
HKU 39849
HKU 66078
HKU 65806
CUHK-W1
HKU36871
GZ50
GZ01
GZ43
GZ60
SZ3
SZ1
SZ16
SZ13

0.001

HU-GZ-04-1
HC-GZ-1
HC-SZ-9
HC-SZ-1
HC-GZ-2
CFB-SZ-4

Human - 2003

Animal - 2003 (May)

Human - 2003/04
Animal - 2003 (Dec)

SARS（中国南部，広東省）�

MERS（中近東）�
宿主�

シナリオ 1�
シナリオ 2�
キクガシラコウモリ�
ある動物（コウモリで ヒトコブラクダ�
ある可能性が高い）�

中間宿主�

ハクビシン�

ヒトコブラクダ等の家畜�

ヒト-ヒト
感染�

ヒト�

ヒト�

ヒト�
院内感染/
家族内感染/
輸入感染

ヒト�

ヒト�

院内感染/
家族内感染/
輸入感染/
実験室関連
ヒト�
感染

obtained from the patient’s spouse as part of the patient
treatment contract.
We did diagnostic RT-PCR and indirect immunofluorescence, following WHO recommendations.7,9 For
serum neutralisation tests, we grew Vero B4 cells to
subconfluence in 24-well plates. Pre-incubation reactions
contained 25 plaque-forming units of MERS-CoV (EMC
strain) in 100 µL of medium, mixed one-to-one withserum samples from the patient prediluted in medium.
The starting dilution was a tenth. After 1 h incubation at
37°C, each well was infected for 1 h at 37°C with the total
200 µL pre-incubation reaction. Supernatants were
removed and overlaid with Avicell resin as described by
Herzog and colleagues.10 Assays were terminated andstained after 3 days. We defined neutralisation titres as
the serum dilution reducing the number of plaques infour parallel wells in summary by greater than 90%.
Antibodies were tested by immunofluorescence assay.7
All clinical materials stored in the ward and laboratories
were gathered and submitted for virological diagnostic
tests. From the time of laboratory diagnosis, respiratory,
faecal, and urine samples were obtained. We designed
two diﬀerent sets of primers generating overlapping
amplicons (available on request). The first set consistedof 70 amplicons, 386–800 bp in length, with all primers
containing two strong Watson-Crick bps at their 3 ends,
so as to bind the template with high aﬃnity. The second
set consisted of 68 amplicons, 415–761 bp in length, withprimers that had no more than two strong bps in theirfive 3 terminal nucleotides and no strong pairings in
the two 3 positions. This method of primer design candecrease sensitivity, but it prevents mispriming within
the product, which can improve the success of

MERS�

Middle East respiratory syndrome
Articles
中東呼吸器症候群amplification. After RT-PCR, we sequenced all fragments
on a Roche 454 Junior instrument (Roche, Penzberg,
Germany) and assembled in Geneious (version 6.1.2).
Virus quantification was done with standard calibration
curves that were based on quantified in-vitro transcribed
RNA for the upE target gene.9
We constructed a maximum likelihood tree of the fiveavailable complete MERS-CoV genomes with PhyML11
and the GTR+Gamma model of molecular evolution;
we assessed phylogenetic support with 1000 bootstrap
replicates. We inferred a timescale by linear regressionof genetic divergence from the root against time ofcollection of the samples. The root was placed such thatthe correlation coeﬃcient was maximised. A
phylogenetic tree based on all available MERS-CoV
sequences was calculated with PhyML11 on aconcatenated 4012 bp dataset with the HKY substitution
model. Reduction of the dataset was determined by thesmall number of sequence fragments that could be
retrieved from a stored clinical sample containing asmall amount of the virus, derived from a patient treatedin Essen, Germany.

u Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus
ADME, Fouchier RA. Isolation of a novel coronavirus
from a man with pneumonia in Saudi Arabia. N Engl J
Med 367:1814-1820, 2012."
u Drosten, C, et al. Clinical features and virologicalobtained from the patient’s spouse as part of the patient amplification. After RT-PCR, we sequenced all fragments
on a Roche 454 Junior instrument (Roche, Penzberg,
treatment contract.
analysis of a case of Middle East respiratory syndromeResults
We did diagnostic RT-PCR and indirect immuno- Germany) and assembled in Geneious (version 6.1.2).
fluorescence, following WHO recommendations. For Virus quantification was done with standard calibration
coronavirus infection. Lancet Infect Dis 13:745, 2013�
serum neutralisation tests, we grew Vero B4 cells to curves that were based on quantified in-vitro transcribed
7,9

MERS-CoV
diagnosis
Day 13

Day 14Day 15 Day 16
March 23,
2013

Death
Day 17

Day 18March 26,
2013C

www.thelancet.com/infection Vol 13 September 2013

Drosten, C, et al. Clinical features and virological analysis
746
of a case of Middle East respiratory syndrome coronavirus
infection. Lancet Infect Dis 13:745, 2013�

Super spreaderの存在�Confirmed case

Patient

Probable case

Family member
Health care
workerProbable transmission
Suspected transmission
Community

P

L

V

Ward 1, Hospital A
X

Ward 2, Hospital A

K

Dialysis, Hospital A

Y
G

M
H

ICU, Hospital A
Ward, Hospital B

S

N

W
U

I

Dialysis, Hospital C
ICU, Hospital D

Q

T

Ward, Hospital D

13

J

M
ay

Figure 1: Disease and treatment(A) Chronology. Frontal (B) and horizontal (C) CT scans done on day 12 of disease, showing intense
basally-pronounced congestions indicative of atypical pneumonia and acute respiratory distress syndrome.
MERS-CoV=Middle East respiratory syndrome coronavirus.

Day 11 Day 12
March 19,
2013

R

6

C

O

M
ay

Day 18March 26,
2013

29

Death
Day 17ril

Day 15 Day 16
March 23,2013

Ap

Day 14Day 2
March 10,2013

Hospital Outbreak of MERS Coronavirus

22

B

MERS-CoV
diagnosis
Day 13Day 0
March 8,2013

On March 8 (day 0), the patient—a 73-year-old manfrom Abu Dhabi, United Arab Emirates—abruptly
developed flu-like symptoms, with fever andnon-productive cough. He was admitted to Mafraq
hospital (Abu Dhabi) on day 2 (figure 1), and wasdiagnosed with pneumonia. He was intubated on day 9
because of progressive hypoxia and acute respiratory
distress syndrome (fraction of inspired oxygen 60%;
positive end-expiratory pressure 10 cm H2O). The
patient had received intensive antimicrobial treatment
withmeropenem,
levofloxacin,vancomycin,
caspofungin, aciclovir, and oseltamivir during his stayin an intensive care unit in Abu Dhabi, without major
improvement in his pulmonary function. The patient
was transferred to Klinikum Schwabing (Munich,Germany) on March 19, 2013 (figure 1).
The patient had been diagnosed with multiple myeloma
in 2008, and had received several lines of treatment in
the previous few years, such as high-dose chemotherapy
with autologous stem-cell transplantation in 2009. At
relapse of his multiple myeloma in November, 2012, he
was given lenalidomide plus dexamethasone. Relatives
reported that the patient owned camels, and had takencare of a diseased animal shortly before onset ofsymptoms. No animal samples, or further details about
potential sources or exposures could be retrieved.

MERSの特徴（2）：院内感染�

ril

Day 11 Day 12
March 19,2013

Transfer
to Munich

746

ApTransfer
to Munich

Day 2
March 10,2013

Admission
to hospital

Figure 1: Disease and treatment(A) Chronology. Frontal (B) and horizontal (C) CT scans done on day 12 of disease, showing intense
basally-pronounced congestions indicative of atypical pneumonia and acute respiratory distress syndrome.
MERS-CoV=Middle East respiratory syndrome coronavirus.

15

Admission
to hospital

Day 0
March 8,2013

Germany

United Arab Emirates

B

On March 8 (day 0), the patient—a 73-year-old manfrom Abu Dhabi, United Arab Emirates—abruptly
developed flu-like symptoms, with fever andnon-productive cough. He was admitted to Mafraq
hospital (Abu Dhabi) on day 2 (figure 1), and wasdiagnosed with pneumonia. He was intubated on day 9
because of progressive hypoxia and acute respiratory
distress syndrome (fraction of inspired oxygen 60%;
positive end-expiratory pressure 10 cm H2O). The
patient had received intensive antimicrobial treatment
withmeropenem,
levofloxacin,vancomycin,
caspofungin, aciclovir, and oseltamivir during his stayin an intensive care unit in Abu Dhabi, withoutB major
improvement in his pulmonary function. The patientEAC
was transferred to Klinikum Schwabing (Munich,F
Germany) on March 19, 2013 (figure 1).
The patient had been diagnosed with multiple myeloma
in 2008, and had received several lines of treatment in
the previous few years, such as high-dose chemotherapyDwith autologous stem-cell transplantation in 2009. At
relapse of his multiple myeloma in November, 2012, he
was given lenalidomide plus dexamethasone. Relatives
reported that the patient owned camels, and had takencare of a diseased animal shortly before onset ofsymptoms. No animal samples, or further details about
potential sources or exposures could be retrieved.
ril

Symptom
onset

Results

Ap

高い致死率

Germany

United Arab Emirates

The sponsors of the study had no role in study design,
data collection, data analysis, data interpretation, or
writing of the report. The corresponding authors had fullaccess to all the data in the study and final responsibility
to submit for publication.

8

A

A

Symptom
onset

The sponsors of the study had no role in study design,
data collection, data analysis, data interpretation, or
writing of the report. The corresponding authors had fullaccess to all the data in the study and final responsibility
to submit for publication.

Role of the funding source

il

MERSの特徴（1）�

RNA for the upE target gene.9
We constructed a maximum likelihood tree of the fiveavailable complete MERS-CoV genomes with PhyML11
and the GTR+Gamma model of molecular evolution;
we assessed phylogenetic support with 1000 bootstrap
replicates. We inferred a timescale by linear regressionof genetic divergence from the root against time ofcollection of the samples. The root was placed such thatthe correlation coeﬃcient was maximised. A
phylogenetic tree based on all available MERS-CoV
sequences was calculated with PhyML11 on aconcatenated 4012 bp dataset with the HKY substitution
model. Reduction of the dataset was determined by thesmall number of sequence fragments that could be
retrieved from a stored clinical sample containing asmall amount of the virus, derived from a patient treatedin Essen, Germany.

Aprsubconfluence in 24-well plates. Pre-incubation reactions
contained 25 plaque-forming units of MERS-CoV (EMC
strain) in 100 µL of medium, mixed one-to-one withserum samples from the patient prediluted in medium.
The starting dilution was a tenth. After 1 h incubation at
37°C, each well was infected for 1 h at 37°C with the total
200 µL pre-incubation reaction. Supernatants were
removed and overlaid with Avicell resin as described by
Herzog and colleagues.10 Assays were terminated andstained after 3 days. We defined neutralisation titres as
the serum dilution reducing the number of plaques infour parallel wells in summary by greater than 90%.
Antibodies were tested by immunofluorescence assay.7
All clinical materials stored in the ward and laboratories
were gathered and submitted for virological diagnostic
tests. From the time of laboratory diagnosis, respiratory,
faecal, and urine samples were obtained. We designed
two diﬀerent sets of primers generating overlapping
amplicons (available on request). The first set consistedof 70 amplicons, 386–800 bp in length, with all primers
containing two strong Watson-Crick bps at their 3 ends,
so as to bind the template with high aﬃnity. The second
set consisted of 68 amplicons, 415–761 bp in length, withprimers that had no more than two strong bps in theirfive 3 terminal nucleotides and no strong pairings in
the two 3 positions. This method of primer design candecrease sensitivity, but it prevents mispriming within
the product, which can improve the success ofRole of the funding source

Onset Date

Figure 2. Transmission Map of Outbreak of MERS-CoV Infection.
confirmed
cases and the two probable cases linked to transmission events are shown. Putative transmissions arewww.thelancet.com/infection Vol 13 All
September
2013
indicated, as well as the date of onset of illness and the settings. The letters within the symbols are the patient identifiers (see Fig. S2 in the Supplementary Appendix).

tients undergoing hemodialysis, not allowing patients with suspected MERS-CoV infection into thedialysis unit, enhancing environmental cleaning,and excluding visitors and nonessential staff. In

Medical Ward

One patient undergoing hemodialysis (Patient H)
who had confirmed infection was admitted to a
medical ward (Fig. 2) on April 21. Patient N, who

Assiri, A. et al. Hospital
Outbreak of Middle East
Respiratory SyndromeCoronavirus. NEJM 369:407,
2013�

MERS
November 2019
2x2494'2x858

Figure 3 Ecology and transmission of MERS-CoV MERS-CoV might have originally spread from bats to camels and other, as yet
unidentified, intermediate hosts. The virus has circulated in camel populations in Africa and the Arabian peninsula for at least 20 y...

hNps://www.who.int/emergencies/mers-cov/MERS-epicurve-July-2019.png?ua=1
WHO: 11 Oct, 2020 access

SARS（中国南部，広東省）�

MERS（中近東）�
宿主�

シナリオ 1�
シナリオ 2�
キクガシラコウモリ�
ある動物（コウモリで ヒトコブラクダ�
ある可能性が高い）�

中間宿主�

ハクビシン�

ヒトコブラクダ等の家畜�

ヒト-ヒト
感染�

ヒト�

ヒト�

ヒト�
院内感染/
家族内感染/
輸入感染

ヒト�

ヒト�

院内感染/
家族内感染/
輸入感染/
実験室関連
ヒト�
感染

The Lancet, 2015, http://dx.doi.org/10.1016/S0140-6736(15)60454-8

COVID-19• 新規コロナウイルス• 中国・湖北省が源• 動物由来コロナウイルス（SARS-CoV）に性質が類似• ヒト-ヒト感染• 世界的流行SARS-coronavirus-2（SARS-CoV-2）

Overview

Search by Country, Territory, or Area

Data Table

WHO Coronavirus (COVID-19) Dashboard

ExploreBack to top

Data may be incomplete for the current day or week.

50k

SARSとCOVID-19

世界での流行状況（WHO, 2021.6.20）
0

Dec 31SARS

Mar 31

Jun 30

Sep 30Dec 31Situation by WHO Region
Americas66,414,286

Europe53,901,476

South-East Asia

30,781,898

Daily

WeeklyMar 31

Cases

DeathsCount

confirmed

10000"

Number of new cases !

confirmed

9000"
8000"

confirmed

7000"

Eastern Mediterranean

9,955,811

Africa3,457,590

confirmed

6000"
5000"

confirmed

4000"

Western Pacific

2,911,654
confirmed

3000"
Source: World Health Organization

2000"

Mar 31

Jun 30

Sep 30Dec 31Mar 31

Data may be incomplete for the current day or week.

1000"
0"
Americas

Europe66,414,286

53,901,476

confirmed cases

confirmed cases

400k

300k

200k
200k
100k

日本におけるCOVID-19流行と致命率の推移

200"
Mar 31

Total new deaths!
0

Jun 30

Sep 30Mar 31Mar 31

South-East Asia

Number of new cases !

Sep 30Dec 31Mar 31

Eastern Mediterranean

100"

30,781,898

9,955,811

confirmed cases

8000"

0
Jun 30Total new deaths"

150"
9000"

Dec 31

confirmed cases
60k

50"

400k

7000"
40k

0"

6000"

200k

5000"

20k

4000"

100"

3000"

Mar 31

2000"

Japan 3 week-total!
0

Jun 30

Sep 30Dec 31Mar 31Mar 310
Jun 30

Sep 30Dec 31Mar 31

10"

1000"
0"

2/4

2021/05/26 21:58

1"

0.1"

Eastern Mediterranean
Eastern Mediterranean
10,916,35310,916,353
confirmed
confirmed
Eastern Mediterranean
Eastern Mediterranean
10,916,353 10,916,353
confirmed
confirmed
AfricaAfrica3,991,362 3,991,362
confirmed
confirmed
AfricaAfrica3,991,362 3,991,362
confirmed

confirmed

Western Pacific 3,521,244 3,521,244
Western Pacificconfirmed
confirmed
Western Pacific3,521,244
Western Pacific
3,521,244

アジアでのCOVID-19流行状況

世界各地域でのCOVID-19流行
Mar 31Mar 31

AmericasAmericas
Americas
Americas71,957,77771,957,777
confirmed cases

confirmed

confirmed

Source:World Health Organization
Source: World HealthOrganization

Dataformay
incomplete
the current day or week.
Data may be incompletethebecurrent
day orfor
week.
Source: World Health Organization
Source: World Health OrganizationData
be incomplete
for the current day or week.
Data may be incomplete
for may
the current
day or week.

Mar 31 Jun 30

Jun 30 Sep 30

Sep 30 Dec 31

Dec 31 Mar 31

Mar 31Mar 31
Jun 30Jun 30
Sep 30

Sep 30Dec 31

Dec 31Mar 31Mar 31

Europe Europe
EuropeEurope55,763,61055,763,610

confirmed cases

confirmed cases

55,763,610 55,763,610

confirmed cases

confirmed cases
400k

confirmed cases

confirmed cases
400k

400K

;

200k

200k

200k

200k

0

0
Mar 31Mar 31

krtXN

Jun 30Sep

Sep 31
30
Dec

Dec31
31
Mar

Mar 310

SepJun
3030

Sep
Dec
31 30

MarDec31 31

Mar 31

South-East
Asia
South-East
Asia
South-East
Asia
South-East
Asia
34,666,15934,666,159

$

bdtq

Mar30
31
Jun

JunMar30 31

confirmed cases

Mar 310

Mar 31

confirmed cases

confirmed cases

YposR

PsabXN

confirmed cases
400k

hOpgs
JunMar30 31

SepJun
3030

Sep
Dec
31 30

MarDec
31 31

WHO Coronavirus (COVID-19) Dashboard
WHO Coronavirus (COVID-19) Dashboard

2/4

2/4

2/4

Dec31
31
Mar

Mar 31MarDec31 31

Mar 3160K

confirmed cases

confirmed cases
400k

200k

https://covid19.who.int/
https://covid19.who.int/

200k

0

Search by Country,
Territory,
Jun
Sep
Mar
Mar30
31
Jun 30or Area Dec
Sep 3130
Dec31
31
Search by Country, Territory, or Area

Mar 31

2/4

Sep 3130
Dec

DecSep
31 30

400k

200k

WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19) Da...
WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19)
Da...
200k

Mar 31

Jun 30Sep

SepJun30 30

10,916,353 10,916,353

400K

confirmed cases

400k

[P

Mar30
31
Jun

JunMar
30 31

Eastern Mediterranean
Eastern Mediterranean
Eastern Mediterranean
Eastern
Mediterranean
10,916,353
10,916,353

34,666,159 34,666,159
confirmed cases

300K

400k

400k

Psa

confirmed cases

71,957,777 71,957,777

0

Mar 310

Overview
Mar 310

Mar 31Mar 31

Data
Table
Explore
Jun
30
Sep
Dec
Mar
31
Jun 30
Sep 3130
Overview
Data Table
JunMar30 31

SepJun30 30

DecSep31 30

Back to top
40k

40K

Mar
Dec31
31

Mar 31MarDec31 31

Mar 31

ExploreBack to top

20K

40k

2021/06/29 15:31
2021/06/29 15:31

2021/06/29 15:31
2021/06/29 15:31

20k
20k

0
Mar 31

Jun 30Mar 31

Sep 30Jun 30Dec 31
Sep 30Mar 31
Dec 31Mar 310

Jun 30Mar 31Mar 31

Sep 30Jun 30Dec 31
Sep 30Mar 31
Dec 31Mar 31

Source: World Health Organization
Source:World
HealthData may be incomplete
for thecurrent
day Organization
or week.
Data may be incomplete for the current day or week.

Situation by Country, Territory or Area
Situation by Country, Territory or Area
Cases

Deaths

Cases

Total
DeathsUnited States of America
United States of America
33,285,377

COVID-19，SARS-CoV-2伝播性

Total

India
30,279,331

India

COVID-19ワクチン開発
confirmed cases

33,285,377

confirmed cases

confirmed cases

30,279,331
confirmed cases• 組換えウイルスCOVID-19ワクチン
BrazilFranceuChimpanzee Adenovirus vector
uVSV vectoru痘瘡ワクチンベクター
u他

18,386,894
confirmed cases

Brazil

18,386,894

5,660,815
confirmed cases

confirmed cases

confirmed cases• Messenger RNAワクチン• 成分ワクチン• DNAワクチン• 不活化ワクチン• 生ワクチンRussian Federation
Russian Federation

5,472,941
confirmed cases

5,472,941
confirmed cases

The United Kingdom
The United Kingdom

4,732,438
confirmed cases

Epidemiology of coronavirus disease 2019 in Yamagata Prefecture, Japan, January–May
2020: The importance of retrospec]ve contact tracing.
DOI:10.7883/yoken.JJID.2020.1073
3/4

3/4

4,732,438
confirmed cases

France5,660,815

Turkey5,409,027
confirmed cases

Turkey5,409,027
confirmed cases

Argentina

4,393,142
confirmed cases

Argentina

4,393,142
confirmed cases

2021/06/29 15:312021/06/29 15:31

organized stage (Fig. 3) defined by parenchymal collapse andenlargement of alveolar septa, filled with incorporated alveolar
fibrin deposits, relatively pronounced hyperplasia of type-2
ay was estimated to be 48 h.
pneumocytes, very sparse multinucleated giant cells and minor
dy showed no traumatic injuries
fibroblast proliferation. Squamous cell metaplasia was not obof the chest confirmed the bilatserved. Immunohistology identified slight-to-moderate interstitial
0 mL of serohaematic fluid. Theor perivascular infiltration by inflammatory TCD3+ lymphoed a moderate dilatation of the• CCOVID-19は単なる呼吸器感染症ではなく，全cytes. Alveolar infiltration by neutrophils was not observed ande of the myocardial wall thick身感染症：ワクチンにより抗SARS-CoV-2免疫
both capillaries and arterioles were thrombosis-free.
d non-obstructive atherosclerotic（中和抗体，細胞性免疫）を誘導できれば発症
Other pathological findings included mild hepatic steatosis
and the aortic bifurcation. Both
予防，軽症化の効果は期待される．
and confirmed a mild coronary artery atherosclerosis. Hearthe liver, spleen, intestines,
kidsections showed no evidence of myocarditis but displayed
macroscopically normal.
• 感染予防（感染しない）効果は期待できない
some scattered wavy fibres. No other microscopic anomalies（COVID-19ワクチンに限らず，あらゆるワクチ
were found in other organs, especially brain and kidney vasンの特徴）．
culitis or disseminated intravascular coagulation.

ワクチンとCOVID-19• ただし，ワクチン接種者が感染源になるリスク
l the samples except in cerebroは低減される．
-CoV-2 viral load, we used an• in
広くワクチン接種が行われれば，根絶も可能
aled a higher viral load
respiDiscussion
6（国際連携）
ies/10 cells in nasopharyngeals in lung biopsy and 5.15 log10
Currently, post-mortem COVID-19 pathology and virology
findings are rare. Clinical and forensic COVID-19 autopsies
on sample) than in plasma (4.5
are usually not required for such deaths, especially when suchentage of SARS-CoV-2 genome
diagnoses are made before death and given the considerable
92.2% for the nasopharyngeal
logistical constraints deployed to limit the risk of virus transa sample, respectively. Multiple
mission. Here we report complete post-mortem data following
t consensus sequences generated
A
75-year-oldman
was natural
admiNedevolution
to a COVID-19
unit COVID-19.
in a French regional hospital
theof tes]ng
untreated
entical. Using the pangolin web
early
in
the
pandemic.
Considering the subject’s clinical history and absence ofog-uk.io), the sequences wereother acute or chronic diseases detected by histologicalently circulating in Europe.

MERS，SARS，COVID-19の特徴の比較�
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SARS

COVID-19

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Figure 1. Molecular detec]on of SARS-CoV-2 and Streptococcus pneumoniae in the lungs of a pa]ent in Japan co-infected withboth pathogens. The 42 lung sec]ons were analyzed and the amount of SARS-CoV-2 RNA and S. pneumoniae DNA in each sec]on
was evaluated. A) The right lung was cut into 6 (R–I to R–VI); B) the lee lung was cut into 7 (L–I to L–VII) coronal slices, fromventral to dorsal. Twenty-two right sec]ons (R1–R22) in R–IV and R–V and 20 lee sec]ons (L1–L20) in L–V and L–IV are shown inblack boxes. The doNed white line is the boundary between the upper and lower lobes. The SARS-CoV-2 RNA score is indicated by
the number of red circles and the S. pneumoniae DNA score is indicated by the number of yellow circles. (-) indicates results
under the detec]on limit. Scale bars indicate 2 cm. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Interna:onal Journal of Legal Medicine
hFps://doi.org/10.1007/s00414-020-02390-1

Tsukamoto T, Nakajima N, Sakurai A, Nakajima M, Sakurai E, Sato Y, et al. Lung Pathology of Mutually Exclusive Co-infec]on with SARS-CoV-2 andStreptococcus pneumoniae. Emerg Infect Dis. 2021;27(3):919-923. hNps://doi.org/10.3201/eid2703.204024

Figure 2

患者確認から解除まで

Figure 2. Microscopic ﬁndings of the lungs of a pa]ent in Japan co-infected with SARS-CoV-2 and Streptococcus pneumoniae. A) Histopathology of lungsec]on R12 (shown in Figure 1). Scale bar indicates 2 mm. B) Magniﬁed image of the black square (top lee) in panel A: exuda]ve phase of diﬀuse alveolar
damage (DAD) with hyaline membranes. Scale bar indicates 100 μm. C) Magniﬁed image of the red square (boNom right) in panel A: edema andbronchopneumonia with massive inﬁltra]on of neutrophils in the alveolar spaces. Scale bar indicates 100 μm. D, E) Magniﬁed images of the same areasof consecu]ve sec]ons as B and C, respec]vely, showing SARS-CoV-2 an]gen stained green (Vina green) and S. pneumoniae an]gen stained brown (3,3ʹdiaminobenzidine) by enzyme-labeled double immunohistochemistry. The SARS-CoV-2 an]gens were detected predominantly in the DAD area (D;scale bar indicates 50 μm). The S. pneumoniae an]gens were detected predominantly in the bronchopneumonia area (E; scale bar indicates 50 μm).
Insets show magniﬁed images of the staining cells (scale bars indicate 10 μm).

• 検査・検出• 告知• 患者調査• 優先度判定• 自宅療養・ホテル宿泊療法，入院調整• 疫学調査• ワクチン接種

Tsukamoto T, Nakajima N, Sakurai A, Nakajima M, Sakurai E, Sato Y, et al. Lung Pathology of Mutually Exclusive Co-infec]on with SARS-CoV-2 andStreptococcus pneumoniae. Emerg Infect Dis. 2021;27(3):919-923. hNps://doi.org/10.3201/eid2703.204024

個々の患者
札幌市でのCOVID-19対策において働いて理解した問題・課題

医療にアクセスできない患者入院させたくてもできない• 自宅療養中の患者• 解除後の患者への無理解（医師・医療機関による）検査・検出・隔離（3K）を考える

COVID-19患者への偏見と差別「夜の街」という言葉の問題
点を考える

ススキノ

まとめ
疫学調査とCOVID-19流行抑制• COVID-19とSARS• COVID-19と倫理