美国伤寒分析.PPTVIP

2003年埃及伤寒：疾病负担和危险因素Typhoid Fever in Egypt, 2003:Burden of disease and risk factors for infection Michael Lynch MD, MPH Foodborne and Diarrheal Diseases Branch National Center for Infectious Diseases 概述Overview 伤寒的流行特点和临床特征 Background on typhoid fever 伤寒发病率 Incidence of typhoid fever 伤寒危险因素 Risk factors for typhoid fever 控制策略 Control strategies 威廉. 巴德William Budd 伤寒Typhoid fever 临床特征 Clinical features 较长潜伏期（10－14天） Long incubation period (10-14 days) 无特异性症状 Symptoms non-specific 高死亡率（5－20％） High mortality (5-20%) 诊断 Diagnosis 血液、骨髓培养分离到伤寒杆菌 Blood or bone marrow culture 血清学检验通常不可靠 Serologic assays unreliable 疾病负担Burden of typhoid fever 全球每年21，000，000人罹患伤寒，200，000人因此死亡 21 million illnesses and 200,000 deaths worldwide 有伤寒疫情的国家缺乏疾病负担的确切数据 Burden ill-defined in endemic countries 多重抗药性 Multidrug-resistant typhoid fever 疾病传播Transmission of S. Typhi 人类是传染源和宿主 Humans are reservoir 粪口途径传播 Spread through fecal oral route 两种主要的传播模式 Two major modes of transmission 水 Water 食物 Food (milk, shellfish, produce) 地方性伤寒危险因素Risk factors for endemic typhoid fever 印度尼西亚 1998 水 Indonesia 1998 = Water 巴基斯坦 1995 食物和水 Pakistan 1995 = Food and water 智利 1981 食物 Chile 1981 = Sharing food at lunch 伤寒的控制Control of typhoid fever 提高水源质量 Improving water quality 加强食品安全 Improving food safety 预防接种 Vaccination 匹兹堡1900-1910年伤寒死亡率和引用安全水源的人口比例Death rate for typhoid fever, and proportion of population with treated water, Pittsburgh PA, 1900-1910 食品安全策略（智利：圣地亚哥）Food safety measures: Typhoid fever in Santiago, Chile 从霍乱中吸取教训 Response to cholera 减少污水污染食品的策略 Measures to decrease sewage contamination of food 禁用污水灌溉 Ban on contaminated water for irrigation 禁止餐馆出售不安全食品 Banned restaurants from selling items at risk 对群众进行肠道传染病传播途径的宣传教育 Educated consumers about enteric pathogens 伤寒的预防接种Vaccines for typhoid fever 接种 Vaccines 口服减毒活疫苗 Live attenuated oral (Ty21a) 注射多聚糖抗原 Vi polysaccharide parenteral