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1、讲 授 内 容 Teaching Content,研究传染病的意义 传染病流行趋势 传染病流行病学基本原理 和方法 疫源地 传染病的预防和控制,study importance epidemic trends basic principles and methods infectious focus prevention&control,研究传染病的意义Study Importance,危害严重重治轻防，后果惨重死灰复燃新发传染病不断出现生物恐怖威胁存在,Seriously burden of diseasesNeglect of prevention,the consequences of
2、heavyThe resurgence of relapseThe new emerging infectious diseases Threat of bioterrorism,1998年鼠疫世界分布,新出现的传染病（emerging infections or emerging infectious diseases，EID）是指新确定的和先前未知的可引起局部或在世界范围内公共卫生问题的传染病。-David Heymann 1997“emerging infections”refers to newly identified and previously unknown infectiou
3、s diseases which cause public health problems，either locally or internationally。,重新出现的传染病（re-emerging infectious diseases）是指那些我们已经熟知的，且其传播水平已降低到不再成为公共卫生问题的感染又重新回复到具有流行程度传播状态的疾病。Re-emerging infectious diseases are infections that have been known about for some time but had fallen to such low levels t
4、hat they were no longer considered a public health problem。They often reappear in epidemic proportions.,新出现的传染病的流行具有某些引人注目的特点 The characteristic of EID,悄然出现 Silent beginning 全球化趋势 Globalization 动物人?Jump of infectious agent across the species barrier from animal to human being新出现的病原体通常具有较大的毒力和/或传染性 M
5、ore virulent and/or epidemic,EID产生的原因The cause of EID,人口数量及人的行为变化 The change of population and peoples behavior技术进步和工业化时间的变化 Technological progress and industrialization,EID产生的原因The cause of EID,经济发展和土地使用模式的变化 Economic development and land-use patterns change 国际旅游、商贸的发展以及人口流动的数量迅速增加 The development
6、of International travel,and commerce,and population movement,EID产生的原因The cause of EID,病原生物适应性变异 Pathogens variation在世界范围内，从地区、国家到全球多个不同层次和水平上，因投入大幅下降，而致应对传染病的公共卫生能力被削弱，以至破坏 Lack of health resources,其他与EID产生相关的原因Other causes of EID,全球气候持续变暖，导致热带、亚热带的范围不断扩大，直接影响了动植物生态系统，使生物群落、传播疾病的啮齿类动物及昆虫媒介的种属、分布区域和密
7、度等发生改变 The global climate continues to warm生物恐怖主义的潜在威胁 Bioterrorism,美国脊髓灰质炎19671997发病趋势,传染病流行趋势,The epidemic trends of Infectious disease,Major achievements of infectious diseases prevention and control till 1970s,Total morbidity decreased Total mortality decreased Fatality rate of the majority decr
8、eased Modes of Transmission changed Large scale epidemics decreased,总的发病率降低总的死亡率降低大多数传染病病死率下降不同传播途径疾病构成改变大规模流行减少,全球传染病的主要防治成果,Global burden of disease(DALY)(2000),DALY=Disability adjusted life-year,Non communicable,Injury,communicableMalnutritionEtc.,Africa,East-Med,Europe,America,E-S Asia,West Paci
9、fic,2000年全球各地区疾病负担（DALY）,Reporting data of legal infectious disease in China(1950-2003),1950-2003年全国法定传染病报告情况,Leading infectious killers,全球传染病的流行现状,100-250/per 100 000,Distribution of Tuberculosis Worldwide（2000）,结核病的全球分布（2000）,3%,丙型肝炎的全球分布（2000）,Distribution of C Hepatitis Worldwide（2000）,The HIV e
10、pidemic in the Worldwide(2005),全球艾滋病流行现状(2005),The Morbidity of Main Infectious Diseases in China,中国传染病的发病现状,The Reported STD Cases in China,19852001年全国报告的STD发病率,1955-2003年全国狂犬病发病率,The Morbidity of Lupomania in China,传染病流行病学基本原理和方法,The basic principles and methods of infectious disease epidemiology,
11、（一）传染源Source of Infection,定义 体内有病原体生长、繁殖并且能排出病原体的人和动物。分类 病人 cases 病原携带者 carriers 受感染的动物 animals,1、病人(cases)体内存在大量病原体 In vivo existence massive pathogen 具有利于病原体排出的临床症状 Clinical symptoms are advantageous for the pathogen discharges,潜伏期（Incubation period）自病原体侵入机体到最早临床症状出现这一段时间The time interval between
12、invasion by an infectious agent and appearance of the first signor symptom of the disease in question,潜伏期的意义Significance of Incubation Period,判断患者受感染时间 To Determine The Infected Time 追踪传染源 Tracing Sources Of Infection查明传播途径 To Identified The Route Of Transmission 确定接触者的留验、检疫和医学观察期限 To Determine The
13、Quarantine And Medical Observation Period,潜伏期的意义 Significance of Incubation Period,确定免疫接种时间 To Determine The Time Of Immunization 评价预防措施效果 Evaluation Of Effectiveness Of Preventive Measures 潜伏期长短还可影响流行特征 Can Affect The Epidemic Characteristics,2、病原携带者（carrier）没有任何临床症状而能排出病原体的人或动物A person or animal t
14、hat harbors a specific infectious agent in the absence of discernible clinical disease and serves as a potential source of infection,3、受感染的动物（infectious animal）自然疫源性疾病（natural focal disease）病原体在自然界中的动物间传播，在一定条件下可以传给人所致的疾病。具有严格的地方性特点。鹦鹉热、鼠疫、莱姆病、登革热 流行性出血热、西尼罗热,人畜共患疾病：在脊椎动物和人之间自然传播的疾病和感染，即人和脊椎动物由共同的病原
15、体引起的并在流行病学上有关联的疾病。,Transmission of infectious agent from animal to human called ZOONOSES,美洲狮 puma,乌鸦 crow,传播西尼罗热的动物,Animals can transmit West Nile fever,牛-疯牛病,老鼠-鼠疫,病原体从传染源排出后，侵入新的易感宿主前，在外环境中所经历的全部过程。,（二）传播途径 Route of Transmission,The whole process that the pathogens experienced in the outer environ
16、ment when they passed from an infected individual or group to a previously uninfected individual or group.,传染病之传播方式,Air-borne transmissionWater-borne transmissionFood-borne transmission Contact-transmitted diseasesVector-borne diseasesSoil-transmitted diseasesNosocomial infectionVertical transmissio
17、n,经空气传播 经水传播 经食物传播 接触传播 虫媒传播 经土壤传播 医源性传播 垂直传播,Modes of Infectious Disease Transmission,1、空气传播传染病（Air-borne diseases）传播途径易实现，易爆发流行 Transmission easy to comply,easy to outbreak冬春季高发 Mostly occurs in winter and spring 少年儿童多见 Mostly occurs in Children未免疫预防人群周期性升高 A cycle period in non-immunity populatio
18、n 受居住条件和人口密度的影响 Overcrowded live conditions and high population density,2-1、饮用水污染（Drinking Water Pollution）病例分布与供水范围一致 Distribution Of Cases Consistent With The Water Supply Coverage除哺乳婴儿外，其余人群均可发病 Except To Lactated Infants,All Population Can Be,2-1、饮用水污染（Drinking Water Pollution）如经常被污染，可表现为慢性流行经过
19、If Often Contaminated,Can Be Expressed As Chronic Epidemic 如一次性严重污染，可出现爆发流行 A Serious Pollution Can Cause An Outbreak 水源停用或净化后，爆发或流行可平息 Stop Drink Or Purified Water,Can Quell The Outbreak Or Epidemic,2-2、疫水接触（Exposure to infected water）疫水接触史 History of exposure to infected water地区、季节与职业上的差别 There ar
20、e regional,seasonal and occupational characteristics 多见于与疫水接触的人群 More common in people who contact with infected water大量易感人群与疫水接触可爆发 A large number of susceptible who contact with infected water easy occur outbreaks 对疫水采取措施可控制发生 Taken against measures can be controlled,人们接触血吸虫疫水,3、经食物传播（Food-borne D
21、iseases）吃污染食物者发病，不食者不发病 Involved Are Limited To Those Who Eat Contaminated Food 一次性大量污染，可形成爆发 A Large Number Of Contamination,The Outbreak Can Be Occur 停止供应该食物后，爆发即可平息 To Stop Supplying The Contaminated Food,The Outbreak Can Be Stop潜伏期较短 The Incubation Period Is Shorter,1988年上海市甲型肝炎爆发和毛蚶,上海市1988年13月
22、急性肝炎发病动态,4、经接触传播Contact-transmitted diseases方式直接接触 Direct contact 没有外界因素参与下，传染源直接与易感者接触。间接接触 Indirect contact 易感者接触了被传染源的排出物或分泌物污染的用品所造成的传播。,5、经节肢动物传播（Vector-borne diseases）特征地区性 Regional 西尼罗热职业性 Occupational 森林脑炎季节性 Seasonal 疟疾 青壮年多发 More Young adults 地方性斑疹伤寒,媒介节肢动物,埃及伊蚊,蜱,白蛉,库蚊,疟疾、丝虫病、乙脑、登革热、黄热病、西
23、尼罗脑炎等,新疆出血热、蜱媒脑炎、莱姆病,白蛉热、利夫特谷热,蚊子传播西尼罗热,6、医源性传播（Nosocomial infection）医疗、预防工作中，由于未严格地执行规章制度和操作规程而造成的传播。,Nosocomial infections(pronounced,nos-uh-KOH-mee-uhl),are infections which are a result of treatment in a hospital or a healthcare service unit.,7、围产期传播（Vertical transmisssion）定义 在围产期病原体通过母体传给子代，也称垂
24、直传播或母婴传播。方式经胎盘传播 By placenta 上行性感染 By genital分娩时传播 By labour,HIV母婴传播率全球 15%-25%我国高流行区 30%HIV干预母婴传播率（法国）拉米夫定组 6.8%拉米夫定与齐多夫定组 1.6%,人群作为一个整体对传染病的易感程度。The susceptibility degree of population,as a whole,to infectious diseases,（三）人群易感性 Herd Susceptibility,升高的因素（The Increase Factors）新生儿增加 Increased Neonata
25、l 易感人口迁入 Susceptible Population Move In 免疫人口免疫力自然消退 Mmuno-population Immunity To Natural Healing 免疫人口死亡 Immuno-population Has Been Dead,降低的因素（Reduction Factor）计划免疫 EPI 传染病流行 Epidemics隐性感染 Subclinical infection,1、概念(concept)在一定条件下，传染源向其周围传播病原体所能波及的范围。,（四）疫源地 Infectious focus,The range that the source
26、s of infection spread pathogens around can reach to under certain conditions.,2、形成条件(the formation conditions)传染源存在 The source of infection exists 病原体能够继续传播 Pathogens can continue to spread,3、消灭条件(eliminate conditions)传染源被移走或消除了携带状态 The source of infection has been removed or eliminate the carrier s
27、tate进行了终末消毒 Carried out terminal disinfection经过最长潜伏期，易感者中没有新的感染发生 After the longest incubation period,no new infections occur among susceptible,（五）影响流行过程的因素The factors that affect the epidemic process,1、自然因素（Natural factors）气候（Climate）地理因素（Geography）媒介昆虫和宿主动物的特异性栖息习性（Vector insects and host）,2、社会因素（
28、Social factors）全球旅游业的急剧发展 The rapid development of global travel环境污染和破坏造成生态恶化 Ecological deterioration caused by environmental pollution and destruction,2、社会因素（Social factors）抗生素和杀虫剂的滥用 The abuse of antibiotics and pesticides 城市化和人口爆炸 Urbanization and population explosion战争、动乱、难民潮和饥荒 War,riots,refug
29、ee flows and famine,传染病的预防和控制Prevention and control of infectious diseases,Immunization of people boosters frequently required 100%immunization is not necessary(herd immunity)Blocking vehicle-mediated transmission water purification effective cooking prevention of food contamination with infectious
30、agents,Public Health Measures for Control of Epidemics,Involves strategies which break the chain of transmission,Quarantine limiting freedom of movement of individuals carrying infectious agents minimum time required for a quarantine period is equal to longest period of communicability(transmissibil
31、ity)of the disease Elimination of animal reservoirs immunization of animals that act as reservoirs of diseases such as bovine tuberculosis,brucellosis(highly effective when monitored properly)eradication of animals that act as reservoirs of diseases such as tularemia,plague,Lyme disease(sometimes ef
32、fective,difficult to monitor properly),Prevention,Intervention,Control,and Eradication of Diseases,Preventionimplies the planning for and taking action to prevent or forestall the occurrence of an undesirable event and is therefore more desirable than.Interventionwhich is defined as taking of action
33、 during an eventControlgeneral term used in the containment of diseaseEradicationtotal elimination of the disease,Control of Infectious diseases,HUMAN1.Change behavior2.Health education3.VaccinationENVIRONMENT1.Habitat improvement2.Water(or soil)treatment3.Revise agriculture pattern,Control of Infec
34、tious diseases,RESERVOIRS1.Treatment2.Vaccination3.EradicationVECTORS1.Chemical control2.Non-chemical control,加强传染病监测 Communicable disease surveillance 传染病报告 Report infectious diseases,针对传染源的措施The control measures for the source of infection（1）病人 Cases 早发现 Early detection 早诊断 Early diagnosis 早报告 Ear
35、ly reporting 早隔离 Early isolation 早治疗 Early treatment,病原携带者 Carriers 措施 Measures 登记 Registration 管理 Management 随访 Follow up期限 Time limit,接触者 Contacts 检疫 Quarantine 留验(隔离观察)Isolated observation 医学观察 Medical observation,动物传染源 Animal 彻底消灭 Wipe捕杀、焚烧或深埋 Killing,burning or deep隔离治疗 Isolation and treatment预
36、防接种和检疫 Vaccination and quarantine,对传播途径的措施measures for route of transmission 消毒 Disinfection 分类 预防性消毒 Preventive disinfection疫源地消毒Foci disinfection,随时消毒 Disinfection at any time 终末消毒 Terminal disinfection,分类,针对易感者的措施Measures for the susceptible免疫预防 Immunization药物预防 Drug prevention 个人防护 Personal Protection,谢 谢,
