【正文】 he disease really what it has been reported to be? 目的：排除診斷錯誤和實驗室錯誤 Goal: rule out misdiagnosis and laboratory error 對病人進行各項檢查 Examine patients 審核病歷 Review medical records 檢查實驗室錯誤 Check for laboratory errors 探訪一些病人 Visit several people who became ill 核實臨床情況 Verify clinical picture Step 3 診斷可以通過將臨床發(fā)現(xiàn)進行列表來確立 Diagnosis may be established by tabulating clinical findings Finding 發(fā)現(xiàn) % Fever ≥176。 C) 100 69 Dry throat 咽干 55 Headache 頭痛 54 Nonproductive cough 干咳 21 Sore throat 咽喉痛 13 Stomach ache 胃痛 10 Diarrhea 腹瀉 9 通過血樣和便樣培養(yǎng)找到病因 Agent Identified in Blood and Stool Cultures Specimen 樣本 Salmonella enterica serovar paratyphi A (+) % Blood 血 Stool 便 定義、計數(shù)和采訪病例 Define, count, and interview cases. 準備現(xiàn)場工作 Prepare for field work 證實暴發(fā)存在 Establish existence of an outbreak Time Verify the diagnosis 驗證診斷 確定人、地點和時間特征 Characterize person, place and time Develop a hypothesis 提出假設 Develop analytic study to test hypothesis 通過分析研究驗證假說 Reconsider, refine, retest hypothesis 再推敲，修正和再檢驗假說 實施控制措施 Implement Control 將調(diào)查結果進行交流 Communicate Findings Define, find, and interview cases 定義，搜索，訪談病例 病例定義可有不同程度的確定性 The case definition may have levels of certainty. 疑似病例 Suspect 可能病例 Possible 臨床病例 Probable 確診病例 Confirmed 在做調(diào)查的過程中不斷修正病例定義 As you proceed you modify the case definition 疑似病例 Suspect 臨床病例 Probable 確診病例 Confirmed 副傷寒的病例定義很簡單 The paratyphoid case definition was simple 發(fā)燒 (≥ 176。 Among students of the school, drinking unboiled water from the school water system between November 10 and 15 caused paratyphoid fever from November 20 to December 15. 水災之后 Followed flooding 水未燒開或是被污染 Water not boiled or disinfected 學生和廚房工人受感染情況相似并且都喝自來水 Students and kitchen workers affected evenly and drank tap water 教師自己燒飲用水未受感染 Teachers not affected and boiled their drinking water 水災距離暴發(fā)高峰期時間過長 Flooding too long before outbreak peak 水災淡化了河水污染 Flooding diluted river pollution 高發(fā)病率與某種食物有關 High attack rate typical of food 流行病學曲線也與典型食物引起的暴發(fā)相類似 Epidemic curve more typical of food Step 6 假設－學校用水導致的暴發(fā) Hypothesis – water from school system caused the outbreak 通過分析研究驗證假說 Develop an analytic study to test hypothesis. 準備現(xiàn)場工作 Prepare for field work 證實暴發(fā)存在 Establish existence of an outbreak Time Verify the diagnosis 驗證診斷 確定人、地點和時間特征 Characterize person, place and time Develop a hypothesis 提出假設 Develop analytic study to test hypothesis 通過分析研究驗證假說 Reconsider, refine, retest hypothesis 再推敲，修正和再檢驗假說 實施控制措施 Implement Control 將調(diào)查結果進行交流 Communicate Findings Define, find, and interview cases 定義，搜索，訪談病例 設計一個分析研究來檢驗假設 Develop an analytic study to test hypothesis 目的：描述問題 What is the question 使用比較組 Use parison group 隊列研究 Cohort studies 病例 對照研究 Casecontrol studies 考慮因果關系 Consider causation Step 6 對學生進行病例對照研究 Casecontrol Study of Students 從所有發(fā)燒 38度或高于 38度的病例中隨機抽取 122例 122 Cases randomly selected from all cases with fever ≥38176。 C), plus ≥1: 頭痛 headache 咽干口躁 dry throat or mouth 干咳 nonproductive cough 腹痛 abdominal pain 住校學生或員工 Boarding school student or employee 2021年 11月 9日到 12月 25日間 Between November 9th and December 25th 2021 努力找到所有可能病例 Try and locate all possible cases 進行系統(tǒng)搜索：發(fā)展監(jiān)測 Conduct systematic search: Develop surveillance 利用多種信息來源 Use multiple sources 將數(shù)據(jù)列表 Construct a line list 識別并計算病例 Identify and count cases D21 檢出副傷寒病例 Paratyphoid Case Finding 考察（鄉(xiāng)、鎮(zhèn)）監(jiān)測和臨床記錄 Reviewed surveillance and clinical records (village, township)