【正文】 C), 和一種以上的下列情況： Fever (≥176。 C) 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(zāi)之后 Followed flooding 水未燒開或是被污染 Water not boiled or disinfected 學(xué)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(zāi)距離暴發(fā)高峰期時間過長 Flooding too long before outbreak peak 水災(zāi)淡化了河水污染 Flooding diluted river pollution 高發(fā)病率與某種食物有關(guān) High attack rate typical of food 流行病學(xué)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(shè)－學(xué)校用水導(dǎo)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(zhǔn)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(shè) 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(jié)果進行交流 Communicate Findings Define, find, and interview cases 定義，搜索，訪談病例 設(shè)計一個分析研究來檢驗假設(shè) 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(guān)系 Consider causation Step 6 對學(xué)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。如何進行暴發(fā)調(diào)查 How to Investigate an Outbreak Robert E. Fontaine, MD MSc US Centers for Disease Control and Prevention Advisor to Chinese Field Epidemiology Training Program 什么是暴發(fā)或流行？ What is an outbreak or epidemic? ? Epidemic 流行性 ? Outbreak 暴發(fā) ? Cluster 聚集性 暴發(fā)和流行病可以突然發(fā)生 Outbreaks and epidemics may happen suddenly 010203040501 9 17 25 33 41有些暴發(fā)和流行病則是緩慢發(fā)展的 Others may develop slowly 010203040501 9 17 25 33 41有些暴發(fā)可能在高本底水平上發(fā)生 Others may happen on a high background level 010203040501 9 17 25 33 41我們?nèi)绾伟l(fā)現(xiàn)暴發(fā)和流行病？ How do we learn about outbreaks and epidemics? 通過定期回顧監(jiān)測數(shù)據(jù) By regular review of surveillance 通過區(qū)縣公共衛(wèi)生人員的報告 By reports from county and district public health workers 通過和臨床人員的討論 From discussions with clinical professionals 通過新聞媒介 From the news media 直接從公眾獲取 Directly from the public 從私人商務(wù)和政府機構(gòu)獲取 From private business and government agencies. 1 為什么要對暴發(fā)和流行病進行調(diào)查？ Why initiate an investigation? 確定問題的特征 Characterize the problem 為控制和預(yù)防措施提供合理依據(jù) Rational basis for control and prevention 科研 回答科學(xué)問題 Researchanswer scientific questions 保持流行病學(xué)家的業(yè)務(wù)熟練性 Maintain proficiency of epidemiologists 出于政治 /法律考慮 Political / legal concerns 出于規(guī)劃的考慮 Program considerations 1 為什么要啟動調(diào)查？ Why initiate an investigation? 來源和傳播方式不清 Uncertainty of cause or mode of transmission 可能涉及食物，水，藥物，疫苗或其他產(chǎn)品 Possible involvement of food, water, drug, vaccine, or other product 對公眾的巨大威脅 Explosive threat to the general public 較高的發(fā)病及死亡 Significant morbidity and mortality 對工作、學(xué)校及公共服務(wù)造成影響 Interfere with work, school, public services 1 已知 未知 已知 調(diào)查 + 控制 +++ 調(diào)查 +++ 控制 + 未知 調(diào)查 +++ 控制 +++ 調(diào)查 +++ 控制 + 來源 /途徑 病因 值得花時間和精力調(diào)查嗎？ ?保護公眾免于持續(xù)存在或反復(fù)發(fā)生問題的侵害 Protect the public from continuing or recurrent problem ?維持流行病學(xué)家工作的有效性 Maintain proficiency of epidemiologists ?出于控制規(guī)劃的考慮 Program considerations ?出于政治 /法律考慮 Political / legal concerns ?調(diào)查成本和難易 Ease and cost of the investigation ?可能會采取的控制決策 Potential for decisive control ?回答重要的公共衛(wèi)生問題 Answer important public heal