【正文】 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(jìn)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(jìn)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(xué)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(jìn)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) 檢查學(xué)生和員工 Examined students and employees 跡象和病征 Signs and symptoms 體溫 Body temperature 血樣和便樣培養(yǎng) Cultured blood and stool 編號 性別 年齡 班級 宿舍號 發(fā)病日期 發(fā)熱 (℃) 咽痛 頭痛 血培養(yǎng) 1 男 15 104 108 12月 4日 0 0 0 2 女 16 104 301 11月 30日 0 1 0 3 男 15 104 108 12月 2日 0 1 1 4 男 15 104 108 11月 27日 0 1 0 5 男 15 104 108 11月 30日 0 1 0 6 女 15 105 401 12月 4日 0 0 0 7 女 15 105 401 12月 1日 0 1 0 8 女 15 105 401 11月 25日 0 1 0 9 女 14 105 401 11月 30日 1 1 0 10 女 14 105 401 12月 4日 0 0 0 將數(shù)據(jù)列表 Construct a line listing 得病之前你去過哪里？ Where did you go before you got sick? 得病之前你做過什么？ What did you do before you got sick? 你得職業(yè)、收入、教育程度、通常日程等等都是什么？ What is your occupation, ine, education, normal routine, etc.? 你知道還有誰得病？ Do you know of anyone else who got sick? 根據(jù)假設(shè)進(jìn)行訪談 Hypothesis generating interviews D13 根據(jù)假設(shè)進(jìn)行訪談 Key observations 根據(jù)假設(shè)進(jìn)行訪談 Key observations 根據(jù)假設(shè)進(jìn)行訪談 Key observations 確定人、地點和時間特征 Characterize cases by person, place and time 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(jìn)行交流 Communicate Findings Define, find, and interview cases 定義，搜索，訪談病例 ？ What can we learn about the distribution by place? 教室 Classroom 教室Classroom 宿舍Dorm 宿舍Dorm 宿舍Dorm 宿舍