一名的学校流行病学9精选文档.ppt

1、Department of Epidemiology Public Health College of Harbin Medical University第一节第一节 概述概述 (Introduction)第二节第二节 地方性碘缺乏病地方性碘缺乏病(Endemic iodine deficiency diseases)Department of Epidemiology Public Health College of Harbin Medical University第一节第一节 概概 述述Introductionp地方病概念地方病概念p地方病的判断依据及分类地方病的判断依据及分类p我国主要

2、的地方病我国主要的地方病p几种主要地方病的流行特征几种主要地方病的流行特征p预防策略与措施预防策略与措施 Concept of endemic diseases Criteria and classification of endemic diseases The major endemic diseases in China Prevalence characteristics of several major endemic diseases Prevention strategies and measuresDepartment of Epidemiology Public Health

3、 College of Harbin Medical University一、地方病的概念一、地方病的概念Concept of endemic diseases 地方病概念地方病概念p地方病也称地方性疾病。地方病也称地方性疾病。指在某些特定地区相对稳指在某些特定地区相对稳定并经常发生、不需从外定并经常发生、不需从外地输入的疾病。地输入的疾病。What were endemic diseases?F Endemic diseases have been defined as“a class of diseases that constantly present in people living

4、in particular areas without imported cases from external sources”Department of Epidemiology Public Health College of Harbin Medical University二、地方病的判断依据及分类二、地方病的判断依据及分类Criteria and classification of endemic diseases地方病的判断依据地方病的判断依据 p该地区的居民任何民族其发该地区的居民任何民族其发病率病率 其他地区居住的相似人群，其他地区居住的相似人群，该病的发病频率该病的发病频率

5、 ，甚至不，甚至不发病发病 Criteria of endemic diseaseF incidence of the disease in any ethnic may increase in the residents in the areaFsimilar residents lived in other areas have the lower incidence,or even not occur the disease Department of Epidemiology Public Health College of Harbin Medical University二、地方病

6、的判断依据及分类二、地方病的判断依据及分类Criteria and classification of endemic diseases地方病的判断依据地方病的判断依据 p迁入该地区的人经一段时间迁入该地区的人经一段时间后，其发病率和当地居民一后，其发病率和当地居民一致致p人群迁出该地区后，发病率人群迁出该地区后，发病率 或患病症状减轻或自愈或患病症状减轻或自愈p除人之外，当地的易感动物除人之外，当地的易感动物也可发生同样的疾病也可发生同样的疾病Criteria of endemic diseaseFwho immigrate the area over a period of time,it

7、s incidence approaches that in local populationFthe people emigrate the area,the incidence would reduce,or symptoms alleviate or self-healingFin addition,the local animals are also susceptible to the same diseaseDepartment of Epidemiology Public Health College of Harbin Medical Universityp 地球化学性地方病地

8、球化学性地方病p 自然疫源性地方病自然疫源性地方病 p 与特定生产生活方式有与特定生产生活方式有 p 关地方病关地方病 p 病因未明地方病病因未明地方病 Classification of endemic diseases)Geochemistry endemic diseases Natural foci endemic disease particular production and Lifestyle-related endemic diseases Endemic disease of unknown etiologyDepartment of Epidemiology Public

9、 Health College of Harbin Medical Universityp地球化学性地方病地球化学性地方病 碘缺乏病碘缺乏病 饮水型地方饮水型地方性氟中毒性氟中毒 砷中毒砷中毒p自然疫源性地方病自然疫源性地方病 血吸虫病血吸虫病 鼠疫鼠疫 布氏布氏杆菌病杆菌病Geochemistry endemic diseases Iodine deficiency disease;drinking water type fluorosis and arsenic poisoning Natural foci endemic disease Schistosomiasis;plague;Br

10、ucellosisDepartment of Epidemiology Public Health College of Harbin Medical Universityp与特定生产生活方式有与特定生产生活方式有关地方病关地方病 燃煤污染型氟中毒燃煤污染型氟中毒 饮茶型氟中毒饮茶型氟中毒 燃煤污染型砷中毒燃煤污染型砷中毒p病因未明地方病病因未明地方病 克山病克山病 大骨节病大骨节病 趴子病趴子病 乌脚病乌脚病Particular production and lifestyle-related endemic diseases Burning coal polluted type fluor

11、osis Drinking tea type fluorosis Burning coal polluted type arsenic poisoningEndemic disease of unknown etiology Keshan disease;Kaschin-Beck disease;Pazhi disease;black foot diseaseDepartment of Epidemiology Public Health College of Harbin Medical University三、我国主要的地方病三、我国主要的地方病 纳入重点防治的地方病：纳入重点防治的地方病

12、：碘缺乏病碘缺乏病 地方性氟中毒地方性氟中毒 地方性砷中毒地方性砷中毒 克山病克山病 大骨节病大骨节病 鼠疫鼠疫 布鲁氏杆菌病布鲁氏杆菌病 血吸虫病血吸虫病Focused endemic diseases of prevention and control includes:IDD Endemic fluorosis Endemic arsenic poisoning Keshan disease Kaschin-Beck disease Plague Brucellosis disease Schistosomiasis diseaseThe major endemic diseases i

13、n ChinaDepartment of Epidemiology Public Health College of Harbin Medical University表表28-1 28-1 全国全国8 8种主要地方病病区范围及病例数种主要地方病病区范围及病例数 Department of Epidemiology Public Health College of Harbin Medical University四、几种主要地方病的流行特征四、几种主要地方病的流行特征p 地方性氟中毒地方性氟中毒p 大骨节病大骨节病p 克山病克山病p 地方性砷中毒地方性砷中毒Prevalent charact

14、eristics of several major endemic diseases Endemic fluorosis Kaschin-Beck disease Keshan disease Endemic arsenic poisoningDepartment of Epidemiology Public Health College of Harbin Medical University(一一)地方性氟中毒地方性氟中毒(地氟病地氟病)（Endemic fluorosis）主要临床表现主要临床表现(The main clinical manifestations)(The main cl

15、inical manifestations)p氟斑牙（氟斑牙（dental fluorosis）氟骨症（氟骨症（skeletal flurosis）定义定义 在特定的地理环境中发生的一种地球化学性疾病，在特定的地理环境中发生的一种地球化学性疾病，人体长期摄入过量氟而导致的全身慢性蓄积性中毒。人体长期摄入过量氟而导致的全身慢性蓄积性中毒。A geochemical disease occurred in a particular geographical environment,for chronic systemic accumulated poisoning caused by long-t

16、erm intake of excessive fluoride in human Department of Epidemiology Public Health College of Harbin Medical University氟斑牙氟斑牙 牙釉质形成期摄入高氟引牙釉质形成期摄入高氟引起的起的 表现为牙釉质白垩、着色表现为牙釉质白垩、着色或缺损改变或缺损改变 一旦形成，残留终生一旦形成，残留终生Dental fluorosiscaused by high fluoride intake the performance of enamel is chalk,coloring,or de

17、fect Once formed,enamel formation would be left over the full lifeDepartment of Epidemiology Public Health College of Harbin Medical University氟斑牙氟斑牙Dental fluorosisDepartment of Epidemiology Public Health College of Harbin Medical University氟骨症氟骨症Skeletal fluorosisDepartment of Epidemiology Public

18、Health College of Harbin Medical University骨症骨症Skeletal fluorosisDepartment of Epidemiology Public Health College of Harbin Medical University 按氟的来源不同分为按氟的来源不同分为 饮水型饮水型 燃煤型燃煤型 饮茶型饮茶型 Divided according to different sources of fluorine:Drinking water type Burning coal type Drinking tea Type(一一)地方性氟中毒地

19、方性氟中毒(地氟病地氟病)（Endemic fluorosis）Department of Epidemiology Public Health College of Harbin Medical University地区分布地区分布 (Regional distribution)p世界广泛分布世界广泛分布:p 中国、印度最为严重中国、印度最为严重p国内国内 Distribution in world wide:China and India are the most seriousDomesticDepartment of Epidemiology Public Health College

20、 of Harbin Medical University饮茶型氟中毒病区分布饮茶型氟中毒病区分布Department of Epidemiology Public Health College of Harbin Medical University 该病的发生与季节年份无该病的发生与季节年份无明显相关明显相关 The occurrence of the disease has no significant correlation with the seasonal and year时间分布时间分布 (Time distribution)氟斑牙氟斑牙 无明显的性别、种族差异无明显的性别、种族

21、差异 婴幼儿症状较轻，主要表婴幼儿症状较轻，主要表现为白垩样改变现为白垩样改变Dental fluorosis No significant gender and ethnic differences Infants and young children suffering from moderate,mainly for the chalk-like change人群分布人群分布 (Population distribution)Department of Epidemiology Public Health College of Harbin Medical University 氟斑牙（

22、白垩样改变）氟斑牙（白垩样改变）Dental fluorosis(chalk-like change)Department of Epidemiology Public Health College of Harbin Medical University氟骨症氟骨症 主要发生在成年主要发生在成年1616岁以后，岁以后，特别是特别是3030岁以后岁以后 年龄年龄 患病率患病率 病情通常女性比男性严重病情通常女性比男性严重Skeletal fluorosis Mainly occurred in adults after 16 years old,and especially after the

23、 age of 30,and the prevalence increases with the increased age Condition of illness is usually severe in women than in men.人群分布人群分布 (Population distribution)Department of Epidemiology Public Health College of Harbin Medical University（二）大骨节病（二）大骨节病 （Kashin-Beck disease）一种地方性、多发性、变一种地方性、多发性、变形性骨关节病形性

24、骨关节病 主要病变是发育期儿童的主要病变是发育期儿童的关节透明软骨变性、坏死关节透明软骨变性、坏死及继发的骨关节炎，严重及继发的骨关节炎，严重者可导致矮小畸形，终生者可导致矮小畸形，终生残疾残疾 It is a endemic,multiple,deformation osteoarthropathy.Primary lesion to children in a developmental stages is the articular hyaline cartilage degeneration,necrosis and secondary bone arthritis,severe ca

25、ses can lead to short stature deformities,permanent disability.Department of Epidemiology Public Health College of Harbin Medical University大骨节病大骨节病Kashin-Beck disease变形性骨关节病变形性骨关节病Deformation osteoarthropathyDepartment of Epidemiology Public Health College of Harbin Medical University Kashin-Beck d

26、iseaseDwarf deformityDepartment of Epidemiology Public Health College of Harbin Medical University大骨节病地区分布大骨节病地区分布The geographical distribution of Kashin-Beck diseaseDepartment of Epidemiology Public Health College of Harbin Medical University1.1.霜期早、秋雨大、粮食水霜期早、秋雨大、粮食水分高的次年多是大骨节分高的次年多是大骨节病的高发年病的高发年2

27、.2.各病区多发季节有所不同，各病区多发季节有所不同，一般春季多发一般春季多发3.3.致病因子活跃的地方，四致病因子活跃的地方，四季都有新发病人季都有新发病人时间分布时间分布 (Time distribution)(Time distribution)The early frosty period,autumn large rain in autumn with high moisture over the next year is a high incidence of Kashin-Beck disease in yearsThe season is different from many

28、 wards,and the general spring-prone.In causative agent active area,the incidence of this disease will could be seen in the four seasons.Department of Epidemiology Public Health College of Harbin Medical University1.1.多发生于儿童和少年，多发生于儿童和少年，成人中新发病例极少成人中新发病例极少 2.2.未见明显的性别差异未见明显的性别差异3.3.民族间患病率差异取决民族间患病率差异

29、取决于主食的粮食种类和生于主食的粮食种类和生活方式活方式Mostly occurs in children and adolescents,and very few new cases in adults,No significant gender differencesDifferences in the prevalence among nationality depends on categories of staple food and lifestyle人群分布人群分布 (Population distribution)(Population distribution)Departm

30、ent of Epidemiology Public Health College of Harbin Medical University一种病因未明的、以心肌坏死为主要病理改变的一种病因未明的、以心肌坏死为主要病理改变的地方性心肌病。地方性心肌病。（三）克山病（地方性心肌病）（三）克山病（地方性心肌病）（keshan disease）A kind of unknown etiology,endemic cardiomyopathy that the main pathological changes in heart is necrosis.Department of Epidemiolo

31、gy Public Health College of Harbin Medical University克山病的克山病的病因学病因学p地球化学说地球化学说p生物病因学说生物病因学说The etiology of Keshan diseaseTheory of geochemical hypothesisTheory of biological causesDepartment of Epidemiology Public Health College of Harbin Medical University地区分布地区分布（Regional distribution）Department o

32、f Epidemiology Public Health College of Harbin Medical University年度多发年度多发 季节性高发季节性高发 Annual Multi-place A high incidence of seasonal时间分布时间分布 (Time distribution)(Time distribution)Department of Epidemiology Public Health College of Harbin Medical University年龄年龄 生育期妇女和儿童为高生育期妇女和儿童为高发人群发人群性别性别 北方急型克山病女

33、性发北方急型克山病女性发病比同龄男性多病比同龄男性多1 12 2倍以倍以上，高时可达上，高时可达4 47 7倍倍Age:women of childbearing age and children are the high-risk population.Gender:North Keshan disease incidence in women is age 1 2 times higher than it in men with the same age,up to 4 7 times.人群分布人群分布 (Population distribution)(Population distri

34、bution)Department of Epidemiology Public Health College of Harbin Medical University职业职业 绝大多数是自产自给的农业人口绝大多数是自产自给的农业人口家庭集聚性家庭集聚性 克山病有家庭多发现象克山病有家庭多发现象民族民族 民族混居地区，若其生产、生活方式无相似则发病无明显差民族混居地区，若其生产、生活方式无相似则发病无明显差异异Occupation:Most self-summary-grown agricultural population.Family clustering:Keshan disease h

35、ave the phenomenon of multiple.National:if their production and way of life have no similar,and there are no significant difference in the incidence of this disease in ethnically mixed areas.人群分布人群分布 (Population distribution)(Population distribution)Department of Epidemiology Public Health College o

36、f Harbin Medical University居住在特定地理条件下居住在特定地理条件下的居民，通过饮水、空气和的居民，通过饮水、空气和食物长期摄入过量的砷而引食物长期摄入过量的砷而引起的以皮肤色素脱失、着色、起的以皮肤色素脱失、着色、角化及癌变为主的全身性慢角化及癌变为主的全身性慢性中毒性疾病。性中毒性疾病。（四）地方性砷中毒（四）地方性砷中毒（地砷病）（地砷病）Endemic arsenic poisoning The residents lives in a specific geographical conditions,through drinking water,air an

37、d long-term intake of food,intake an excessive amount of arsenic,caused the skin pigmentation change,keratosis,and cancer-based systemic chronic toxic illnesses.（四）地方性砷中毒（四）地方性砷中毒（地砷病）（地砷病）Endemic arsenic poisoningDepartment of Epidemiology Public Health College of Harbin Medical University皮肤角化皮肤角化色

38、素沉着色素沉着Skin KeratosisHyperpigmentationDepartment of Epidemiology Public Health College of Harbin Medical University地砷病的危害地砷病的危害手手/趾掌角化趾掌角化花肚皮花肚皮-腹部色素沉着与脱失腹部色素沉着与脱失The hazard of endemic arsenicosisHand/toe palm keratosisFlower belly-abdominal pigmentation changeDepartment of Epidemiology Public Healt

39、h College of Harbin Medical University皮肤癌皮肤癌Skin cancerDepartment of Epidemiology Public Health College of Harbin Medical University地区分布地区分布（Regional distributionRegional distribution）Department of Epidemiology Public Health College of Harbin Medical University该病没有多发季节和多发年该病没有多发季节和多发年 There is not m

40、ultiple seasons and multiple years to this disease.时间分布时间分布 (Time distribution)(Time distribution)Department of Epidemiology Public Health College of Harbin Medical University年龄分布年龄分布 任何年龄摄入过多的砷均可任何年龄摄入过多的砷均可患病患病 年龄年龄 该病的检出率该病的检出率 性别分布性别分布 调查结果不相一致，多数为调查结果不相一致，多数为男性男性 女性女性 Age distributionExcessive

41、intake of arsenic at any age may be sick.The detection rate of the disease increases with the increased ageGender distributionSurvey results are not consistent,and the number of male beyond the Female In most cases.人群分布人群分布 (Population distribution)(Population distribution)Department of Epidemiology

42、 Public Health College of Harbin Medical University五、预防策略与措施五、预防策略与措施p 预防策略与措施预防策略与措施p 防治机构防治机构p 监监 测测Prevention strategies and measures Prevention strategies and measures Institutions of prevention and control SurveillanceDepartment of Epidemiology Public Health College of Harbin Medical University

43、（一）预防策略与措施（一）预防策略与措施地方病的预防与控制原则：地方病的预防与控制原则：预防为主，兼顾救治预防为主，兼顾救治 政府领导、部门配合，政府领导、部门配合，群众参与群众参与 可持续性可持续性Prevention strategies and measuresEndemic disease prevention and control principles:Focusing on prevention and also give consideration to remedy.Government leading,department co-participating and mass

44、 participation.SustainabilityDepartment of Epidemiology Public Health College of Harbin Medical Universityp 碘缺乏病碘缺乏病 p “全民食盐加碘全民食盐加碘”p 克山病克山病 p “采用综合性措施采用综合性措施”不同疾病防治措施不同疾病防治措施Preventive measures for different diseasesFLodine deficiency disease National salt iodization F Keshan disease Adopting inte

45、grated measure according to etiological factor Department of Epidemiology Public Health College of Harbin Medical Universityp大骨节病大骨节病 p “换粮、补硒、移民、换粮、补硒、移民、退耕还林还草退耕还林还草”p 地方性氟中毒和地方性砷地方性氟中毒和地方性砷中毒中毒 p “改水、改灶改水、改灶”不同疾病防治措施不同疾病防治措施Preventive measures for different diseasesF Kashin-Beck disease“changing

46、grain,intaking Se,immigration,returning farmland to forest and grassF Endemic fluorosis and endemic arsenic poisoning reforming water and changing cooking stovesDepartment of Epidemiology Public Health College of Harbin Medical University （二）防治机构（二）防治机构The institutions of prevention and control地区地区国

47、家国家省省县县 National Province Area County （二）防治机构（二）防治机构The institutions of prevention and controlDepartment of Epidemiology Public Health College of Harbin Medical University卫生部卫生部国家国家中国疾控地方病控制中心中国疾控地方病控制中心全国鼠疫布病防治基地全国鼠疫布病防治基地寄生虫病预防控制所寄生虫病预防控制所Endemic Disease Control center of Chinese Center for Diseas

48、e Control and PreventionNational base for the prevention and control of Brucellosis and Plague Institute for the prevention and control of parasitic diseasesNational The Ministry of Health （二）防治机构（二）防治机构The institutions of prevention and control （二）防治机构（二）防治机构The institutions of prevention and contr

49、olDepartment of Epidemiology Public Health College of Harbin Medical University省（区、市）省（区、市）地方病防治所地方病防治所省、市疾病控制中心地方病防治科省、市疾病控制中心地方病防治科Provinces(regions and municipalities)Institute for the prevention and control of endemic disease Endemic disease department of provincial and municipal Center for Dise

50、ase Control and prevention （二）防治机构（二）防治机构The institutions of prevention and control （二）防治机构（二）防治机构The institutions of prevention and controlDepartment of Epidemiology Public Health College of Harbin Medical University县县乡乡 镇镇 县（旗）疾控中心地方病科县（旗）疾控中心地方病科乡镇卫生院乡镇卫生院County Countryside TownCounties(banners)C