《名的学校流行病学》PPT课件

,地方病,哈,目录,第一节概述(Introduction)第二节地方性碘缺乏病(Endemiciodinedeficiencydiseases),第一节概述Introduction,地方病概念地方病的判断依据及分类我国主要的地方病几种主要地方病的流行特征预防策略与措施,ConceptofendemicdiseasesCriteriaandclassificationofendemicdiseasesThemajorendemicdiseasesinChinaPrevalencecharacteristicsofseveralmajorendemicdiseasesPreventionstrategiesandmeasures,一、地方病的概念Conceptofendemicdiseases,地方病概念地方病也称地方性疾病。指在某些特定地区相对稳定并经常发生、不需从外地输入的疾病。,Whatwereendemicdiseases?Endemicdiseaseshavebeendefinedas“aclassofdiseasesthatconstantlypresentinpeoplelivinginparticularareaswithoutimportedcasesfromexternalsources”,二、地方病的判断依据及分类Criteriaandclassificationofendemicdiseases,地方病的判断依据该地区的居民任何民族其发病率其他地区居住的相似人群，该病的发病频率，甚至不发病,Criteriaofendemicdiseaseincidenceofthediseaseinanyethnicmayincreaseintheresidentsintheareasimilarresidentslivedinotherareashavethelowerincidence,orevennotoccurthedisease,二、地方病的判断依据及分类Criteriaandclassificationofendemicdiseases,地方病的判断依据迁入该地区的人经一段时间后，其发病率和当地居民一致人群迁出该地区后，发病率或患病症状减轻或自愈除人之外，当地的易感动物也可发生同样的疾病,Criteriaofendemicdiseasewhoimmigratetheareaoveraperiodoftime,itsincidenceapproachesthatinlocalpopulationthepeopleemigratethearea,theincidencewouldreduce,orsymptomsalleviateorself-healinginaddition,thelocalanimalsarealsosusceptibletothesamedisease,地球化学性地方病自然疫源性地方病与特定生产生活方式有关地方病病因未明地方病,地方病的分类(Classificationofendemicdiseases),GeochemistryendemicdiseasesNaturalfociendemicdiseaseparticularproductionandLifestyle-relatedendemicdiseasesEndemicdiseaseofunknownetiology,地球化学性地方病碘缺乏病饮水型地方性氟中毒砷中毒自然疫源性地方病血吸虫病鼠疫布氏杆菌病,GeochemistryendemicdiseasesIodinedeficiencydisease;drinkingwatertypefluorosisandarsenicpoisoningNaturalfociendemicdiseaseSchistosomiasis;plague;Brucellosis,与特定生产生活方式有关地方病燃煤污染型氟中毒饮茶型氟中毒燃煤污染型砷中毒病因未明地方病克山病大骨节病趴子病乌脚病,Particularproductionandlifestyle-relatedendemicdiseasesBurningcoalpollutedtypefluorosisDrinkingteatypefluorosisBurningcoalpollutedtypearsenicpoisoningEndemicdiseaseofunknownetiologyKeshandisease;Kaschin-Beckdisease;Pazhidisease;blackfootdisease,三、我国主要的地方病,纳入重点防治的地方病：碘缺乏病地方性氟中毒地方性砷中毒克山病大骨节病鼠疫布鲁氏杆菌病血吸虫病,Focusedendemicdiseasesofpreventionandcontrolincludes:IDDEndemicfluorosisEndemicarsenicpoisoningKeshandiseaseKaschin-BeckdiseasePlagueBrucellosisdiseaseSchistosomiasisdisease,ThemajorendemicdiseasesinChina,表28-1全国8种主要地方病病区范围及病例数,四、几种主要地方病的流行特征,地方性氟中毒大骨节病克山病地方性砷中毒,Prevalentcharacteristicsofseveralmajorendemicdiseases,EndemicfluorosisKaschin-BeckdiseaseKeshandiseaseEndemicarsenicpoisoning,(一)地方性氟中毒(地氟病)（Endemicfluorosis）,主要临床表现(Themainclinicalmanifestations)氟斑牙（dentalfluorosis）氟骨症（skeletalflurosis）,定义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。,Ageochemicaldiseaseoccurredinaparticulargeographicalenvironment,forchronicsystemicaccumulatedpoisoningcausedbylong-termintakeofexcessivefluorideinhuman,氟斑牙牙釉质形成期摄入高氟引起的表现为牙釉质白垩、着色或缺损改变一旦形成，残留终生,Dentalfluorosiscausedbyhighfluorideintaketheperformanceofenamelischalk,coloring,ordefectOnceformed,enamelformationwouldbeleftoverthefulllife,氟斑牙,Dentalfluorosis,氟骨症,Skeletalfluorosis,氟骨症,Skeletalfluorosis,按氟的来源不同分为饮水型燃煤型饮茶型,Dividedaccordingtodifferentsourcesoffluorine:DrinkingwatertypeBurningcoaltypeDrinkingteaType,(一)地方性氟中毒(地氟病)（Endemicfluorosis）,地区分布(Regionaldistribution),世界广泛分布:中国、印度最为严重国内,Distributioninworldwide:ChinaandIndiaarethemostseriousDomestic,饮茶型氟中毒病区分布,该病的发生与季节年份无明显相关,Theoccurrenceofthediseasehasnosignificantcorrelationwiththeseasonalandyear,时间分布(Timedistribution),氟斑牙无明显的性别、种族差异婴幼儿症状较轻，主要表现为白垩样改变,DentalfluorosisNosignificantgenderandethnicdifferencesInfantsandyoungchildrensufferingfrommoderate,mainlyforthechalk-likechange,人群分布(Populationdistribution),氟斑牙（白垩样改变）,Dentalfluorosis(chalk-likechange),氟骨症主要发生在成年16岁以后，特别是30岁以后年龄患病率病情通常女性比男性严重,SkeletalfluorosisMainlyoccurredinadultsafter16yearsold,andespeciallyaftertheageof30,andtheprevalenceincreaseswiththeincreasedageConditionofillnessisusuallysevereinwomenthaninmen.,人群分布(Populationdistribution),（二）大骨节病（Kashin-Beckdisease）,一种地方性、多发性、变形性骨关节病主要病变是发育期儿童的关节透明软骨变性、坏死及继发的骨关节炎，严重者可导致矮小畸形，终生残疾,Itisaendemic,multiple,deformationosteoarthropathy.Primarylesiontochildreninadevelopmentalstagesisthearticularhyalinecartilagedegeneration,necrosisandsecondarybonearthritis,severecasescanleadtoshortstaturedeformities,permanentdisability.,大骨节病Kashin-Beckdisease,变形性骨关节病Deformationosteoarthropathy,大骨节病矮小畸形,Kashin-Beckdisease,Dwarfdeformity,大骨节病地区分布,ThegeographicaldistributionofKashin-Beckdisease,1.霜期早、秋雨大、粮食水分高的次年多是大骨节病的高发年2.各病区多发季节有所不同，一般春季多发3.致病因子活跃的地方，四季都有新发病人,时间分布(Timedistribution),Theearlyfrostyperiod,autumnlargeraininautumnwithhighmoistureoverthenextyearisahighincidenceofKashin-BeckdiseaseinyearsTheseasonisdifferentfrommanywards,andthegeneralspring-prone.Incausativeagentactivearea,theincidenceofthisdiseasewillcouldbeseeninthefourseasons.,1.多发生于儿童和少年，成人中新发病例极少2.未见明显的性别差异3.民族间患病率差异取决于主食的粮食种类和生活方式,Mostlyoccursinchildrenandadolescents,andveryfewnewcasesinadults,NosignificantgenderdifferencesDifferencesintheprevalenceamongnationalitydependsoncategoriesofstaplefoodandlifestyle,人群分布(Populationdistribution),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。,（三）克山病（地方性心肌病）（keshandisease）,Akindofunknownetiology,endemiccardiomyopathythatthemainpathologicalchangesinheartisnecrosis.,克山病的病因学,地球化学说生物病因学说,TheetiologyofKeshandisease,TheoryofgeochemicalhypothesisTheoryofbiologicalcauses,地区分布（Regionaldistribution）,年度多发季节性高发,AnnualMulti-placeAhighincidenceofseasonal,时间分布(Timedistribution),年龄生育期妇女和儿童为高发人群性别北方急型克山病女性发病比同龄男性多12倍以上，高时可达47倍,Age:womenofchildbearingageandchildrenarethehigh-riskpopulation.Gender:NorthKeshandiseaseincidenceinwomenisage12timeshigherthanitinmenwiththesameage,upto47times.,人群分布(Populationdistribution),职业绝大多数是自产自给的农业人口家庭集聚性克山病有家庭多发现象民族民族混居地区，若其生产、生活方式无相似则发病无明显差异,Occupation:Mostself-summary-grownagriculturalpopulation.Familyclustering:Keshandiseasehavethephenomenonofmultiple.National:iftheirproductionandwayoflifehavenosimilar,andtherearenosignificantdifferenceintheincidenceofthisdiseaseinethnicallymixedareas.,人群分布(Populationdistribution),居住在特定地理条件下的居民，通过饮水、空气和食物长期摄入过量的砷而引起的以皮肤色素脱失、着色、角化及癌变为主的全身性慢性中毒性疾病。,（四）地方性砷中毒（地砷病）,Endemicarsenicpoisoning,Theresidentslivesinaspecificgeographicalconditions,throughdrinkingwater,airandlong-termintakeoffood,intakeanexcessiveamountofarsenic,causedtheskinpigmentationchange,keratosis,andcancer-basedsystemicchronictoxicillnesses.,（四）地方性砷中毒（地砷病）,Endemicarsenicpoisoning,皮肤角化,色素沉着,SkinKeratosis,Hyperpigmentation,地砷病的危害,手/趾掌角化,花肚皮-腹部色素沉着与脱失,Thehazardofendemicarsenicosis,Hand/toepalmkeratosis,Flowerbelly-abdominalpigmentationchange,皮肤癌,Skincancer,地区分布（Regionaldistribution）,该病没有多发季节和多发年,Thereisnotmultipleseasonsandmultipleyearstothisdisease.,时间分布(Timedistribution),年龄分布任何年龄摄入过多的砷均可患病年龄该病的检出率性别分布调查结果不相一致，多数为男性女性,Agedistribution,Excessiveintakeofarsenicatanyagemaybesick.,Thedetectionrateofthediseaseincreaseswiththeincreasedage,Genderdistribution,Surveyresultsarenotconsistent,andthenumberofmalebeyondtheFemaleInmostcases.,人群分布(Populationdistribution),五、预防策略与措施,预防策略与措施防治机构监测,Preventionstrategiesandmeasures,PreventionstrategiesandmeasuresInstitutionsofpreventionandcontrolSurveillance,（一）预防策略与措施,地方病的预防与控制原则：预防为主，兼顾救治政府领导、部门配合，群众参与可持续性,Preventionstrategiesandmeasures,Endemicdiseasepreventionandcontrolprinciples:Focusingonpreventionandalsogiveconsiderationtoremedy.Governmentleading,departmentco-participatingandmassparticipation.Sustainability,碘缺乏病“全民食盐加碘”克山病“采用综合性措施”,不同疾病防治措施,Preventivemeasuresfordifferentdiseases,LodinedeficiencydiseaseNationalsaltiodizationKeshandiseaseAdoptingintegratedmeasureaccordingtoetiologicalfactor,大骨节病“换粮、补硒、移民、退耕还林还草”地方性氟中毒和地方性砷中毒“改水、改灶”,不同疾病防治措施,Preventivemeasuresfordifferentdiseases,Kashin-Beckdisease“changinggrain,intakingSe,immigration,returningfarmlandtoforestandgrassEndemicfluorosisandendemicarsenicpoisoningreformingwaterandchangingcookingstoves,（二）防治机构,Theinstitutionsofpreventionandcontrol,（二）防治机构,Theinstitutionsofpreventionandcontrol,卫生部,中国疾控地方病控制中心,全国鼠疫布病防治基地,寄生虫病预防控制所,EndemicDiseaseControlcenterofChineseCenterforDiseaseControlandPrevention,NationalbaseforthepreventionandcontrolofBrucellosisandPlague,Instituteforthepreventionandcontrolofparasiticdiseases,National,TheMinistryofHealth,（二）防治机构,Theinstitutionsofpreventionandcontrol,（二）防治机构,Theinstitutionsofpreventionandcontrol,省（区、市）,地方病防治所,省、市疾病控制中心地方病防治科,Provinces(regionsandmunicipalities),Instituteforthepreventionandcontrolofendemicdisease,EndemicdiseasedepartmentofprovincialandmunicipalCenterforDiseaseControlandprevention,（二）防治机构,Theinstitutionsofpreventionandcontrol,（二）防治机构,Theinstitutionsofpreventionandcontrol,县乡镇,县（旗）疾控中心地方病科,乡镇卫生院,CountyCountrysideTown,Counties(banners)CDCendemicDivision,Townshiphospitals,（二）防治机构,Theinstitutionsofpreventionandcontrol,病区地方病发病、患病情况病区外环境状况防治措施落实情况,ThemorbidityandprevalenceofEndemicendemicdiseaseThestateoftheenvironmentoutsideendemicdeseaseTheimplementationofpreventionandcontrolmeasures,（三）监测（surveillance）,52,病因学流行特征预防策略与措施地方性甲状腺肿的分型、分度及诊断标准,EtiologyEpidemiologicfeatureStrategiesandmeasuresTypes、degreesanddiagnosticstandardforendemicgoiter,第二节地方性碘缺乏病Iodinedeficiencydisorders,53,碘缺乏病是由于自然环境碘缺乏造成机体甲状腺激素不足所表现的一组地方病的总称。包括地方性甲状腺肿(地甲肿)、地方性克汀病(地克病)、地方性亚临床克汀病(亚克汀)、由于碘缺乏引起的胎儿流产、早产、死产、先天畸形等。,Iodinedeficiencydisordersareageneraltermforagroupofendemicdiseasesduetoenvironmentaliodinedeficiencyleadingtotheinsufficiencyofthyroidhormoneinthebody.Include:endemicgoiter,endemiccretinism,subclinicalcretinism,abortions,pretermbirth,stillbirths,andcongenitalanomaliesbecauseofiodinedeficiency.,54,Iodinedeficiencydisorders,地方性甲状腺肿Endemicgoiter,55,Iodinedeficiencydisorders,地方性甲状腺肿Endemicgoiter,正位,56,地方性克汀病Endemiccretinism,57,克汀病患者的傻笑Cretinismpatientgiggle,一代甲、二代傻、三代四代断根芽Firstgenerationgoiter,secondgenerationidiot,thirdandfourthenerationnooffspring.,58,碘缺乏碘缺乏病的影响因素致甲状腺肿物质营养因素环境污染遗传因素,IodinedeficiencyRiskfactorsforIDDGoitrogenoussubstanceNutritionalfactorsEnvironmentalpollutionHereditaryfactor,一、病因学(Etiology),59,地区分布时间分布人群分布,GeographicaldistributionTemporaldistributionPopulationdistribution,二、流行特征Epidemiologyfeature,60,IDD是世界上分布最广、受威胁人口最多的一种地方病,IDDistheworldsmostwidelydistributedendemicdisease,andthelargestpopulationareunderitsthreat.,地区分布（Regionaldistribution）,61,流行较重亚洲的喜马拉雅山区欧洲的阿尔卑斯和比里牛斯山区南美的安第斯山区非洲的刚果河流域大洋洲的巴布亚新几内亚北美洲的五大湖盆地,EpidemicseriouslyHimalayanregionsinAsiaAlpsandPyreneesinEuropeAndesinSouthAmericaCongoRiverBasininAfricaPapuaNewGuineainOceaniaGreatLakesinNorthAmerica,地区分布（Regionaldistribution）,全球共有22亿人口（占全世界人口的38%）生活在缺碘地区Atotalof220millionpeopleworldwide(accountingfor38%oftheworldspopulation)liveiniodine-deficientregions.,我国是世界上IDD分布广泛、病情严重的国家之一,主要流行特征是山区多于平原，内陆多于沿海，乡村多于城市ChinaisoneofthecountrieswhereIDDhavebeenwidelydistributedandseverelyprevalent,themainepidemiologicfeatureisthatmountainsaremorethanplains,inlandmorethancoastal,ruralmorethanurban.,地区分布（Regionaldistribution）,图28-2世界碘缺乏病波及的国家,表28-21994、2000年度中国碘缺乏病范围例数Table28-2ScopeandcasesofIDDinChinafor1994and2000,时间分布(Timedistribution),流行地区的人群任何年龄均可发病Peopleofanyageinendemicareascanbeill.5岁以下儿童发病较少，一般在青春发育期开始发病，随着年龄患病率，40岁以后逐渐Childrenunder5yearsofagehave