從預防醫(yī)學角度-論述寄生蟲病防治應從何處著手

1、Q3:從預防醫(yī)學角度論述寄生蟲病防治應從何處著手？,蠕蟲討論課,從預防醫(yī)學角度，論述寄生蟲病防治應從何處著手,模式：環(huán)境-人群-健康 研究對象：人群 思想：預防為主 針對：疾病的發(fā)展規(guī)律 目的：制定防制對策 促進健康和預防疾病 防制傷殘和夭折,,Preventive Medicine,特點：預防醫(yī)學的工作對象包括個體及群體；主要著眼于健康和無癥狀患者；研究重點為人群健

2、康與環(huán)境（工作、生活、社會環(huán)境）的關系；采取的對策更具積極的預防作用，具有較臨床醫(yī)學更大的人群健康效益；研究方法上更注重微觀和宏觀相結合。,Preventive Medicine,發(fā)展三階段：個體預防(from 16st) 以個體為對象進行疾病預防的科學稱為衛(wèi)生學群體預防(19st—20st) 除個人攝生之道外，還需采用免疫接種、隔離消毒、檢疫監(jiān)測、消滅病媒動物、垃圾糞便處理、食物和用水安全等全球（人類）預防(

3、1948—) 使所有的人都盡可能地達到最高的健康水平 慢性非傳染性疾病,Preventive Medicine,模式：環(huán)境-人群-健康對象：健康和無癥狀患者方式：群體預防目的：積極的預防作用,Core humanity,感染及被感染模型：,傳染途徑,傳染源,易感人群,Common existence,血吸蟲傳染源：人、家畜、野生動物（病人、病牛）傳染途徑：含有血吸蟲卵的糞便污染水體、水體中存在釘螺、人群接觸疫

4、水易感人群：人,絲蟲傳染源：血中帶有微絲蚴的病人和無癥狀帶蟲者傳染途徑：淡色庫蚊，中華按蚊易感人群：受蚊媒叮咬,模型檢驗：,傳染途徑,傳染源,易感人群,Common existence,模型建立,傳染源,糞便等宿主帶蟲者、隱形患者,,消滅傳染源： 通過普查普治帶蟲者和患者，查治或處理宿主。 流動人口的監(jiān)測，控制流行區(qū)傳染源的輸入和擴散。,傳染途徑,Unsafe drinking-water and sani

5、tation: an acute problem in urban areas切斷傳播途徑：加強糞便和水源的管理，搞好環(huán)境衛(wèi)生，以及控制或殺滅媒介肢動物和中間宿主。,,,易感人群,保護易感者：在某些寄生蟲的流行地區(qū)從事耕作或旅行，要采取必要的防護措施，必要時可咨詢醫(yī)生，服用某些預防藥物。,尼泊爾：確保童年期不患蠕蟲病(2008.8)發(fā)展中國家大多數(shù)兒童感染常見的腸道蠕蟲病。這些寄生蟲可引起營養(yǎng)不良，削弱兒童的發(fā)育、成長及學習能力。

6、過去近10年間，在實施一個全球最有效的蠕蟲控制項目時，尼泊爾的女性鄉(xiāng)村志愿者已向尼泊爾的學前兒童分發(fā)了超過2000萬片阿苯達唑藥片，后者是一種驅蟲藥。,尼泊爾衛(wèi)生工作人員在世衛(wèi)組織和聯(lián)合國兒童基金會幫助下，在學校兒童中開展研究，以確定此藥是否仍然有效。,注意個人生活衛(wèi)生,勤洗澡、換衣，勤理發(fā)、剪指甲，洗手要認真。,,,,Prevent reinfection and infection of othersChange bed lin

7、en & underwear daily Launder seperatelyDaily bathing (showering is best)Disinfect shower immediately after use,Clean Care is Safer Care,,食*戒——“病從口入”,改變不良飲食習慣，生吃瓜果蔬菜時，清洗一定要徹底，不吃未煮熟的河鮮、海鮮及肉類。不求新奇感與刺激感。,,,Antiparasi

8、tic Drugs,ParasiteHelminthiasisMalariaAmebiasis,,Anthelmintic Drugs,Action: ? Albendazole (阿苯達唑) - Interferes with synthesis of the parasites microtubules resulting in death of the larva ? Mebendazole (甲苯達唑)

9、 - Blocks the uptake of glucose by the helminthes which interferes with the production of substances needed for reproduction and survival,319,Action,? Pyrantel (噻嘧啶)Paralyzes the helminthes causing it to release its

10、grip on the intestinal wall, thus the parasite can be excreted from the body with feces ? Thiabendazole (噻苯咪唑) - Suppresses egg or larval production thus interrupting the life cycle of the helminthes,321,Anthelmin

11、tic Drugs Uses,Uses - AlbendazolePork tapeworms Treatment of liver, lung, & peritoneum diseases caused by dog tapeworm,Anthelmintic Drugs Uses,Uses --Mebendazole »Whipworm, pinworm, roundworm, hook

12、worm,Hookworm Roundworm Whipworm,Anthelmintic Drugs Uses,Uses - Pryantel »Roundworm and threadworm -Thiabendazole »Threadworm -DEC(海群生) »filaria,,,Safe, s

13、ingle-dose drugsNo individual diagnosis requiredSimple procedures,HelminthiasisPreventive treatment,,No need for recommendations,X,CHILDREN UNDER 12 MONTHS OF AGE SHOULD NOT BE TREATED,Recommendation No.1,,,In 2002,

14、a WHO Informal Consultation concluded that albendazole and mebendazole are safe for administration to children aged 12 months and older. There are no data on the use of these drugs in children aged under 12 months. Child

15、ren under 12 months of age should not be treated (unless indicated by a physician in a clinical setting).,Do NOT force a child to swallow the mixtureDo NOT hold the child’s nose to make him/ her swallow,Recommendation N

16、o.2,,,,Crush tablets and use waterOnly chewable deworming tablets should be given to children under 5 years of age.Tablets which taste good should be chosen. For children under 3 years of age, tablets should be broken

17、 and crushed between two spoons, then water added to help administer the tablets.,,DO let the child go home untreated if administration is unsuccessful; he/she will be treated during the next round or give tablets to

18、 mothers to give at home.,,Preventive chemotherapy,,,Regular preventive treatment,Regular, coordinated use of drugs to improve health, prevent disability and enhance human development,Identify groups or high-risk commu

19、nities,,Availability and affordability of drugs,(0.01 US$/treatment),(0.20 US$/treatment),(0.02 US$/treatment),(0.02 US$/treatment),Preventive chemotherapy,albendazoleormebendazole,ivermectinorDEC,praziquantel,+,+,On

20、chocerciasis(旋）, lymphatic filariasis, schistosomiasis,hookworm infections, ascariasis（蛔）, trichuriasis（鞭）,,,Current best practice in coordinated use of anthelminthic drugs,Preventive chemotherapy,,What are the next st

21、eps?Use elements from the Manual that are relevant for each specific country situationIdentify opportunities for co-deliveryBuild partnerships at country level,NTDsNeglected tropical diseases,If you haven't he

22、ard of leprosy, lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths, and trachoma, you aren't alone. Most of these diseases have little name recognition in industrialized countries, but

23、together they cause severe disability in the world's poorest countries, resulting in billions of dollars of lost productivity. Both the World Health Organization (WHO) and the Centers for Disease Control and Prevent

24、ion (CDC) have recently identified these diseases as 'targets of opportunity' in the effort to improve global health.,Global scale of NTDs,Regional perspectives,An overview on NTDs,NTDs in AFRO,Priority diseases

25、are:Dracunculiasis（麥地那龍線蟲?。〣uruli ulcerHuman African trypanosomiasisLeprosyLymphatic filariasisOnchocerciasisSchistosomiasisSoil-transmitted helminthiasis,NTDs in AMRO,The top priorities are:Chagas diseaseBlind

26、ing trachomaLymphatic filariasisOnchocerciasisSchistosomiasisSoil-transmitted helminthsLeprosy,NTDs in EMRO,Priority diseases are:DracunculiasisLeishmaniasisLymphatic filariasisOnchocerciasisSchistosomiasis (ur

27、inary schistosomiasis)Soil-transmitted helminthsZoonosis (brucellosis and rabies),NTDs in SEARO,Regional elimination/eradication initiatives are being taken for:Leprosy: target of elimination by 2005Lymphatic filaria

28、sis: elimination by 2020Kala-azar: elimination by 2015Yaws: eradication by 2012,NTDs in WPRO,Most of the problems in the Region are due to:DengueFood-borne trematodesIntestinal helminthsLymphatic filariasisSchisto

29、somiasis,,,COMMUNICABLE DISEASEPREVENTION AND CONTROL,Significant progress has been made in this area of work and, most importantly, a global plan for combating neglected tropical diseases 2008-2015 has been completed w

30、ith the active collaboration of all WHO regions, together with a group of 25 partner organizations. Major progress has also been made in building new partnerships, and in filling crucial gaps in access to essential drugs

31、 for neglected tropical diseases.,COMMUNICABLE DISEASERESEARCH,It aligns with the integrated approaches being promoted in the area of neglected tropical diseases, but has extensions into other disease areas, notably in

32、relation to malaria, and provides an evidence base for new primary health care concepts.,總述,Globalization：Area—Country—Region—WorldCare—Donation—Delivery—MoneySelf-consciousness—Interventions,Prevention, treatment and

33、 control,control,,Desease without boundaries,,The last decade has witnessed profound and novel threats to the public’s health: the emergence of deadly new infections such as SARS and the H5N1 influenza virus; 9/11 and th

34、e specter of bioterrorism; the spread of drug-resistant pathogens; a steep rise in obesity, diabetes and related chronic afflictions; widening disparities between rich and poor. All these trends represent health and soci

35、al problems compounded by the forces of globalization. Against this backdrop have unfolded revolutions in technology, genetics/genomics and communications – an explosion of knowledge that, when properly harnessed, could

36、turn back many of the scourges of our time.,,At HSPH, the ultimate goal of knowledge is improving lives and informing policy. Today, the School continues its long tradition of making a difference – from promoting interna