名的学校流行病学课件

1、1 哈哈 2 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) 3 第一节第一节 概概 述述 Introduction p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 Concept of endemic diseases Criteria and classification

2、 of endemic diseases The major endemic diseases in China Prevalence characteristics of several major endemic diseases Prevention strategies and measures 4 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

3、 were endemic diseases? F Endemic diseases have been defined as “a class of diseases that constantly present in people living in particular areas without imported cases from external sources” 5 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

4、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 ，甚至不，甚至不 发病发病 Criteria of endemic disease F incidence of the disease in any ethnic may increase in the residents in the area Fsimilar residents lived in other areas have the lower incidence, or even not occur the disease 6 二、地方病的判断依据及分类二、地方病的判

5、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 disease Fwho immigrate the area over a period of time, its inc

6、idence approaches that in local population Fthe people emigrate the area, the incidence would reduce, or symptoms alleviate or self-healing Fin addition, the local animals are also susceptible to the same disease 7 p 地球化学性地方病地球化学性地方病 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 关地方病关地方病 p 病因未明地方病病因未明地方

7、病 Classification of endemic diseases) Geochemistry endemic diseases Natural foci endemic disease particular production and Lifestyle-related endemic diseases Endemic disease of unknown etiology 8 p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 Geoche

8、mistry endemic diseases Iodine deficiency disease; drinking water type fluorosis and arsenic poisoning Natural foci endemic disease Schistosomiasis; plague ; Brucellosis 9 p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 Part

9、icular production and lifestyle-related endemic diseases Burning coal polluted type fluorosis Drinking tea type fluorosis Burning coal polluted type arsenic poisoning Endemic disease of unknown etiology Keshan disease; Kaschin-Beck disease; Pazhi disease; black foot disease 10 三、我国主要的地方病三、我国主要的地方病 纳

10、入重点防治的地方病：纳入重点防治的地方病： 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 disease The

11、major endemic diseases in China 11 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 12 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 characteristics of several major endemic diseases Endemic fluorosis Kaschin-Beck disease Keshan disease Endemic arsenic poiso

12、ning 13 ( (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 clinical 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 geoch

13、emical disease occurred in a particular geographical environment , for chronic systemic accumulated poisoning caused by long-term intake of excessive fluoride in human 14 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 fluorosis caused by high fluoride

14、intake the performance of enamel is chalk, coloring, or defect Once formed, enamel formation would be left over the full life 15 氟斑牙氟斑牙 Dental fluorosis 16 氟骨症氟骨症 Skeletal fluorosis 17 骨症骨症 Skeletal fluorosis 18 按氟的来源不同分为按氟的来源不同分为 p 饮水型饮水型 p 燃煤型燃煤型 饮茶型饮茶型 Divided according to different sources of fl

15、uorine: Drinking water type Burning coal type Drinking tea Type ( (一一) )地方性氟中毒地方性氟中毒( (地氟病地氟病) ) （Endemic fluorosis） 19 地区分布地区分布 (Regional distribution) p世界广泛分布世界广泛分布: : 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 serious Domestic 20 饮茶型氟中毒病区分布饮茶型氟中毒病区分布 21 该病的

16、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 childr

17、en suffering from moderate, mainly for the chalk-like change 人群分布人群分布 (Population distribution) 22 氟斑牙（白垩样改变）氟斑牙（白垩样改变） Dental fluorosis (chalk-like change) 23 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

18、years old, and especially after the 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) 24 （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

19、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 cases can lead to short sta

20、ture deformities, permanent disability. 25 大骨节病大骨节病 Kashin-Beck diseaseKashin-Beck disease 变形性骨关节病变形性骨关节病 Deformation osteoarthropathy 26 Kashin-Beck disease Dwarf deformity 27 大骨节病地区分布大骨节病地区分布 The geographical distribution of Kashin-Beck disease 28 1.1.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

21、高发年病的高发年 2.2.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 years The season is di

22、fferent from many wards, and the general spring-prone. In causative agent active area, the incidence of this disease will could be seen in the four seasons. 29 1.1.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 chi

23、ldren and adolescents, and very few new cases in adults, No significant gender differences Differences 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) 30 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

24、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. 31 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 disease Theory of geochemical hypothesis Theory of biological causes

25、 32 地区分布地区分布（Regional distribution） 33 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) 34 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 ch

26、ildren 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 distribution) 35 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

27、，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 have 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

28、 this disease in ethnically mixed areas. 人群分布人群分布 (Population distribution)(Population distribution) 36 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

29、 residents lives in a specific geographical conditions, through drinking water, air and 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 poi

30、soning 37 皮肤角化皮肤角化色素沉着色素沉着Skin KeratosisSkin Keratosis HyperpigmentationHyperpigmentation 38 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 arsenicosis Hand / toe palm keratosis Flower belly- abdominal pigmentation change 39 皮肤癌皮肤癌 Skin cancerSkin cancer 40 地区分布地区分布（Reg

31、ional distributionRegional distribution） 41 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 multiple seasons and multiple years to this disease. 时间分布时间分布 (Time distribution)(Time distribution) 42 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 distribut

32、ionAge distribution Excessive intake of arsenic at Excessive intake of arsenic at any age may be sick.any age may be sick. The detection rate of the disease The detection rate of the disease increases with the increased ageincreases with the increased age Gender distributionGender distribution Surve

33、y results are not Survey results are not consistent, and the number of consistent, and the number of male beyond the Female In most male beyond the Female In most cases.cases. 人群分布人群分布 (Population distribution)(Population distribution) 43 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 Preven

34、tion strategies and measures Prevention strategies and measures Institutions of prevention and control Surveillance 44 （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 measures Endemic disease prevention and control pri

35、nciples: Focusing on prevention and also give consideration to remedy. Government leading, department co- participating and mass participation. Sustainability 45 p 碘缺乏病碘缺乏病 “全民食盐加碘全民食盐加碘” p 克山病克山病 “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 diseases FLodine deficiency disease

36、 National salt iodization F Keshan disease Adopting integrated measure according to etiological factor 46 p大骨节病大骨节病 “换粮、补硒、移民、退换粮、补硒、移民、退 耕还林还草耕还林还草” 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 “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 diseases F Kashin-Beck disease “changing grain, intaking

37、 Se, immigration, returning farmland to forest and grass F Endemic fluorosis and endemic arsenic poisoning reforming water and changing cooking stoves 47 （二）防治机构（二）防治机构 The institutions of prevention and control 地区地区国家国家省省 县县 National Province Area County （二）防治机构（二）防治机构 The institutions of preventio

38、n and control 48 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 Disease Control and Prevention National base for the prevention and control of Brucellosis and Plague Institute for the prevention and control of parasitic

39、diseases National 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 control 49 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

40、endemic disease Endemic disease department of provincial and municipal Center for Disease 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 control 50 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 County Countrysi

41、de Town Countryside Town Counties (banners) CDC endemic DivisionCounties (banners) CDC endemic Division Township hospitalsTownship hospitals （二）防治机构（二）防治机构 The institutions of prevention and control 51 病区地方病发病、患病区地方病发病、患 病情况病情况 病区外环境状况病区外环境状况 防治措施落实情况防治措施落实情况 The morbidity and prevalence of Endemic

42、endemic disease The state of the environment outside endemic desease The implementation of prevention and control measures （三）监测（三）监测 （surveillance） 52 p病因学病因学 p流行特征流行特征 p预防策略与措施预防策略与措施 p地方性甲状腺肿的分型、地方性甲状腺肿的分型、 分度及诊断标准分度及诊断标准 Etiology Epidemiologic feature Strategies and measures Types、degrees and di

43、agnostic standard for endemic goiter 第二节第二节 地方性碘缺乏病地方性碘缺乏病 Iodine deficiency disorders 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。包括现的一组地方病的总称。包括 地方性甲状腺肿地方性甲状腺肿( (地甲肿地甲肿) )、地方、地方 性克汀病性克汀病( (地克病地克病) )、地方性亚临床克汀病、地方性亚临床克汀病( (亚克汀亚克汀) )、由于碘缺、由于碘缺 乏引起的胎儿流产、早产、死产、先天畸形等。乏引起的胎儿流产、早产

44、、死产、先天畸形等。 Iodine deficiency disorders are a general term for a group of endemic diseases due to environmental iodine deficiency leading to the insufficiency of thyroid hormone in the body. Include: endemic goiter, endemic cretinism , subclinical cretinism, abortions, preterm birth, stillbirths, and

45、 congenital anomalies because of iodine deficiency. 54 Iodine deficiency disorders 地方性甲状腺肿地方性甲状腺肿 Endemic goiter 55 Iodine deficiency disorders 地方性甲状腺肿地方性甲状腺肿 Endemic goiter 正正 位位 56 地方性克汀病地方性克汀病 Endemic cretinism 57 Cretinism patient giggle 一代甲、二代一代甲、二代 傻、三代四代傻、三代四代 断根芽断根芽 second generation idiot,

46、third and fourth eneration no offspring. 58 p碘缺乏碘缺乏 p碘缺乏病的影响因素碘缺乏病的影响因素 p致甲状腺肿物质致甲状腺肿物质 p营养因素营养因素 p环境污染环境污染 p遗传因素遗传因素 Iodine deficiency Risk factors for IDD Goitrogenous substance Nutritional factors Environmental pollution Hereditary factor 一、病因学一、病因学 (Etiology) 59 p 地区分布地区分布 p 时间分布时间分布 人群分布人群分布 Ge

47、ographical distribution Temporal distribution Population distribution 二、流行特征二、流行特征 Epidemiology feature 60 p IDD是世界上分布最广、受威胁人口最多的一是世界上分布最广、受威胁人口最多的一 种地方病种地方病 IDD is the worlds most widely distributed endemic disease, and the largest population are under its threat. 地区分布地区分布（Regional distribution） 61

48、61 p流行较重流行较重 亚洲的喜马拉雅山区亚洲的喜马拉雅山区 欧洲的阿尔卑斯和比里牛斯山区欧洲的阿尔卑斯和比里牛斯山区 南美的安第斯山区南美的安第斯山区 非洲的刚果河流域非洲的刚果河流域 大洋洲的巴布亚新几内亚大洋洲的巴布亚新几内亚 北美洲的五大湖盆地北美洲的五大湖盆地 Epidemic seriously Himalayan regions in Asia Alps and Pyrenees in Europe Andes in South America Congo River Basin in Africa Papua New Guinea in Oceania Great Lakes

49、 in North America 地区分布地区分布（Regional distribution） 62 全球共有全球共有2222亿人口（占全世界人口的亿人口（占全世界人口的38%38%）生活在缺碘地区）生活在缺碘地区 A total of 220 million people worldwide (accounting for 38% of the worlds population) live in iodine-deficient regions. 我国是世界上我国是世界上IDD分布广泛、病情严重的国家之一分布广泛、病情严重的国家之一, ,主要流行主要流行 特征是山区多于平原，内陆多于沿

50、海，乡村多于城市特征是山区多于平原，内陆多于沿海，乡村多于城市 China is one of the countries where IDD have been widely distributed and severely prevalent, the main epidemiologic feature is that mountains are more than plains, inland more than coastal, rural more than urban. 地区分布地区分布（Regional distribution） 63 图图28-2 28-2 世界碘缺乏病波及

51、的国家世界碘缺乏病波及的国家 64 表表28-2 199428-2 1994、20002000年度中国碘缺乏病范围例数年度中国碘缺乏病范围例数 Table 28-2 Scope and cases of IDD in China for1994 and 2000 时间分布时间分布 (Time distribution)(Time distribution) 65 p流行地区的人群任何年龄均可发病流行地区的人群任何年龄均可发病 People of any age in endemic areas can be ill. p5 5岁以下儿童发病较少，一般在青春发育期开始岁以下儿童发病较少，一般在青春发育期开始 发病，随着年龄发病，随着年龄 患病率患病率 ， 4040岁以后逐渐岁以后逐渐 Children under 5 years of age have a low incidence of IDD, generally beginning at puberty. Prevalence increases with age, but prevalence decreases after 40 years of age with age. 人群分布人群分布 (Population distribution)(Popula