災(zāi)后疾病監(jiān)測醫(yī)療實(shí)務(wù)

1、災(zāi)后疾病監(jiān)測醫(yī)療實(shí)務(wù)The 921 Earthquake, 1999天然災(zāi)害疫病爆發(fā)流行?疾病爆發(fā)流行的因素感染流行居住環(huán)境改變空氣污染土地污染水源污染病媒孳生通報(bào)不及民眾抵抗力降低供水系統(tǒng)破壞 媒體炒作(假疫情)通訊破壞住處擁擠食物儲存設(shè)備破壞各種災(zāi)害可能引起之防疫問題災(zāi)害名稱防疫問題處理方法備註颱風(fēng)腸胃道疾病蟲媒傳染病其它疾病注意飲用水煮沸、食物煮熟食用環(huán)境衛(wèi)生消毒孳生源去除常挾帶豪雨造成淹水，引起水污染及形成孳生源，甚至攜帶新病源水災(zāi)腸胃道疾病蟲媒傳染病同上淹水造成水污染及形成孳生源地震外傷感染(破傷風(fēng))腸胃道疾病(飲水系統(tǒng)遭破壞時(shí))蟲媒疾病(災(zāi)民收容所或露宿街頭)施打類毒素、充份消毒處

2、理餘同上列處理方法防疫應(yīng)變工作參考手冊內(nèi)政部消防署、營建署國防部環(huán)境保護(hù)署農(nóng)業(yè)委員會疾病管制局病媒及昆蟲病組各分局衛(wèi)生署指揮中心總指揮-局長(副局長)行政院細(xì)菌性疾病組預(yù)防接種組疫 情 組血清疫苗研製中心特殊性疾病組檢 疫 組寄生蟲病組綜合業(yè)務(wù)組地方衛(wèi)生局病毒性疾病組疫情組成立中央災(zāi)害防疫緊急應(yīng)變工作小組各組協(xié)助進(jìn)行防疫需求評估及相關(guān)防疫措施負(fù)責(zé)協(xié)調(diào)及後勤支援工作陳報(bào)召集協(xié)調(diào)秘書室 會計(jì)室中央防疫處理組織圖衛(wèi)生局自 來 水事業(yè)單位農(nóng)業(yè)局環(huán)境保護(hù)局農(nóng)業(yè)委員會內(nèi)政部衛(wèi)生署環(huán)境保護(hù)署動植物防疫檢疫局疾病管制局成立應(yīng)變工作小組評估防疫需求疫病監(jiān)視與疫情之處理病媒調(diào)查環(huán)境衛(wèi)生調(diào)查各項(xiàng)傳染病防治督導(dǎo)災(zāi)區(qū)環(huán)

3、境清理及消毒事項(xiàng)督導(dǎo)災(zāi)區(qū)飲用水水質(zhì)抽驗(yàn)事項(xiàng)自來水供應(yīng)自來水管線維護(hù)自來水水質(zhì)抽驗(yàn)人畜共通傳染病之動物防疫與養(yǎng)殖業(yè)問題流浪動物防治行政院縣(市)政府災(zāi)後防疫體系各權(quán)責(zé)單位分工架構(gòu)圖重大災(zāi)害發(fā)生時(shí)縣市支援分配表需支援之縣市互相提供支援縣市第一順位 第二順位北區(qū)臺北市、基隆市、臺北縣、宜蘭縣、桃園縣、新竹市、新竹縣、金門縣、連江縣北區(qū)東區(qū)中區(qū)苗栗縣、臺中市、臺中縣、彰化縣、南投縣、雲(yún)林縣南區(qū)嘉義縣、嘉義市、臺南市、臺南縣、高雄市、高雄縣、屏東縣、澎湖縣東區(qū)臺東縣、花蓮縣北區(qū)東區(qū)北區(qū)東區(qū)北區(qū)東區(qū)災(zāi)害發(fā)生後應(yīng)考慮之防疫事項(xiàng)疫苗儲存設(shè)備是否受損通訊設(shè)備是否中斷進(jìn)行災(zāi)區(qū)防疫需求評估環(huán)境致病危險(xiǎn)因子監(jiān)視與控制

4、傳染病監(jiān)視與控制災(zāi)害發(fā)生防疫需求評估(災(zāi)害防疫緊急應(yīng)變小組)環(huán)境衛(wèi)生監(jiān)視系統(tǒng)環(huán)境衛(wèi)生環(huán)境衛(wèi)生調(diào)查病媒監(jiān)測水質(zhì)監(jiān)測疫病監(jiān)視自來水食品災(zāi)民臨時(shí)聚集場所廢污處理有害動物屍體資料分析防疫措施決定動員之人力及監(jiān)視系統(tǒng)監(jiān)測改善災(zāi)害發(fā)生後之防疫需求評估流程簡圖防疫需求評估的實(shí)施步驟災(zāi)後由地方防疫緊急應(yīng)變工作小組立即進(jìn)行防疫需求調(diào)查視災(zāi)區(qū)範(fàn)圍區(qū)域決定由地方或中央緊急應(yīng)變工作小組快速進(jìn)行問題之評估及分析，供主管機(jī)關(guān)決策或政策判斷地方無法單獨(dú)進(jìn)行防疫需求調(diào)查時(shí)，可由中央防疫緊急應(yīng)變工作小組視情況成立先遣部隊(duì)，協(xié)助進(jìn)行防疫需求評估調(diào)查及問題分析Need Assessment QuestionnaireNeed as

5、sessmentRandom sampling 100 householdsInterview face-to-face by structure questionnaireAssessment of post-earthquake needs Items of Needs the most % - Adequate no. of shower and toilets in the shelter 63.8 - Drinking water 47.8 - The sanitation of shower and toilets 36.2 - The assurance of living in

6、 those home 33.3 - The structural safety of homes 30.0 - School of children 18.8 - Job 8.7 - Tents 7.3 - Food 2.9 - Medication supply 2.9 - Clothes for winter 2.9 - Blanket 2.9The most needed from the government Items % Household arranged 75.3Reconstructure of home 13.0 Living expense 10.1Job 7.2Sch

7、ooling of children 5.8決定疫情監(jiān)視通報(bào)點(diǎn)工作分派決定疫情監(jiān)視通報(bào)內(nèi)容及項(xiàng)目決定監(jiān)視通報(bào)之頻率決定監(jiān)視通報(bào)之通訊及傳輸方式彙整監(jiān)視通報(bào)資料對於法定傳染病及暴發(fā)流行疾病之處理對於假疫情之處理疾病監(jiān)視及疫情處理Charts used in 921quake medical stations25 monitor stationsStaff from central and local Health DepartmentMonitored diarrhea, respiratory illness, injuries, dermal conditions, 38 notifiabl

8、e disease, chronic disease, drinking water, garbageReporting every dayEstablish active surveillance Disease Surveillance Teams in Disaster AreasNo. of Teams and Workers Assigned for Disease SurveillanceSupporting Agency No. of Teams No. of workers* Duration (person-times) CDC,DOH 3 77 29/9-16/10Heal

9、th Bureau(less bureaus 7 141 13/10-30/11 in central part)*one team a week ; teams worked together for one day for shift-reliefMorbidity, percentage for selected diseases (from Oct. 4 to Nov. 14)Data:Wei-Jen Chen, M.D., Ph.D. Crude incidence for selected disease in earthquake ARI No. of cases (per se

10、ntinel physician per week)Post-earthquake timeCrude incidence for selected disease in earthquake Acute gastroenteritis Post-earthquake timeNo. of cases (per sentinel physician per week)Cases* of Shigellosis identified in Nantou County during the quakeDistributed Area No. of CasesNanfeng Village (南豐村

11、) 6 Chunyang Village (春陽村) 2# Chingying Village (精英村) 5Hetsuo Village (合作村) 1Fahsiang. Village (發(fā)祥村) 1 Total 15* Number of positive cases in the last three years : 36 (1996), 38 (1997), 28 (1998)# one of them lived in Puli (埔里鎮(zhèn)) two were asymptomatic.Comparison of Shigella Dysentery Cases between 19

12、97-1998 in Taichung and Nantou CountyTaichung CountyNantou CountyReported CasesConfirmed Cases災(zāi)後飲用水處理注意事項(xiàng)以蓄水池貯水時(shí)應(yīng)檢查是否淹水，如有淹水應(yīng)予適當(dāng)消毒，才可繼續(xù)使用假設(shè)災(zāi)後水質(zhì)濁度增高，應(yīng)煮沸後再飲用或暫時(shí)飲用包裝水災(zāi)後因加氯量增加，燒開水煮沸後應(yīng)再開煮三分鐘，以保障飲水平安自來水用戶災(zāi)後飲用水處理注意事項(xiàng)災(zāi)後管理單位應(yīng)去除水井或水源地之污泥，並刷洗乾淨(jìng)，必要時(shí)施以消毒飲用水煮沸後才可飲用簡易自來水用戶災(zāi)後飲用水處理注意事項(xiàng)個(gè)人飲用水來源為井水，山泉水或河川池塘等者，在災(zāi)後水質(zhì)濁度增高

13、時(shí)， ，宜加強(qiáng)過濾或投以適量明礬充份攪拌後，靜置一段時(shí)間，取其澄清液煮沸後再飲用必要時(shí)可暫時(shí)飲用包裝水，以保障飲水平安非自來水地區(qū)Division heads visited the disaster areas for supervisionTeam for Environmental Sanitation SurveyWater supplies in disaster areasDonated mineral water in disaster area災(zāi)後廢污處理注意事項(xiàng)廢水應(yīng)設(shè)法排入下水道，垃圾應(yīng)裝在不透水的垃圾袋並妥善存放定點(diǎn)，以利消毒及去除廢棄物消毒應(yīng)取一公斤裝30%濃度之漂白粉

14、，直接灑於外表，灑漂白粉時(shí)應(yīng)配帶護(hù)目鏡，手套與口罩一般環(huán)境消毒應(yīng)使用二十五加崙或100公升大型塑膠桶裝滿清水後，倒入4-5平複方媒餾油酚，攪拌，靜止後以噴灑方式使用廢棄物災(zāi)後廢污處理注意事項(xiàng)有害動物處理方法吸血性昆蟲，蟑螂，蒼蠅吸血性昆蟲包括蚊蟲，跳蚤等，使用標(biāo)示上有環(huán)保署登記許可證字號之殺蟲劑，並在使用時(shí)，仔細(xì)研讀藥瓶上之標(biāo)示老鼠使用捕鼠籠，粘鼠板或標(biāo)示上有使用標(biāo)示上有環(huán)保署登記許可證字號之滅鼠劑，並需配合滅蚤虎頭蜂，蛇，流浪狗使用捕鼠籠，粘鼠板或標(biāo)示上有使用標(biāo)示上有環(huán)保署登記許可證字號之滅鼠劑，並需配合滅蚤Insecticide sprayVector controlDisinfectio

15、n of fields冷運(yùn)冷藏系統(tǒng)、疫苗損施及請求支援通報(bào)確認(rèn)災(zāi)區(qū)尚可支應(yīng)之冷藏動力與設(shè)備及重建疫苗供應(yīng)臨時(shí)接種站之建立預(yù)防接種應(yīng)變措施之即時(shí)宣導(dǎo)與通知管道之建立疫苗供需與管理行政院衛(wèi)生署行政院衛(wèi)生署疾病管制局大 區(qū) 域 性 災(zāi) 害區(qū)域性災(zāi)害縣市衛(wèi)生局鄉(xiāng)鎮(zhèn)、市、區(qū)衛(wèi)生所衛(wèi)生室、合約院所其他鄉(xiāng)鎮(zhèn)、市、區(qū)衛(wèi)生所其他縣(市)衛(wèi)生局地方性災(zāi)害天然災(zāi)害後疫苗供應(yīng)及冷儲管理緊急作業(yè)流程陳報(bào)支援統(tǒng)籌調(diào)撥支援*災(zāi)害報(bào)告應(yīng)於二小時(shí)內(nèi)完成；局彙整報(bào)告於*二十四小時(shí)(*四小時(shí)*二小時(shí))內(nèi)通報(bào)支援支援*支援支援*Vaccination Established temporary vaccination station

16、 Influenza vaccination for 65 years old personsHepatitis A vaccination for cook Keep routine immunization programinfluenza for the elderlyadditional 70,000 doses procured50,292 persons immunizedhepatitis A vaccines for food handlers3,750 doses usedImmunizationHealth Education for PublicProvide the Information of Communicable DiseasesReport of disease informationCorrect of RumorsHealth education of the publicPublishing a “ Manual on Disease Control at EarthquakeTo educate the public how to handle food and drinking water, and how to dispose of refuse