G OO 6 S GS SO OO f e s ata se pa ea

1. ???????? ???????? ???G??? ????O??O?6? ???S???????? ???????  ???G??S ??S????????O? ????O??O????f?�??e?? ??s?�ata se ?????? pa????? ??e?a? ?a??a ????????? ??d???? ?a??????? � ???�?????????, G.?.?????? �?pp????te??� 3 ??e��???? 2006

2. ???f?�??e?? ??s?�ata

3. ??sa????-?p?d?�??????a ? ???f?�??e?? ??s?�ata p??s�????? pe??p?? 76 e?at?�???a ?t?�a �e 325000 ??s??e?e? ?at� ?t?? st?? ?.?.?. (?p?????s�?? CDC) ??? ? ??s???t?ta e??a? p??? �e???? ? ???t?t?ta e??a? �???? (pe??p?? 5000 ?t?�a pe?a????? ?at� ?t??). S?????? p??? ??a ? ??????�??a ?t?�a ? ?t?�a �e ?p??e?�e?? a??s??atast???. ?? p??sfate? a??a??? st?? t??p? ???? (ta??t?ta �etaf????) ?a??? ?a? ?? te??st?e? a??a??? p?? e??a? ?? ap?t??es�a t?? �a????p???s? st?? pa?a???? ?a? st?? d?a??�? t??f?�?? ?p?? ep?s?? ?a? ? a?t??? t?? �????�??? ????? ?? ap?t??es�a t?? e�f???s? ???? �a?? �e t?? p???? pa?ad?s?a??? �??f?? t?? t??f?�??e??? ???�??e??. Practice Guidelines for the Management of Infectious Diarrhea. IDSA. CID 2001;32:331-351

4. ??sa????-?p?d?�??????a ?? ?? ????? pa????? ??e?a? ???? �a????? pa?a????? ?a? d?a????s?? t??f?�?? ?a? pa???s?a? ?d?a?te?a e?pa??? at?�?? e??a? s???? ped?? e�f???s?? e???se?? ????s�?t?? t?f?�??e??? ???�??e??. ?a t??f?�??e?? ??s?�ata de? d?af????? ?? p??? t?? e?d???se?? e?te af????? t?? ?????t?ta e?te ?????? pa????? ??e?a?. ????te?? d?af????? d?????s? st??? ?????? pa????? ??e?a? d??t? ?p?????? p???? ???a a?t?a ?ast?e?te??t?da?-?d?a?te?a p??�??�ata ????? d??t?a ep?t???s?? ?a? ?ata??af?? pa?????? s?st?�at??? ep?d?�???????? st???e?a p?? af????? t?? ?????t?ta se p????? ???e?.(p?.FOOD-NET st?? ???, ???????, ?F??) ?p? ?????? pa????? ??e?a?: p????? �e�???�??e? pe????af?? �????ep?d?�??? �e t?? e?a??es? �e????? p???? s?st?�at???? st???e??? ap? ???s�??e? ???e?( ?e?. ??etta??a ? ??st?a??a)

5. ?p?d?�??????a-??st?? ??st??: St?? ?e?. ??etta??a $ 1.488 e? ?? ???�??e?? s?et???�e?e? �e ?????? pa????? ??e?a?. ?p?d?�???? e???se?? ?ast?e?te??t?da?: 12,5% t?? s???????? ??st??? (sta ep?peda t?? ???????�??e??): $ 184 e?. (2002-2003)

6. ?p?pt?se?? ????a e?d???s? e??a? ? ?ast?e?te??t?da p??????? e?t?se?? (?????? ??s???t?ta-? ???t?t?ta e??a? s?????? �????) ?? ???�?de?? pa?????te? p?? p???a???? t??f?�??e?e?? ???�??e?? s?????? �etad?d??ta? p??? e????a �e ?�es? ? ?�es? epaf? ap? ?t?�? se ?t?�? e?te �e t? ?e?? ?a? ta t??f?�a (t??f?�??e?e?? ???�??e??) ?a? s???? p???a???? de?te???e?e?? ep?d?�???? e???se?? ????s�?t?? a? de? a?a?????s???? ???a??a Current Opinion in Pharmacology 2005;5:559-565

7. ???e? ep?pt?se?? S?st?�at??? ??s?? ?p?? ? t?f?e?d?? p??et??, ??ste???s? (�??????t?da, s???), ?e??ta??? p??et??, ????p?as�a, t??????s? ?e????????? ??s??: ???a?t?as?, ??ste???s? (�??????t?da), nvCreutzefelt-Jakobs(??s?? t?e??? a?e??d??), �a??t???a, tet?ad?t????? S?�a??? �a????????e? ep?p????? : a?�???t??? ???a?�??? s??d??�? ?a? ?ef???? a?ep???e?a s?et???�e?? �e E.Coli 0-157 ?:7 (STEC ? e?te??a?�???a???? ? VTEC) s??d??�? Guillain-Barre �et? ap? ???�??? �e C. jejuni Diagnosis and Management of foodborne illnesses CDC MMWR 2004;53(No RR-4)

8. S?�pt?�ata

9. ???f???? d???t????se??

10. ?a?????a p?? p???a???? t??f?�??e?e?? ???�??e?? ?p? ta 250 ?a? p???? pa?????a p?? p???a???? t??f?�??e?e?? ???�??e?? ta s????te?a e??a?: ?a?t???a: Salmonella spp ,Shigella spp, .Campylobacter spp E Coli ?:157 ?7. Listeria spp Yersinia, Clostiridium perfingens ?a??s?ta: Cryptosporidium, Giardia Lamblia, Entamoeba histolytica ???: Norwalk virus Rotavirus, Adenovirus,, ?epatitis A virus S????te?a ta?t?p?????ta? ?? �????�?a??? pa?????te? a? ?a? s????te?e? e??a? ?? ???e?e?? t?f?�??e?e?? ???�??e?? a??? ?? ??? ta?t?p?????ta? d?s???a. Diagnosis and Management of foodborne illnesses CDC MMWR 2004;53(No RR-4)

11. S????? a?t?a t??f?�??e??? ???�??e??

12. S????? a?t?a t??f?�??e??? ???�??e??

14. ?? ???�?d? a?t?a t??f?�??e??? ???�??e??

15. ?p?d?�???? e???se?? (outbreak) ??????? st?? ?????a ?a? ?e?. ??etta??a 1990-5

16. ?p?d?�???? e???se?? ??????? st?? ?????a ?a? ?e?. ??etta??a 1990-5

17. ?p?d?�???? e???se?? ???�?d??? ?ast?e?te??t?da? sta ??s???�e?a st?? ?????a ?a? ?e?. ??etta??a 1992-200

19. ?p?d?�???? e???se?? ???�?d??? ?ast?e?te??t?da? sta ??s???�e?a st?? ?????a ?a? ?e?. ??etta??a 1992-2000???f?�??e?e?? ???�??e??

20. ?p?d?�???? e???se?? ???�?d??? ?ast?e?te??t?da? sta ??s???�e?a st?? ?????a ?a? ?e?. ??etta??a 1992-2000T??t?t?ta

24. ???s�?? ???????a: ????s? t?? �????? t?? ??p????? > 250gr a?? 24???. ????s? t?? ?e?st?t?ta? t?? ??p????? (�a?a?? ? ?da?? ??p?a?a) e?te a???s? t?? ????? t??? e?te a???s? t?? s????t?ta? t?? ?e??se?? se pe??ss?te?e? ap? t?e?? ?�e??s??? ??s???�e?a?? ???????a: ?�f???s? 72 ??e? �et? t?? e?s?d? t?? as?e???? st? ??s???�e?? �??? d?a?????? s??d??�?�: ?????e?a < 14 ?�??e? (? ?a? �???? t?e?? �d?�?de? ?at� ???s�?????). �?p?�??? d?a?????? s??d??�?�: >14 ?�??e? �?????? d?a?????? s??d??�?�: > 1 �??a �F?e?�???d?? d??????a�: ?????a?? ?????, te??es�??, pa???s?a a?�at?? , ?e?????t???? st? ??p?a?a

25. ???t???a ??a t? d?????s? t?? ?ast?e?te??t?da? ???t?? ??????? ??d???? ???�??e?? ???t???? 1 (???a??): ? as?e??? e�fa???e? ap?t?�? d??????a (?da?? ??p?a?a ??a pa?ap??? ap? 12 ??e?) �e ? ????? e�?t??? ? p??et? (>38 ?C), ?a? ????? t?? pa???s?a e�fa???? �? ???�?d??? a?t?a? (p?. ??????s? fa?�????, ??e?a pa?????s? ?????a? ??s?? ? ?????????? stress)

26. ???t???a ??a t? d?????s? t?? ?ast?e?te??t?da? ???t?? ??????? ??d???? ???�??e?? ???t???? 2 (?e�a??�???):? as?e??? e�fa???e? 2 t??????st?? ap? ta a??????a s?�e?a s?�e?a ? s?�pt?�ata ????? ?a ?p???e? ???? a?a?????s�??? a?t?a: ???et?? (>38 ?C,?a?t?a, ?�et?? ,?????a?? ????? ,? e?a?s??s?a) ?a? t??????st?? 1 ap? ta a??????a 1. Tet??? ?a??????e?a ??a e?te???? pa?????? ap? ta ??p?a?a ? ap? de??�at?????a ????? �e st??e? 2. ??e??es? e?te????? pa??????? �e �????s??p?s? (�e ????? ? ??e?t?????? �????s??p?? ) 3. ??e??es? e?te????? pa??????? �?s? a?t???????? ? a?t?s?�at???? a????s?? st? a?�a ? sta ??p?a?a 4. ??de??e?? ??a t?? pa???s?a e?te????? pa??????? p?? a????e?eta? d?a ?st???? ?a??????e?a? (a????e?s? t??????) 5. ??a???st??? �????? t?t?? a?t?s?�?t?? (IgM) ? tet?ap?as?as�? t?? t?t??? t?? e?d???? ??a t? pa?????? a?t?s?�?t?? .(IgG)

27. ??e?e???s? s?????? ????s�?t?? t??f?�??e??? ???�??e?? ???e ??a?s? ????s�?t?? a????e? �e ??a as?e?? p?? �p??e? ?a �?? e??a? ?d?a?te?a p?s??? ?a s?�pt?�ata e??a? s?????? p??? ????? (e?d???se?? ?ast?e?te??t?d??) ????? ?a ap???e???ta? ?a? p???? s?st?�at???. S?�a?t??? st???e?a: ?????? ep?as?? (p??s??? a? e??a? �a????) ?????e?a ?p???e?��at???? ??s?? ????a ??????? s?�e?a ?a? s?�pt?�ata ?p?pte? t??f?? ? p????s�?? p?? e?t????e ???a ?t?�a �e s????? se ?????, ???? �e pa??�??a s?�pt?�ata ?p???????? ??s??-f??e?a

28. ?ata????s? ?p?pt?? t??f?? ???f?? p?? ?ata?a?????ta? f??s??e? ? a?epa???? ??�??e?: F??s?a ? �?s???�??a a??? (�a??????a), ?st?a?a, ???ata (??t?p???a, ??�??), ????a, �? paste???�??a ???ata ? p?????ta ???a?t?? ? f???t???�??, ???s??�e?, ?a?a???? ? �a?a?? t???? ap? �? paste???�??? ???a

29. ??de??? ??s???�e?a??? ep?d?�?a? ?ast?e?te??t?da? ? e�f???s? d?? ? pe??ss?te??? pe??pt?se?? ??s???�e?a??? ???�?d??? ?ast?e?te??t?da? p?? p????????a? ap? t?? ?d?? �???????a??s�? �?sa se �e????? �d?�?de? ?a p??pe? ?a ??t??? ?p????a t???? s?s??t?s?? �eta?? t???. ? d?e?e???s? t?? pe??stat???? �p??e? ?a �?? a?ade??e? t?? p??? t?? ???�??e??. ? pa?a???????s? t?? ?a???e??e??? ????? ??s??e??�???? as?e??? st?? ?d?e? pe?????? ??s??e?t???? f???t?da? t?? as?e?? �e ?ast?e?te??t?da, �???? st?? a?a?????s? t?? as?�t?�at???? as?e???. S???pa??? pe??pt?se?? ?ast?e?te??t?da? se p??s?p??? ?a? as?e?e?? ??????????ta? ?? ?a???e? d?e?e???s?? ??s???�e?a??? ep?d?�?a?

30. ??????s?

31. ??????s?

32. ????????s? as?e???? �e ?p????a t??f?�??e???? ??s???�e?a??? ?ast?e?te??t?da?

33. ??te p??pe? ?a st???eta? ?a??????e?a ??p?????;???? e??a? t? s?st?;

34. ??te p??pe? ?a st???eta? ?a??????e?a ??p????? ??a ????? e?te???? pa?????a;

35. ??te st????�e ?a??????e?a ??p????????te s???st?ta? d?a???st??? d?e?e???s??

36. ??a??t?s? p???�??f?p??????

37. ??a???st??? p??s????s? se s?�a?? d?a?????? s??d??�?? s?�as?a t?? ?a??????e?a? ??p?????

38. ??a???st??? p??s????s? se s?�a?? d?a?????? s??d??�?? s?�as?a t?? ?a??????e?a? ??p?????

39. ??????s? ?e t?? ?a??????e?a ??p????? ap?�??????ta? ??????: Salmonella spp , Campylobacter jejuni, Shigella spp., ste???? ?. Coli. ?e t?? s????e?? ?a??????e?e? ??p????? de? d?a???????ta? ta ??te??a?�???a???? (STEC) ap? t? ETEC ?a? EAEC ap? t?? �? pa?????? E. Coli. ???pe? ?a a?a??t???ta? �e e?d???? te?????? ?p?? ?a? ?? t????e? �????�??? ?? ??? ep?s?? de? ?a???e?????ta? se ?a??????e?a ??p?????.

40. ??a???st??? p??s????s? se ?p????a t??f?�??e???? ??s???�e?a??? ?ast?e?te??t?da?-?

41. ??a???st??? p??s????s? se ?p????a t??f?�??e???? ??s???�e?a??? ?ast?e?te??t?da?-??

42. ??a???st??? p??s????s?-Real time PCR

43. ??????s? Se pa?ateta�??a p??e??????ta s?�pt?�ata ap? t? a??te?? pept??? (?a?t?a ,e?????) pa?as?t??????? ??p????? ??a G. lamblia ?a? cyclospora . ?et? ap? pa???e?s? ?�e??? ?a? e��??? s?�pt?�?t?? > 7 ?, ???s? ??e??t??? ? t?p?p???�??? ??e??t???? Cryptosporidium, Isospora, and Cyclospora. Se a??s??atesta?�??a ?t?�a (AIDS �e CD4 c<100 cells/�L, t?????�?? ???s? ??a Microsporidium

44. Te?ape?t??? p??s????s? se t??f?�??e???? ??s???�e?a??? ?ast?e?te??t?da?

45. Te?ape?t??? p??s????s? t??f?�??e???? ??s???�e?a??? ?ast?e?te??t?da?  S?�pt?�at??? a?t?d?a?????? a????. ??te;

46. Te?ape?t??? p??s????s? t??f?�??e???? ??s???�e?a??? ?ast?e?te??t?da?  ?�pe????? a?t?�??t??? a????. ??te;

47. Te?ape?t??? p??s????s? t??f?�??e???? ??s???�e?a??? ?ast?e?te??t?da?  ?�pe????? a?t?�??t??? a????. ????;

48. Te?ape?t??? p??s????s? t??f?�??e???? ??s???�e?a??? ?ast?e?te??t?da?  ??t?�??t??? a????. Se p??? pa?????a e??a? apa?a?t?t?;

49. Te?ape?t??? p??s????s? se d?a?????? s??d??�? ??t?�??t??? a????. ??te de? ?????e?ta?;

50. Salmonella entericaGast?e?te??t?da

51. Salmonella entericaGast?e?te??t?da

52. Salmonella-2004 Whonet. gr 

53. ????pa??? d??t?? ep?t???s?? Sa?�??e???se???a? E.coli (STEC ? VTEC ? e?te???a?�???a????)

54. Salmonella-2004 Whonet. gr 

58. Shigella A??�? ?a? ?a�??? d?s? t?? ???a??s�?? a?t?? e??a? ???�??????. ?p??e? ?a pa???s???eta? �e a?�at???? d??????e? Ge???? s?�pt?�ata ???et?. ????t?da, te??es�? , t?s? ??a af?de?s?, ?????a?? ?????.

59. Campylobacter jejuni Campylobacter :e�fa?????ta? �e a?�at??? d??????a ?a? p??et?. ???�??�a ? a?t?stas? t?? ????????? ?a? a?????�??????. ????t?da,te??es�? ,t?s? ??a af?de?s?,?????a?? ????? ?a? a?�a sta ??p?a?a (s????)

62. Meat Products Associated with Transmission of E. coli O157(e?te??a?�???a????) Ground beef products Other red meats Roast beef Dry cured salami Cooked meat products Turkey meat

63. Dairy Products and other Foods Associated with Transmission of E. coli O157 (e?te??a?�???a????) Raw milk �Pasteurised milk� Yoghurt Cheese Cream

64. ?a��??as?

65. Vibrio spp. ?? ????? Vibrio parahaemolyticus ?a? non-O-group 1 Vibrio cholerae �p??e? ?a s??d?eta? �e t? �??s? ?�?? ? ?a?? �a?e??e�???? ?a????. .

66. ?a??s?ta ?? s????te??? ???a??s�?? t?? ?at?????a? a?t?? e??a? : Giardia intestinalis, Cryptosporidium parvum, Cyclospora cayetanensis, Entamoeba histolytica, ?a? Dientamoeba fragilis. Entamoeba histolytica

69. ???????

70. S???st?�e??? (recommended) ??f?e?d?? p??et??: ?. ?s?a (pe????? ??d???), ?f???? (a??�? ?a? ???e???) ?a? ?at????? ?�e????. ????a??e?t??? ste???? Salmonella. ??te??st?�at??? ?d?? �etad?se??. S????t?ta: 6 -118 pe??pt?se?? /106 ta??d??te? a??�a ?a? �???? d????e?a ta??d??? se ???a ?????? ???d???? ?????? ?a??d??te? se a?apt?ss?�e?? ???a �e pa?ateta�??? ???es? se �???s�??a t??f?�a ?a? ?e??. ???�a ?a? business travelers (?e????? ??d??? > 2 �d?�?de?) ?��???a 1. ?p? t?? st?�at?? (Viv?tif Berna). ??? e?as?e??�??? Ty21 st??e??? S. Typhi > 6 et??. 4 ??????e?. ???a pa?? �??a d?? �d?�?de? p?? t?? a?a????se??. ???s???! ???e??. ??? �a?? �e a?t?�??t??? ? �ef?????? 2. ????sa??a??d??? e��???? ????? ??a pa?e?te???? ???s? (Typhim Vi, Aventis Pasteur 1 d?s? e?d?�????? > 2 et?? ?p?te?es�at???t??: 50-80% ??f?e?d?? p??et??

71. ??? e��???? ??a?t? t?? ??ta???

72. ???: www.who.int London school of hygiene and tropical medicine www. lshtm.ac.uk Eurosurveillance www.eurosurv.org/update Centers for disease Control and www.cdc.gov/foodsafety prevention (CDC) H?? Foodsafety Information www.foodsafety.gov ??????? mednet/whonet.gr whone ??de??t???? p???? p????f????? ??? t?? ??at??

73. S?�pe??s�ata-? ???a??? a?a?????s? t?? p??a??t?ta? t??f?�??e???? ???�??e?? st? ??s? e??? as?e??. ??a??t?s? ?a? ????? ????s�?t??. ???t?????? d?e?e???s?? ??s???�e?a??? ep?d?�?a? ?at? ?a???a a??? ??? p??ta ????a????? ta ?ast?e?te???? s?�pt?�ata ???a??? ap?st??? ?a???e??e??? ??p????? a??? ?a? a?aa??t?s? e?d???? pa??????? �e e?d???? d?a???st???? d???�as?e? (E.Coli 0157-H7, Vibrio spp.) ?at? pe??pt?s? ?a??????e?a ?p?pt?? t??f?? ? a?a??t?s? t??????

74. S?�pe??s�ata-?? ??af??? st?? ep?t??p? ??s???�e?a??? ???�??e?? ?a? st?? ?p??es?e? ??�?s?a? ??e?a? ???e as?e??? �e t??f?�??e?? ???�??? �p??e? ?a ap?te?e? t?? p??t? e?de??t??? pe??pt?s? �??? �e?a??te??? s?????? ????s�?t?? ?pa?a???????s? t?? �?t??? e?????? ?a? p???????

75. S?�pe??s�ata ?e t?? pa???s�??p???s? ?a? t?? �a????p???s? t?? pa?a????? t?? pa?a????? t??f?�?? ?a? t?? a?t??? sta a?t?�??t??? ta t??f?�??e?? ??s?�ata st??? ?????? pa????? ??e?a? ap?te???? ??a s?�a?? pa???s�?? p??�??�a ??e?a? p?? af??? e??s?? a?apt??�??e? ?a? a?apt?ss?�e?e? ???e?

76. ?as???? p??f????e?? (standards precautions)