E N D
2. 2
3. 3 ?????????? ??? ...
4. 4 ???????????????????????????????? ?????????
??????????????
??????????
???????????????????????
* RM Page, et al. Basic epidemiological
methods and biostatistics, 1995 p.32
5. 5
6. 6 ???????????? vs. ??????????? : ???????????????? ???????? Infectious/ ?????? communicable
??????/????????? ????????/?????????
7. 7 Causal Chain Leading to Disease Distal
socioeconomic
causes
8. 8 ???????? (Outbreak or Epidemic) ????? ????????
??????????
?????????????? ??? Epidemic curve
9. 9 ??????????? ???.. ???????
?????????? 5 ?? ???????? *** ????
????????? + ???????????????????? 5 ?????????? ????
???????????? 2-3 ??????????? 2-3 ????? ????????????
???? 2 ????????? ???????????????????????
??????????????????????????????????
???? 1 ??? ?????????????????? ???? ????????????????????
10. 10 ????? Epidemic = Outbreak
(outbreak -> ????????????????????????????????,
Epidemic -> ???????????????????????????????????)
Cluster = ????????????????????????????????????
(????????????????????????)
Pandemic = ???????????????????????????????
?????????????????????
Endemic = ????????????
11. 11
12. 12 ???????? 5 ??????????? : ????????? ?., ????????????????
3-8 ??? (??????? Median = 5)
??????????????????????????????????????????????
?????????????????????????????
?. 3 ?. 5 ?. 8 ?. 3-8
(??????? Preventable Death )
13. 13 Pandemic : ???????? AIDS in the world, 1992
?????????????????????????????????????????? 1981
????????????? 12.9 ?????? : ??? 7.1 ????,
???? 4.7 ???? ??????? 1.1 ????
1 ?? 5 ????????????????????
???????????? ?? 2000 ?????? 40 ????????????????
14. 14
15. 15
16. 16 ?????????? ???????????????????
17. 17
18. 18 ?????????????????? ?????????????????? :
???????????????????????????????????????????????
???????????? ??????? ??????????
??????????? ??. ???? ????????????????????????
??? ? ??????????
???????????? : ????????????, ????, ????????????
19. 19
20. 20 ?????????????????????????????????????????
21. 21 ??????????????????????????
??????????????????????
????????????????????????????????????
?????????????????????????????????????????
?????????????????????????????????
???????????????????
?????????????????????????? ???????? ??????????
22. 22
23. 23 ?????????????????? ??????????????
24. 24 ???????????? ??? ????????????
25. 25 ???????????????????????(????????)
26. 26 ?????????????? (outbreak patterns) ????????????????????????? (Common source outbreak)
Point (?????????????????? ??????????????)
Intermittent (?????????????????? ???????????????)
Continuous (?????????????????? ??????????????)
?????????????????????????????
Propagated source outbreak (Person-to-person)
27. 27 ?????????????????????????Common Source Outbreak
28. 28 Epidemic Curve ????????????????????????????
29. 29 ??????????????????????????????????
30. 30
31. 31
32. 32 1. ?????????????????????????? Rapid Response Team
2. ???????????????????????? ???????????
3. ??????????????????????????????????????
4. ????????????????????????? -???????????????
???? ??????? ?????
5. ????????????????????????
6. ???????????????????????????? ??????????????
7. ??????????????????? ?????????
8. ???????????????????
9. ?????????????????
10. Follow-up the control implementations
33. 33 1. ?????????????????????????? Rapid Response Team ????????? : ???????, ???????, ????????????????????????????????? ???
????????? ??????????? ??????? ?
?????????????
34. 34 2. ???????????????????????? ??????????? ???????????? ????????????? ???????
???????????????????????? ? ?????????????????? y ?
???????????????? ?
?????????????????????????????????????????
???????????????????, ??????????, ??????????????????
35. 35
36. 36
37. 37
38. 38
39. 39 3. ????????????????? ???????????????????????? ????????????????????
???????????????????????????????? ????????????????????????????????????????? ????????????????
???????????????/????????? ?????????????????????? ???? ?????????? ????????? ???????????????????
??????? ??????????????????
????????????? (Sensitivity) ??? ?????????? (specificity)
40. 40 ???????????? : ????????
41. 41 ?????? Sensitivity vs.?????????? specificity
42. 42 ???????????????????Sensitive case definition
43. 43 ??????????????????????? Specific case definition
44. 44 ????????????????????????Multiple case definition ???????????? (Possible)
???????????????????????????????? ...
???????????????? (Probable)
?????????? 5 ???????? ???????????????????????? ??????????????????????????????????
????????????? (Confirmed)
?????????????? ???????? Vibrio cholerae ???
45. 45
46. 46
47. 47 4. ?????????????????????????
48. 48
49. 49
50. 50
51. 51
52. 52
53. 53 ?????????????????? ??. (/ ??????? 100,000 ??) ????????????????? ?????? Cyprus, 5 July - 5 November 1996
54. 54
55. 55
56. 56
57. 57 ?????????????
58. 58 ??????????? Cohort
59. 59 ??????????? Cohort
60. 60 ??????????? Case control
61. 61 ??????????? Case control
62. 62 ?????????????????????????? ????????????????????
63. 63
64. 64 ???????? ????????????????????????
65. 65 ???????????????? ???????????????????????????
???????????? ????????????????????????
?????????????
??????????????????????????????
66. 66 ??????????? ?????????????????
??????????????????
???????????????????????
??????????????????
67. 67
68. 68 ??????????? 1956 ???????????????????????????????????
1956 ?????????????? ??????? -??????????????? ??? ?????????? ?????????? ????????????????????????????
1965 ????????????????????????????????
1968 ??????? ??????????? -?????????????????????????????????? -????????????? methylmercury ????????????????
69. 69
70. 70 ??????????? the main signs and symptoms
sensory disturbance in the distal portions of four extremities
cerebellar ataxia
bilateral concentric contraction of the visual field
disturbed ocular movement caused by central nervous system (CNS)
impairment of hearing caused by CNS
equilibrium disturbance caused by CNS ,
Also, fetal Minamata Disease
cerebral infantile paralysis
71. 71 Houseboat-Associated Carbon Monoxide Poisonings on Lake Powell --- Arizona and Utah, 2000 During August 2000
At Lake Powell in the Glen Canyon National Recreation Area on the Arizona-Utah border
Two brothers died of carbon monoxide (CO) poisoning as they swam near the stern of a houseboat
As a result of these deaths, an investigation was initiated
The study identified nine boat-related fatal CO poisonings since 1994 and approximately 100 nonfatal poisonings since 1990
72. 72
73. 73 Carbon Monoxide Poisonings Resulting from Open Air Exposures to Operating Motorboats --- Lake Havasu City, Arizona, 2003 During February 1997--August 2002, two fatal and six nonfatal cases of carbon monoxide (CO) poisoning occurred in vacationers who were wading in or boating near the Bridgewater Channel of Lake Havasu
The vacationers were near operating motorboats
CDC and the Havasu Regional Medical Center Emergency Department (HRMCED) conducted an initial investigation during Labor Day weekend 2002 (August 31--September 1)
74. 74
75. 75 Carbon Monoxide Poisonings Resulting from Open Air Exposures to Operating Motorboats --- Lake Havasu City, Arizona, 2003
76. 76 The assessment determined that the majority of public health emergencies resulted from electric power outages, which affected access to food, water, and medical care.
Data and recommendations were provided immediately to local and state emergency responders, who used the information to direct Hurricane Isabel recovery efforts and also to improve the assessment, which was next deployed in August 2004 with Hurricane Charley.
77. 77
78. 78 ???? 1 ???????????
?????????????????: common source, and propagated source
????????????????? ??????????????????????????????????????????????????
79. 79 ???? 2 ???????????????? : Verify Dx & OB
->Active case finding
-> Descriptive study
-> Hypothesis
-> Analytic Study
?????????????????????? as soon as possible (ASAP)
80. 80
81. 81 Gold Standard
82. 82
83. 83
84. 84
85. 85
86. 86
87. 87
88. 88
89. 89