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  • 學位論文

金門地區田野工作者恙蟲病流行病學研究

An Epidemiology Study fo Scrub Typhus among Field Workers in Kinmen

指導教授 : 葉錦瑩
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摘要


恙蟲病(tsutsugamushi disease)又名叢林性斑疹傷寒(scrub typhus),它是由帶有恙蟲病立克次體的恙?幼蟲叮咬後而感染的急性熱病,其主要臨床症狀有頭痛、高燒、潰瘍性焦痂(eschar)、局部淋巴腺發炎腫大、紅疹等,嚴重者造成肺炎、心腎衰竭、休克等症狀,死亡率可達60%。台澎金馬地區過去一直以澎湖、蘭嶼及花東等為主要流行地。金門地區自民國82年戰地政務解除後,才開始向衛生單位通報恙蟲病的病例。本研究選擇近3年來台澎金馬地區恙蟲病確定病例最多之-金門,收集並分析近幾年的流行特徵,同時參考目前衛生署疾病管制局在金門的鼠類及恙?的調查結果,探討其關聯性。另外針對常活動於恙蟲孳生環境中的高危險族群,即田野工作者,利用血清學檢查測定特異性抗體效價,並以問卷方式收集人口學特性、疾病認知及環境資料等,作同步分析。 結果顯示:83-88年恙蟲病在金門地區的流行,集中在每年的5-10月間,6年內的發病率以金湖鎮的確定病例最多,為11.7?,並與當地的鼠隻活動有一致性。在本研究239個研究個案中,恙蟲病總感染率為10.9%,偶而及經常暴露在野外的工作者,其感染率又比不需要暴露在野外者為高,感染率分別為16.0%、11.5%、8.3%。金門過去並沒有建立有關恙蟲病的主動監測資料,本次研究除提供當地恙蟲病的流行病學背景資料外,並可供未來相關研究之參考。

並列摘要


Tsutsugamushi, also known as scrub typhus, is a febrile illness caused by the biting of mite with Richettsia tsutsugamushi. Its main clinical symptoms and signs are headache, fever, eschar, local lymph node enlargement, skin rash and the serious ones will result in pneumonia, heart and renal failures, and shock, with mortality reaching 60%. Formerly, Peng-hu, Lan-yu, Hualien, and Taitung were the most seriously infected areas. In 1993, martial law was lifted in Kinmen and tsutsugamushi disease cases were started to be reported there. For the past three years, Kinmen was confirmed as the most seriously infected area with the most reported and confirmed cases. This study concentrates on this area. It collects and analyze the epidemic characteristics of the past few years, uses the research results done by the Center for Disease Control, Department of Health and investigates the relatedness. Moreover, this study concentrates on the high risk field workers, using seroepidemiologic survey to find the specific antibody titer and collecting the demographic characters, environmental data and perception by constructed questionnaire. Then, this study does a simultaneous analysis. The study results show that during the 1994-1999 epidemic in Kinmen area, most cases occurred form May to October. And the most confirmed cases occurred in Kinhu village, which was 11.7% and there was a high coefficiency with the rat activity. Among the 239 research cases, the total infected rate is 10.9%. People who often and sometimes work in the field have a higher infected rate than people who need not work in the field, with the infection rate 16.0%, 11.5%, and 8.3% respectively. Kinmen did not establish the active monitoring data for the tsutsugamushi disease, and this study hopes to fill the epidemiology background gap and be used as a starting point for future studies.

參考文獻


7. 行政院衛生署(1996)傳染病防治工作手冊。
8. 行政院衛生署(1998)民國87年衛生統計,公務統計。
10. 行政院衛生署預防醫學研究所(1995)防疫檢驗標準作業程序手冊。
12. 周欽賢、連日清、王正雄(1985初版)醫學昆蟲學。南山堂出版社。283-294。
18. Abram SB.(1990)Typhus Fever.Pp 479-480.In:S.B. Abram, Ed. Control of Communicable Diseases in Man.15th Ed. American Public Health Association, Washington, D.C.

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