餐饮业从业人员感染戊肝的快速风险评估-- 指导公共卫生响应

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亢䰽䆘Ԅ

WPSAR Vol 5, No 4, 2014 | doi: 10.5365/wpsar.2014.5.3.003

www.wpro.who.int/wpsar

1

a ▇໻߽Ѯ佪䛑⡍ऎि⫳ሔि⫳䰆ᡸ᳡ࡵЁᖗˈ▇໻߽Ѯ෾෍ᢝǄ

b ▇໻߽Ѯ佪䛑⡍ऎि⫳ሔि⫳䰆ᡸ᳡ࡵЁᖗӴᶧ⮙᥻ࠊ໘ˈ2])RRG1HWˈ▇໻߽Ѯ෾෍ᢝǄ

c ▇໻߽Ѯ೑ゟ໻ᄺ೑ᆊ⌕㸠⮙ᄺϢҎষعᒋⷨおЁᖗ૆ᄺᑨ⫼⌕㸠⮙ᄺ⸩຿乍Ⳃˈ▇໻߽Ѯ෾෍ᢝǄ

d ▇໻߽Ѯ佪䛑⡍ऎि⫳ሔҎষعᒋ໘ҹঞ▇໻߽Ѯ೑ゟ໻ᄺएᄺ䰶ˈ▇໻߽Ѯ佪䛑⡍ऎǄ

e ෾෍ᢝए䰶ঞए⭫᳡ࡵЁᖗᖂ⫳⠽ঞӴᶧ⮙⾥ˈ▇໻߽Ѯ෾෍ᢝǄ ᡩ〓᮹ᳳ˖2014ᑈ8᳜4᮹˗থ㸼᮹ᳳ˖2014ᑈ10᳜30᮹ doi: 10.5365/wpsar.2014.5.3.003

2 011ᑈ߱ˈԡѢ▇໻߽Ѯ佪䛑෾෍ᢝⱘ▇໻߽

Ѯ佪䛑⡍ऎि⫳ሔAustralian Capital Territory

Health Directorateˈㅔ⿄ACTि⫳ሔӴᶧ⮙᥻ࠊ

໘Communicable Diseases Control Section᥹ࠄϔৡ令佂ϮҢϮҎਬᛳᶧ៞㙱⮙↦HEVⱘ᡹ਞǄ䆹ᛳᶧ㗙 থ⮙᳝ࠡ៞㙱⌕㸠೑ᆊᮙ㸠৆ˈৢ಴㝍⮯੠咘⮌ܹ䰶

⊏⭫ˈ㙱ࡳ㛑Ẕ⌟ᓖᐌ㙱䝊ঞ㚚㑶㋴छ催ˈ㸔⏙ᄺ Ẕ⌟ᰒ⼎HEV IgM䰇ᗻˈIgG䰈ᗻǄ䆹ᛳᶧ㗙ⱘЈᑞǃ

⌕㸠⮙ᄺঞᅲ偠ᅸ⡍ᕕഛヺড়HEVᛳᶧ⮙՟ᅮН^[1]Ǆ ᛳᶧ㗙ܹ䰶ৢ᥹ফᇍ⮛⊏⭫ǄҪ೼ϔᆊ令佚Ꮉ԰ᑊখ Ϣ亳⠽ࠊ໛ⱘ৘Ͼ⦃㡖Ǆ

▇໻߽Ѯ᳝᳒ᛳᶧ⬆㙱⮙↦

HAV

ⱘ令佂ϮҢϮ Ҏਬᇚ⬆㙱ϔ⾡Ϣ៞㙱㉏Ԑⱘ⮒⮙Ӵᶧ㒭令ख़乒ᅶ

ⱘܜ՟^[2,3]ˈᑊࠊᅮњ▇໻߽Ѯ೑ᆊ⬆㙱⭿ᚙᑨᇍᣛ

फ^[4]Ǆ✊㗠ᇮ᳾ࠊᅮ݇Ѣ令佂ϮҢϮҎਬ៞㙱ᛳᶧⱘ ᑨᇍᣛफǄ㱑✊⬆㙱Ϣ៞㙱᳝ⳌԐП໘ˈԚϸ⾡⮒⮙

೼⮒⮙⡍ᕕǃӴ᪁࡯ҹঞ⮒⮙Ϲ䞡⿟ᑺㄝᮍ䴶᳝᠔ϡ ৠǄ᠔ҹ೼໘⧚៞㙱䯂乬ᯊϡ㛑ᅠܼখ✻⬆㙱ⱘᑨᇍ ᣛफǄ

ᴀ᭛ᦣ䗄ᑊ䅼䆎њ䩜ᇍ令佂ϮҢϮҎਬ៞㙱ᛳᶧ џӊⱘᖿ䗳亢䰽䆘ԄǄ亢䰽䯂乬Ў˖ᙷ⮙ⱘ令佂ϮҢ ϮҎਬᇚ៞㙱Ӵ᪁㒭令佚乒ᅶⱘ亢䰽໮໻˛៥Ӏᇍᖿ

令佂ϮҢϮҎਬᛳᶧ៞㙱ⱘᖿ䗳亢䰽䆘Ԅ ᣛᇐ݀݅ि⫳ડᑨ

Ranil Appuhamy

^a

, Cameron Moffatt

^b

, Stephanie Davis

^c

, Paul Kelly

^d

੠Karina Kennedy

^e

䗮䆃԰㗙˖Ranil Appuhamy (e-mail: [email protected])Ǆ

䗳亢䰽䆘Ԅⱘᮍ⊩੠㒧ᵰ䖯㸠њ䆎䗄ˈᑊ䇈ᯢњ᥹ϟ ᴹ䞛পⱘ݀݅ि⫳᥾ᮑǄ

亢䰽䆘Ԅᮍ⊩

䗮䖛ᶹ䯙

HEV

Ⳍ݇᭛⤂ˈ੼䆶⦄എ⌕㸠⮙ᄺǃӴᶧ⮙

ᄺঞ⍜࣪䘧⮒⮙ㄝ乚ඳⱘϧᆊˈ㦋ᕫᓔሩᖿ䗳亢䰽䆘 Ԅ᠔䳔ⱘֵᙃǄ⦃๗ि⫳Ꮉ԰Ҏਬ೼⮙՟Ꮉ԰ⱘ令佚 ᓔሩњ⦄എ䇗ᶹˈᑊᇍ⮙՟䖯㸠њ䆓䇜Ǆ

㓐ড়㗗㰥令佂ϮҢϮҎਬᇚ៞㙱Ӵ᪁㒭令佚乒ᅶ ⱘৃ㛑ᗻҹঞᛳᶧ⮒⮙ⱘৢᵰϹ䞡ᗻ⹂ᅮ亢䰽ㄝ㑻Ǆ 亢䰽ㄝ㑻ᰃӴ᪁ৃ㛑ᗻҹঞᛳᶧৢᵰϹ䞡ᗻⱘ㓐ড়㒧 ᵰǄ

㒧ᵰ

Ӵ᪁ৃ㛑ᗻ

亢䰽䆘Ԅⱘ㄀ϔ䚼ߚᰃ䆘Ԅ⮒⮙Ӵ᪁ⱘৃ㛑ᗻҹঞ令佚乒ᅶᲈ䴆Ѣ⮙↦ⱘৃ㛑ᗻǄ೼䆘Ԅ乒ᅶᛳᶧ៞㙱⮙

↦ⱘৃ㛑ᗻᯊˈ㗗㰥њᙷ⮙令佂ϮҢϮҎਬⱘӴᶧ ᗻǃ⮙↦ⱘӴ᪁࡯ǃᇍ催亢䰽亳⠽ⱘ໘⧚ǃৃ֗䖯⮒

⮙Ӵ᪁ⱘ⦃๗಴㋴ҹঞҎ㕸ᯧᛳᗻǄ

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WPSAR Vol 5, No 4, 2014 | doi: 10.5365/wpsar.2014.5.3.003 www.wpro.who.int/wpsar

2

Appuhamyㄝ ᛳᶧ៞㙱ⱘ令佂ϮҢϮҎਬᏺᴹⱘ亢䰽

ᛳᶧৢᵰϹ䞡ᗻ

亢䰽䆘Ԅⱘ㄀Ѡℹᰃ⹂䅸থ⫳៞㙱Ӵ᪁ৃ㛑Ӯᇐ㟈ⱘ

ৢᵰǄ៞㙱⮙↦ЎRNA⮙↦ˈᰃ⛁ᏺঞѮ⛁ᏺഄऎᇐ 㟈ҟ∈㙱♢ⱘЏ㽕⮙ॳˈ೼ᎹϮ࣪೑ᆊг᳝ᬷথ⮙՟

᡹ਞ^[6]Ǆ݌ൟⱘЈᑞ⮛⢊ࣙᣀ咘⮌ǃॠ亳ǃ㙱㚓໻ǃ 㝍䚼⮐⮯ǃᙊᖗǃ਩৤ҹঞথ⛁^[6,7]Ǆ㱑✊Јᑞ⮛⢊Ϣ

⬆㙱㉏ԐˈԚ៞㙱᳈ࡴϹ䞡ᯋ᮹ᣕЙⱘޱ㸔ࡳ㛑䱰⹡

੠㚚∕⎸⿃ǃ⮙⅏⥛᳈催^[10]Ǆ

HEV

ᛳᶧৢৃ㛑ϡߎ⦄Јᑞ⮛⢊ˈгৃ㛑ᇐ㟈ᗹ ᗻᲈথ⮒⮙Ǆ៞㙱ᇍѢᙷ᳝᜶ᗻ㙱㛣⮒⮙ⱘҎ㕸ҹঞ ᄩཛᇸЎॅ䰽ˈ⮙⅏⥛ৃҹ催䖒

15–20%

Ǆᗔᄩᳳ䯈ᛳ ᶧৃ㛑ᇐ㟈㚢ܓ⅏ѵǃᮽѻঞᮄ⫳ܓߎ⫳ৢ䖙䗳⅏ѵ ㄝᑊথ⮛^[6]ǄⳂࠡ▇໻߽Ѯ≵᳝៞㙱⭿㢫г≵᳝⡍ᓖ ᗻ㥃⠽Ǆ

亢䰽ㄝ㑻߸ᅮঞ亢䰽ㅵ⧚

ᇍӴ᪁ৃ㛑ᗻҹঞᛳᶧৢᵰϹ䞡ᗻ䖯㸠њ䆘ԄǄᙷ⮙

ⱘ令佂ϮҢϮҎਬ೼令佚Ꮉ԰ᳳ䯈ᕜৃ㛑݋᳝Ӵᶧ ᗻǄҪখϢࠊ໛催亢䰽᳾❂❳ⱘ亳⠽ˈ⦄എ䇗ᶹথ

⦄令佚ᄬ೼ᇐ㟈⮒⮙Ӵ᪁ⱘϡ㡃⦃๗Ǆ៞㙱⮙↦Ӵ᪁

࡯Ⳃࠡ䖬ϡकߚᯢ⹂ˈሑㅵҎҎӴ᪁ᑊϡᐌ㾕ˈԚҡ

᳝ৃ㛑থ⫳ǄЏ㽕ᢙᖗᙷ⮙ⱘ令佂ϮҢϮҎਬ䗮䖛݊

ࠊ໛ⱘ亳⠽៪᥹㾺ⱘ令݋ᇚ⮒⮙Ӵᶧ㒭ህ令ⱘ乒ᅶǄ 㓐Ϟ᠔䗄ˈ令佂ϮҢϮҎਬᇚ៞㙱Ӵ᪁㒭令佚乒ᅶⱘ

ৃ㛑ᗻЎĀৃ㛑āǄԚᰃབᵰথ⫳Ӵ᪁ˈᛳᶧ

HEV

ⱘ

ৢᵰϹ䞡ᗻЎĀ催āˈ⡍߿ᇍѢᄩཛ੠ᙷ᳝᜶ᗻ㙱㛣

⮒⮙ⱘҎ㕸Ǆ⬅Ѣ᮴⊩⹂ᅮࠡᴹ令佚ህ令ᑊ亳⫼ᛳᶧ 㗙ޚ໛ⱘ亳⠽ⱘ乒ᅶЁᰃ৺᳝催ॅҎ㕸ˈᘏԧ亢䰽ㄝ㑻ЎĀᕜ催ā೒

1

Ǆ

ᴀ⃵亢䰽䆘ԄⱘЏ㽕ϡ䎇П໘Ў㔎ᇥ䯤ᯢ៞㙱

⮙↦Ӵ᪁࡯ⱘ᭛⤂੠ᣛफǄ෎Ѣৃҹ㦋ᕫⱘֵᙃ੠

䆕᥂ˈᴀⴔ乘䰆ЎЏⱘᮍ䩜ˈᴀ⃵亢䰽䆘Ԅᓎ䆂ᇍ᳒

೼ᛳᶧ㗙໘ѢӴᶧᳳᯊࠄ݊Ꮉ԰令佚ህ令ⱘ乒ᅶᦤկ ᅷӴˈᅷӴݙᆍࣙᣀ˖ᛳᶧHEVⱘৃ㛑ᗻᇣˈHEVⱘ

(1)

ᙷ⮙令佂ϮҢϮҎਬⱘӴᶧᗻ

HEVⱘӴᶧᳳ᳾ⶹ

^[5]Ǆ✊㗠ˈߎ⦄咘⮌⮛⢊14໽ৢҹ

ঞᨘܹফ∵ᶧⱘ亳⠽៪∈㑺਼ৢ䛑ҡৃҹҢ㉾֓ЁẔ

⌟ࠄ⮙↦乫㉦^[5]Ǆ䆹ᛳᶧ㗙ߎ⦄咘⮌⮛⢊ࠡ4໽Ꮖᓔྟ

೼令佚Ꮉ԰ˈ᠔ҹҪ೼令佚Ꮉ԰ᳳ䯈ᕜৃ㛑݋᳝Ӵᶧ ᗻǄ

(2)

⮙↦ⱘӴ᪁࡯

+(9Џ㽕䗮䖛㉾ষ䗨ᕘӴ᪁ˈ∈⑤ফ∵ᶧ䗮ᐌᰃᇐ㟈

໻㾘῵៞㙱ᲈথ⭿ᚙⱘॳ಴^[6]Ǆ㚗㙴䘧໪䗨ᕘӴ᪁੠

↡၈Ӵ᪁гৃথ⫳^[6]ǄሑㅵҎҎӴ᪁ᑊϡᐌ㾕ˈ໻㾘

῵ᲈথ⭿ᚙг䗮ᐌϡᰃ⬅ҎҎӴ᪁ᇐ㟈ˈԚ៞㙱⹂ᅲ

᳝ৃ㛑ҎӴҎ^[7,8]ǄҎ䯈Ӵ᪁䗮ᐌ⬅݅⫼∈ᵃǃ⋫᠟Ⲛ ঞ令݋᠔㟈^[8]Ǆ

(3)

ᇍ催亢䰽亳⠽ⱘ໘⧚

ᙷ ⮙ ⱘ 令佂 Ϯ Ң Ϯ Ҏ ਬ ೼ ݊ Ꮉ ԰ ⱘ 令佚 খ Ϣ ࠊ ໛

৘⾡亳⠽ˈࣙᣀϡ䳔㒣䖛ࡴ⛁े㹿乒ᅶ亳⫼ⱘ⫳≭

ᢝǄᙷ㗙⿄Ҫ೼ࠊ໛亳⠽ᯊԽ᠈᠟༫Ǆ

(4)

⦃๗䆘Ԅ

ACTि⫳ሔⱘ⦃๗ि⫳ᅬਬᇍ令佚䖯㸠њẔᶹˈথ⦄亳

⠽ࠊ໛ऎඳᄬ೼ϔѯ䱤ᙷབ㔎Уϧ⫼ⱘ⋫᠟䆒໛Ǆ 䖭ৃ㛑Ў⮒⮙Ӵ᪁ᦤկᴎӮǄ

(5)

Ҏ㕸ᯧᛳᗻ

ᴀ䆘Ԅ݇⊼ⱘҎ㕸ࣙᣀACTⱘ᠔᳝ҎষǄ៞㙱೼▇໻߽

Ѯথ⮙⥛Ԣ᡹ਞথ⮙⥛Ў0.1–0.2/10ϛ^[9]Ǆ2006ᑈ ҹᴹACTҙ᡹ਞ6՟HEVᛳᶧ㗙ˈഛ೼⍋໪ᛳᶧǄϢ݊

Ҫ⊩ᅮ᡹ਞӴᶧ⮙㉏Ԑˈৃ㛑⬅Ѣ᮴⮛⢊ᛳᶧҹঞ㔎 УẔ⌟ᇐ㟈ᇍᅲ䰙থ⮙⥛ⱘԢԄǄԚ䖬ᰃৃҹড়⧚ഄ

᥼⌟ˈ៞㙱থ⮙⥛䴲ᐌԢǄ಴ℸৃҹ䅸ЎACTҎষഛЎ

HEVⱘᯧᛳҎ㕸Ǆ

೒1亢䰽ߚᵤⶽ䰉ᬍ㓪㞾▇໻߽Ѯए⭫ᴎᵘᛳᶧ乘䰆᥻ࠊᣛफ^[11]

থ⫳ৃ㛑ᗻ ৢᵰϹ䞡ᗻ

ᵕԢ Ԣ Ёㄝ催 ᵕ催

ᵕϡৃ㛑 Ԣ Ԣ Ԣ Ёㄝ催

ϡ໾ৃ㛑 Ԣ Ёㄝ Ёㄝ催 ᕜ催

ৃ㛑 Ԣ Ёㄝ催 ᕜ催 ᕜ催

ᕜৃ㛑 Ёㄝ催 ᕜ催 ᕜ催 ⡍߿催

޴Т⹂ᅮ Ёㄝ ᕜ催 ᕜ催 ⡍߿催 ⡍߿催

⊼˖咥㡆೚೜㸼⼎䆘Ԅߎⱘ亢䰽Ǆ

(3)

WPSAR Vol 5, No 4, 2014 | doi: 10.5365/wpsar.2014.5.3.003

www.wpro.who.int/wpsar

3

ᛳᶧ៞㙱ⱘ令佂ϮҢϮҎਬᏺᴹⱘ亢䰽 Appuhamyㄝ

Western Pacific Surveillance and Response Journal, 2014, 5(4):1–4. doi:10.5365/wpsar.2014.5.3.003

খ㗗᭛⤂

1. Communicable Diseases Network Australia. Australian national notifiable diseases case definitions: Hepatitis E case definition.

Canberra, Department of Health, 2004 (http://www.health.gov.au/

internet/main/publishing.nsf/Content/cda-surveil-nndss-casedefs- cd_hepe.htm, accessed 9 October 2014).

2. Rowe SL, Tanner K, Gregory JE. Hepatitis A outbreak epidemiologically linked to a food handler in Melbourne, Australia.

Communicable Diseases Intelligence Quarterly Report, 2009, 33(1):46–48. pmid:19618771

3. Tricco AC et al. A review of interventions triggered by hepatitis A infected food-handlers in Canada. BMC Health Services Research, 2006, 6:157–163. doi:10.1186/1472-6963-6-157 pmid:17156461

4. Communicable Diseases Network Australia. Hepatitis A: National Guidelines for Public Health Units. Canberra, Department of Health, 2009 (http://www.health.gov.au/internet/main/publishing.

nsf/Content/FB28A405CBF6E64ECA257BF0001DAB33/$File/

hepa-song.pdf, accessed 9 October 2014).

5. Heymann DL, editor. Control of Communicable Diseases Manual 19th edition. Washington, DC, American Public Health Association, 2008.

6. Mushahwar IK. Hepatitis E virus: molecular virology, clinical features, diagnosis, transmission, epidemiology, and prevention.

Journal of Medical Virology, 2008, 80:646–658. doi:10.1002/

jmv.21116 pmid:18297720

7. Teshale EH, Hu DJ, Holmberg SD. The two faces of hepatitis E virus. Clinical Infectious Diseases, 2010, 51:328–334.

doi:10.1086/653943 pmid:20572761

8. Teshale EH et al. Evidence of person-to-person transmission of hepatitis E virus during a large outbreak in Northern Uganda. Clinical Infectious Diseases, 2010, 50:1006–1010.

doi:10.1086/651077 pmid:20178415

9. National Notifiable Diseases Surveillance System. Canberra, Department of Health, 2014 (http://www9.health.gov.au/cda/

source/cda-index.cfm, accessed 9 October 2014).

10. Chau TN et al. Epidemiology and clinical features of sporadic hepatitis E as compared with hepatitis A. The American Journal of Gastroenterology, 2006, 101:292–296. doi:10.1111/j.1572- 0241.2006.00416.x pmid:16454833

11. National Health and Medical Research Council. Australian Guidelines for the Prevention and Control of Infection in Healthcare. Commonwealth of Australia 2010. Canberra, Department of Health, 2010 (http://www.nhmrc.gov.au/_

files_nhmrc/publications/attachments/cd33_infection_control_

healthcare_140616.pdf, accessed 9 October 2014).

12. Moffatt C et al. An assessment of risk posed by a Campylobacter- positive puppy living in an Australian residential aged-care facility. Western Pacific Surveillance and Response Journal, 2014, 5(3):1–6. doi:10.5365/wpsar.2014.5.2.009 pmid:

25320673

13. Rapid risk assessment of acute public health events. Geneva, World Health Organization, 2012 (http://whqlibdoc.who.int/

hq/2012/WHO_HSE_GAR_ARO_2012.1_eng.pdf, accessed 9 October 2014).

14. Series of National Guidelines. Canberra, Department of Health, 2014 (http://www.health.gov.au/internet/main/publishing.nsf/

Content/cdnasongs.htm, accessed 9 October 2014).

ᐌ㾕⮛⢊ˈঞᮽህएⱘ䞡㽕ᗻ⡍߿ᰃ催ॅҎ㕸Ǆ

⬅Ѣᛳᶧ㗙Ꮉ԰ⱘ令佚᮴䅶令䆄ᔩˈ᮴⊩⹂䅸ህ令乒ᅶЁᰃ৺ࣙ৿催ॅҎ㕸ˈ៥Ӏ䗮䖛ၦԧ৥݀ӫᓔ ሩᅷӴᑊ೼

ACT

ि⫳ሔ㔥キ䗮᡹Ⳍֵ݇ᙃˈӴᶧ⮙੼䆶

⛁㒓ৃҹಲㄨ݀ӫ੼䆶Ǆ৥

ACT

৘Ͼए䰶੠ए⭫ᴎᵘ ⱘᗹ䆞䚼䮼থ䗕䗮ⶹˈᦤ催⮙՟ᮽᳳ䆚߿੠ㅵ⧚ⱘᬜ ᵰǄ

㒣䖛䇼ᜢ㗗㰥ˈއᅮ৥݀ӫ䗮᡹ᛳᶧ㗙Ꮉ԰令佚 ⱘৡ⿄ǄЎњሑৃ㛑ޣᇥ䆹令佚ⱘᤳ༅ˈ䞛পњ䇼ᜢ ⱘ≳䗮ㄪ⬹ˈ䅽令佚ㅵ⧚㗙খϢࠄџӊ䇗ᶹ੠݀݅ि

⫳ડᑨⱘ৘Ͼ⦃㡖ЁǄ䖭⹂ֱњ令佚ㅵ⧚㗙ᇍⳌ݇Ꮉ

԰ⱘܼ࡯䜡ড়Ǆ

䗮䖛ᇍHEVⱘࡴᔎⲥ⌟ˈ≵᳝থ⦄Ϣ䆹令佚Ⳍ݇

ⱘѠҷ៞㙱⮙՟Ǆ

㒧䆎

೼㔎Уᯢ⹂ᣛफⱘᚙމϟˈᓔሩᖿ䗳亢䰽䆘Ԅ㛑໳ֱ

䆕԰ߎ෎Ѣ䆕᥂ⱘއㄪᑊঞᯊᓔሩ݀݅ि⫳ડᑨǄ ℸࠡACTि⫳ሔӴᶧ⮙᥻ࠊ໘ᇍ݊Ҫ݀݅ि⫳џӊᏆᓔ ሩњᖿ䗳亢䰽䆘Ԅ^[12]ǄϪ⬠ि⫳㒘㒛Ꮖ㒣থᏗњさথ

݀݅ि⫳џӊᖿ䗳亢䰽䆘Ԅᣛफ^[13]ˈ䖭ᰃकߚ᳝ᬜⱘ 䕙ࡽ݀݅ि⫳އㄪⱘ亢䰽䆘ԄᅲᮑḚᶊǄ䖬ᑨ㗗㰥೼

▇໻߽Ѯⱘϔ㋏߫ᣛफ^[14]Ё๲ࡴ䩜ᇍ៞㙱ⱘ䰆᥻ᑨᇍ ᣛफǄ

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෎䞥

OzFood Net

⬅▇໻߽Ѯि⫳䚼䌘ࡽǄ 㟈䇶

ᛳ䇶णࡽ䇗ᶹⱘҎਬˈࣙᣀACTि⫳ሔӴᶧ⮙᥻ࠊ໘ਬ ᎹǃACTि⫳䰆ᡸЁᖗ⦃๗ि⫳ᅬਬǃACTᬓᑰߚᵤᅲ 偠ᅸਬᎹǃACT⮙⧚ᄺӮਬᎹǃ佪䛑⮙⧚ᄺӮਬᎹҹঞ 令佚ㅵ⧚㗙੠ਬᎹǄ

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