2012年菲律宾拉古纳省基孔肯雅热暴发调查

(1)

ᲈথ䇗ᶹ᡹ਞ

WPSAR Vol 6, No 3, 2015 | doi: 10.5365/wpsar.2015.6.1.006

www.wpro.who.int/wpsar

1

a 㧆ᕟᆒ偀ሐᢝ೷ศܟ剕ݍऎˈि⫳䚼ˈ⌕㸠⮙ᄺሔˈ⦄എ⌕㸠⮙ᄺ෍䆁乍ⳂǄ

b 㧆ᕟᆒ偀ሐᢝ೷ศܟ剕ݍऎˈि⫳䚼Ǆ

ᡩ〓᮹ᳳ˖2015ᑈ1᳜23᮹˗থ㸼᮹ᳳ˖2015ᑈ8᳜10᮹ doi: 10.5365/wpsar.2015.6.1.006

෎

ᄨ㚃䲙⛁ᰃ㒣Ӟ㱞Ӵ᪁㰿ၦ⮙↦㗠ᓩ䍋ⱘ

⮙↦ᗻ⮒⮙Ǆ䖭⾡⮒⮙佪ܜ೼ഺḥሐѮ㘨 ড়݅੠೑ⱘϔ䍋ᲈথЁ䆄䕑˄1952˅˗

෎ ᄨ 㚃䲙 ⱘ ৡ ᄫ 䍋 ⑤ Ѣ 偀 ᄨ ᖋ ᮍ 㿔 ˈ ᛣ ᗱ ᰃ ˖ Āᔃ᳆āˈᔶᆍ⮙Ҏ಴݇㡖⮐⮯㗠ᔃ㝄᳆㚠ǃ㴋㓽䑿 ԧⱘ⡍ᕕԧᗕ^[1]Ǆ

෎ᄨ㚃䲙⛁೼ϰफѮഄऎᰃ݋᳝催ᑺ݀݅ि⫳ᛣ НⱘᮄথၦҟӴ᪁⮒⮙Ǆ೼䴲⌆फ䚼੠ϰ䚼ˈफѮ੠

ϰफѮᏆ᳝᡹䘧Ǆ೼Ѯ⌆ˈॄᑺǃॄᑺሐ㽓Ѯǃ偀ᇨ ҷ໿ǃ㓙⬌ǃᮃ䞠݄व੠⋄೑䛑᳒᡹䘧䖛෎ᄨ㚃䲙⛁

ᲈথ^[1]Ǆ

೼㧆ᕟᆒˈ೼

1968

ᑈϰݙḐ㔫ⳕⱘ

Amlan

᡹ਞњ 佪՟෎ᄨ㚃䲙⛁⮙՟ˈ⊶ঞ

698

Ҏ^[2]Ǆ

1996

ᑈ⾥࿕䖾 ⳕⱘ

Indang

ᓔሩњ佪⃵ᲈথ䇗ᶹˈ݅⹂䅸

151

ৡ⭥Ԑ⮙

՟^[3]Ǆ

2011

ᑈ佪⃵ᅲ偠ᅸ⹂䆞ᲈথথ⫳೼䖒≗Ꮦ੠व

ࡴᓊᖋ༹㔫Ꮦ^[4]Ǆ

2012ᑈ7᳜ˈ㧆ᕟᆒि⫳䚼$ऎඳࡲ݀ᅸˈ৥䆒

ゟ೼೑ᆊ⌕㸠⮙Ёᖗⱘ㧆ᕟᆒҹџӊЎ෎⸔ⱘⲥ⌟੠

ডᑨ䚼䮼᡹ਞˈᢝস㒇ⳕ೷Ꮘࢗ㔫Ꮦথ⫳ϔ䍋⭥Ԑ෎

ᄨ㚃䲙⛁ᲈথ⭿ᚙǄ䖭ᰃ㞾2007ᑈᓎゟ䆹⮒⮙ⲥ⌟㋏

㒳ҹᴹ佪⃵᡹ਞⱘජᏖ෎ᄨ㚃䲙⛁⮙՟Ǆ㧆ᕟᆒ⦄എ

⌕㸠⮙ᄺ෍䆁乍Ⳃ˄FETP˅ⱘᎹ԰䯳㹿ྨ⌒ᓔሩᲈথ 䇗ᶹˈҹᶹᯢ෎ᄨ㚃䲙⛁ⱘॅ䰽಴㋴Ǆ

2012 ᑈ㧆ᕟᆒᢝস㒇ⳕ෎ᄨ㚃䲙⛁ᲈথ䇗ᶹ

Julius Erving Ballera

^ab

ˈ Ma Justina Zapanta

^ab

ˈ Vikki Carr de los Reyes

^b

ˈ Ma Nemia Sucaldito

^b

੠ Enrique Ta yag

^b

䗮䆃԰㗙˖Julius Erving Ballera (⬉ᄤ䚂ӊ: [email protected])Ǆ

ᮍ⊩

⮙՟ᇍ✻ⷨお

⮙՟ᅮНЎ2012ᑈ6᳜23᮹㟇8᳜6᮹ˈ೷Ꮘࢗ㔫Ꮦᒋ า᱂㽓㖕ᴥ᮶ᕔعᒋⱘሙ⇥Ёˈߎ⦄ᣕ㓁থ⛁ı2໽ˈ ᑊԈ᳝݇㡖⮐⮯៪㗙Ⲃ⮍㗙Ǆ៥Ӏ೼Ꮦि⫳ࡲ݀ᅸ੠

ए䰶ᶹ䯙⮙ग़ˈᓎゟ⮙՟ϔ㾜㸼Ǆᑊ೼ᴥ䞠ᓔሩܹ᠋

᧰㋶⮙՟Ǆ

ᣝ✻

1:1

ⱘ↨՟ˈᓔሩ䴲ऍ䜡ⱘ⮙՟ᇍ✻ⷨおǄফ

৘ᮍ䴶಴㋴ᕅડˈϡᰃ᠔᳝⮙՟䛑㒇ܹⷨおǄЎњᮍ

֓ˈᇍ✻䗝ᢽϢ⮙՟ᴹ㞾ৠϔᆊᒁ៪Ϣ⮙՟᳔䖥ⱘᆊ ᒁⱘعᒋሙ⇥ˈϨ෎ᄨ㚃䲙⛁

IgM

䰈ᗻǄ

䆒䅵㒳ϔⱘ䇗ᶹ䯂ोˈݙᆍࣙᠽҎষᄺ䌘᭭੠

ि⫳㸠Ўˈᇍ᠔᳝⮙՟੠ᇍ✻ᓔሩ䇗ᶹǄ䞛⫼

Epi Info 3.5.4

ᔩܹ੠ߚᵤ᭄᥂Ǆ䞛⫼ঠব䞣ߚᵤˈ䅵ㅫ

OR

੠ৃ

ֵऎ䯈˄

CI

˅ˈ᳝ᛣНⱘॅ䰽಴㋴˄

P < 0.05

˅㒇ܹ

䗤ℹ৥ࠡⱘ໮ܗ

logistic

ಲᔦߚᵤǄ

⦃๗䇗ᶹ

⦃๗䇗ᶹࣙᣀ㾖ᆳ∈੠ि⫳㸠ЎˈẔᶹᒋา᱂㽓㖕 ᴥ ┰ ೼ ⱘ 㱞 ᄤ ⒟ ⫳ ഄ Ǆ ೼

3੠ 4

ো 㞾 ✊ ᴥ 䱣 ᴎ 䗝 ᢽ

100᠋ᆊᒁ䅵ㅫ᠓ሟᣛ᭄˄᠓ሟЁ᳝ᑐ㰿੠៪㳍ᅇ⫳

(2)

WPSAR Vol 6, No 3, 2015 | doi: 10.5365/wpsar.2015.6.1.006 www.wpro.who.int/wpsar

2

Balleraㄝ

෎ᄨ㚃䲙⛁ᲈথˈᢝস㒇ⳕˈ㧆ᕟᆒˈ2012

1.2%

˄Ҏষ᭄˖

7881

˅Ǆ䰸থ⛁ˈ⮙՟г㸼⦄ЎⲂ

⮍˄

88%

˅ǃ݇㡖⮯˄

85%

˅ǃ༈⮯˄

61%

˅੠ઇ௑

˄

23%

˅Ǆ

⮙՟ᇍ✻ⷨお

⮙ ՟ ᇍ ✻ ⷨ お ࣙ ᣀ

88ৡ ⮙ ՟ ੠ 88ৡ ᇍ ✻ Ǆ ऩ ಴ ㋴

੠໮಴㋴ߚᵤ㒧ᵰ㸼ᯢˈ⮙՟㒘ᆊЁ᳝݊Ҫⱘ⮙՟

ⱘ ↨ ՟ ᰃ ᇍ ✻ 㒘 ⱘ

6ס ˄ 䇗 ᭈ OR˖ 6.2˗95%CI

˖

3.0–12.9˅ˈ⮙՟㒘ᆊᒁхᠨൗഒⱘ↨՟ᰃᇍ✻㒘ⱘ 2ס˄䇗ᭈOR˖2.7˗95% CI˖1.4–5.4˗㸼1˅Ǆ

⦃๗䇗ᶹ

䆹ᴥ⬅Ꮦᬓկ∈㋏㒳կ∈Ǆ✊㗠ˈ⬅Ѣϡ㛑ᣕ㓁կ

∈ˈᆊᒁݙ䗮ᐌټ㮣∈ˈ㒣ᐌৃҹⳟࠄᬲষⱘټ∈ᆍ

఼Ǆ೼☠⑝⏴䰘䖥ߎ⦄㘮䲚ᗻ⮙՟Ǆϡᰃ᠔᳝ᆊᒁ㒣 ᐌ⏙⧚ൗഒǄ៥Ӏ㾖ᆳࠄሙ⇥䱣ᛣᇚൗഒᠨࠄ䰘䖥ⱘ

☠⑝⏴੠ৢ䰶Ǆ೼ൗഒЁৃ㾕϶ᓗⱘἄᄤ໇੠݊Ҫ┰

೼ⱘ㱞ᄤᅇ⫳ᆍ఼Ǆ

᠓ ሟ ᣛ ᭄ ੠ Ꮧ 䳋 ೒ ᣛ ᭄ ߚ ߿ Ў

27%

੠

28%

ˈ ϸ 㗙 ഛ 䍙䖛 ೑ ᆊ ᷛ ޚ 㾘 ᅮ ˄ ᠓ ሟ ᣛ ᭄

<5%

੠ Ꮧ 䳋

೒ ᣛ ᭄

<20%

˅^[5]Ǆ 䖭 ѯ ᣛ ᭄ 䕗催 ᛣ ੇ ⴔ ᄬ ೼ ໻ 䞣 ⱘ Ӟ 㱞㐕 Ⅺ ᷪ ᙃ ഄ ˈ г 㸼 ᯢ 䖭 ѯ ഄ ᮍ ᰃ ᯧ ᛳ

ഄऎˈᑊ᳝߽Ѣ⮒⮙Ӵ᪁Ǆ᠔᳝ⱘᑐ㰿Ё඗ঞӞ㱞ऴ

79%

ˈⱑ㒍Ӟ㱞ऴ

21%

Ǆ

ⱘ↨՟˅੠Ꮧ䳋೒ᣛ᭄˄Ẕᶹ↣ⱒ᠋᳝䰇ᗻᆍ఼ⱘ Ͼ᭄˅Ǆ✊ৢৠ㧆ᕟᆒ೑ᆊⱏ䴽⛁乘䰆੠᥻ࠊ乍Ⳃ ⱘᷛޚⳌ↨䕗ˈ䖭2乍ᣛᷛⱘ೑ᆊᷛޚ㾘ᅮؐߚ߿Ў

<5%੠20%

^[5]Ǆᯚ㰿ᄺᆊ⦄എ䡈ᅮ㱞ᄤᑐ㰿ⱘ⾡㉏Ǆ ᅲ偠ᅸ䇗ᶹ

䞛䲚 ⮙ ՟ ੠ ᇍ ✻ ⱘ 㸔 ⏙ ᄺ ᷛ ᴀ 䗕 ᕔ 㧆 ᕟ ᆒ ᭛ ⦡ ֲ ᏈᏖ⛁ᏺएᄺⷨお᠔ˈ䗮䖛䝊㘨ܡ⭿਌䰘ᅲ偠Ẕ⌟

෎ᄨ㚃䲙⛁

IgM NovaTec

ˈ

Waldstrasse

ˈ䖾㡽Ꮘ䌿 ᖋ೑Ǆ

Ӻ⧚ᄺ

⬅Ѣ䖭⃵䇗ᶹᰃᲈথᑨᗹডᑨⱘ䚼ߚݙᆍˈ಴ℸϡ䳔㽕䖯㸠Ӻ⧚ᄺᅵᡍǄ

㒧ᵰ

⮙՟⡍ᕕ

㞾

6

᳜

23

᮹佪՟᡹ਞҹᴹˈ݅᧰㋶ࠄ

98

՟⮙՟ˈ᡹ਞ

⮙՟催ዄথ⫳೼

7

᳜

20

㟇

21

᮹˄೒

1

˅Ǆ

1

՟˄

1%

˅ ԣ䰶Ǆ᮴⅏ѵ⮙՟᡹ਞǄ⮙՟ᑈ啘Ў

5

Ͼ᳜㟇

83

ቕ

˄Ёԡ᭄˖

27

ቕ˅ˈ

54

՟˄

55%

˅ᰃཇᗻǄ⮙՟᭄

᳔໮ⱘᑈ啘㒘Ў

11–20

ቕǄ᠔᳝ⱘ⮙՟ᴹ㞾ᒋา᱂㽓㖕ᴥⱘ㞾✊ᴥ

3

੠㞾✊ᴥ

4

Ǆᒋา᱂㽓㖕ᴥᘏ㕍ᙷ⥛Ў

೒

1. 2012

ᑈ

6

᳜

23

᮹㟇

8

᳜

6

᮹ˈ㧆ᕟᆒ೷Ꮘࢗ㔫Ꮦᒋา᱂㽓㖕ᴥˈ෎ᄨ㚃䲙⛁⮙՟থ⮙ᚙމ

n = 98

0 2 4 6 8 10 12

6᦬20–21ᣣ 6᦬22–23ᣣ ᣣ24–25 Jun 6᦬26–27ᣣ 6᦬28–29ᣣ 6᦬30ᣣ–7᦬1ᣣ 7᦬2–3ᣣ 7᦬4–5ᣣ 7᦬6–7ᣣ 7᦬8–9 ᣣ 7᦬10–11ᣣ 7᦬12–13ᣣ 7᦬14–15ᣣ 7᦬16–17ᣣ 7᦬18–19ᣣ 7᦬20–21ᣣ 7᦬22-23ᣣ 7᦬24–25ᣣ 7᦬26–27ᣣ 7᦬28–29ᣣ 7᦬30–31ᣣ 8᦬1–2ᣣ 8᦬3–4ᣣ 8᦬5–6ᣣ 8᦬7–8ᣣ

⮙՟᭄⮙՟᭄

থ⮙᮹ᳳ

(3)

WPSAR Vol 6, No 3, 2015 | doi: 10.5365/wpsar.2015.6.1.006

www.wpro.who.int/wpsar

3

෎ᄨ㚃䲙⛁ᲈথˈᢝস㒇ⳕˈ㧆ᕟᆒˈ2012 Balleraㄝ

ᶹ䯳ⱘᓎ䆂ˈ⼒ऎᑨᇍᲈথⱘ᥾ᮑࣙᣀ೼⭿ᚙᴥᓔሩ ᅮᳳᬊ䲚ൗഒ੠↣਼ⲥ⌟ᑐ㰿ᣛ᭄Ǆ៥Ӏᓎ䆂Ҟৢ෎

ᄨ㚃䲙⛁ᲈথ䇗ᶹ㗙ᑨᇚхᠨൗഒ԰Ў䆘Ӌ๲ࡴ㱞ᄤ

⒟⫳ഄⱘϔϾॅ䰽಴㋴Ǆ

߽Ⲟކさ

᮴Ǆ 㒣䌍䌘ࡽ

᮴Ǆ

ᓩ⫼ᴀ᭛ഄഔ˖

Ballera JE et al. Investigation of chikungunya fever out- break in Laguna, Philippines, 2012. Western Pacific Surveillance and Response Journal, 2015, 6(3):8–11.

doi:10.5365/wpsar.2015.6.1.006

খ㗗᭛⤂

1. Guidelines on clinical management of chikungunya fever.

New Delhi, World Health Organization Regional Office for the South-East Asia, 2008 (http://www.wpro.who.int/mvp/topics/

ntd/Clinical_Mgnt_Chikungunya_WHO_SEARO.pdf, accessed 24 July 2015).

2. Macasaet FF et al. Epidemiology of arbovirus infections in Negros Oriental: I. Clinical features of an epidemic in Amlan. Journal of the Philippine Medical Association, 1969, 45:207–215.

3. Retuya JT. Chikungunya fever outbreak in an agricultural village in Indang, Cavite, Philippines, June 1996. Philippine Journal of Microbiology and Infectious Diseases, 1998, 27 (3) (http://www.

psmid.org.ph/vol27/vol27num3topic1.pdf?origin=publication_

detail, accessed 24 July 2015).

4. Beware of chikungunya. Quezon City, Philippine Online Chronicles, 2013 (http://thepoc.net/index.php/beware-of- chikungunya/, accessed 24 July 2015).

5. National Dengue Prevention and Control Program. Manila, Department of Health, 2011 (http://www.doh.gov.ph/content/

national-dengue-prevention-and-control-program.html, accessed 24 July 2015).

6. Guidelines for prevention and control of Chikungunya fever.

New Delhi, World Health Organization Regional Office for the

ᅲ偠ᅸ䇗ᶹ

䞛⫼ELISA⊩ᇍ84՟⮙՟䖯㸠Ẕ⌟ˈ58˄69%˅ӑ㸔

⏙ᄺᷛᴀ෎ᄨ㚃䲙⛁IgM䰇ᗻǄ

䅼䆎

2012ᑈ6᳜23᮹㟇8᳜6᮹ˈ㧆ᕟᆒ೷Ꮘࢗ㔫Ꮦᒋา᱂

㽓㖕ᴥᲈথ෎ᄨ㚃䲙⛁Ǆ⮙՟㸔⏙Ẕ⌟ࠄ෎ᄨ㚃䲙⛁

IgMҢ㗠⹂ᅮњ䖭⃵ᲈথǄৃ㛑ⱘၦҟЎᨎᏺ⮙↦ⱘ඗

ঞӞ㱞੠ⱑ㒍Ӟ㱞^[6]Ǆ⦃๗䇗ᶹᳳ䯈ˈ៥Ӏ೼☠⑝⏴

੠ৢ䰶㾖ᆳࠄ䆌໮㱞ᄤ⒟⫳ഄǄၦҟ䇗ᶹ㸼ᯢ೼ᲈথ ⱘ㞾✊ᴥЁ᳝ᕜ催ⱘᑐ㰿ᣛ᭄Ǆि⫳䚼FETPᓔሩⱘ݊

Ҫⱘᲈথ䇗ᶹˈথ⦄㧆ᕟᆒⱘ⦃๗Ё᳝ⳌԐⱘ催ᑐ㰿 ᣛ᭄^[4]Ǆ

ᆊЁ᳝෎ᄨ㚃䲙⛁⮙՟ᇍᲈথЁ㕍ᙷ䆹⮙ᰃϔϾ 䞡㽕ⱘॅ䰽಴㋴Ǆ䖭Ͼ㒧ᵰৠ᳔䖥೼⍋ഄᓔሩⱘ໻㾘

῵䇗ᶹ㒧ᵰᰃϔ㟈ⱘ^[7]ǄϪ⬠ि⫳㒘㒛ᓎ䆂ӏԩᆊᒁ ៤ਬᗔ⭥㕍ᙷ෎ᄨ㚃䲙⛁ˈ೼⮙↦㸔⮛ᳳ䛑ᑨ䆹೼㱞 ᏤЁऻᑞӥᙃҹ᥻ࠊᛳᶧ੠Ӵ᪁^[6]Ǆ

ᴀⷨおথ⦄хᠨൗഒᰃ঺໪ϔϾॅ䰽಴㋴Ǆൗ

ഒ䰏⹡њ☠⑝⏴∈ⱘ㞾⬅⌕ࡼˈ㟈Փ⏴ݙ๲ࡴњ㱞 ၦ⒟⫳ˈгᦤկњ᳈໮ⱘկ㱞ᄤᅇ⫳ⱘᄬ∈ᆍ఼Ǆ

೼݊ҪⱘၦҟӴ᪁⮙ᲈথ䇗ᶹЁхᠨൗഒгᰃϔϾॅ

䰽಴㋴^[8]ˈᵕৃ㛑ᰃ಴Ўхᠨൗഒ๲ࡴњ㱞ᄤⱘ⒟⫳

ഄǄ

ᴀⷨおЁˈ៥Ӏҙ೼2Ͼ㞾✊ᴥᓔሩњܹ᠋⮙՟

᧰㋶ˈৃ㛑Ӯⓣᥝ䰘䖥㞾✊ᴥⱘ⮙՟Ǆ䞛⫼Јᑞ䆞ᮁ

⮙՟ᅮНৃ㛑ᇐ㟈䇃䆞ˈᇸ݊ᰃߚᵤᗻⷨおЁ䖥ϝߚ Пϔⱘ⮙՟෎ᄨ㚃䲙⛁IgM䰈ᗻǄ㗠Ϩˈᇍ✻䗝ᢽሔ䰤

೼᳝㛑࡯ᓔሩⳌ݇ॅ䰽಴㋴Ẕ⌟ⱘഄऎˈབ䴴䖥☠⑝

⏴Ǆ

ሑㅵ෎ᄨ㚃䲙⛁⮙⅏⥛Ⳍᇍ䕗ԢˈԚᰃ㕍ᙷ⥛

ᕜ催Ǆᣕ㓁ⱘ݇㡖⮐⮯Ӯᇐ㟈༅㛑ˈޣᇥ⫳ѻ࡯^[9]Ǆ

಴ℸˈ෎ᄨ㚃䲙⛁ⱘ݀݅ि⫳䋳ᢙᰃᕜ䞡ⱘǄḍ᥂䇗

㸼

1. 2012

ᑈ

6

᳜

23

᮹㟇

8

᳜

6

᮹ˈ㧆ᕟᆒ೷Ꮘࢗ㔫Ꮦᒋา᱂㽓㖕ᴥˈ෎ᄨ㚃䲙⛁থ⮙ॅ䰽಴㋴

ব䞣 ⮙՟㒘 (n = 88) ᇍ✻㒘 (n = 88) ㉫ OR (95% CI) 䇗ᭈ OR* (95% CI) ᆊᒁ៤ਬᙷ෎ᄨ㚃䲙⛁ 49 (56%) 15 (17%) 6.11 (3.04–12.27) 6.19 (2.98–12.86)

хᠨൗഒ 47 (53%) 27 (31%) 2.51 (1.39–4.80) 2.71 (1.36–5.42)

ټᄬ⫳⌏⫼∈ 31 (35%) 23 (26%) 1.53 (0.80–2.93) – ᅮᳳᬊ䲚ൗഒ 29 (33%) 31 (35%) 0.91 (0.49–1.71) – CI, ৃֵऎ䯈OR, Ⳍᇍॅ䰽ᑺǄ

* 䇗ᭈᑈ啘੠ᗻ߿Ǆ

(4)

WPSAR Vol 6, No 3, 2015 | doi: 10.5365/wpsar.2015.6.1.006 www.wpro.who.int/wpsar

4

Balleraㄝ

෎ᄨ㚃䲙⛁ᲈথˈᢝস㒇ⳕˈ㧆ᕟᆒˈ2012

(AP-EINet), 2012 (http://blogs.uw.edu/apecein/2012/10/26/

philippines-team-sent-to-investigate-chikungunya-outbreak/#.

VbgqeflKenM, accessed 29 July 2015).

9. Pan America Health Organization; National Center for Emerging and Zoonotic Diseases (US), Division of Vector-Borne Diseases.

Preparedness and response for chikungunya virus, introduction in the Americas. Atlanta, CDC Stacks, 2011 (http://stacks.cdc.gov/

view/cdc/21188, accessed 24 July 2015).

South-East Asia, 2009 (http://www.wpro.who.int/mvp/topics/ntd/

Chikungunya_WHO_SEARO.pdf, accessed 24 July 2015).

7. Kolbe AR, Herman A, Muggah R. Break your bones: mortality and morbidity associated with Haitis’s chikungunya epidemic.

Riode Janeiro, Igarape Institute, 2014 (http://igarape.org.br/

wp-content/uploads/2014/07/NE16-Chikugunya.pdf, accessed 24 July 2015).

8. Philippines: Team sent to investigate chikungunya outbreak.

Washington, DC, Asia Pacific Emerging Infections Network