2012年10月马来西亚霹雳州曼绒区甲肝暴发调查

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ᲈথ䇗ᶹ᡹ਞ

WPSAR Vol 6, No 2, 2015 | doi: 10.5365/wpsar.2015.6.1.012

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1

a ि⫳䚼एᄺⷨお᠔एᄺⷨお䌘⑤Ёᖗ⌕㸠⮙ᄺϢ⫳⠽㒳䅵ᅸˈ偀ᴹ㽓Ѯঢ়䱚വǄ

b 偀݁⬆Ꮂि⫳ሔˈ偀ᴹ㽓Ѯ偀݁⬆∝䛑Ѯ䌒ѮǄ

c ᳐㒦ऎि⫳ሔˈ偀ᴹ㽓Ѯ䴍䳇ᎲǄ

d 偀ᴹ㽓Ѯि⫳䚼݀݅ि⫳ࡃ䚼䭓ࡲ݀ᅸˈ偀ᴹ㽓Ѯ໾ᄤජǄ ᡩ〓᮹ᳳ˖2015ᑈ2᳜20᮹˗থ㸼᮹ᳳ˖2015ᑈ5᳜27᮹ doi: 10.5365/wpsar.2015.6.1.012

⬆

㙱⮙↦˄HAV˅ᛳᶧ೼ܼ⧗ഛ᳝থ⫳ˈ೼ि

⫳⢊މ䕗Ꮒⱘഄᮍ᳈ᐌ㾕ǄHAVЏ㽕䗮䖛㉾

ষ䗨ᕘǃҎϢҎ᥹㾺੠ᨘܹ㹿∵ᶧⱘ亳⠽੠

佂᭭Ӵ᪁^[1]Ǆ亳⠽Ӵ᪁⬆㙱᳔ᐌ᡹䘧ⱘϔ⾡ᮍᓣᰃϢ 亳⫼䋱㉏᳝݇^[1,2]Ǆॄᑺ᳒᡹䘧⬆㙱⮙՟Ϣ佂⫼ẩ὜䜦

᳝݇ˈ݊Ўϔ⾡䜦㊒佂᭭ˈ⬅ἄᷥ੠݊Ҫẩ὜ᷥⱘᷥ

⎆ࠊ԰㗠៤Ǆ

᳐㒦ԡѢ偀ᴹ㽓Ѯ䴍䳇Ꮂ㽓फ䚼ǄЏ㽕⾡ᮣЎ 偀ᴹҎ˄

160 650

˅ǃЁ೑Ҏ˄

76 500

˅ǃॄᑺҎ

˄

12 750

˅ঞ݊Ҫ˄

5100

˅^[3,4]ǄݰϮ੠ᮙ␌Ϯᰃ᳐

㒦ⱘЏ㽕㒣⌢䚼ߚǄἄᷥᰃ᳐㒦ᔧഄⱘϔ⾡Џ㽕ݰ

԰⠽ˈ݊∕⎆⫼Ѣ⫳ѻẩ὜䜦佂᭭ˈἄᷥⱘ㢅〫㹿 ߛ ᓔ ǃ থ 䝉 ˈ ✊ ৢ ԰ Ў ẩ ὜ 䜦佂 ⫼ Ǆ ẩ ὜ 䜦䗮 ᐌ 䳔 ೼ ϔ ໽ ݙ 佂 ⫼ ˈ བ ᵰ ދ 㮣 ৃ ҹ ᄬ ᬒ ᯊ 䯈 ⿡ 䭓 Ǆ

2012

ᑈ

9

᳜

19

᮹ˈ᳐㒦ऎि⫳ሔ᥹᡹

10

՟⭥Ԑ⬆㙱⮙

՟ˈ⮙՟݋᳝⬆㙱ⱘ݌ൟ⮛⢊੠ԧᕕˈ㸔⏙ḋᴀẔ⌟

HAV IgM

ᡫԧ䰇ᗻǄЎ⹂ᅮৃ㛑ᴹ⑤੠Ӵ᪁䗨ᕘˈᦤߎ

᥻ࠊ᥾ᮑᓎ䆂ˈ៥Ӏᓔሩњℸ⃵䇗ᶹǄ

ᮍ⊩

⌕㸠⮙ᄺ䇗ᶹ

៥Ӏᓔሩњ⮙՟ᇍ✻ⷨおˈᶹ䯙њि⫳ֱعᎹ԰㗙ⱘ ᐌ㾘᡹ਞवˈᑊ೼催ॅҎਬЁᓔሩ⮙՟ⱘЏࡼ᧰㋶ˈ 催ॅҎ㕸ࣙᣀ亳કࡴᎹ㗙ǃ亳ક㒣㧹⚍ⱘᎹҎ੠⮙՟

2012 ᑈ 10 ᳜偀ᴹ㽓Ѯ䴍䳇Ꮂ᳐㒦ऎ⬆㙱ᲈথ 䇗ᶹ

Faudzi Ahmad Yusoff

^a

ˈRusdi Abdul Rahman

^b

ˈLing He May

^c

ˈSuzana Binti Budart

^c

੠Lokman Hakim Sulaiman

^d

䗮䆃԰㗙˖Faudzi Ahmad Yusoff (⬉ᄤ䚂ㆅ˖[email protected])Ǆ

ⱘᆊᒁ៤ਬǄ⬆㙱⭥Ԑ⮙՟Ў

2012

ᑈ

9

᳜᳐㒦ഄऎሙ

⇥Ёߎ⦄ϔ㋏߫ⱘᗹᗻথ⮙⮛⢊ϨԈ᳝咘⮌៪䕀⇼䝊 छ催㗙Ǆ⹂䆞⮙՟Ў㸔⏙ᄺẔ⌟

HAV IgM

ᡫԧ䰇ᗻǄᇍ

✻Ў᮴Јᑞ⮛⢊੠

HAV

Ẕ⌟䰈ᗻ㗙ˈҢ⮙՟ৠϔሙԣ

ഄऎЁ䱣ᴎ䗝ᢽᇍ✻Ǆ

៥ӀՓ⫼㒧ᵘᓣ䯂ोᇍ⮙՟䖯㸠䴶ᇍ䴶䆓䇜ˈݙ ᆍࣙᣀ⼒ӮҎষᄺֵᙃǃ亳⫼ⱘ亳ક⾡㉏ҹঞϢৃ㛑 ⱘӴ᪁ᮍᓣ᳝݇ⱘ⌏ࡼˈгࣙᣀњ亳⫼⍋ѻક੠佂⫼

ẩ὜䜦ⱘᚙމˈ঺໪ˈ៥Ӏ䖬䆓䇜Ϣ

2012

ᑈ

9

᳜ⱘ⡍

⅞џӊ˄བᓔ᭟㡖˅᳝݇ⱘ䯂乬Ǆ

៥ӀՓ⫼STATA 11䖯㸠ऩ಴㋴੠໮಴㋴logisticಲ ᔦ ߚ ᵤ ˈ 䞛 ⫼ ৢ 䗔 ⊩ ໮ ܗ

logsiticಲ ᔦ ῵ ൟ ˈ ᑊ ᇍ

໮ ܗ ݅ 㒓 ᗻ ੠ Ѹ Ѧ ԰ ⫼ 䖯㸠 њ Ẕ ᶹ Ǆ Փ ⫼Hosmer-

LemeshowẔ偠ǃߚ㉏㸼Ḑ੠ROC᳆㒓ϟ䴶⿃߸߿῵ൟ

ⱘᢳড়ᑺǄ

ᅲ偠ᅸ䇗ᶹ

㸔⎆ᷛᴀ䗕㟇偀ᴹ㽓Ѯ䲾݄㥾Ꮂঠ⑾↯剕੠䴍䳇Ꮂ䖥 ᠧওⱘ݀݅ि⫳ᅲ偠ᅸˈẔ⌟

HAV

˄

IgM

˅ᡫԧǄ 亳ક੠⦃๗ि⫳ᄺ䇗ᶹ

ᇍϸᆊẩ὜䜦⫳ѻ⚍੠

341

ᆊ亳ક㒣㧹⚍䖯㸠њ䇗 ᶹˈḍ᥂Ꮉ԰ഄ⚍੠᠔䫔ଂⱘ亳ક㉏ൟ䗝ᢽ䚼ߚ亳ક

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WPSAR Vol 6, No 2, 2015 | doi: 10.5365/wpsar.2015.6.1.012 www.wpro.who.int/wpsar

2

Yusoffㄝ偀ᴹ㽓Ѯ䴍䳇Ꮂ⬆㙱ᲈথ

⦃๗ि⫳ᄺ䆘Ӌ

ẩ὜䜦ᰃ೼AǃBϸϾࡴᎹॖ⫳ѻˈৃҹ೼ࡴᎹॖⳈ᥹

䌁фᑊ佂⫼ˈгৃᇚẩ὜䜦ߚথ㟇݊Ҫⱘ㒣㧹⚍Ǆᇍ

ࡴᎹॖ䖯㸠⦄എ㾖ᆳˈথ⦄ϸϾࡴᎹॖि⫳ᴵӊഛ䕗 Ꮒˈ᮴३᠔ˈᎹҎⳈ᥹⫼᠟᧙ᢠẩ὜䜦ˈ䜦೼㺙⫊П

ࠡ⫼ϔϾ᱂䗮∈Ṋᴹⲯ㺙Ǆ೼亳ક㒣㧹⚍ˈ㒣㧹㗙Փ

⫼ѩ∈ᴹ⏙⋫令݋੠݊Ҫ⠽કǄBࡴᎹॖⱘѩ∈ḋᴀ Ẕ⌟㒧ᵰᰒ⼎໻㙴ᴚ㦠䰇ᗻǄ᠔᳝ⱘ⦃๗ḋકⱘHAV Ẕ⌟㒧ᵰഛ䰈ᗻǄẩ὜䜦៤કⱘpHؐЎ3.37–3.63ˈ

⫊㺙ẩ὜䜦pHؐЎ3.07–3.27Ǆẩ὜䜦ḋક᳾㛑Ẕ⌟

HAVǄ

೼亳ક㒣㧹⚍݅䞛䲚њ

341ӑ亳⠽ḋક⫼ѢẔ

⌟ ˈ ݊ Ё

10ᆊ 㒣㧹 ⚍ ձ ᥂ 偀 ᴹ 㽓 Ѯ 亳 ક ⊩ ќ ҹ ݇

䯁ˈ4ᆊձ᥂⮒᥻Ёᖗ⊩㾘ќҹ݇䯁Ǆ᠔᳝67ৡ亳⠽

ҢϮ㗙HAVẔ⌟㒧ᵰഛЎ䰈ᗻˈ㱑✊᳝71.6%ⱘҎᘏ ᡫԧ䰇ᗻǄҢ佁ᑫ䞛䲚ⱘḋકབބഫǃ໘⧚䖛ⱘ∈੠

㞾ᴹ∈ㄝˈHAVẔ⌟㒧ᵰഛЎ䰈ᗻǄ

䅼䆎

ሑㅵ䆌໮ᔧഄᅬਬ⣰⌟⍋ѻક੠∈ৃ㛑ᰃᴀ⃵ᲈথⱘ ॳ಴ˈԚᰃ䇗ᶹ㒧ᵰᰒ⼎⬋ᗻ佂⫼ẩ὜䜦᳈ৃ㛑ᰃ⬆

㙱থ⮙ⱘॅ䰽಴㋴ˈे֓೼᥻ࠊњ݊Ҫ亳કⱘᕅડ

ৢˈ⍋ѻકҡϢথ⮙᮴݇㘨Ǆ

ẩ὜䜦ৃ㛑ᰃᴀ⃵ᲈথⱘॳ಴ˈᲈ䴆ᯊ䯈Ϣ偀ᴹ 㽓ѮҎᑚ⼱ᓔ᭟㡖ᳳ䯈ℷདਏড়Ǆሑㅵᓔ᭟㡖ᰃ〚ᮃ ໘⧚Ҏਬ䖯㸠⬆㙱Ẕ⌟Ǆ䞛䲚њᎹॖⱘބഫǃẩ὜

䜦ǃ⍋ѻક੠ѩ∈ㄝ⦃๗ḋકˈ䗕ᅲ偠ᅸ䖯㸠

PCR

Ẕ

⌟Ǆᇍϡৠ⫳ѻ⦃㡖ⱘẩ὜䜦䛑䞛䲚њḋકẔ⌟

PH

ؐǄ

㒧ᵰ

݅থ⦄

78

՟⹂䆞⮙՟ˈ㕍ᙷ⥛Ў

3.1/10 000

Ǆ⮙՟Џ 㽕Ў⬋ᗻ˄

95%

˅ˈᑈ啘㣗ೈЎ

13–72

ቕ˄ഛؐЎ

31.4

ቕ˅Ǆ໻䚼ߚ⮙՟ᴹ㞾⠅໾ढ

47.4%

ᇣऎ੠

ᅲܚ䖰

37.2%

ᇣऎǄ໮᭄⮙՟ᴹ㞾ॄᑺҎ㕸˄㕍

ᙷ⥛Ў

5.1/1000

˅ˈᑈ啘↉೼

25–40

ቕˈҢџԧ࡯

ࢇ ࡼ ǃ ᬊ ܹ 䕗 Ԣ ˄㸼1˅ Ǆ 佪 ՟ ⮙ ՟ ⱘ থ ⮙ ᮹ ᳳ Ў

2012

ᑈ

9

᳜

8

᮹˄೒

1˅ˈ⌕㸠⮙ᄺ᳆㒓ਜ⦄๲ؐ῵

ᓣˈҢ

9

᳜

8

᮹㟇

19

᮹ᳳ䯈থ⮙Ҏ᭄ᣕ㓁Ϟछˈ㟇

9

᳜

24

᮹ߎ⦄㄀ѠϾ催ዄǄ

2015

ᑈ

9

᳜

25

᮹Пৢথ⮙Ҏ᭄

䗤⏤ϟ䰡㟇䕗Ԣ∈ᑇˈⳈ㟇

2012

ᑈ

10

᳜

11

᮹ˈা᳝

䕗ᇥ⮙՟᡹ਞǄ ߚᵤᗻⷨお

ऩ಴㋴ߚᵤᰒ⼎䆌໮ব䞣᳝㒳䅵ᄺᛣН˄

P < 0.05

˅ˈ

ࣙᣀ⬋ᗻǃ೼໪ህ令ǃৗ⍋ѻકǃୱ䜦˄ࣙᣀẩ὜䜦

੠ସ䜦˅ǃ೼ᓔ᭟㡖ᳳ䯈㒣ᐌୱ䜦ˈҹঞ݊Ҫ݇Ѣ೼

ϡৠഎ᠔佂⫼ẩ὜䜦ⱘⳌ݇ব䞣˄㸼

1

˅Ǆ

໮಴㋴ߚᵤ㒧ᵰᰒ⼎ˈা᳝⬋ᗻ˄䇗ᭈ↨ؐ↨

[OR]18.4 [5.13–65.9]˅੠佂⫼AࡴᎹॖⱘẩ὜䜦݋

᳝㒳䅵ᄺᛣНǄ

೒1. 2012ᑈ9᳜8᮹㟇10᳜19᮹偀ᴹ㽓Ѯ᳐㒦⬆㙱ᲈথ⌕㸠᳆㒓

0 2 4 6 8 10 12

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

⮙՟᭄⮙՟᭄

থ⮙᮹ᳳ

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WPSAR Vol 6, No 2, 2015 | doi: 10.5365/wpsar.2015.6.1.012

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偀ᴹ㽓Ѯ䴍䳇Ꮂ⬆㙱ᲈথ Yusoffㄝ

೒

1. 2012

ᑈ

9

᳜

8

᮹㟇

10

᳜

19

᮹偀ᴹ㽓Ѯ᳐㒦⬆㙱ᲈথ⌕㸠᳆㒓

⡍ᕕ ⮙՟˄%˅ ᇍ✻˄%˅ OR (95% CI) Pؐ

ᗻ߿

⬋ᗻ 75 (96.2) 37 (47.4) 27.7 (8.0–95.4) < 0.001

ཇᗻ 3 (3.8) 41 (52.6) খ㗗ؐ

ᑈ啘㒘

11 (14.1) 8 (10.3) খ㗗ؐ

̢ 28 (35.9) 27 (34.6) 0.8 (0.3–2.2) 0.600

̢ 25 (32.1) 17 (21.8) 1.1 (0.4–3.2) 0.905

̢ 10 (12.8) 8 (10.3) 0.9 (0.3–3.3) 0.886

̢ 3 (3.8) 12 (15.4) 0.2 (0.0–0.9) 0.032

ቕҹϞ 1 (1.3) 6 (7.7) 0.1 (0.0–1.2) 0.012

⾡ᮣ

ॄᑺҎ 65 (83.3) 63 (80.8) 1.0 (0.1–16.9) 0.983

Ё೑Ҏ 12 (15.4) 13 (16.7) 0.9 (0.1–16.5) 0.957

偀ᴹҎ 0 (0) 1 (1.3) খ㗗ؐ

݊Ҫ 1 (1.3) 1 (1.3) –

㘠Ϯ

ᄺ⫳ 5 (6.4) 6 (7.7) খ㗗ؐ

ᆊᒁЏཛ᮴Ϯ 6 (7.7) 28 (35.9) 3.9 (0.9–17.1) 0.720

ৌᴎᄺ⫳ 18 (23.1) 5 (6.4) 0.2 (0.1–1.1) 0.640

ᬓᑰ䚼䮼 5 (6.4) 5 (6.4) 0.9 (0.2–4.6) 0.835

Ͼԧ㒣㧹 8 (10.3) 4 (5.1) 0.4 (0.1–2.3) 0.309

ԧ࡯ࢇࡼ㗙 30 (38.5) 26 (33.3) 0.7 (0.2 -2.6) 0.623

㒣ଚ 6 (7.7) 4 (5.1) 0.6 (0.1–3.1) 0.507

佂亳佂᭭ᲈ䴆

ᓔ᭟㡖ᳳ䯈೼໪ህ令 72 (57.6) 53 (68.0) 5.7 (2.2–14.8) 0.000

਼⃵ҹϞ 63 (80.8) 27 (34.6) 1.8 (1.4–2.3) 0.000

೼໪ህ令

⍋ѻક 32 (41.0) 19 (24.4) 2.2 (1.1–4.3) 0.028

剐㉏ 1.4 1 2.1 0.080

佂䜦

ӏԩ䜦㉏ 73 (93.6) 33 (42.3) 19.9 (7.2–54.7) 0.000

ସ䜦 52 (66.7) 23 (29.5) 4.8 (2.4–9.4) 0.000

ẩ὜䜦 56 (71.8) 21 (26.9) 6.9 (3.4–14.0) 0.000

ᓔ᭟㡖ᳳ䯈佂䜦⃵ҹϞ 72 (57.6) 53 (68.0) 5.7 (2.2–14.8) 0.000 ᓔ᭟㡖ᳳ䯈㒣ᐌ佂䜦 63 (80.8) 27 (34.6) 1.8 (1.4–2.3) 0.000

೼ࡴᎹഄ⚍ 56 (71.8) 23 (29.5) 6.1 (3.0–12.2) 0.000

$ࡴᎹॖ 12 (15.4) 1 (1.3) 14.0 (1.8–110.5) 0.012

%ࡴᎹॖ 40 (51.3) 11 (14.1) 6.4 (3.0–13.9) 0.000

೼佁ᑫ 32 (41.0) 12 (15.4) 3.8 (1.8–8.2) 0.001

⫼⫊ᄤୱ 20 (25.6) 8 (10.3) 3.0 (1.2–7.4) 0.015

⫼ϡ䫜䩶ᵃୱ 26 (33.3) 7 (9.0) 5.1 (2.1–12.6) 0.000

CIৃֵऎ䯈˗ORˈ↨ؐ↨Ǆ

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WPSAR Vol 6, No 2, 2015 | doi: 10.5365/wpsar.2015.6.1.012 www.wpro.who.int/wpsar

4

Yusoffㄝ偀ᴹ㽓Ѯ䴍䳇Ꮂ⬆㙱ᲈথ

㟈䇶

៥Ӏᛳ䇶偀ᴹ㽓Ѯि⫳䚼䭓ܕ䆌ℸ᭛থ㸼ˈᛳ䇶䴍䳇 Ꮂि⫳ሔ乚ᇐᇍᴀ⃵䇗ᶹ㒭ќⱘᬃᣕˈᛳ䇶Yeoh So Fan म຿ǃHaslinda Ismailम຿ҹঞᇍᴀⷨおᦤկᐂࡽⱘ᳐

㒦ि⫳ሔⱘ᠔᳝Ꮉ԰ҎਬˈҪӀ䰸њ೼⮒⮙乘䰆੠᥻

ࠊЁথ᣹԰⫼໪ˈ䖬ᐂࡽ៥Ӏᔩ᭄ܹ᥂Ǆ঺໪гᛳ䇶䴍䳇Ꮂि⫳ሔ᠔᳝Ꮉ԰Ҏਬᇍᴀ⃵䇗ᶹⱘ䋵⤂Ǆ ᓩ⫼᭛ᴀഄഔ˖

Yusoff FA et al. Investigation of hepatits A in district of Manjung, Perak, Malaysia, October 2012. Western Pacific Surveillance and Response Journal, 2015, 6(2):21–25. doi:10.5365/wpsar.2015.6.1.012

খ㗗᭛⤂

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3. Report MHDA. Perak Darul Ridzuan, Health State Department, 2011.

4. Basic population characteristic report. Putrajaya, Department of Statistics Malaysia, 2010.

5. Sowmyanaranan TV et al. Investigation of a hepatitis A outbreak in children in an urban slum in Vellore, Tamil Nadu, using geographic information systems. Indian Journal of Medical Research, 2008, 28:32–37.

6. Leong PC. The nutritive value of coconut toddy. The British Journal of Nutrition, 1953, 7:253–259. doi:10.1079/BJN19530030 pmid:13081939

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Molecular Pathology of Liver Diseases. Springer, 2011, 5:527–

552.

8. Health T et al. A community-wide hepatitis A outbreak in the Shoalhaven region, New South Wales. CDI, 1997, 21:9.

ᵫ⼒ऎⱘᑚ⼱㡖᮹ˈ޴Т᠔᳝ⱘ偀ᴹ㽓Ѯ⼒ऎ䛑Ӯᑚ

⼱䖭Ͼ㡖᮹Ǆि⫳ᴵӊᏂӮ֗䖯⬆㙱ⱘӴ᪁^[5]ˈ㱑✊

⌕㸠⮙ᄺᰒ⼎佂⫼AࡴᎹॖⱘẩ὜䜦Ϣথ⮙᳝݇ˈԚ ᰃ⦃๗ि⫳ᄺ䇗ᶹথ⦄ϸ᠔ࡴᎹॖि⫳ᴵӊഛ䕗ᏂǄ ẩ὜䜦㹿⬆㙱⮙↦∵ᶧৃҹথ⫳೼ࡴᎹ䖛⿟ⱘӏԩ⦃

㡖^[6]ˈޚ໛䖛⿟ǃ⏋ড়䖛⿟ǃ䗕䜦᳡ࡵⱘ䖛⿟ҹঞ⫼

ѩ∈⏙⋫令݋ⱘ䖛⿟ˈ㒣㾖ᆳഛৃ㛑ᰃ∵ᶧⱘ⦃㡖Ǆ Ẕ⌟ẩ὜䜦ⱘpHؐ㣗ೈ೼3.0–3.8㣗ೈ䯈ˈ䗖ᅰHAV ⱘ⫳ᄬ੠๲ⅪǄẩ὜䜦ᕜᆍᯧфࠄϨӋḐԢѢ݊Ҫ䜦

㊒佂કˈ݊䜦㊒৿䞣া᳝4–5%^[7]Ǆℸ໪ˈ໻䚼ߚ⮙

՟䛑ᰃॄᑺҎˈৃ㛑ϢҪӀ᳝ୱẩ὜䜦ⱘдᛃ᳝݇Ǆ Ё೑Ҏ੠偀ᴹҎ䖭ϸ໻⾡ᮣҎ㕸㱑✊гሙԣ೼থ⫳⬆

㙱ⱘഄऎˈԚᰃҪӀⱘ㕍ᙷ⥛䴲ᐌԢˈᔧ✊гৃ㛑Ϣ ᠔᳝偀ᴹҎ಴Ўᰃ〚ᮃᵫ㗠⽕ℶୱ䜦᳝݇Ǆ

ᴀ⃵ᲈথЁˈ៥Ӏ乘ᳳ⮙՟Ӯᣕ㓁ߎ⦄ˈ䖭⾡ᚙ މ೼߿ⱘഄᮍᏆ㒣থ⫳䖛˗ᲈথ㒣ᐌӮᣕ㓁ᕜ䭓ᯊ䯈㗠䲒Ѣ᥻ࠊ^[5]Ǆ䗮ᐌᲈথӮᣕ㓁6–18Ͼ᳜Ⳉ㟇ᯧᛳҎ 㕸㹿㗫ሑ^[8]Ǆ

ᴀ⃵䇗ᶹ᳝ϔѯሔ䰤ᗻ˖佪ܜᰃ䇗ᶹ佂亳ᚙމᯊ

ৃ㛑ᄬ೼ಲᖚأ׮ˈԚ៥Ӏ䗮䖛䆶䯂Ϣᓔ᭟㡖᳝݇ⱘ 䯂乬ᴹޣᇥಲᖚأ׮Ǆ঺໪ϔϾሔ䰤ᗻᰃᲈথᳳ䯈៥ Ӏ಴ᅲ偠ᅸᴵӊ䰤ࠊ᳾㛑ᇍẩ὜䜦䖯㸠

HAV

Ẕ⌟Ǆ

ሑㅵ݋᳝䖭ѯሔ䰤ᗻˈᴀ⃵䇗ᶹ㒧ᵰᰒ⼎њẩ὜

䜦ᰃℸ⃵⬆㙱ᲈথⱘॳ಴Ǆḍ᥂䇗ᶹ㒧ᵰˈẩ὜䜦ࡴ

Ꮉॖ㹿݇䯁ˈᇍ⮙՟䖯㸠↣਼䱣䆓ˈ಴ЎҪӀৃ㛑ᰃ Ѡҷ⮙՟ⱘᛳᶧᴹ⑤Ǆ៥Ӏгᓎ䆂ᬍ୘ि⫳䆒ᮑˈᑊ Ў⦄എᎹҎᦤկᅝܼⱘ∈⑤Ǆ

߽Ⲟކさ

᮴Ǆ 㒣䌍

ᴀ⃵䇗ᶹ㒣䌍ᴹ㞾ि⫳䚼ⱘ⌏ࡼǄ

2012年10月马来西亚霹雳州曼绒区甲肝暴发调查

ᲈথ䇗ᶹ᡹ਞ

1

⬆

160 650

76 500

12 750

5100

2012

9

19

10

HAV IgM

ᮍ⊩

2012 ᑈ 10 ᳜偀ᴹ㽓Ѯ䴍䳇Ꮂ᳐㒦ऎ⬆㙱ᲈথ 䇗ᶹ

Faudzi Ahmad Yusoff

ˈRusdi Abdul Rahman

ˈLing He May

ˈSuzana Binti Budart

੠Lokman Hakim Sulaiman

2012

9

HAV IgM

HAV

2012

9

logsiticಲ ᔦ ῵ ൟ ˈ ᑊ ᇍ

LemeshowẔ偠ǃߚ㉏㸼Ḑ੠ROC᳆㒓ϟ䴶⿃߸߿῵ൟ

HAV

IgM

341

2

HAVǄ

341ӑ亳⠽ḋક⫼ѢẔ

10ᆊ 㒣 㧹 ⚍ ձ ᥂ 偀 ᴹ 㽓 Ѯ 亳 ક ⊩ ќ ҹ ݇

䅼䆎

PCR

PH

㒧ᵰ

78

3.1/10 000

95%

13–72

31.4

47.4%

37.2%

5.1/1000

25–40

2012

9

8

1˅ˈ⌕㸠⮙ᄺ᳆㒓ਜ⦄๲ؐ῵

9

8

19

9

24

2015

9

25

2012

10

11

P < 0.05

1

[OR]18.4 [5.13–65.9]˅੠佂⫼AࡴᎹॖⱘẩ὜䜦݋

3

1. 2012

9

8

10

19

4

Yusoff FA et al. Investigation of hepatits A in district of Manjung, Perak, Malaysia, October 2012. Western Pacific Surveillance and Response Journal, 2015, 6(2):21–25. doi:10.5365/wpsar.2015.6.1.012

HAV

10ᆊ 㒣㧹 ⚍ ձ ᥂ 偀 ᴹ 㽓 Ѯ 亳 ક ⊩ ќ ҹ ݇