2013年10–12月斐济Ba地区一起甲肝暴发

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ᲈথ䇗ᶹ᡹ਞ

WPSAR Vol 6, No 2, 2015 | doi: 10.5365/wpsar.2014.5.4.006

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a ݀݅ि⫳Ϣ߱㑻ֱعᄺ䰶ˈएᄺᡸ⧚੠عᒋ⾥ᄺᄺ䰶ˈ᭤⌢೑ゟ໻ᄺˈ㢣⪺ˈ᭤⌢Ǆ

b ᭤⌢ि⫳䚼ˈ㢣⪺ˈ᭤⌢Ǆ

c ▇໻߽Ѯ೑䰙থሩ㞾ᜓ㗙ˈ㢣⪺ˈ᭤⌢Ǆ

d ᭤⌢⮒⮙乘䰆᥻ࠊЁᖗˈि⫳䚼ˈ㢣⪺ˈ᭤⌢Ǆ

e Baएᄺഄऎˈ㽓䚼عᒋ᳡ࡵˈ㢣⪺ˈ᭤⌢Ǆ

ᡩ〓᮹ᳳ˖2014ᑈ11᳜20᮹˗থ㸼᮹ᳳ˖2015ᑈ6᳜10᮹ doi: 10.5365/wpsar.2014.5.4.006

᭤

⌢ᰃԡѢफ໾ᑇ⋟ⱘϔϾቯ೑ˈࣙᣀ᳝300

໮ϾቯቓˈҎষ㑺837 000Ҏˈ݊Ё58%Ў

ೳ㨫᭤⌢Ҏˈ35%Ўॄ㄀ᅝ㸔㒳᭤⌢Ҏ^[1]Ǆ

᭤ ⌢ 㔎 У ᳝ ݇ ⬆ 㙱 ⱘ ⌕ 㸠 ⮙ ᄺ ᭄ ᥂ ˈ ҙ থ 㸼䖛 1976–1978ᑈ⬆㙱㸔⏙ᄺⱘⷨお᡹ਞˈᰒ⼎84%ⱘ㸔

⏙ḋક⬆㙱⡍ᓖᗻᡫԧ䰇ᗻǄ5ቕҹϟܓス⬆㙱ᙷ⮙⥛

Ў13%ˈ6–10ቕܓスᙷ⮙⥛Ў60%ˈࠄ20ቕᯊˈ⬆

㙱ᙷ⮙⥛Ꮖ催䖒90%^[2]Ǆ᳝ϔѯӴ䯏៪㗙ᇮ᳾থ㸼ⱘ Ϣ᭤⌢⬆㙱᳝݇ⱘ᡹ਞˈԚҢ᳾᡹䘧䖛໻㾘῵ⱘ⼒ऎ

ᲈথ^[3,4]ǄҢ᭤⌢ᮙ㸠ᔦᴹⱘ␌ᅶЁˈ⬆㙱থ⮙Ϣ佂⫼

व⪺䜦˄ϔ⾡ỡ⠽ᗻ䬛䴭ࠖ˅᳝݇^[5]Ǆ

೼᭤⌢ˈ⬆㙱ᰃᐌ㾘ⲥ⌟ⱘӴᶧ⮙Пϔˈ⭥Ԑ⬆

㙱ᲈথ៪㗙㘮䲚ᗻ⮙՟㽕∖೼24ᇣᯊݙ᡹ਞ㒭ि⫳䚼

੠᭤⌢⮒⮙乘䰆᥻ࠊЁᖗ˄FCCDC˅^[6]Ǆ

ᴀ⃵ᲈথ䇗ᶹഄ⚍ЎBaഄऎˈԡѢ᭤⌢ЏቯVite Levuⱘ㽓࣫䚼ˈᰃϔϾݰϮЁᖗǄḍ᥂Baए䰶ᦤկⱘ

ֵᙃˈBaഄऎҎষ㑺55 805Ҏˈ݊Ёॄ㄀ᅝ㸔㒳ⱘ᭤

⌢Ҏᰃ᳔໻ⱘϔᬃˈऴ72%ǄBaഄऎ᳝ϝϾि⫳᳡ࡵ

Ёᖗ˖Ba䬛ǃBalevuto੠NailagaǄBalevutoए⭫ഄऎࣙ

ᣀNukuloaǃMoto ϸϾᡸ⧚ऎˈए䰶Ԅ䅵Balevutoए

⭫ഄऎ໻ὖ᳝6255Ҏˈ݊Ё68%Ўॄ㄀ᅝ㸔㒳ⱘ᭤⌢

ҎǄ

2013 ᑈ 10–12 ᳜᭤⌢ Ba ഄऎϔ䍋⬆㙱ᲈথ

Aneley GetahunâˈEric Rafai^bˈMaria Ximena Tolosa^cˈAkanisi Dawainavesi^dˈAnaseini Maisema Tabuaê੠ Josefa Tabuaê

䗮䆃԰㗙˖Aneley Getahun (⬉ᄤ䚂ӊ˖aneley.getahun@fnu.ac.fj)Ǆ

2013ᑈ10᳜22᮹ˈBalevutoए⭫ഄऎ৥FCCDC

᡹ਞњ8՟咘⮌੠থ⛁⮙՟ǄFCCDC੠᭤⌢೑ゟ໻ᄺ㒘 ៤㘨ড়䇗ᶹ㒘ᓔሩњᴀ⃵ᲈথ䇗ᶹˈᑊᦤߎњ݀݅ि

⫳᥾ᮑˈҹ᥻ࠊᴀ⃵ᲈথᑊ䰆ℶ⭿ᚙⱘ䖯ϔℹ㫧ᓊǄ

ᮍ⊩

ᴀ⃵ᲈথ䇗ᶹᣝ✻FCCDCᲈথᑨᗹᣛफ䖯㸠䇗ᶹ^[6]Ǆ

೼᥹ࠄ咘⮌⮙՟᡹ਞⱘ24ᇣᯊݙ㒘ᓎњ䇗ᶹ㒘Ǆ

⬆㙱ⱘ⭥Ԑ⮙՟Ў2013ᑈ10᳜8᮹㟇12᳜2᮹

ᳳ䯈ˈᗹᗻ䍋⮙ˈϨ݋᳝ϟ߫ϸ乍ঞҹϞ⮛⢊㗙˖থ

⛁ǃ༈⮯ǃУ࡯ǃॠ亳ǃ਩ᖗǃ਩৤ǃ㝍⋏ǃ㝍⮯ǃ 咘⮌䕀⇼䝊छ催Ǆ⹂䆞⮙՟Ў⭥Ԑ⮙՟Ё⬆㙱IgM䰇 ᗻ㗙ˈ៪㗙Ϣᅲ偠ᅸ⹂䆞⮙՟᳝⌕㸠⮙ᄺ㘨㋏㗙^[7]Ǆ ҢBaഄऎⱘए䰶ҹঞBalevutoि⫳Ёᖗ㦋ᕫњ݋᳝咘

⮌៪݊ҪЈᑞ⮛⢊⮙՟ⱘϔ㾜㸼ˈ䇗ᶹ㒘гᓔሩњܹ

᠋䇗ᶹ䖯㸠⮙՟Џࡼ᧰㋶੠عᒋ֗䖯ᅷӴ⌏ࡼǄ 䇗ᶹ㒘Փ⫼㒧ᵘᓣ䇗ᶹ䯂ोᬊ䲚ֵᙃˈݙᆍࣙᣀ ҎষᄺֵᙃǃЈᑞ㸼⦄ǃ⮙՟থ⮙ࠡ2–6਼ݙⱘ佂亳੠

佂∈ҹঞ݊Ҫॅ䰽಴㋴੠ᲈ䴆৆Ǆᲈথ䇗ᶹⱘݙᆍП ϔᰃᬊ䲚ॅ䰽಴㋴੠ᲈ䴆ֵᙃˈࣙᣀথ⮙ࠡ2–6਼ݙᰃ

৺亳⫼⫳ⱘ៪⛍䇗ϡᕏᑩⱘ䋱㉏ˈᰃ৺᥹㾺䖛咘⮌⮙

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WPSAR Vol 6, No 2, 2015 | doi: 10.5365/wpsar.2014.5.4.006 www.wpro.who.int/wpsar

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Getahunㄝ 2013ᑈ᭤⌢ϔ䍋⬆㙱ᲈথ

0.3/10 000Ǆ೼Balevutoए⭫ഄऎˈNukuloa੠Motoϸ Ͼᡸ⧚ऎⱘ㕍ᙷ⥛ߚ߿Ў349/10 000੠52/10 000Ǆ

Јᑞ㸼⦄

⮙ ՟ ᐌ 㾕 ⱘ Ј ᑞ 㸼 ⦄ Ў থ ⛁ ˄8 6 %˅ ǃ 咘 ⮌

˄85%˅ǃॠ亳˄69%˅ǃУ࡯੠៪ᙊᖗ˄65%˅ǃ 㝍 ⮯ ˄63%˅ ੠ ਩ ৤ ˄53%˅ Ǆ ݊ Ҫ ⮛ ⢊ ⱘ ↨ ՟ 䕗Ԣˈࣙᣀ༈⮯ǃܼ䑿⮯੠⏅㡆ሓǄ໽ހ⇼䝌䕀⇼

䝊 ˄AST˅ ੠ ϭ ⇼ 䝌䕀 ⇼ 䝊 ˄ALT˅ ⱘ ഛ ؐ ߚ ߿ Ў 1165m/L੠1575m/LǄ᮴⅏ѵ⮙՟Ǆ

⌕㸠᳆㒓ᰒ⼎㑺30%˄n=48˅ⱘ⮙՟೼10᳜ 18᮹–21᮹ᳳ䯈থ⮙˄೒1˅Ǆᣛ⼎⮙՟ᰃϔৡ59ቕ ཇᗻˈЎNukuloaᅮሙ⚍ⱘሙ⇥ˈѢ9᳜24᮹থ⮙Ǆ 䆹⮙՟᳔߱⮛⢊ࣙᣀথ⛁ǃ਩৤੠ᙊᖗˈ䱣ৢߎ⦄Ꮍ 㝰咘ᶧǄ䞛䲚ⱘ㸔⏙ᷛᴀ⬅Ѣ䞣ϡ䎇᮴⊩䖯㸠⬆㙱㸔

⏙ᄺẔ⌟ˈ㙱ࡳ㛑Ẕ⌟㒧ᵰASTЎ2550m/LˈALTЎ 2610m/LǄ䆹⮙՟᮴Baഄऎҹ໪ⱘ໪ߎᮙ␌৆ˈг᳾

᥹㾺䖛咘⮌⮙՟Ǆ

ᲈ䴆੠⦃๗䆘Ԅ

ᬊ 䲚 њ5 0՟ ⮙ ՟ ⱘ ᲈ 䴆 ੠ ॅ 䰽 ಴ ㋴ ֵ ᙃ Ǆ 18՟˄36%˅⮙՟᡹ਞ᳒᥹㾺䖛咘⮌⮙՟ˈ咘⮌⮙՟

Џ㽕Ў݊ᆊᒁ៤ਬǄ໻㑺᳝ಯߚПϔ˄24%˅ⱘ⮙՟

খࡴ䖛ᦤկ佂亳ⱘ⼒Ѹ㘮Ӯǃ໻ൟ䲚Ӯ៪㗙ᆊᒁ㘮Ӯ ㄝ⌏ࡼǄ䇗ᶹⱘ᠔᳝ᆊᒁഛ᳝३᠔ˈ㞾䗄᮴䱣ഄ֓⒎ ⱘᚙމǄ

՟៪⹂䆞ⱘ⬆㙱⮙՟ˈᰃ৺໪ߎᮙ␌៪㗙খࡴ݀ӫϾ Ҏ㘮ӮㄝǄ䞛䲚њ⮙՟ⱘ㸔⎆ᷛᴀ䖯㸠⫳࣪Ẕ⌟˄ࣙ

ᣀ㙱ࡳ㛑੠㚒ࡳ㛑˅੠ܼ㸔㒚㚲䅵᭄ˈҹঞⱏ䴽⛁੠

䩽ッ㶎ᮟԧ㸔⏙ᄺẔᶹǄ14ӑ㸔⏙ᷛᴀ㹿䗕ᕔSuva⾕ゟए䰶䖯㸠⬆㙱IgMẔ⌟ˈẔ⌟䆩ࠖЎᖋ೑㔫⇣䆞ᮁ݀

ৌ⫳ѻⱘElecsys⬆㙱,J0Ẕ⌟䆩ࠖⲦǄ

䇗ᶹ㒘ᓔሩњ⦃๗䆘Ԅҹ߸ᮁৃ㛑ⱘᛳᶧᴹ⑤Ǆ ҢЏ㽕∈⑤ഄҹঞϔѯሙ⇥ᆊЁ䞛䲚њ佂⫼∈ḋકˈ

䗕FCCDC݀݅ि⫳ᅲ偠ᅸ䖯㸠Ẕ⌟ˈẔ⌟໻㙴㦠㕸ᘏ

᭄੠඗Ꮰ⇣໻㙴㦠㕸ᘏ᭄˄MPN/100ml˅ҹ䆘Ԅ∈䋼㹿∵ᶧⱘ⿟ᑺǄ

Փ⫼ᖂ䕃Office Excel 2007䖯㸠᭄᥂ᔩܹ੠ߚᵤˈ ᑊᣝ✻থ⮙᮹ᳳࠊ԰⌕㸠᳆㒓ˈབᵰ⮙՟ⱘথ⮙ᯊ䯈 ϡ䆺ˈ߭Փ⫼⮙՟㸔ᷛᴀⱘ䞛䲚᮹ᳳ᳓ҷǄߚ߿䅵ㅫ ҹϡৠए⭫ഄऎЎᲈ䴆ব䞣ⱘ㕍ᙷ⥛੠Ⳍᇍॅ䰽ᑺˈ ᑊ㒬ࠊ⮙՟ᬷ⚍೒ᦣ䗄⮙՟ⱘഄऎߚᏗ⡍ᕕǄ

㒧ᵰ

⮙՟Ҏষᄺ⡍ᕕ

᳝݅160՟⬆㙱⭥Ԑ⮙՟ˈ݊Ё18՟⹂䆞⮙՟˄15՟

Ў㸔⏙ᄺ⹂䆞ˈ3՟䗮䖛⌕㸠⮙ᄺ݇㘨⹂䆞˅Ǆ66%

ⱘ⮙՟Ў⬋ᗻˈॄ㄀ᅝ㸔㒳ⱘ᭤⌢ሙ⇥ऴ93%Ǆ⮙

՟ᑈ啘Ёԡ᭄Ў31ቕ˄㣗ೈ˖3–80ቕ˅ˈ46%ⱘ⮙

՟೼10–29ቕП䯈ǄBalevutoǃNailaga੠Ba䖭ϝϾए

⭫ഄऎⱘҎ㕸㕍ᙷ⥛ߚ߿Ў246/10 000ǃ5/10 000੠

೒1. ᭤⌢Baഄऎ⬆㙱ᲈথ⌕㸠᳆㒓˄n = 160˅

FCCDC᭤⌢⮒⮙乘䰆᥻ࠊЁᖗ˗MOH,ि⫳䚼Ǆ 0

2 4 6 8 10 12 14 16 18 20 22 24

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

⮙՟᭄⮙՟᭄

থ⮙᮹ᳳ

৥MOH/FCCDC᡹

ਞ㘮䲚ᗻ咘⮌⮙՟

ᓔሩᲈথ䇗ᶹˈᓔྟ

ᅲᮑ乘䰆᥻ࠊ᥾ᮑ

ذℶՓ⫼㹿 ᗔ⭥ⱘ∈⑤

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WPSAR Vol 6, No 2, 2015 | doi: 10.5365/wpsar.2014.5.4.006

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2013ᑈ᭤⌢ϔ䍋⬆㙱ᲈথ Getahunㄝ

೼43਼ ੠45਼ ᯊ 䖬 ᇚ ᲈ থ Ⳍ ݇ ֵ ᙃ ᓴ 䌈 ೼PacNet listservϞ^[8]Ǆ

⮙՟ㅵ⧚

ᇍ⭿ᚙথ⫳ഄऎⱘि⫳ए⭫ᴎᵘᦤկњ乱໪ⱘए⭫⫼

ક⫼Ѣ⬆㙱⮙՟ⱘㅵ⧚Ǆ䮼䆞ᡸ຿ᓔሩњЏࡼߚ䆞ҹ থ⦄⭥Ԑ⮙՟ˈᑊ䖯㸠ᖿ䗳Ẕᶹ੠ㅵ⧚Ǆ

⦃๗ि⫳ᑆ乘

⡍߿Ꮉ԰㒘ᣕ㓁᥼䖯⼒ऎᑆ乘⌏ࡼˈᑊ⿃ᵕ੠ᔧഄⱘ

ೳഄᢹ᳝㗙੠ᬓᑰㅵ⧚䚼䮼䖯㸠णଚˈҹֱ䆕৥ফ ᕅડⱘᆊᒁᦤկᅝܼⱘ佂⫼∈Ǆ2013ᑈ11᳜9᮹ˈ

Waicaറկ∈ॖЈᯊ݇䯁ˈ᭤⌢∈ࡵሔᇍ∈റ੠կ∈㋏

㒳䖯㸠њछ㑻ᬍ䗴ˈᬍᓎৢ๲ࡴњ∃࣪໘⧚ॖˈᑊ᳓

ᤶ㗕ᮻկ∈ㅵ䘧㋏㒳ˈ᳔㒜Ўᔧഄ600᠋ᆊᒁᦤկњ

⏙⋕ᅝܼⱘ佂⫼∈^[9]Ǆ

䅼䆎

ᴀ⃵ᲈথЎ᭤⌢Baഄऎ㄀ϔ⃵᳝䆄ᔩⱘ⼒ऎ⬆㙱ᲈ থǄᲈথЏ㽕ϢNukuloaᅮሙ⚍᳾㒣໘⧚ⱘկ∈᳝݇Ǆ

೼Waicaറկ∈㣗ೈݙ᳝ᕜ໮㘮䲚ᗻ⮙՟থ⫳Ǆ2⃵ Ba䬛ሙ⇥Փ⫼⬅᭤⌢∈ࡵሔ˄WAF˅໘⧚ⱘㅵ

㔥կ∈ǄԚᰃˈNukuloaᅮሙ⚍໻䚼ߚফᕅડⱘ⼒ऎ ҡ Փ ⫼ ⾕ Ҏ ∈ ॖ ⱘWaicaറ ∈ ˄Dayal˅ ˄೒2˅ ˈ 䇗ᶹ㒘ᇍ䆹റ∈∈ॖ䖯㸠њẔᶹǄWaicaറ∈∈ॖ᳾

䆒㕂⫼Ѣ∈໘⧚ⱘ㪘∈∴ˈϨⳈ᥹Ң⊇Ёপ∈Ǆ೼䇗 ᶹᯊˈ∈⑤ഄ਼ೈ᮴ӏԩሣ䱰䰏ℶҎ៪ࡼ⠽䖯ܹറ ݙǄҢറݙ䞛䲚∈ḋ䖯㸠ᖂ⫳⠽ᄺẔ⌟ˈ㒧ᵰᰒ⼎∈

䋼ফࠄҎ៪ࡼ⠽ᥦ⊘⠽ⱘϹ䞡∵ᶧ˄໻㙴㦠㕸᭄˖

43–154/100mlˈ඗Ꮰ⇣໻㙴㦠㕸᭄˖5–43/100ml˅ ˈ㗠Ң᭤⌢∈ࡵሔկ∈㋏㒳䞛䲚ⱘ∈ḋẔ⌟㒧ᵰ߭↨

䕗ད˄໻㙴㦠㕸᭄˖<3/100mlˈ඗Ꮰ⇣໻㙴㦠㕸᭄Ў 0˅ǄNukuloaഄऎሙ⇥⬆㙱ᛳᶧⱘⳌᇍॅ䰽ᑺᰃՓ⫼

঺໪ϔ∈⑤˄ഄ㸼∈˅ⱘMotoഄऎሙ⇥ⱘ6.6ס˄95%

ৃֵऎ䯈˖3.8–12.5˅Ǆ

ᲈথ᥻ࠊ᥾ᮑ

Ўण䇗Baഄऎⱘᲈথᑨᇍˈϧ䮼៤ゟњϔϾ⡍߿Ꮉ԰

㒘Ǆ᳔߱ⱘᲈথ᥻ࠊ᥾ᮑࣙᣀ䗮䖛໻ӫӴၦ੠⼒ऎ䍄䆓˄ᄺ᷵ǃᅮሙ⚍੠ᴥᑘ˅ᓔሩعᒋ֗䖯⌏ࡼˈ䞡⚍

ᔎ䇗ୱᓔ∈ˈ⫼㙹ⱖ⋫᠟ˈ⊼ᛣϾҎि⫳ҹঞ亳ક੠

佂∈ᅝܼㄝǄ೼Nukuloaᅮሙऎ੠ᄺ᷵Ёˈ䖬㒭ᆊᒁ থᬒњޔ∈⠛ǃ∈䖛Ⓒ఼ҹঞ⋫᠟⎆Ǆि⫳䚼ᓔথࠊ

԰њ⬆㙱عᒋᬭ㚆ᅷӴ᠟ݠˈᑓ⊯থ㒭ফᕅડഄऎǄ

೒

2. 2013

ᑈ

10–12

᳜᭤⌢

Ba

ഄऎ

Dayal

∈⑤կᑨ㣗ೈϢ⬆㙱⮙՟ⱘԡ㕂ߚᏗ

೒՟˖咘㡆䰈ᕅऎඳüDayal∈⑤կᑨ㣗ೈ˗㑶㒓üᏆ㹿ᢚ䰸ⱘᮻㅵ䘧㋏㒳˗㪱㒓üᮄᓎկ∈ㅵ䘧㋏㒳Ǆ ᴹ⑤˖ഄ೒⬅᭤⌢∈ࡵሔᦤկǄ

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WPSAR Vol 6, No 2, 2015 | doi: 10.5365/wpsar.2014.5.4.006 www.wpro.who.int/wpsar

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Getahunㄝ 2013ᑈ᭤⌢ϔ䍋⬆㙱ᲈথ

㟈䇶

ᛳ䇶Baഄऎⱘ᠔᳝एᄺᅬਬǃᡸ຿ǃᅲ偠ᅸᎹ԰Ҏਬ ҹঞि⫳ⲥⴷਬ೼ᲈথ䇗ᶹܼ䖛⿟Ёⱘ໻࡯ᬃᣕʽᛳ 䇶FCCDCⱘᡔᴃ੠ᅲ偠ᅸᬃᣕǄ

ᓩ⫼ᴀ᭛ഄഔ˖

Getahun A et al. Hepatitis A outbreak in Ba subdivision, Fiji, October–December 2012. Western Pacific Surveillance and Response Journal, 2015, 6(2):32–36.

doi:10.5365/wpsar.2014.5.4.006

খ㗗᭛⤂

1. Fiji Bureau of Statistics. Suva, 2015 (http://www.stats fiji.gov.fj/index.php/2007-census-of-population, accessed 26 March 2014).

2. Gust ID, Lehmann NI, Dimitrakakis M. A seroepidemiologic study of infection with HAV and HBV in five Pacific Islands.

American Journal of Epidemiology, 1979, 110:237–242.

pmid:224697

3. Patient information system 2004–2007 (unpublished data).

Suva, Fiji Ministry of Health, 2008.

4. Fiji: Country health information profile, 2011. Manila, World Health Organization Regional Office for the Western Pacific, 2011 (http://www.wpro.who.int/countries/fji/7FIJtab2011_finaldraft.

pdf, accessed 21 A pril 2015).

5. Parker JA, Kurien TT, Huppatz C. Hepatitis A outbreak associated with kava drinking. Communicable Diseases Intelligence Quarterly Report, 2014, 38:E26–28. pmid:25409352

6. National Communicable Diseases Surveillance and Outbreak Response Guidelines. Suva, Fiji Ministry of Health, 2010 (http://www.health.gov.fj/PDFs/CD%20Guidelines.pdf, accessed 21 April 2015).

7. National Notifiable Diseases Surveillance System. Hepatitis A (Acute), 2012 case definition. Atlanta, United States Centers for Disease Control and Prevention, 2015 (http://wwwn.

cdc.gov/NNDSS/script/casedef.aspx?CondYrID=703&DateP ub=1/1/2012, accessed 21 April 2015).

8. Weekly Pacific Syndromic Surveillance Report – weeks 43 and 45. Suva, World Health Organization, Division of Pacific Technical Support, 2013.

9. Nasiko R. Families to receive piped water. The Fiji Times, 8 April 2014 (http://www.fijitimes.com/story.aspx?id=265012, accessed on 21 April 2015).

10. Thuppal V 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 Medicine, 2008, 128:32–37.

11. Ye-Qing X et al. An outbreak of hepatitis A associated with a contaminated well in a middle school, Guangxi, China. Western Pacific Surveillance and Response Journal, 2012, 3:44–47.

doi:10.5365/wpsar.2012.3.4.014 pmid:23908939

ߚ߿䞛䲚റ∈∈ḋક䛑Ϲ䞡∵ᶧ˄඗Ꮰ⇣໻㙴㦠㕸੠

໻㙴㦠㕸䍙ᷛ˅ˈ⌕㸠᳆㒓ᦤ⼎䖭ᰃϔ䍋ᣕ㓁ৠ⑤ᲈ থˈ⮙՟೼䕗䭓ᯊ䯈ݙϡᮁ๲ࡴˈҢ10᳜12᮹ࠄ26᮹

໻㑺ᣕ㓁њ2਼Ǆ

㱑✊30%ⱘ⮙՟䲚Ёߎ⦄೼4໽ݙˈԚ⌕㸠᳆㒓 ᑊ≵᳝ᰒ⼎ߎⷁᳳݙߎ⦄໻䞣㘮䲚ᗻ⮙՟ⱘ݌ൟ⚍⑤ ᲈথ῵ᓣǄ⌕㸠᳆㒓Ϣᣕ㓁ৠ⑤ᲈথⱘ⡍ᕕ↨䕗ϔ 㟈ˈᣕ㓁ৠ⑤ᲈথⱘ⡍ᕕᰃᲈ䴆ᯊ䯈䕗䭓ˈ՟བ⬅㹿

∵ᶧⱘ∈ᇐ㟈ⱘᲈথǄ⬅㹿∵ᶧⱘ∈ᇐ㟈⼒ऎ⬆㙱ᲈ থ೼Ё೑੠ॄᑺ᳝᳒䖛᡹䘧^[10,11]Ǆ⌕㸠᳆㒓ⱘ๲Ⅺ῵

ᓣᦤ⼎ҎӴҎৃ㛑ᰃᲈথᣕ㓁ᄬ೼ҹঞӴ᪁ࠄ݊Ҫഄ

ᮍⱘॳ಴ˈ៥Ӏৃҹⳟࠄ೼ϸϾ䚏䖥ए⭫ഄऎг᳝ᬷ

೼⮙՟থ⫳Ǆ

93%ⱘ⬆㙱⮙՟ᰃॄ㄀ᅝ㸔㒳ⱘ᭤⌢ҎǄ㗕ᑈ Ҏߎ⦄⬆㙱ᛳᶧ⮛⢊㸼ᯢҪӀПࠡ᳾᳒ᲈ䴆䖛⬆㙱⮙

↦Ǆ1970ᑈᓔሩⱘᙷ⮙⥛ⷨおԄ䅵໻໮᭄⮙՟ⱘᛳ ᶧ䛑ᰃ೼ᇣᯊ׭থ⫳ⱘˈ㗠Ϩ೼ϸϾЏ㽕⾡ᮣҎ㕸Ё ⱘ㕍ᙷ⥛ⳌԐ^[2]ǄԚᰃᴀ⃵ᲈথЁᰒ⼎ߎᴹⱘ⡍ᕕ㸼 ᯢ೼᭤⌢%Dഄऎⱘ⬆㙱⌕㸠⮙ᄺ⡍ᕕৃ㛑Ꮖ㒣থ⫳ব

࣪Ǆ

ᴀⷨお佪⃵᡹䘧њ᭤⌢⼒ऎ∈ᑇথ⫳ⱘϔ䍋⬆㙱 ᲈথ⭿ᚙˈ✊㗠ˈᲈথ⍝ঞⱘഄऎ䕗Ўሔ䰤Ǆᴀ⃵䇗 ᶹЁ᳾㛑ᑓ⊯ഄ೼৘Ͼ⼒ऎЁњ㾷ᲈ䴆੠ॅ䰽಴㋴ᚙ މˈг᳾㛑㾷䞞ϸϾϡৠ⾡ᮣҎ㕸Ё㕍ᙷ⥛Ꮒ߿ⱘॳ

಴Ǆ಴Ў⬆㙱┰ӣᳳ䕗䭓ˈಲᖚأ׮໻ˈг᳾ᇍ⮙՟

䖯亳亳⠽ⱘ䆺㒚ֵᙃ䖯㸠ᬊ䲚Ǆ಴ℸˈгϡ㛑ᥦ䰸ᄬ

೼亳⑤ᗻӴ᪁ⱘৃ㛑ᗻǄ⬅Ѣ᭤⌢ⱘ⬆㙱ⲥ⌟㋏㒳ᰃ 䗮䖛ᇍि⫳ए⭫ᴎᵘ᳝⮛⢊ⱘ⮙՟䖯㸠㹿ࡼⲥ⌟ˈ㗠 Ϩг᳾ࣙᣀϾԧए⭫ᴎᵘ៪Baഄऎҹ໪ⱘ᠔᳝⮙՟ˈ

಴ℸৃ㛑ӮԢԄᴀ⃵ᲈথⱘᔎᑺǄ

㒧䆎

ᴀ⃵ᲈথᰃBaഄऎ佪⃵䆄ᔩⱘ໻㾘῵⬆㙱ᲈথˈ೼᭤

⌢ৃ㛑гᰃ佪⃵Ǆᔎ࣪⬆㙱ⲥ⌟ˈৃ㛑Ӯথ⦄ቯݙ݊

Ҫⱘ⬆㙱㘮䲚ᗻ⮙՟Ǆᬍ䖯Џ㽕ⱘ∈⑤ഄि⫳ৢˈ䰡 Ԣњফᕅડ⼒ऎ੠Ⳍ䚏ഄऎ⮙՟ⱘথ⫳Ǆ

߽Ⲟކさ

᮴Ǆ

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