Protec

1. 2554ISBN : 978-616-11-0980-6 : : : . : : 1 : 2554 : 25,000 :

3. .. 2551 2554

4. 1 4 11 .. 2548 24 47 62Algorithm 63 (HANTAVIRAL DISEASES) 64 (INFLUENZA, SEASONAL) 79 104 (INFLUENZA, AVIAN) (LEGIONELLOSIS) 128 (LEGIONNAIRESS PNEUMONIA) (NONPNEUMONIC LEGIONELLOSIS) (PONTIAC FEVER) (PLAGUE) 141 156 (SEVERE ACUTE RESPIRATORY SYNDROME; SARS)

5. 179Algorithm 180 (ENCEPHALOPATHY, 181 CREUTZFELDT-JAKOB DISEASE, SUBACUTE SPONGIFORM) 199 (HENDRA AND NIPAH VIRAL DISEASES) (WEST NILE FEVER) 209 (RIFT VALLEY FEVER) 218 228 (OTHER MOSQUITO-BORNE AND CULICOIDES- BORNE FEVERS) 237 (STREPTOCOCCUS SUIS) 258Algorithm 259 260 (CHIKUNGUNYA VIRUS DISEASE) - 269 (EBOLA-MARBURG VIRAL DISEASES) 281 (MENINGOCOCCAL INFECTION) (YAWS) 300

6. 309Algorithm 310 (ENTEROVIRUS DISEASES) : 311 (HAND, FOOT AND MOUTH DISEASE; HFMD) 321 322Algorithm 326 (BRUCELLOSIS) 327 (CAT-SCRATCH DISEASE) 340 (LASSA FEVER) 349 (LEISHMANIASIS) 359 (MELIOIDOSIS) 373 (Q FEVER) 385 (TULAREMIA) 398 411 Algorithm 412 (ANTHRAX) 413 (BOTULISM) 435 () (SMALLPOX) 458 472Algorithm 473 (YELLOW FEVER) 474

7. 1 86 AUSSR77 H1N1 2 86 3 107 MDCK 4 132 5 HCoV-229E 162 WI-38 6 virion 210 7 243 8 272 9 Neisseria meningitidis 284 10 Ulceropapillomatous yaws 302 11 303 (Gangosa)

8. 12 314 13 331 14 343 15 344 Parinauds oculoglandular syndrome 16 Vero cell 352 17 362 18 362 19 363 20 (Sandfly) 366 21 Leishmania major 367 22 Ulceroglandular 400 tularemia 23 416 24 B. anthracis 419 sheep blood agar 25 440 26 441 27 462

9. 490 491 2318/2553 497 2554 500

10. Algorithm 1. International Classification of Disease 9 10 (ICD-9 ICD-10) 1

11. 2. 3. 4. 5. 6. 7. 8. 9. 2

12. 10. 11. 12. ( ) 3

13. .. 2477 .. 2479 .. 2482 .. 2485 .. 2486 .. 2523 5 .. 2523 .. 2523 1. 5 5 5 2. 18 .. 2524 2 (.. 2534) 49 (cholera) (plaque)4

14. (smallpox) (yellow fever) (meningococcal meningitis) (diphtheria) (pertussive) (tetanus) (poliomyelitis) (measle) (rubella) (mumps) (chickenpox) (influenza) (encephalitis) (haemorrhagic fever) (rabies) (hepatitis) (viral conjunctivitis) (food poisoning) (bacillary dysentery) (amoebic dysentery) (typhoid) (paratyphoid) (typhus) (scrub typhus) (murine typhus) (tuberculosis) (leprosy) (malaria) (anthrax) (trichinosis) (yaws) (leptospirosis) (syphilis) (gonorrhea) (non-gonococcal urethritis) (lymphogranuloma venerum) (chancroid) (granuloma inguinale) (genital herpessimplex infection) (condyloma accuminata) (relapsing fever) (acutediarrhea) (filariasis) (AIDS) (acute flaccidparalysis) (severe acuterespiratory syndrome) (chikungunyafever) 5

15. 3. 5 5 6 6 6 5 5 20 1. (cholera) 2. (plague) 3. (smallpox) 4. (yellow fever) 5. (meningococcal meningitis) 6. (diphtheria) 7. (tetanus neonatorum) 8. (poliomyelitis) 9. (influenza) 6

16. 10. (encephalitis) 11. (rabies) 12. (typhus) 13. (tuberculosis) 14. (anthrax) 15. (trichinosis) 16. (yaws) 17. (acute flaccid paralysis) 18. (severe acute respiratory syndrome) 19. (chikungunya fever) 20. (haemorrhagic fever) 7 (1) (2) (3) 7

17. 8 (1) (2) (3) (4) 8

18. (5) (6) (7) (8) (9) (10) (11) (12) 9

19. .. 2495 .. 2505 (.. 2521) 1. . 121 126 . 9 2547. . ( 26 2554): URL: http:// www.ddc.moph.go.th/law/all_law.php.2. . 126 87 . 22 2552. . ( 26 2554): URL: http:// www.ddc.moph.go.th/law/all_law.php.3. . 126 106 . 29 2552. . ( 26 2554): URL: http://www.ddc.moph.go.th/law/all_law.php.10

20. .. 2548 (COMMUNICABLE DISEASE CONTROL AND THE INTERNATIONAL HEALTH REGULATION (2005)) .. 2512 (International HealthRegulation; IHR ..1969) 4 .. 2548 .. 2551 .. 2548 194 11

21. .. 2548 : .. 2548 ..2548 .. 2548 12

22. .. 2548 .. 2548 66 9 .. 2548 (Public HealthEmergency of International Concern; PHEIC) 13

23. .. 2548 ( ) (PHEIC) .. 2548 6 .. 2551 14

24. .. 2548 2 .. 2548 24 4 1) 2) 3) 4) / 2 4 () .. 2548 ( 15

25. ) 2 .. 2548 1) (cholera) 2) (pneumonic plague) 3) (yellow fever) 4) (dengue hemorrhagic fever) (ebola) (Marburg) 5) (west nile virus) 6) (dengue fever) (Rift Valley fever) (meningococcal disease)16

26. .. 2548 4 1 1) (smallpox) 2) (wild-type poliovirus) 3) ( H5N1 ) 4) (SARS) .. 2548 24 17

27. 1) 2) 3) .. 2548 ( ) .. 2548 .. 2548 18

28. (Global OutbreakAlert and Response Network; GOARN) GOARN .. 2543 GOARN 19

29. .. 2543 GOARN 50 400 40 .. 2548 20

30. / (PHEIC) .. 2548 (PHEIC) () 21

31. .. 2548 1 5 .. 2548 .. 2548 22

32. .. 2548 .. 2548 .. 2548 http://www.who.int/csr/ihr/en/ 23

33. (RISK ASSESSMENT AND RISK MANAGEMENT) / 1. (hazard and exposure assessment) 2. (vulnerability assessment) 3. (risk characterization) 4. (risk analysis) 1. (options analysis) 2. (response to a potential threat or an outbreak)24

34. 3. (monitoring) 4. (response modification) 1. / 25

35. (virulence) (transmissibility) (pathogenesis) - / 26

36. (Host factors) ( ) / 27

37. (Organizational factors) ( ) event-based indicator-based ( 75 ) 28

38. (Societal factors) () (vulnerability) / ( ) (vulnerability) 29

39. 2. ( ) ( ) 30

40. () () () 31

41. () () ( ) 3. 32

42. .. 2542 St. Louis encephalitis 33

43. .. 2545 - 2546 / 34

44. .. 2546 800 30 (BSE) .. 2533 1 2 35

45. 5 ( ) (trust) (early announcement) (transparency) (listening) (operational planning) 36

46. - ? - ? - ? 37

47. .. 2544 38

48. 22.00 . 23.30 . 24 39

49. 40

50. 41

51. ( ) 42

52. () 43

53. / 44

54. http://www.who.int/csr/resources/publications/WHO_CDS_2005_31/en/index.html TOTAL 5 (Trust) (Operational planning) 45

55. (Transparency) (Announce early) (Listening) TOTAL 46

56. .. 2544 22 5 47

57. 32,000 .. 2548 .. 2550 48

58. / ( ) ( coccidiomycosis) ( arboviruses, hemorrhagic fever virus, variola virus) 49

59. 50

60. ( 1 - 2 ) / ( ) 51

61. / ( ) 48 52

62. / ( ) (///) ( ) 53

63. http://www.who.int/csr/en // ( ) / 54

64. 3 Anthrax Bacillus anthracisBotulism Clostridium botulinum (botulinum toxins)Plague Yersinia pestis 55

65. Smallpox Variola major Tularemia Francisella tularensis Viral Filoviruses and Arenaviruses hemorrhagic fevers (e.g. Ebola, Lassa Fever) Brucellosis Brucella spp. Food Safety Salmonella spp., Escherichia coli Threats O157:H7 Glanders Burkholderia mallei Melioidosis Burkholderia pseudomallei Psittacosis Chlamydia psittaci Q fever Coxiella burnetti Ricin toxin Ricinus communis (Castor Beans) Staphylococcal Exotoxin from Staphylococcus enterotoxin B aureus bacterium Typhus fever Rickettsia prowazekii Viral encephalitis Alphaviruses (*VEE, EEE, WEE) Water safety threats Vibrio cholerae, Cryptosporidium parvum56

66. Nipah virus Paramyxoviridae familyencephalitisHendra virus Paramyxoviridae familyencephalitisHantavirus Hantaviruspulmonarysyndrome* Venezuelan equine (VEE), eastern equine (EEE), and western equineencephalomyelitis (WEE) viruses Adapted from Centers for DiseaseControl and Prevention, Bioterrorism Agents/Diseases, By Category.http://bt.cdc.gov/agent/agentlist-category.asp. CDC: http://www.bt.cdc.gov/agent/agentlist. asp : http://www.who.int/csr/delibepidemics/annex3.pdf / / 57

67. 2 ( ) - (meningitis) (encephalitis) (encephalopathy) (neurological disturbance) - - (pneumonia, infiltrates, pneumonitis, ARDS) - (acute fulminating septicemia or shock) - (fulminant hepatitis or hepatic failure)58

68. () ( ) / ( ) 59

69. / (median or mean incubation period) ( 1 ; infectivity) ( ; increase transmissibility) ( ; increase virulence) 60

70. / 1. Clements BW. Bioterrorism. Diaster and Public Health Planning and Response. USA: Amy Pedersen; 2009.2. Heymann DL, editor. Control of Communicable Diseases Manual. 19th ed. Washington DC: American Association of Public Health; 2008. 61

71. 62

72. Algorithm 7 / / / / / ( Pneumonic Plague) (Legionellosis) (Pontiac fever) 63

73. (HANTAVIRAL DISEASES) (HEMORRHAGIC FEVER WITHRENAL SYNDROME) ICD-9 078.6; ICD-10 A98.5(Epidemic hemorrhagic fever, Korean hemorrhagic fever,Nephropathia epidemica, Hemorrhagic nephrosonephritis,HFRS)(HANTAVIRUS PULMONARYSYNDROME) ICD-9 480.8; ICD-10 B33.4(Hantavirus adult respiratory distress syndrome,Hantavirus cardiopulmonary syndrome) .. 2536 () 64

74. ( ) : : (Amur River) .. 2494 .. 2520 (Apodemus agrarius) : .. 2528 Hanta-like virus (Edwell,R.M. ) ( ) 1 .. 2541 ELISA Hanta-like virus IgG ( ) 65

75. 1 - 33 Rattus rattus, Rattus exulans, Rattus norvegicus, Bandicotaindica, Bandicota savilei 2 - 24 (HEMORRHAGIC FEVER WITHRENAL SYNDROME) ICD-9 078.6; ICD-10 A98.5(Epidemic hemorrhagic fever, Korean hemorrhagicfever, Nephropathia epidemica, Hemorrhagicnephrosonephritis, HFRS)1. : () () 5 ) 3 - 7 66

76. ) 3 ) 3 - 7 ) 3 - 6 ) 5 - 15 ( 1) (Puumala virus) (nephropathia epidemica) (Seoul virus) (brown rat Norway rat) ELISA IFA IgM (rat) 67

77. (mouse) (Leptospirosis) 2. : (Hantaviruses) Bunyaviridae ( Bunyaviridae ) (RNA virus) 95 - 110 25 (Seoul virus) ; (Puumala virus) ; (Hantaan virus) ; (Dobrava virus Belgrade) 3. : 200 - 300 ( 5 - 15) (nephropathiaepidemica) 68

78. 4. : Apodemus spp.* -** Clethrionomus spp. Rattus spp. (accidental host) * wood mouse Common field mouse long-tailed mouse Subfamily Murinae 89 genus 408 species Wood mouse ** red-backed voles (Cl. rutilus) bankvoles (Cl. glareolus) 69

79. 5. : (aerosol transmissionfrom rodent excreta) 6. : 2 - 3 2 2 - 4 7. : 8. : 9. : . : 1. 2. 3. 70

80. 4. 5. 6. (Rattusnorvegicus) . : 1. : 2. : 3. : 4. : 5. : 6. : 7. : (hypoxia) (ribavirin) 2 - 3 . : 71

81. . : . : (HANTAVIRUS PULMONARYSYNDROME) ICD-9 480.8; ICD-10 B33.4(Hantavirus adult respiratory distress syndrome, Hantaviruscardiopulmonary syndrome)1. : 35 - 50 72

82. IgM ELISA western blot stripimmunoblot IgM PCR (PolymeraseChain Reaction) immunohistochemistry2. : (Andes virus) (Laguna Negra virus) (Juquitiba virus) (Black Creek Canal and Bayou virus) -1 (New York-1 and Momongahelaviruses) (Sin Nombre virus) .. 2536 3. : .. 2536 73

83. ( ) 4. : (deer mouse: Peromyscus maniculatus) Peromyscus (Pack rats) (Chipmunk) Sigmodontinae5. : 6. : 2 2 - 3 6 7. : 74

84. 8. : 9. : 9.1 9.1.1 ELISA FA 3 - 5 . 14 100 2 - 8o. 7 -20o. 9.1.2 RT-PCR buffy coat 2 -20o. 75

85. 9.2 2 - 8o. 3 -20o. -20o. 9.3 08.30 . 16.30 . 9.4 9.4.1 9.4.2 10. : . : . : 1 - 6 : 7 : 76

86. (ribavirin) (aerosoltransmission) airborne precaution (negative pressure) . : . : . : 77

87. 1. Heymann DL, editor. Control of Communicable Diseases Manual. 19th ed. Washington DC: American Association of Public Health; 2008.2. Lee HW, Calisher C and Schemaljohn C, editor. Manual of Hemorrhagic Fever With Renal Syndrome and Hantavirus pulmonary syndrome; 1999.3. Mandell GL, Bennett JE, Dolin R. Mandell, Douglas, and Bennetts Principles and Practice of Infectious Diseases. 7th ed. Philadelphia (USA): Elsevier; 2010.4. National Center for Infectious Diseases, Centers for Disease Control and Prevention. Technical information for health care providers, public health professionals, educators, and others. All About Hantavirus; 2005 [cited 2011 June 22]. Available from: http://www. cdc.gov/ncidod/diseases/hanta/hps/noframes/phys/ printtechsection.htm5. Okumura M, Yoshimatsu K, and Kumperasart S. Development of Serological Assay for Thottapalayam Virus, an Insectivore-Borne Hantavirus. J. Clinical and Vaccine Immunology. 2007: 173-181.6. Pattamadilok S, Lee BH, and Kumperasart S. Geographical Didtribution of Hantaviruses in Thailand and Potential Human Health Significance of Thailand Virus. Am. J. Med. Hyg. 2006: 1-9.78

88. (SEASONAL INFLUENZA) ICD-9 487; ICD-10 J10, J111. : : (H1N1) 2009 .. 2552 .. 2009 214 .. 2552 (H1N1) (H3N2) 3 - 5 250,000 - 500,000 26 2554 ( ) ( ) ( ) (H1N1) 79

89. : 700,000 - 900,000 12,575 - 75,801 2.5 .. 2552 120,400 189.73 .. 2552 3 - 5 (H1N1) 2009 (Influenza A novel H1N1; pandemic strain) (H1N1) 2009 (H1N1) 1 .. 2552 .. 2552 30,956 48.78 1: 1.03 157 0.31 0.64 80

90. (H1N1)2009 (H1N1) 2009 (H1N1) 2009 2. : () 2 5 - 7 Rhinovirus, RSV, Parainfluenza, Adenovirus (croup) 81

91. (bronchiolitis) (febrile seizure) (pneumonia) 25 (H1N1) (congestive heart failure) 70 95 RT-PCR 2 64 82

92. ( ) (compromise respiratoryfunction) Metthicillin ResistanceStaphylococcus aureus (MRSA) S. pneumonia (worsening of underlying conditions) (encephalitis/encephalopathy) (ReyesSyndrome) (salicylates) 90 65 5 83

93. (isolation of viruses from throat, nasal, andnasopharyngeal secretion or tracheal aspirate or washings) (FA ELISA) (4-fold or greater rise in specificantibody titer) 3 5 - 7 3. : (Influenzavirus) (spherical) (filamentous form) 80 - 120 ( 1) 3 subtypes 84

94. 2 (hemagglutinin, H) (neuraminidase, N) ( 2) 16 9 2 (H1N1) (H3N2) subtypes 2 (two antigenically distinct lineages of B viruses) 85

95. 1 : AUSSR77 H1N1 189,000 2 : 86

96. (antigenic drift) (virus replication) antigenic drift 1 ( ) A/NewCaledonia/20/99 (H1N1), A/Brisbane/10/2007 (H3N2),B/Malaysia/2506/2004 4. : () 5 - 20 87

97. 50 8 - 10 1 / 2 /5. : (H3N2), (H1N1) 6. : (; airborne spread) ( ) 88

98. 7. : 2 ( 1 - 4 )8. : 3 - 5 7 - 10 9. : 89

99. 10. : 10.1 10.1.1 10.1.2 real timeRT-PCR 10.2 10.2.1 38o. 10.2.2 10.3 10.4 1 - 3 90

100. (aseptic technique) nasopharyngeal aspiration, throat swab,nasopharyngeal swab, nasal swab Nasopharyngeal aspirate 2 - 3 . viral transportmedia Throat swab swab posteriorpharynx swab viral transport media swab Nasopharyngeal swab swab nasopharynx 2 - 3 swab swab viral transportmedia Nasal swab swab palate 2 - 3 swab swab viral transport media swab : swab calcium alginate swab PCR Dacron Rayon swab 91

101. 10.5 swab (4o.) 48 -70o. (viral transport media ) 10.6 08.30 16.30 . 10.7 (TAT) 10.7.1 cell culture IFA 13 10.7.2 real timeRT- PCR 24 5 92

102. 10.8 10.8.1 (A/H1, A/H3, B) 10.8.2 real (A/H1, A/H3, B) time RT-PCR 10.8.3 real time RT-PCR 10.8.4 (A or B) real time RT-PCR 10.9 10.9.1 1,500 10.9.2 real time RT- PCR 3,500 93

103. 10.9.3 real time RT-PCR 2,500 10.9.4 real time RT-PCR 1,500 10.10 10.10.1 cell culture IFA 10.10.2 real timeRT- PCR 10.11 10.11.1 10.11.2 swab (4 .) o 10.11.3 11. : . : 1. 94

104. 2. (inactivated influenza vaccines; IIV) (live vaccines) 70 - 90 (live attenuated influenza vaccines; LAIV) 2 - 49 50 - 60 80 9 2 1 ( 2. ) 95

105. (aspirin) ( ) : .. 2519 Guillain - Barr syndrome 6 Guillain - Barr syndrome Guillain -Barr syndrome Guillain - Barr syndrome 6 3. 2 96

106. 2 2 48 (neuraminidase inhibitors) (oseltamivir) (zanamivir) (oseltamivir) 1 (zanamivir) 7 (prophylaxis) 5 (oseltamivir) 2 5 1 (oseltamivir) 97

107. 7 - 10 6 .. 2551 (H1N1) (oseltamivir) (oseltamivir) (oseltamivir) (zanamivir) (zanamivir) (bronchospasm) (zanamivir) (adamantanes); (amantadine) (rimantadine) 1 15 - 30 (adamantanes) (amantadine) 5 - 10 98

108. (rimantadine) (amantadine) . : 1. : 2. : (cohorting) (droplet precautions) 5 - 7 / (standard precautions) (droplet precautions) 99

109. 3. : 4. : 5. : ( 11 3) 6. : 7. : 48 ( 11 3) MethicillinResistance Staphylococcus aureus (salicylates) . : 1. 100

110. 2. 3. 4. . : . : 101

111. 1. (http://www.who.int/flunet) 2. (http://www.who. int/influenza) 3. 4. 1. , , . : / 1. : ; 2548. 103-107.102

112. 2. , . . : - . ; 2552. 31 - 33.3. Armour MA. Hazardous Laboratory Chemicals Disposal Guide. 3rd ed. Edmonton (Canada): CRC Press; 2003.4. Chemicon International Inc. Respiratory Panel 1 Viral Screening & Identification Kit Manual, November 2003. Livingston (UK): Millipore; 2007.5. Heymann DL, editor. Control of Communicable Diseases Manual. 19th ed. Washington DC: American Association of Public Health; 2008.6. Mandell GL, Bennett JE, Dolin R. Mandell, Douglas, and Bennetts Principles and Practice of Infectious Diseases. 7th ed. Philadelphia (USA): Elsevier; 2010.7. World Health Organization. Collecting preserving and shipping specimens for the diagnosis of avian influenza A(H5N1) virus infection, Guide for field operations; October 2006.8. World Health Organization. Influenza (Seasonal). 2009 [cited 2011 20 September 2011]; Available from: http:// www.who.int/mediacentre/factsheets/fs211/en/index. html.9. World Health Organization. Influenza update - 26 August 2011. 2009 [cited 2011 20 September 2011]; Avail- able from: http://www.who.int/influenza/surveillance_ monitoring/updates/latest_update_GIP_surveillance/ en/index.html. 103

113. 10. World Health Organization. WHO Animal Influenza Training Manual, The National Training Course on Animal Influenza Diagnosis and Surveillance. Harbin (China): 20-26 May 2001.11. World Health Organization. WHO information for laboratory diagnosis of pandemic (H1N1) 2009 virus in humans - revised Publication date; 23 November 2009. (INFLUENZA VIRUS INFECTION OF AVIANAND OTHER ANIMAL ORIGIN) ICD-10 J091. : : H5N1 .. 2546 63 400 20,000 .. 2546 - 2551 .. 2551 - 2554 104

114. .. 2546 19 .. 2554 565 331 15 .. 2554 () H5N1 Clade 2.3.2.1 : H5N1 23 .. 2547 7 30 .. 2554 25 17 18 .. 2547 17 12 .. 2548 5 2 .. 2549 3 14 .. 2549 25 22 ( 88) 15 105

115. ( 60) 4 (16) .. 2551 4 . .. 2554 2. : H5N1 ( 3) H5N1, H7N2, H7N3, H7N7, H9N2, H10N7 H1 106

116. H1 (H5N1) H5N1 60 H5N1 H5N1 3 : () MDCK () 107

117. .. 2461 .. 2500 .. 2511 4 H7 .. 2546 (H7N7) 89 1 .. 2550 (H7N2) 4 .. 2542 - 2550 (H9N2) 4 .. 2519 A/New Jersey/76(Hsw1N1) 13 108

118. 1 Fort Dix Fort Dix .. 2550 5 (H1N1) ( 3 ) H5N1 H7N7 H7N2 RNA Realtime RT-PCR Conventional RT-PCR seroconversion (rapid tests) 109

119. H5N1 .. 2540 H5N1 .. 2546 H5N1 H5N1 60 ( 38o.) .. 2547 .. 2548 (virusclades) 4 9 - 10 110

120. (leukopenia) (lymphopenia) (mild-to-moderatethrombocytopenia) aminotransferases (lymphopenia) lactate dehydrogenase creatine phosphokinase (hypoalbuminemia) D-dimer (disseminatedintravascular coagulopathy) 6 4 2 (seroepidemiologic) .. 2547 3. : H5N1 .. 2540 .. 2546 H5N1 .. 2548 111

121. H5N1 H5N1 H5N1 10 clades (Phylogenetic) antigenic subclade .. 2540 3 clades H5N1 H5N1 4. : H5N1 / 10 - 19 50 18 90 40 112

122. 5. : H5N1 6. : H5N1 H5N1 113

123. (aerosol, droplet or direct contact) .. 2519 Fort Dix 7. : H5N1 7 2 - 5 2 - 7 8. : H5N1 3 ( ; corticosteriod) 27 ()114

124. 9. : H5N1 10. : 10.1 RT-PCR 10.2 ( 38o.) ( ) 10.2.1 / 7 14 10.2.2 / 7 10.3 10.4 1 - 3 115

125. (aseptic technique) nasopharyngeal aspiration,throat swab, nasopharyngeal swab, nasal swab Nasopharyngeal aspirate 2 - 3 . viral transportmedia Throat swab swab posteriorpharynx swab viral transport media swab Nasopharyngeal swab swab nasopharynx 2 - 3 swab swab viral transportmedia Nasal swab swab palate 2 - 3 swab swab viral transport media swab : swab calcium alginate swab PCR Dacron Rayon swab 116

126. 10.5 swab (4o.) 48 -70o.(viral transport media ) 10.6 08.30 16.30 . 10.7 (TAT) 5 24 10.8 RT- PCR 10.9 3,500 10.10 RT-PCR 10.11 10.11.1 117

127. 10.11.2 swab (4 .) o 10.11.3 11. : . : 1. 2. / 3. 118

128. 1 4. H5N1 H5N1 5. 119

129. . : 1. : .. 2548 2. : H5N1 (standard and droplet precaution) (airborne precaution) (suction) (nebulizers) (intubation) (mechanical ventilation) 3. : 120

130. 4. : H5N1 5. : (neuraminidase inhibitors) (oseltamivir) (zanamivir) 7 - 10 H5N1 (amantadine) (rimantadine) (amantadine) (rimantadine) 6. : H5N1 throat swab 121

131. PCR / http://www.who.int/csr/disease/avian_influenza/guidelines/RapidContprotOct15.pdf 7. : H5N1 (oseltamivir) (oseltamivir) (; oseltamivir ; amantadine) H5N1 Clade 1 Clade 2 subclade 1122

132. M2 inhibitors H5N1 Clade 2 subclade 2 H5N1 Clade 2 subclade 3 (oseltamivir) H5N1 (oseltamivir) 2 H5N1 (Acute Respiratory Distress Syndrome;ARDS) passive(intermittent positive pressure ventilation; IPPV) (ventilation) (low tidal volumns) (low pressure) (corticosteroid) (immunomodulator) (serotherapy) . : 1. H5N1 H5N1 123

133. H5N1 2. 3. 4. 5. . : 124

134. . : .. 2548Class 1 1. H5N1 http://www.who.int/collaboratingcentres/database/en/ 2. .. 2548 3. H5N1 http://www.who.int/csr/disease/avian_influenza/en/ www.pandemicflu.gov 125

135. 1. , , . : / 1. : ; 2548. 103-107.2. , . . : . ; 2552. 34 - 35. 3. Armour MA. Hazardous Laboratory Chemicals Disposal Guide. 3rd ed. Edmonton (Canada): CRC Press; 2003.4. Erdman DD, Weinberg GA, Edward KM et al. Genescan reverse transcription-PCR assay for detection of six common respiratory viruses in young children hospitalized with acute respiratory illness. J Clin Microbiol. 2003;41:4298-4303.5. Heymann DL, editor. Control of Communicable Diseases Manual. 19th ed. Washington DC: American Association of Public Health; 2008.6. Mandell GL, Bennett JE, Dolin R. Mandell, Douglas, and Bennetts Principles and Practice of Infectious Diseases. 7th ed. Philadelphia (USA): Elsevier; 2010.126

136. 7. Spackman E, Senne DA, Myers TJ et al. Development of a real-time reverse transcriptase PCR assay for type A influenza virus and the avian H5 and H7 hemagglutinin subtype. J Clin Microbiol. 2002;40:3256-3260.8. World Health Organization. Collecting preserving and shipping specimens for the diagnosis of avian influenza A(H5N1) virus infection, Guide for field operations; October 2006.9. World Health Organization. Influenza A H5N1 Laboratory Training Manual, Regional Workshop on Human Influenza A(H5N1). Bangkok (Thailand): Ministry of Public Health; 19-20 February 2004.10. World Health Organization. WHO Animal Influenza Training Manual, The National Training Course on Animal Influenza Diagnosis and Surveillance. Harbin (China): 20-26 May 2001.11. World Health Organization. WHO information for laboratory diagnosis of pandemic (H1N1) 2009 virus in humans - revised Publication date; 23 November 2009. 127

137. (LEGIONELLOSIS) ICD-9 482.8; ICD-10 A48.1(LEGIONNAIRE DISEASE; LEGIONNAIRE S PNEUMONIA)(NONPNEUMONIC LEGIONELLOSIS) ICD-10 A48.2(PONTIAC FEVER)1. : : .. 2490 .. 2500 .. 2519 (AmericanLegion Convention) 221 34 6 McDade JE Legionella pneumophila 4.45 18,000 - 88,000 2 - 5 128

138. (Centers for DiseaseControl and Prevention) 70 - 90 : .. 2527 .. 2542 3 .. 2553 European Working Group for Legionella Infection(EWGLI) Network 29 2 () EWGLI .. 2536 - 2553 109 129

139. 2. : 2 (ICD-10 A48.1) (ICD-10 A48.2) 15 2 - 5 (BCYE) Legionella pneumophila serogroup 1 130

140. Immunofluorescent L. pneumophilaserogroup 1 4 3 - 6 L. pneumophila species Direct immunofluorescent antibody stain 3. : (Legionellae) ( 4) 52 70 serogroups Legionella pneumophila 18 serogroups serogroup 1 L. micdadei, L. bozemanii,L. longbeachae L. dumoffii 131

141. 4 : (A) BCYE ( 10 ) (B) ( 1,000 )4. : ( ) 1 - 20 L. pneumophila serogroup 1 1 : 128 0.5 - 5.0 ( 0.1 - 5) 95132

142. 5. : (waterborne disease) 25 - 42. 6. : (airborne transmission) 7. : 2 - 10 5 - 6 5 - 72 24 - 48 8. : 9. : ( 50 ) 2.5 : 1 133

143. 20 10. : 10.1 (penicillin) (cephalosporins) 10.2 10.2.1 1) 25 - 30 . 2) Sterile body fluid (pleural, pericardial peritoneal) 5 . 3) (lung, spleen) 1 - 5 . 4) 2 - 5 . 5) 5 . 3 10.2.2 1) ( 100o. 1 134

144. 2) Cooling tower 200 - 1,000 . 3) swab swab 4 () 1 . 4) spa 500 - 1,000 . 5) (hot water storage tank) 10 - 50 . 30 10 - 50 . 1) 2) 1) 0.1 N-sodiumthiosulfate 0.83 . 1 chlorine neutralized 2) ( -) swab 3) Cooling tower 3 (basin) (inlet) (outlet drain) 135

145. 10.3 1) 2 20o. 24 4o. 1 -70 . o 2) ( ) 4o. 2 10.4 10.4.1 : 15 () (PCR screening) : 5 () 10.4.2 1) : 12 () 2) species : 15 () 10.5 1) 2) 1 136

146. 3) Cooling tower 200 . 500 . 2 4) 11. : . : Legionella Biocides 50 . o . : 1. : 2. : 3. : 4. : 5. : 6. : 137

147. 7. : (fluoroquinolones) (levofloxacin) (macrolides) (azithromycin) (levofloxacin) (macrolides) (rifampicin) (penicillin) (cephalosporins) (aminoglycosides) 138

148. . : (superchlorination) / (superheating) . : . : 1. , . : , . . 1. : ; 2551.2. Carroll KC, Funk G, Jorgensen JH, Landry ML, Warnock DW. Legionella. In: Versalovic J, editor. Manual of Clinical Microbiology. 10th ed: ASM Press; 2011. p. 770-1.3. Department of Health and Human Services, Center for Disease Control and Prevention. Procedures for Recovery of Legionella from the Environment. Atlanta (U.S); 2005. 139

149. 4. Hall NH. Culture of hospital water for Legionellaceae. In: Garcia LS, editor. Clinical Microbiology Procedures Handbook. 3rd ed. and 2007 update Vol.3. Washington DC, (USA): ASM Press; 2010: 13.6.1 -13.6.14.5. Heymann DL, editor. Control of Communicable Diseases Manual. 19th ed. Washington DC: American Association of Public Health; 2008.6. Mandell GL, Bennett JE, Dolin R. Mandell, Douglas, and Bennetts Principles and Practice of Infectious Diseases. 7th ed. Philadelphia (USA): Elsevier; 2010.7. Pascule W. and McDevitt D. Legionella cultures. In: Garcia LS, editor. Clinical Microbiology Procedures Handbook. 3rd ed. and 2007 update Vol.1. Washington DC, (USA): ASM Press; 2010: 3.11.4.1-3.11.4.15.8. Washington C and Winn JR, Legionella. In: Murray PR, Baron EJ, Pealler MA, Tenover FC, and Yolken RH, editors. Manual of Clinical Microbiology. 6 th ed. Washington DC, (USA): ASM Press; 1995: 533-544.140

150. (Plague) ICD-9 020; ICD-10 A20(Pestis)1. : : (Botswana) .. 2541 ( .. 2543 5 - 15 /) .. 2467 : 20 .. 2447 141

151. 2 .. 24952. : (zoonosis) Yersinia pestis (Bubonic plague) (inguinal lymph nodes) 142

152. (Septicemia plague) (bubonic plague) (endotoxin) (disseminated intravascular coagulation : DIC) (mediastinitis) (pleural effusion) (Secondarypneumonic plague) 2 (primary pneumonic plague) (Pharyngealplague) 50 - 60 2 (Earlydetection & early treatment) 143

153. FA test Antigen-capture ELISA dipstick formats PCR Yersinia pestis 4 dipstick Yersinia pestis passive hemagglutination (PHA) Fraction-1 Yersinia pestis F1 144

154. 3. : bacillus Yersinia pestis4. : 5 20 5. : 6. : 2 ( Sylvatic) 145

155. (Xenopsylla cheopis oriental rat flea) (Pulex irritans) ( ) 7. : 1 - 7 2 - 3 1 4 8. : 9. : 146

156. 10. : * **1. Bubo - 10 . aspirate ( ) 1 . 2 - 8o. - 10 . 1 - 2 147

157. * ** 2. 1. (Tissue Cary-Blair biopsy) 2. 2 - 8o. 1 - 2 3. Tissue autopsy 4. Blood Hemoculture 5. Bronchial 1 . wash, Tracheal aspirate 2 - 8o. 6. Sputum ( ) 2 - 8o. 148

158. * **7. CSF 2 - 8o. * Yersinia pestis Biohazard ()** Yersinia pestis 11. : . : 1. 149

159. 2. ( . 6) / 3. (rat-proofing) 4. 150

160. 5. . : 1. : class 1 1 2. : () 48 48 ( 7) 3. : 151

161. 4. : ( 5) 7 7 5. : (tetracycline) 2 ./ 2 - 4 25 - 50 ././ 2 - 4 8 (doxycycline) 100 ./ 2 45 . 2.2 ./. 8 45 . (chloramphenicol) 30 ././ 4 1 (tetracycline) (doxycycline) 8 6. : 152

162. 7. : ( 8 - 18 ) (streptomycin) (2 ./ 30 ././ 2 ) (gentamicin) (3 ././ 6.0 - 7.5 ././ 3 ) (streptomycin) (tetracycline) (2 ./ 25 - 50 ./ 8 4 ) (chloramphenicol) (50 ././ 4 ) (chloramphenicol) . : 1. 153

163. 2. 3. 4. 5. ( . 5) . : 154

164. . : 1. 2. 3. 4. 5. 6 6 155

165. 1. Heymann DL, editor. Control of Communicable Diseases Manual. 19th ed. Washington DC: American Association of Public Health; 2008.2. Mandell GL, Bennett JE, Dolin R. Mandell, Douglas, and Bennetts Principles and Practice of Infectious Diseases. 7th ed. Philadelphia (USA): Elsevier; 2010.(SEVERE ACUTE RESPIRATORY SYNDROME : SARS) ICD-10 U

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