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1、传染病学,同济大学附属东方医院感染科李杨,总论,传染： communication 传染病：communicable Diseases,Two concepts,感染病 Infectious Diseases感 染 Infection 传染病 Communicable Diseases （Contagious Diseases）传 染 CommunicationCommunicable diseases belongs to infectious diseases, but it doesnt mean that all communicable diseases are infectious
2、 diseases,Examples :,Communicable and Infectious Diseases （传染病和感染病） noncommunicable infectious diseases （非传染性感染病）,Fifty-two millions people die each year in the world， 32.7% of which，about 17 millions people die of infectious diseases。,概论,WHO Reports：,The outbreak of “Spanish flu” in 1918 caused dea
3、th of 40 millions people all over the world.,I、 In 1674, Mr. Leeuwenhoek（列文虎 克） Observed microorganisms by homemade microscope. It was the first time that human set eyes on microorganisms.,II. In 1796, Jenner ,An English country doctor, inoculated cowpox vaccinia（牛痘） for a 8 years old boy, cowpox va
4、ccinia was invented since that and human are immune from smallpox. Today smallpox has been the first infectious disease eradicated by human through vaccination.,III. In 1882, Koch（科赫）, a German bacteriologist discovered tubercle bacillus. Pasteur and Koch established the base of microbiology togethe
5、r.,Nobel prize winner of physiology and medicine, 1905 Robert Koch,IV. In 1928, Fleming（费列明）, a doctor from Scotland, discovered penicillin, since then a new age-antibiotics age was initiated.,Nobel prize winner of physiology and medicine, 1945 Sir Alexander Fleming,In 1988, WHO brought forward to e
6、liminate poliomyelitis（脊髓灰质炎） on 31-12-2000 （postponed to 2005）.,In developing countries，about half of the dead persons are due to infectious diseases。 Each hour，about 1500 people die of infectious diseases，most of cases occur in developing countries。,近年来人的死因顺位发生了由传染病为主转向以心、脑血管病、肿瘤等为主的重大变化。,The prev
7、alence of Infectious Diseases,Re-emergence of Classical Infectious Diseases,Tuberculosis Viral hepatitisSexually transmitted diseasesOthers WNV, Rabies,Each year, 2 millions people die of TB Each year, 78 millions are infected with TB,New Infectious Diseases are Emerging Unceasingly,According to the
8、 reports issued by WHO, more than 30 new infectious diseases were discovered in recent 30 years ,which are called “emerging infectious diseases”。,表 1 1973年以来新发现的部分传染病,年代 微生物 疾病 1973 轮状病毒 世界范围婴儿腹泻的主要病因 1975 细小病毒B19 5号病，慢性溶血性贫血中的再障危象 1976 隐孢子虫 隐孢子虫病，急性小肠结肠炎 1977 埃博拉病毒 埃博拉出血热 1977 嗜肺军团菌 军团病 1977 汉坦病毒 肾
9、综合征出血热 1977 空肠弯曲杆菌 全球分布的肠炎 1977 丁型肝炎病毒 丁型肝炎 1980 嗜人T细胞病毒I型 T细胞淋巴瘤/白血病 1981 金黄色葡萄球菌产毒株 中毒性休克综合征 1982 大肠杆菌O157:H7 出血性结肠炎，溶血性尿毒综合征 1982 嗜人T细胞病毒II型 毛细胞白血病 1982 伯氏疏螺旋体 莱姆病 1983 人类免疫缺陷病毒 艾滋病 1983 幽门螺杆菌 消化性溃疡,年代 微生物 疾病 1986 环孢子球虫 顽固性腹泻 1988 人疱疹病毒6型 突发性玫瑰疹 1988 戊型肝炎病毒 戊型肝炎 1989 查菲氏埃立克体 人埃立克体病 1989 丙型肝炎病毒 丙型
10、肝炎 1991 Guanarito病毒 委内瑞拉出血热 1992 O139霍乱弧菌 O139霍乱 1992 巴尔道氏体 猫抓病，杆菌性血管瘤病 1993 汉坦病毒分离株 汉坦病毒肺综合征 1994 Sabia病毒 巴西出血热 1995 庚型肝炎病毒 庚型肝炎 1996 朊毒体 新变异型克雅病 1997 TTV TTV肝炎 1997 H5N1 禽流感 1999 Nipah 病毒 脑炎 2003 SARS病毒 SARS,There were 40 millions HIV infected persons/AIDS patients in the world by the end of 2004.
11、 More than 20 millions of which died of AIDS,Figure1 The structure of HIV,SARS (severe acute respiratory syndrome, atypical pneumonia) is an acute respiratory infectious disease caused by a new coronavirus (SARS-CoV),From 16 Nov, 2002(the first case was reported) to July, 2003, only several months,
12、SARS spread to six continents, 32 countries or zones, about 8437 people were infected with SARS and 916 patients lost their lives The epidemic situation in Chinese mainland and Hong Kong was severest. Data showed that 5327 persons were suffered from SARS and 349 patients died in Chinese mainland.,SA
13、RS is the first one which is the most dangerous emerging infectious disease in 21 century !,保护自己才能保护别人,图 电镜下SARS病毒形态,avian influenza bird flu Caused by H5N1 virus,禽流感,In 1997, the first bird-to-human transmission was identified in the outbreak of H5N1 in Hong Kong, 18 persons were infected, 6 of whi
14、ch died during the outbreak. According to the data issued by WHO on 2-Feb-2005, 55 cases of laboratory confirmed avian influenza in human were reported in the world since 28-Jan-2004 (37 cases in Vietnam, 17 cases in Thailand, 1 case in Cambodia), 42 cases died.,H5N1型禽流感病毒的电子显微照片,禽流感症状,感染禽流感初时的症状与普通
15、流感差不多 包括： 发热 全身肌肉疼痛 咳嗽和喉咙痛 但较易道致高烧、肺炎、呼吸衰竭、多种器官衰竭，以致死亡。,流感的高峰期一般在每年一至三月和七至八月。 傳播途徑 人感染H5N1禽流感是通过与家禽近距离接触而传播,未发现人与人之间的传播,我国全国原因不明性肺炎病例监测实施方案的定义：,不明原因肺炎，且符合如下条件之一者：（1）接触禽类人员（饲养、贩卖、屠宰、加工禽类的人员）、兽医、及其捕杀、处理病死禽及进行疫点消毒的人员等）中发生的不明原因肺炎； （2）可能暴露于禽流感病毒或潜在感染性材料中人员出现不明原因肺炎的病例； （3）已排除SARS 的不明原因肺炎死亡病例。,WHO病例定义,在一个明
16、确的地理范围内710天内3个人相继发病，和无法解释的中重度急性呼吸道疾病（或死于无法解释的急性呼吸道疾病），和有如下1条流行病学史：-到过家禽中或其他动物中有禽流感暴发的地区旅行或居住，或-在受禽流感暴发的地区直接接触病死禽类或其他动物，或-密切接触H5N1病人（活的或死者），或密切接触无法解释的重症急性呼吸道疾病，或-可能的职业性接触，包括从事动物屠宰、兽医、实验室或医务工作的人员,The control of infectious disease is a permanent occupation.We can win battles, the campaign is likely to be never-ending.Infections disease which antidated the emergence of humankind will last as long as humanity itself.Hopefully we will be better prepared in the future than we have been in the past.,
