94.11.10 1 3. 3. 4. 5. 7..7..9..9..11...11..... 13. 18..20.23... 23..26..... 29. 30..30.....33.......39.. 40 41 81-94 10 41
.... 42...43..... 45.52.53.54
94.04.08 measles outbreaks 1996 WHO PAHO US, CDC 2005-2010 2001 () 1. 95% 2. 3. 1
4. A 2
(Disease description) 3-4 Koplik spots 34 24 48 2 3 3-4 47 34 510 Infectious agent Measles virus (Reservoir) Mode of transmission Incubation period 1014 14 Period of communicability 4 (Susceptibility and resistance) 3
69 ( ) 510% 99 1978 80 9 7-8 4
WHO 1980 400 2003 53 2000 1 7 1,376 2 2000 3 2001 1 39,537 6 2002 33,812 2004 2005 1 66 14 3 5 WPRO 2003 71,879 10,501 16,818 1,000 10,000 8,286 1,127 1,810 100 1,000 649 632 10 100 91 66 63 33 31 21 3 5
10 90 9 5 55 6
95 1978 9 15 9 80 15 1992 9 15 MMR 1992-1994 2001-2004 MMR 9 15 MMR 95 12-15 MMR 7
1. 2. 5-10 6-12 2-5 3. 1. 2. 3. 4. MMR 1. B HBIG 3 2. 6 3. 11 2-8 2 8 8 8
Case definition 1. 3. 38.5. 1. 2. RT-PCR 3. IgG 4 4. IgM parvovirus, rheumatoid factor, heterophile antibody 1. 3 MMR 2. 9
1. 2. 10
24 WEB WHO 4 7 4 4 7 11
1. 2. 3. 4. 5. 12
13
4-8 3-5 48 4-8 30 48 4-8 48 2 4-8 3-28 48 Bar-code WEB 14
1. Enzyme-linked immunosorbent assay, ELISA IgM IgG 1IgM 3 MMR 2IgM IgG 3 IgM IgG 15
2. 1. 3 IgM IgG - 7 2. IgM IgG ± 14 3. IgM IgG IgG 14 16
IgM IgG ± 14 14 7 ± ± 14 ± 14 17
1. 72 WEB 2. 814 4 1 2 3 A. / B. 100 1000 18
15 C. D. E. 9 14 3. 9 14 4. 1 A. 2 B. 9 55 2 A. 82 B. 19
4 3 2 3-4 4 3 MMR 1. 20
7 7 2. 3. 1 1. MMR 2. 72 2 1. 2. 3. 4. 3 4. 5. 6. 21
22
/ 24 1. 1. 2. 2. - 1. - 7 2. 1. - 3-28 2. - - 23
24 / 72 1. 2.. 1. 5
3 / 1. 2. - 14-1. 12 2. - - 25
26 / - 1. 2. 1. 2. 1. 2. 1. 1. 2.
27 / 2. 3. 1. 2. 3. 1. 2. 1. 2. 3. 1. 2. 1. 2.
/ 1. 14 2. - - 1. 14 2. 28
(secondary cases) (index / primary case) 24 (sporadic cases) (cluster of cases) (outbreak) (epidemic) (pandemic) (endemic) 29
02-23959825 100 9 3670 02-23959835 02-23577934 3671 02-23945177 02-23577934 / 02-27850513 115 161 888 02-26531362 02-27853944 805 26531335 02-27850288 526 02-26531002 02-27822319 115 161 02-26531402 02-26517285 04-24739940 20 04-24734549 04-24739784 07-5565803 180 6 07-5561270 07-5574664 03-8226343 202 03-242259 03-8224732 30
02-23759800 108 100 6 02-22577155 220 192 02-24276154 226 03-3363270 330 55 035-264094 300 111 035-518160 320 1 037-336781 360 6 04-23801151 811 04-25265394 420 136 049-220904 540 6 05-5373488 34 047-115141 500 162 05-2248076 600 1 05-3620607 612 3 06-2906386 418 06-6335140 163 07-2513467 261 4 07-7334866 834-1 31
08-7380208 900 271 03-9322644 260 141 038-226975 970 200 089-331171 950 336 082-330697 891 1 12 06-9270508 880 115 2 0836-22095 209 216 32
33
34
35
36
37
38
1. 93 12 2. 90 3 3. 93 12 4. CDC: Measles EradicationExperience in the Americas. MMWR199948,SU01. 5. WHO guidelines for epidemic preparedness and response to measles outbreaks. Geneva, World Health Organization, 1999 (unpublished document WHO/CDS/CSR/ISR/99.1). 6. CDC: Progress Toward Interrupting Indigenous Measles Transmission--- Region of the Americas. MMWR2001; 50(50). 7. Measles eradication field guide. Washington DC; Pan American Sanitary Bureau, Regional Office of the World Health Organization; 1999 (Technical Paper No. 41).
81-94 10 94 40
300 250 200 150 100 50 0 33 0 2 0 0 5 9 0 5 9 24 6 0 4 81 82 83 84 85 86 87 88 89 90 91 92 93 94 41
42
43
44
2004 11 1. 2. 3. 4. 1 2 5. 1 2 3 4 5 6. / 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 1 2 3 19. 1 2 3 () 20 45
21. 22. 23. 1. 1 2 3 2. 1 2 3. 4. 1 2 38.5 5. 1 (rash) 2 (fever) 10 (malaise) 3 (conjunctivitis) 11 (bronchitis) 4 (cough) 12 (nausea vomiting) 5 (coryza) 13 (photophobia) 6 (sore throat) 14 (allergy) 7 (headache) 15 (lymphadenopathy) 8 (joint pain) 9 (Koplik spots) 16 6. 1 2 3 1.? 1 1 2 3 4 2 3 2. (MMR) 1 1 2 3 4 2 46
3 3. MMR 1 1.2.MMR 1.2.MMR 2 3 4. 1 2 3 5. 1 2 3 ( 8-14 2 ) 2. 2 3. / / 1. 1-1 47
1-2 1-3 2. MMR 3. 4 4 3-1 3-2 3-3 20 20-49 50-99 100-249 250 3-4 3-5 3-6 10 11-20 21-49 50 3-7 48
MMR 4. 4 5 4-1 4-2 4-3 B 4-4 6-6 4-5 4-6 MMR 5. 49
5-1 5-1 ( )? 1 2 KTV 3 / 4 5-2 MMR 50
1. 1 2 3 4 5 6 2. 1 2 3 4 5 6 51
52
94 53
24 B 24 25 B 1 B 2 4 B 6 9 12 13 ( 3 5 ) ( 3 5 ) 16 23 ( 3 5 ) ( 3 5 ) 92 54