美国加州22年来最大规模人传人甲肝暴发

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美国加州22年来最大规模人传人甲肝暴发
检索：陈志锦翻译：陈志锦审核：陈燕琼


甲型肝炎的致命爆发导致加利福尼亚州长宣布全州进入紧急状态，仅在圣地亚哥地区就有500多人受感染。自去年十一月至今，加州至少有十九人死于甲肝感染，尤其是无家可归者，是1995年甲肝疫苗引入以来全美最大规模人传人甲肝疫情。甲型肝炎在卫生条件差的环境中传染性非常强，它能通过被粪便污染的食物和饮水，或通过与感染者密切接触而传播。

目前圣地亚哥地区卫生官员主要采取疫苗接种和卫生宣传活动来控制疫情进一步蔓延。用水冲洗大街小港，将中和病毒的漂白物质清洗干净；确保洗手间更方便以及在某些地区放置了移动洗手台；派放了近8000套卫生用品。


但不幸的是，目前没有受到疫苗保护的无家可归者相当一部分对接种疫苗等健康行为有抵触，或是精神病患者和药物滥用人员。所以需要花费大量的时间才能与他们建立信任、提供健康教育，并解析清楚提出接种疫苗的原因是为了保护他们的健康。

甲型肝炎最常见的基本上是发热、疲劳、恶心呕吐、腹痛明显、食欲不振等。然后，其中一个表征是尿液变暗或所谓的黄疸，这是眼睛的常见黄化和皮肤的黄染，表明肝酶会溢出到血液中。所以黄疸也是一个很常见的症状。
这次甲型肝炎爆发对人类来说，就是健康决定因素生态学模型中社会因素的鲜活例子。因此，需要重新审视我们目前的公共卫生基本策略，以免类似感染暴发的发生，不仅仅是圣地亚哥地区，而是整个国家。

原文搜索A deadly outbreak of hepatitis A has led the governor of California to declare a state of emergency. In San   Diego County alone, more than 500 people have been infected. At least 19 have died since last November. California's homeless population has been especially hard-hit. Hepatitis A is highly contagious and thrives where sanitation is poor. It spreads through the ingestion of food and water contaminated by feces or through close contact with those infected. Dr. Nick Yphantides is chief medical officer in San Diego County, where they've responded with a vaccination and sanitation campaign.


NICK YPHANTIDES: Literally power washing the streets with water and the bleach substance that neutralizes the virus, making bathrooms more accessible, putting literal mobile hand-washing stations in certain areas. And then we've passed out almost 8,000 sanitation kits. So a whole different approach than we typically do of waiting for people to come to us.


BLOCK: And when you approach these populations and say, we're concerned you might be at risk - we'd like to vaccinate you against hepatitis A - how open have people been to that?


YPHANTIDES: Unfortunately, we know that the homeless individuals who are unsheltered and living in the street are disproportionately burdened with behavioral health challenges, mental disease, substance abuse disorders. And so if a nurse from the government shows up with a syringe and says, hey, I'm here from the government. I'm here to help you. Take this shot - it's not so simple. We have had to spend a tremendous amount of time building trust, providing education and making the case for why receiving a vaccine is such a critical opportunity for them to protect their health.


BLOCK: What are the symptoms of hepatitis A?


YPHANTIDES: These are symptoms that basically reflect inflammation of the liver. And the most common symptoms are basically fever, fatigue, nausea and vomiting, significant abdominal pain, the loss of appetite. And then one of the telltale things is either darkening of the urine or what's called jaundice, which is the common yellowing of the eyes and the yellow hue of the skin, indicating liver enzymes being spilled into the bloodstream. So jaundice is also a very common symptom.


BLOCK: Dr. Yphnatides, if you think long term about changes you would want to see made to prevent another outbreak like this in the future, where does that take you?


YPHANTIDES: Well, you know, this hepatitis outbreak to me is, like, the ultimate example of social determinants of health. One of the worst social determinants to be struggling with is not having a place to live. It is my hope that we are going to come together - not just the San Diego County but the country at large - in terms of figuring out strategies where folks can have basic needs met so as to not be at risk disproportionately for infections such as this.


http://www.tingvoa.com/17/10/Hepatitis-A-Outbreak-Hits-California.html

图文编辑：朱迪