2017-10-272024-05-17https://scholars.lib.ntu.edu.tw/handle/123456789/681859摘要：中國大陸自2014年出現許多人類感染禽流感病毒H5N6的案例，至今已18人，目前已造成數12人死亡(致死率為66.7%)，其中多數流感患者均曾經與禽鳥接觸，該亞型病毒讓中國在今年六月與八月家禽病死的數量攀升至四萬與一萬多隻；而去年禽流感疫情爆發讓中國大陸損失超過1800億台幣。日本因此撲殺了120萬隻家禽。此三國今年均是山雨欲來風滿樓，積極備戰。 臺灣2017年2月初於花蓮縣檢測出H5N6禽流感病毒亞型，此H5N6禽流感病毒雖已造成日、韓兩國嚴重疫情及經濟損失，且在中國更有人死亡的年輕病例，幸自 4月起也未再分離此型別。另由於臺灣禽農對生物安全的認知與防疫參與程度低、屠宰場的工作量能不同及缺乏運送防護，往往造成「高」致病性禽流感病毒在短時間內突然散布各地區，徒增防疫困難。因此，必須由流行病學的角度，進行危險因子的數據分析，依據不同的風險程度，再決定不同的偵測作法(risk-level stratified sampling)，易更有效率。期望未來能依據花蓮經驗以推動整合偵測跨越不同宿主(inter-species transmission)。本計畫最重要的是明瞭禽農的想法與憂慮處，並結合流行病學專業防疫知能，不但提升防疫效能、協助產業升級，並能促進多方和諧的互動，未來也將嘗試尋找具抗禽流感病毒高效能之新型消毒劑，避免大流行所致之經濟損失。 因此，本計畫目的有四:(1) 了解花蓮縣禽流感的流行病學, (2) 探詢花蓮禽農對禽流感的認知、態度與防護行為，(3)探查禽農與其接觸者的社群網絡知識傳遞與教育可行性分析，及(4) 綜合計畫整體成果提出有利於花蓮縣政府在禽流感威脅下的應變作為、實驗診斷檢測的侷限處與改進之道及提出誠摯建言。做法上，本計畫將:在目的(1)以流行病學方法先瞭解花蓮縣禽流感的流行病學特徵，目的(2)經由訪查了解禽農對禽流感的相關認知、態度與防護行為，目的(3)並由訪視成果與各項數據建立之危險因子基礎數據做為往後風險判斷之依據，及目的(4)針對不同高、低風險區提出誠摯懇切的建議，並嘗試改進實驗分子診斷檢測。未來能以此整合政府、學術以及基層禽農的想法提供禽流感偵測的病徵差異，協助各級單位建構更有效率的禽流感預警偵測系統，並優化自下而上的可行防疫策略與切實作法。 <br> Abstract: Outbreaks of H5N6 avian influenza had resulted in 18 human cases and 12 deaths (case fatality rate of 66.7%) since 2014 in China. Several fatal cases were very young. Most of these cases had contacts with poultry. The economic loss of H5N6 in China, Japan and Korea has led these 3 countries to spend more efforts to prepare the up-coming epidemic season in this year. In Taiwan, Hualien detected H5N6 event on Feb. 3rd but the outbreak had been successfully controlled in early April. However, most poultry farmers have had little knowledge on avian influenza, biosecurity, and low participation in preventing outbreaks. In addition, various levels of work load at killing sites and lack of protective transportation measures for poultry have created difficulties in spreading highly pathogenic avian influenza to many different areas within a short period of time. Therefore, this study planned to start from epidemiological viewpoints considering risk factors and establish data-base on important risk factors for subsequent risk-level stratified sampling that will be more efficient in future surveillance. In other words, we intended to have a pilot study on integrated surveillance to involve different host species and hopefully such an effort can increase interactions among different stake-holders and also trying to search for any possible antiviral agents that might be applicable during the epidemic period to minimize economic loss. This study has four major aims: (1) to understand the epidemiology of avian influenza in HuaLien, (2) to search for the knowledge, attitude and practice (KAP) of HuaLien poultry farmers on avian and human influenza, (3) to seek for possible social network that can be used for knowledge transfer and more effective education on those poultry workers, and (4) to compile above information for improving laboratory diagnosis and address sincere feasible recommendations. For Aim #1, we will focus on epidemiological characteristics. For Aim #2, we will use questionnaire to collect the KAP of poultry workers from high vs low outbreak-risk areas. For Aim #3, we will analyze those interview data to set up epidemiological-related data bank for future risk assessment. For Aim #4, we will stratify high vs low risk areas for addressing different approaches from surveillance to laboratory diagnosis and prevention and control measures. We believe this bottom-up effort through respecting different opinions from poultry workers can be more helpful and effective to formulate our integrated influenza surveillance from animals to humans as well as find out the most feasible prevention control measures that poultry workers like to participate this team effort to match the final goal.禽流感流行病學危險因子防疫策略avian influenzaepidemiologicalrisk factorsprevention control measures