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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 方啟泰(Chi-Tai Fang) | |
| dc.contributor.author | Shu-Wan Jian | en |
| dc.contributor.author | 簡淑婉 | zh_TW |
| dc.date.accessioned | 2021-05-14T17:48:55Z | - |
| dc.date.available | 2015-03-12 | |
| dc.date.available | 2021-05-14T17:48:55Z | - |
| dc.date.copyright | 2015-03-12 | |
| dc.date.issued | 2015 | |
| dc.date.submitted | 2015-01-27 | |
| dc.identifier.citation | 1. Kuo, H.-W. et al. A foodborne outbreak due to norovirus in Austria, 2007. J. Food Prot. 72, 193–196 (2009).
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Influenza A(H7N9) virus gains neuraminidase inhibitor resistance without loss of in vivo virulence or transmissibility. Nat. Commun. 4, (2013). 58. Buchholz, U. et al. German Outbreak of Escherichia coli O104:H4 Associated with Sprouts. N. Engl. J. Med. 365, 1763–1770 (2011). 59. Beutin, L. & Martin, A. Outbreak of Shiga toxin-producing Escherichia coli (STEC) O104:H4 infection in Germany causes a paradigm shift with regard to human pathogenicity of STEC strains. J. Food Prot. 75, 408–418 (2012). 60. Bielaszewska, M. et al. Characterisation of the Escherichia coli strain associated with an outbreak of haemolytic uraemic syndrome in Germany, 2011: a microbiological study. Lancet Infect. Dis. 11, 671–676 (2011). 61. Frank, C., et al. Results of surveillance for infections with Shiga toxin-producing Escherichia coli (STEC) of serotype O104:H4 after the large outbreak in Germany, July to December 2011. Euro Surveill. Bull. Eur. Sur Mal. Transm. Eur. Commun. Dis. Bull. 19, (2014). 62. Werber, D. et al. Outbreaks of virulent diarrheagenic Escherichia coli--are we in control? BMC Med. 10, 11 (2012). 63. Devaux, I. et al. Challenges and Opportunities in Routine Time Series Analysis of Surveillance Data. Online J. Public Health Inform. 5, (2013). | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/4858 | - |
| dc.description.abstract | 歐洲現場流行病學訓練計畫(European Programme for Intervention Epidemiology Training, EPIET)，是歐洲疾病預防及控制中心（European Centre for Disease Prevention and Control, ECDC）重點長期訓練計畫之一。經2007年我國行政院衛生福利部疾病管制署（下稱疾管署）與奧地利健康暨食品安全署（Osterreichische Agentur fur Gesundheit und Ernahrungssicherheit, 下稱AGES )簽定合作備忘錄下，我國得派員以奧地利衛生調查訓練班訓練員身分，參加為期兩年之EPIET計畫。學生有幸通過疾管署遴選流程，自 2011年9 月至2013年11月在AGES進行EPIET訓練及實務實習。
EPIET訓練內容包含10週流行病學相關課程及於代訓機構進行實務實習，以具備疫病調查、監測系統評估或建立、研究計畫撰寫及執行、教學經驗、學術發表等能力。受訓期間學生參與疫病調查及監測系統評估與學術成果發表等經驗摘要如下：1. 以回溯性世代研究法調查一起校園學生諾羅病毒感染事件，經分析結果顯示男住宿生（Risk Ratio: 3.4; 95%CI: 1.4-8.2）、食用酸奶醬（RR: 16.2; 95%CI: 3.9-67.5）及火雞肉片沙拉（RR: 5.2; 95%CI: 2.3-11.8）為經分層分析後感染諾羅病毒之危險因子，推測因該校學生餐廳廚房未依相關規定，執行危害分析重要管制點系統制度(Hazard Analysis Critical Control Point, HACCP)， 在餐點配製及料理過程中造成食物交叉污染。2. 奧地利流行性感冒季節性監測，以結合定點醫師監測、非定點病毒監測、類流感監測等，掌握流感季期間，類流感趨勢及病毒型別變化與疾病負擔。3. 闡述奧地利李斯特菌監測系統監測架構及評估其簡易性及時效性，於2009年該國法定傳染病線上通報系統啟用後顯著提升。4. 為評估省市間百日咳通報率差異，進行奧地利一般科醫師、小兒科醫生及肺專科醫生通報百日咳感染病例之知識、態度、行為（knowledge, attitude, practices, KAP）調查研究，發現於高通報率省份之教學醫院執業（Prevalence Ratio: 1.6; 95%CI: 1.1-2.2），及百日咳病原體實驗室診斷相關知識程度較高(PR: 1.4; 95%CI: 1.0-1.8)者，為具百日咳確定病例通報行為之獨立因子，推測醫師通報行為可能是造成省市間百日咳通報率差異原因之一。5. 於四場奧地利學術研討會或國際研討會進行口頭或壁報報告。6. 籌辦食媒性疾病疫情調查教育訓練，進行教材設計及教學 。 回國後，學生應用EPIET受訓期間所學，協助疾管署評估國際間H7N9及H10N8等新型流感疫情發生於我國之可能風險及衝擊，評估結果研判H7N9流感病毒於冬季流行期間境外移入風險提高，預期我國仍可能出現中國大陸移入病例，惟目前證據顯示病毒不具持續性人傳人之能力且造成社區感染風險低。另中國大陸H10N8流感疫情僅出現零星個案，推測我國出現境外移入個案之風險極低，惟仍建議加強我國禽畜相關從業人員及台商與入境陸客之健康監測，及持續掌握新型流感病毒特性及疫情變化，於必要時更新風險評估報告。 | zh_TW |
| dc.description.abstract | The European Programme for Intervention Epidemiology Training (EPIET) hosted at the European Centre for Disease Prevention and Control (ECDC) in Sweden, provides training and practical experience in intervention epidemiology at the national centres for surveillance and control of communicable diseases in the European Union. In 2007, Taiwan Centers for Disease Control (TCDC) and Austrian Agency for Health and Food Safety (AGES) agreed the Memorandum of Understanding that set down the mechanisms and scope of cooperation, which enabled a Taiwanese trainee to join EPIET. It's a great honour for me to be elected as the representative of TCDC and AGES to participate in the programme during September 2011and November 2013.
The ten-week EPIET modules and practising in the training site provide knowledge and skills that lead the trainees to acquire the ECDC core competencies for field epidemiologist. During the training, I have accomplished the following learning objectives: 1. Investigation of a foodborne outbreak due to norovirus in a school in 2011, which indicated sour cream sauce (Relative risk: 16.1; 95% CI: 3.9–67.5) and turkey-strip salad (RR: 5.2; 95% CI: 2.3–11.8) prepared by the school kitchen as the most likely sources of the outbreak. The lack of a hazard analysis critical control point soncept (HACCP) in the school kitchen might have caused the failure of food safety procedures. 2. Analysis of influenza surveillance data during flu seasons (Week 40- Week 15), 2011-2013. 3. Evaluation of the surveillance system for listeriosis in Austria before and after implementation of the national electronic web-based reporting system (EMS) in terms of simplicity and timeliness. The implementation of the EMS eliminated two steps from the data reporting process and reduced the time needed between case identification and case reporting. 4. A knowledge, attitude and practice survey for pertussis among general practitioners, paediatricians and pulmonologists in Austria. We found that in the provinces of high notification rate of pertussis, paediatricians and pulmonologists who have high level of knowledge on laboratory diagnostics for pertussis and practice in a university hospital were independently associated with the behaviour of reporting a laboratory confirmed case of pertussis (adjusted PR: 1.4, 95%CI: 1.0-1.8 and adjusted PR: 1.6, 95%CI: 1.1-2.2 respectively). The observations may partly explain the differences of pertussis notification rates between Austrian provinces. 5. Oral and poster presentations in four Austrian or international conferences. 6. Obtaining teaching experience through organizing a workshop about introduction of foodborne outbreak investigations. After EPIET training, I assisted TCDC to assess the risk associated with emergence of avian influenza A (H7N9) and A (H10N8) virus and formulated appropriate prevention and control strategies. The result showed that risk of diseases widely spreading in Taiwan via humans in the near future is considered low, while a higher likelihood at the moment is imported case-patients who have acquired the infection in mainland China. Health monitoring and serological surveys of poultry workers were recommended to evaluate the risk of poultry-to-human transmission of the viruses. It is essential to continuously monitor the variations of H7N9, H10N8 and other influenza viruses and update the assessment of estimated risks. | en |
| dc.description.provenance | Made available in DSpace on 2021-05-14T17:48:55Z (GMT). No. of bitstreams: 1 ntu-104-R99847023-1.pdf: 40878526 bytes, checksum: 9f9d20800bd37a57da7a1a2d489af8bc (MD5) Previous issue date: 2015 | en |
| dc.description.tableofcontents | 目錄
中文摘要 VI 英文摘要 VIII 第一章 緒論 1 1 實習單位特色與簡介 1 2 實習機構與實習目標之相關性 2 3 實習內容相關文獻回顧 2 第二章 訓練內容 8 1. EPIET課程 8 2. 實習機構訓練內容 10 第三章、訓練成果 11 1. 疫情調查-職業學校諾羅病毒感染群聚事件 11 2. 季節性流行性感冒病毒監測 16 3. 李斯特菌感染症監測系統評估 19 4. 奧地利臨床醫師百日咳相關知識、態度、行為調查研究 25 5. 食媒性疾病疫情調查教育訓練 30 6. 學術發表 32 7. 新興傳染病疫情風險評估 34 第四章 評析與政策建議 48 1. 奧地利傳染病調查及監測機制與我國之比較 48 2. 德國腸道出血性大腸桿菌 (SHIGA TOXIN PRODUCING E. COLI , STEC ) O104感染疫情流病調查及可供我國借鏡之經驗 50 3. 歐洲食品安全管理機制與我國之比較：可供我國借鏡之處 56 4. 歐洲聯盟跨國傳染病疫情資訊整合機制：在法規面及資訊技術面可供我國借鏡之處 58 第五章 結語 59 參考文獻 61 圖表區 65 附錄 86 1. EPIET訓練課程表 86 2. EPIET訓練結業明書 90 3. 諾羅病毒腹瀉群聚事件論文發表 92 4. 諾羅病毒腹瀉群聚事件壁報 98 5. 諾羅病毒腹瀉群聚事件口頭報告投影片 99 6. 奧地利李斯特菌監測系統評估報告 101 7. 奧地利百日咳2005至2011年趨勢報告壁報 127 8. 奧地利百日咳流行病學分析研究—橫斷式KAP調查 128 9. 教學案例—奧地利沙門氏菌群聚事件 163 10. 歐洲及奧地利百日咳流行病學近況口頭報告投影片 177 11. 人類感染H10N8禽流感病毒風險評估報告發表文章 181 12. 人類感染H7N9流感病毒風險評估報告發表文章 188 圖表目錄 表一、奧地利諾羅病毒疫情事件單日侵襲率 65 表二、個案所暴露食物之侵襲率及風險比 65 表三、高風險日暴露食物之分層分析風險比 66 表四、奧地利李斯特菌症通報定義 67 表五、奧地利各省市一般科醫師、兒科醫師及肺專科醫師分布 68 表六、奧地利各省市專業醫師預期樣本數 68 表七、百日咳問卷調查結果加權百分比分布 69 表八、小兒科及肺專科醫師屬性題目得分百分比 72 表九、多變量分析達統計顯著性之屬性題目 73 表十、全球H10N8禽流感病毒分離紀錄 73 表十一、我國2011-2014年禽流感病毒候鳥帶毒監測結果 74 表十二、H10N8流感疫情國內風險評估 75 表十三、H7N9流感疫情國內發生可能性之風險評估 76 圖一、2011年奧地利薩爾斯堡職業學校諾羅病毒疫情趨勢 77 圖二、奧地利流行性感冒監測系統架構 77 圖三、奧地利李斯特菌監測系統架構 78 圖四、1996-2012年奧地利李斯特菌症每十萬人口發生率 78 圖五、1996-2012年奧地利李斯特菌症通報個案發生率 79 圖六、1996-2008年奧地利各省市李斯特菌症個案採檢日至檢體收到日比較 79 圖七、2009-2011年奧地利各省市李斯特菌症個案發病日至診斷日及診斷日至通報日比較 79 圖八-1、2005-2012年奧地利Styria、Salzburg、Upper Austria、及Tyrol省百日咳通報率趨勢 80 圖八-2、2005-2012年奧地利Vorarlberg、Burgenland、Lower Austria、Carinthia、Vienna省百日咳通報率趨勢 80 圖九、2009-2012年奧地利各省市0-14歲孩童百日咳病例通報數比較 81 圖十、全球H10N8禽流感病毒檢出地理分布 81 圖十一、2013年入秋前中國大陸各省市H7N9流感確定病例分布 82 圖十二、2013年入秋後中國大陸各省市H7N9流感確定病例分布 82 圖十三、WHO公布H7N9流感病毒可用疫苗株 83 圖十四、德國2011年EHEC O104:H4病例發病日之疫情趨勢 83 圖十五、2011年5-6月德國醫院急診室血便症狀監測結果趨勢 84 圖十六、ECDC與EFSA病原體分子監測資料庫介接流程圖 84 圖十七、ECDC傳染病疫情監測架構圖 84 圖十八、STATA時間序列分析工具簡介圖 85 | |
| dc.language.iso | zh-TW | |
| dc.subject | 百日咳 | zh_TW |
| dc.subject | EPIET | zh_TW |
| dc.subject | 奧地利 | zh_TW |
| dc.subject | 諾羅病毒 | zh_TW |
| dc.subject | 李斯特菌 | zh_TW |
| dc.subject | Austria | en |
| dc.subject | EPIET | en |
| dc.subject | Pertussis | en |
| dc.subject | Listeriosis | en |
| dc.subject | Norovirus | en |
| dc.title | 赴歐洲參加現場流行病學訓練計畫 | zh_TW |
| dc.title | European Programme for Intervention Epidemiology Training (EPIET):A Two-Year Training Experience | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 103-1 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 施惟量(Wei-Liang Shih),劉定萍(Ding-Ping Liu) | |
| dc.subject.keyword | EPIET,奧地利,諾羅病毒,李斯特菌,百日咳, | zh_TW |
| dc.subject.keyword | EPIET,Austria,Norovirus,Listeriosis,Pertussis, | en |
| dc.relation.page | 190 | |
| dc.rights.note | 同意授權(全球公開) | |
| dc.date.accepted | 2015-01-27 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 公共衛生碩士學位學程 | zh_TW |
| 顯示於系所單位： | 公共衛生碩士學位學程 | |
文件中的檔案：
| 檔案 | 大小 | 格式 | |
|---|---|---|---|
| ntu-104-1.pdf | 39.92 MB | Adobe PDF | 檢視/開啟 |
系統中的文件，除了特別指名其著作權條款之外，均受到著作權保護，並且保留所有的權利。