內容大綱 Main Points

1. 病毒性腸胃炎及流感之預防、調查及控制專題講座Seminar on Prevention, Investigation and Control of Viral Gastroenteritis and Influenza歐家榮醫生二零零四年十月七日

2. 內容大綱 Main Points • 何謂病毒性腸胃炎及流行性感冒? What is viral gastroenteritis and influenza? • 在甚麼情況下需要通知生防護中心?Under what conditions to notify Centre for Health Protection? • 如何處理有病徵師生/長者? How to manage symptomatic staff or students? • 傳染病調查 Investigation of infectious diseases • 其他資訊 Other resources

3. 病毒性腸胃炎Viral Gastroenteritis • 腸胃炎指腸胃(包括小腸及大腸)發炎。若腸胃炎由病毒所引致，這稱為病毒性腸胃炎。Gastroenteritis is an inflammation of the stomach and intestines (both small and large).

4. 病毒性腸胃炎Viral Gastroenteritis • 在天氣涼的季節較為常見。It is more commonly found during cooler months of the year. • 病毒性腸胃炎可由多種病毒引致，最常見的是諾沃克病毒及輪狀病毒。 Viral gastroenteritis is an infection caused by a variety of viruses. The most common viruses that cause gastroenteritis are Norovirus and rotavirus.

5. 病毒性腸胃炎:最新情況Viral Gastroenteritis: Update • 截至9月15日，今年共有103宗由諾沃克類病毒引致的腸胃炎爆發，影響約1142人，大部份個案均發生於院舍，包括幼兒中心(17)、幼稚園(5)、小學(9)、中學(2) 及老人院(35)。As of September 15, there were 103 reported outbreaks of viral gastroenteritis caused by Norovirus, affecting about 1142 persons and occurring in institutions like schools, child care centres and homes for the elderly. • 在二○○三年，共有113宗，涉及1719人。In 2003, there were 113 reported outbreaks, involving 1719 persons.

6. 病徵Symptoms • 病毒性腸胃炎的主要徵狀有: The main symptoms of viral gastroenteritis are: • 腹瀉 (diarrhea)； • 嘔吐(vomiting)； • 其他症狀包括頭痛、發燒及腹痛；Other symptoms include headache, fever, and abdominal cramps; • 症狀一般在染病後一至兩天開始出現，可持續一至十天，視乎致病病毒而定； In general, the symptoms begin 1 to 2 days following infection with a virus that causes gastroenteritis and may last for 1 to 10 days, depending on which virus causes the illness.

7. 傳播途徑 Mode of transmission • 病毒性腸胃炎具傳染性，任何年齡的人士都有機會染上此病，且易於安老院及學校等院舍環境出現及傳播；其傳播途徑包括：Viral gastroenteritis is contagious. People in any age group may be infected and it is particularly easy to occur and spread in institutional setting like residential care homes for the elderly or schools. It can be transmitted via the following means: • 食用或飲用受病毒污染的食物或水； By food or water contaminated with the viruses • 接觸患者的嘔吐物或糞便； By contact with vomitus or faeces from infected persons; • 接觸受病毒污染的物品；或 By contact with contaminated objects; or • 經噴沫傳染。 By aerosol spread.

8. 治療Treatment • 治理方面，不論患者是成人或兒童，治療的主要目的同樣是防止病者身體失去大量水分(脫水)。The most important point for both children and adult is to prevent severe loss of fluids (dehydration). • 除非經醫生指示，否則應避免使用抗生素(對病毒感染並無療效)或其他藥物，去治理此病。Medications, including antibiotics (which have no effect on viruses) and other treatments, should be avoided unless specifically recommended by a physician. • 此病對多數人而言並不嚴重。病者如多補充水分，一般都能完全康復，而沒有長期後遺症。 Most people will not be seriously ill by viral gastroenteritis. Those who get viral gastroenteritis require fluid replacement and usually recover completely without any long-term problems.

9. 預防 (1) Preventive measures (1) • 由於目前並無疫苗預防病毒性腸胃炎，要預防病毒性腸胃炎，市民要採取以下措施，減低染病機會：Currently, there is no effective vaccination against viral gastroenteritis. However, the public is advised to reduce their chance of being infected by adopting the following measures: • 處理食物或進食前、如廁後，以及處理嘔吐物或糞便後須徹底洗淨雙手； Wash hands thoroughly before handling food and eating, and after going to toilets and handling vomitus or faecal matter;

10. 預防(2) Preventive measures (2) • 立即用1：49的稀釋家用漂白水清洗和消毒染污的地方及物件； Clean and disinfect contaminated areas and items promptly and thoroughly with 1:49 diluted household bleach; • 患病學生應在家休息，不應上課； Sick students should rest at home and not attend class; • 保持室內空氣流通；Maintain good indoor ventilation; • 清理嘔吐物及糞便時須戴上手套，事後須再洗手； Wear gloves while cleaning up vomitus and faeces, and wash hands afterwards; • 只進食已徹底煮熟的食物，尤其是海鮮及貝殼類海產。Eat only thoroughly cooked food, particularly seafood and shellfish.

11. 流行性感冒 Influenza 甚麼是流行性感冒? What is influenza? • 傳染性極高的病毒感染 Caused by highly infectious viruses • 分為甲、乙、丙型三類 3 types of viruses: Influenza A, B and C • 甲型 (H3N2; H1N1)及乙型較為常見 Influenza A (H3N2; H1N1) and B more commonly seen • 香港流感高峰期在每年二、三月及七 月 Higher incidence in February, March and July of each year in Hong Kong

12. 流行性感冒:最新情況Influenza: Update • 截至9月15日，今年共有 206 宗流行性感冒爆發，影響約2395人，大部份個案均發生於院舍，包括幼兒中心(7)、幼稚園(1)、小學(26)、中學(18) 及老人院(116)。As of September 15, there were 206 reported outbreaks of influenza, affecting about 2395 persons and occurring in institutions like schools, child care centres and homes for the elderly. • 在二○○三年，共有63宗，涉及928人。In 2003, there were 63 reported outbreaks, involving 928 persons.

13. 流行性感冒病徵Symptoms of Influenza • 咳嗽、喉嚨痛、流鼻涕、發熱 、頭痛 Cough, sore throat, runny nose, fever, headache • 身體疲倦 Malaise • 肌肉痛 Muscle pain

14. 傳染途徑Mode of transmission • 透過空氣或直接接觸患者的噴沬而傳播 Airborne or droplet spread

15. 流行性感冒 Influenza 潛伏期 Incubation period • 通常為一至四天 usually 1-4 days 傳染期 Period of communicability • 病毒可在患者病發前數天及病發後7天出現於其分泌物 The viruses may be found in the secretion of a patient from a few days before and up to 7 days after symptom onset

16. 治療方法Treatment • 健康情況良好的人士大都會自動復原 Majority will recover spontaneously • 病徵一般持續約三至四天 Symptoms usually last 3-4 days • 咳嗽可持續一至兩星期 Cough may last for 1-2 weeks • 服用可舒緩徵狀的藥物 如：止咳藥、止痛退熱藥、止鼻水及通鼻藥等 Symptoms can be relieved by medicine such as cough suppressant, anti-pyretics, and nasal decongestants

17. 何時必須請教醫生When to consult a doctor? • 發高燒、喉嚨痛及咳嗽持續 High fever, sore throat and persistent cough • 痰涎轉黃綠色 Purulent sputum • 胸痛、咳血、及呼吸困難 Chest discomfort, haemoptysis and shortness of breath • 小孩有耳痛、發高燒、煩躁不安、並用手揉擦耳朵 Children complain of ear pain, high fever, become irritable and scratch the ears

18. 預防方法Preventive measures • 均衡飲食 Balanced diet • 充份休息 Adequate rest • 保持空氣流通 Maintain good ventilation • 保持環境及個人衛生 Good personal and environmental hygiene

19. 在甚麼情況下需要通知生防護中心?Under what conditions to notify Centre for Health Protection? • 疾病蔓延的徵兆 Signs of disease spread • 疾病情況： Disease conditions: • 例如：嘔吐、腹瀉、發燒 e.g., vomiting, diarrhea, fever • 因病告假 Sick leave absence • 整間中心與同一班房 Whole centre vs. same class

20. 中心有學生生病Students noted to have disease in centre • 如發現同一班學生中不尋常地出現疾病組群 If there is a cluster of sickness in same class above what is normally expected • 例如: 三位學生有腹瀉或發燒 Ex: 3 students with diarrhea or fever • 有不尋常的事件顯示傳染病於中心爆發 Unusual incidents suggestive of infectious disease outbreaks in centre • 例如:於一天內發生數次學生嘔吐現象 Ex: multiple vomiting incidents requiring clean up in a day

21. 因病缺席Sick leave absence • 就整間中心而言: In whole centre: • 記錄整間中心每天因病缺席的人數 Log sick leave absence of whole centre every day • 確定因病缺席的正常範圍 Determine baseline range • 如缺席人數超出正常範圍，請通知生防護中心 Notify CHP if above baseline range • 就一班而言: Within a class: • 調查學生是否因病缺席 Find out if absence is due to sickness • 如發現因病缺席的情況不尋常地集中於同一班，請通知生生防護中心 If cluster of sickness absence in same class is above what is normally expected, notify CHP • 例如:三位學生報稱有腹瀉或發燒 Ex: 3 students reported to have diarrhea, or fever

22. 如有疑問，請與生防護中心聯絡In case of doubt:Call CHP24772772

23. 有病徵師生處理方法Management of sick staff and students • 如在中心發病，到醫療室隔離 If onset at centre, stay in isolation room • 盡快通知家長或監護人 Inform parents or guardians immediately • 如有不適盡快求醫 Seek medical advice promptly • 請病假 Sick leave, refrain from school/ work • 病假至痊癒後48小時 (諾沃克病毒) Sick leave until 48 hours after recovery (Norovirus)

24. 傳染病調查工作Investigation of infectious diseases • 資料搜集 obtain information • 問卷調查 questionnaire survey • 視察環境 environmental assessment • 控制措施 control measures • 通報 communication

25. 資料 Information required • 告假記錄 (事假、病假) leave records (nature of leave) • 受影響人士名單、聯絡方法 name list of affected persons, contact number • 師生人數 total number of staff and students • 班級、活動、時間表、座位表 class, activities, timetable, sitting plan • 平面圖 floor plan • 膳食安排/餐單 meal arrangements/ menu • 員工更期表 staff duty roster

26. 問卷調查 Questionnaire survey • 患者本人、老師/ 導師代問 information from affected persons, or through the staff • 病發時間 onset time • 病徵 symptoms • 求診 medical consultation • 食物資料 food history 資料保密 confidentiality

27. 視察環境 Environmental assessment • 設施分佈 setting • 環境衛生 hygiene • 空氣流通 ventilation • 洗手間、厨房 Toilet, kitchen facilities • 消毒步驟 disinfection techniques • 面見病者 interview patients • 收集樣本 specimen collection

28. 控制措施 Control measures • 接受治療及留在家中休息 Seek medical treatment and sick leave • 隔離措施 Cohorting • 消毒、清潔 Disinfection • 正確處理嘔吐物 Correct handling of vomitus • 取消大形活動 Suspension of mixing activities • 疾病監察 Surveillance

29. 通報 Communication • 通知家長或監護人 notify parents or guardian • 電話 telephone • 通告 Memo/ letter • 社會福利署 SWD • 傳媒查詢 media enquiries

30. 其他資訊 Other resources • 生署中央健康教育組 熱線: 2833 0111 Central Health Education Unit Hotline 網頁 Website: http://www.cheu.gov.hk • 食物環境衛生署Food and Environmental Hygiene Department 網頁 Website: http://www.fehd.gov.hk

31. 其他資訊 Other resources • 生署生防護中心 http://www.chp.gov.hk 主頁> 指引、報告及刊物> 指引> 院舍及業界 1.長者及殘疾人士日間中心服務、家居照顧服務、家居訓練及支援服務預防傳染病指引 2. 幼兒中心／幼稚園／學校預防傳染病指引

32. 多謝Thank you

33. 問題 Questions??