附表二：自然灾害后减少流行性疾病爆发的工作顺序
Appendix Table. Priority measures to reduce the risk for communicable diseases after natural disasters
1. Safe water, sanitation, site planning Ensuring uninterrupted provision of safe drinking water is the most important preventive measure to be implemented following a natural disaster. Chlorine is widely available, inexpensive, easily used, and effective against nearly all waterborne pathogens. Settlement planning must provide for adequate access for water and sanitation needs and meet the minimum space requirements per person, in accordance with international guidelines.
1.水源安全，卫生条件，场所的安排
确保持续提供安全饮用水，是大灾后最重要的一项防病措施。氯化物是容易得到，廉价好用的药品，可以有效抑制水中的大多数病菌。人员安置计划必须能够提供足够的水源，保证卫生需求，以及每个人都需要有满足国际标准最低限的空间。
2. Primary healthcare services Access to primary care is critical for prevention, early diagnosis, and treatment of a wide range of diseases, as well as for providing an entry point for secondary and tertiary care. The immediate impact of communicable diseases can be mitigated with the following interventions:
2.基础医疗护理条件
最基本的医疗护理条件对于疾病的预防，早期诊断和常见病治疗是至关重要的。提供进入二级和三级医护设施的渠道也同样重要。以下一些措施可以减轻传染病的影响。 • Early diagnosis and treatment of diarrheal diseases and ARI,* particularly in those aged <5 y.
• Early diagnosis and treatment for malaria in malaria-endemic areas (within 24 h of onset of fever, using artemisinin-based combination therapy for falciparum malaria). • Availability and use of treatment protocols for the main communicable disease threats. • Proper wound cleaning and care. Tetanus toxoid with or without tetanus immunoglobulin, as appropriate, should accompany wound treatment postdisaster. • Availability of drugs included in the interagency emergency health kit,† e.g., oral rehydration salts for management of diarrheal diseases, antimicrobial agents for ARI. . 尽早诊断和治疗腹泻和急性呼吸道感染，特别是在那些5岁以下的幼儿。
. 在疟疾高发区尽早诊断和治疗疟疾，发烧24小时内，用青蒿素为主的综合疗法来治疗恶性疟疾。
. 针对主要传染性疾病的医护和防治措置。
. 正确清洁和护理伤口。灾难后的伤口处理，应予以注射破伤风疫苗（适当选择有或没有破伤风免疫球蛋白的疫苗）。
. 提供必要的药品，设置一个医疗应急箱，比如提供处理腹泻病的口服补液盐，治疗急性呼吸道感染的抗菌素等。 • Distribution of health education messages emphasizing:
Good hand hygiene practices，
Safe food preparation techniques
Boiling or chlorination of water
Early treatment seeking behavior in case of fever
Use of insecticide-treated mosquito nets as a personal protection measure in malaria-endemic areas
Vector control interventions adapted to the local context and disease epidemiology
. 传播卫生知识，宣教重点在于：
好的净手习惯
安全的食物准备方式
煮沸水或氯化处理水
发烧的早期诊治
在疟疾高发区，使用杀虫剂处理过的蚊帐
与当地疾病流行情况相适应的传病媒介控制
3. Surveillance/early warning system Rapid detection of cases of epidemic-prone diseases is essential to ensure rapid control. A surveillance/early warning system should be quickly established to detect outbreaks and monitor priority endemic diseases.
• Priority diseases to be included in surveillance system should be based on a systematic communicable disease risk assessment. • Healthcare workers should be trained to detect priority diseases and promptly report them to lead health agency. • Sampling and transport materials (and appropriate stockpiles) for investigation need to be readily available for rapid response to outbreaks, e.g., cholera kits, if cholera is considered a risk.
3.监测/早期预警系统。
尽早发现有流行倾向的病例是保证迅速控制疫情的关键。监测/早期预警系统应及早建立，以发现疾病的爆发并监控当地重要的流行病。
.监测系统是否应包括某种重点疾病，应基于对该传染病危险性的系统评估。
.应陪训医疗工作者识别某种疾病，并且迅速向上级卫生部门汇报。
.为应对疾病爆发，需要有能迅速进行化验采样，储存和运输样本的手段，以便进一步监测研究。比如，如果认为有霍乱爆发的危险，则应该准备进行霍乱化验的设施。
4. Immunization Mass measles immunization and vitamin A supplementation are immediate health priorities in areas with inadequate coverage. Where baseline coverage rates among those <15 y of age are<90%, mass measles immunization should be implemented as soon as possible. The priority age groups are 6 mo to 5 y, and up to 15 y, if resources allow.
Current typhoid vaccines are not recommended for mass campaigns to prevent typhoid disease. Typhoid vaccination in conjunction with other preventive measures may be useful to control typhoid outbreaks, depending on local circumstances.
Hepatitis A vaccine is generally not recommended to prevent outbreaks in the disaster area. The cost of the cholera vaccine and the logistic difficulties involved with its administration have prohibited its widespread use. Although helpful in specific circumstances, it should not be viewed as a replacement for adequate water and sanitation. The usefulness of the cholera vaccine, relative to other public health priorities, has not been evaluated in disaster-affected areas.
4.免疫
在没有进行广泛接种的地区，大规模麻疹免疫和补充维生素A非常重要。对于那些年龄低于15岁，接种覆盖率低于90%的人群里，应该尽快进行大面积的麻疹疫苗接种。接种的优先年龄段应该在6个月到5岁，如果条件允许的话，可上至15岁。
目前不推荐伤寒疫苗用于大面积预防伤寒病。根据当地的情况，可以把伤寒疫苗与其他预防手段结合，来防止伤寒在灾区的爆发。
一般来说，不推荐使用甲型肝炎疫苗用于防止该病在灾区的爆发。
霍乱疫苗的费用、处理使用该疫苗的相关后勤工作的复杂性限制了它的广泛使用。霍乱疫苗在某些情况下是有用，但并不能替代足够水和良好的卫生条件。相对于其他公共卫生条件的重要性，霍乱疫苗的有效性还未在灾难波及地区得到评估。
5. Prevention of malaria and dengue
Specific preventive interventions for malaria must be based on an informed assessment of the local situation, including on the prevalent parasite species and the main vectors.
An increase in mosquito numbers may be delayed following flooding, which allows time for implementing preventive measures such as indoor residual spraying of insecticides, or the retreatment/distribution of insecticide-treated nets, preferably long-lasting insecticidal nets in areas where their use is well-known and accepted.
5.预防疟疾和登革热。
对疟疾需采取针对性的预防措施。这应该建立于对当地实际情况评估的基础上，主要包括寄生虫类别和病菌携带源等。
灾后的大水可能延缓蚊子数量的滋长，这就给我们时间来实施预防措施，比如在室内喷洒杀虫剂，重新处理/安置经杀虫剂处理过的捕蚊网，特别是在那些之前已经在使用长效杀虫剂的地区。
Weekly case numbers must be monitored to allow early detection of malaria outbreaks. Periodic laboratory confirmation of rapid test–positive fever cases is recommended to track the slide/test positivity rate.
Treatment with artemisinin-based combination therapy should be provided free of charge to the user in areas with falciparum malaria. An active search for fever cases may be necessary to reduce deaths.
For dengue, the main preventive efforts should be directed toward vector control. Social mobilization and health education of the community should emphasize elimination of breeding sites as much as possible, specifically by:
• Continuous covering of all stored water containers • Removal or destruction of solid debris where water can collect (e.g., bottles, tires, tins).
（应该关注每周的病例数以尽早的预防疟疾的爆发。推荐定期对发烧案例进行快速阳性反应确认以跟进-Fishinus）
在恶性疟疾发病的地区，应该免费提供以青蒿素为主的综合治疗。而尽快发现发烧的病例可减少死亡人数。
对于登革热，主要的预防措施应该集中于对病原携带源的控制。在社区里，应该重点动员民众消除蚊子的孳生地并进行卫生教育，具体来说：
--保证所有储水的器皿用盖子封闭。 --清除和破坏有可能存水的器皿或残骸，比如瓶子，轮胎，罐子等。
†Available from https://www.who.int/medicines/publications/mrhealthkit.pdf
