Water-related Communicable Diseases
与水相关的传染病
清洁的水源可能会因为一场自然灾害而遭破坏。饮用水被污染后，可能会爆发腹泻疫情。有些地方的洪灾（以及受灾人口迁移）之后出现过类似报道。在2004年孟加拉国洪水后的一次腹泻疫情中，超过17000个病例出现腹泻症状；霍乱弧菌（小川血清型和稻叶血清型）、产毒大肠杆菌都曾被检出（13）
Access to safe water can be jeopardized by a natural disaster. Diarrheal disease outbreaks can occur after drinking water has been contaminated and have been reported after flooding and related displacement. An outbreak of diarrheal disease after flooding in Bangladesh in 2004 involved >17,000 cases; Vibrio cholerae (O1 Ogawa and O1 Inaba) and enterotoxigenic Escherichia coli were isolated (13).
1998年，西孟加拉的一次霍乱大爆发（小川血清型，超过1.6万个病例）也被认为与之前的洪水有关（14）；2000年1月到3月在莫桑比克的洪水也导致了腹泻病例的增多。
A large (>16,000 cases) cholera epidemic (O1 Ogawa) in West Bengal in 1998 was attributed to preceding floods (14), and floods in Mozambique in January–March 2000 led to an increase in the incidence of diarrhea (15).
1992-1993年在印度尼西亚进行的一次大规模研究中，洪水被认为是引发甲型副伤寒沙门氏菌导致的腹泻疫情的重要风险因素（16）。2001-2003年印度尼西亚另一个有关小隐孢子虫感染的风险因素的独立研究中，与对照组相比，洪水受灾人群得病的几率要高4倍以上（17）。
In a large study undertaken in Indonesia in 1992–1993, flooding was identified as a significant risk factor for diarrheal illnesses caused by Salmonella enterica serotype Paratyphi A (paratyphoid fever) (16). In a separate evaluation of risk factors for infection with Cryptosporidium parvum in Indonesia in 2001–2003, case-patients were >4× more likely than controls to have been exposed to flooding (17).
相对工业化国家，发展中国家在自然灾害后爆发腹泻疫情的风险更高（8，11）。2004年12月的海啸两周后，在印度尼西亚的亚齐省扎朗镇进行的一次健康评估发现，100%的幸存者饮用井水，而85%的居民声称在此前的两周中出现过腹泻症状（18）。（译者：地名译名据新华社资料库，下同）
The risk for diarrheal disease outbreaks following natural disasters is higher in developing countries than in industrialized countries (8,11). In Aceh Province, Indonesia, a rapid health assessment in the town of Calang 2 weeks after the December 2004 tsunami found that 100% of the survivors drank from unprotected wells and that 85% of residents reported diarrhea in the previous 2 weeks (18).
2005年大地震后，在巴基斯坦的穆扎法拉巴德，住有1800人的简陋的临时住所中出现大面积急性水泻症状。超过750人得病，其中大部分是成人。在提供了充足的饮用水和卫生设施之后，疫情得到了控制（19）。
In Muzaffarabad, Pakistan, an outbreak of acute watery diarrhea occurred in an unplanned, poorly equipped camp of 1,800 persons after the 2005 earthquake. The outbreak involved >750 cases, mostly in adults, and was controlled after adequate water and sanitation facilities were provided (19).
在美国，艾里森和卡特里娜飓风之后也出现腹泻疫情。在卡特里娜飓风中被撤离的人群中，曾检查出诺罗病毒，沙门氏菌，毒性和非毒性的霍乱胡菌等。
In the United States, diarrheal illness was noted after Hurricanes Allison (20) and Katrina (21–23), and norovirus, Salmonella, and toxigenic and nontoxigenic V. cholerae were confirmed among Katrina evacuees.
A型（甲型）和E型肝炎（戊型肝炎）主要通过粪-口途径传播，也与缺乏清洁的水源和卫生设施有关。A型肝炎是大多数发展中国家的一种地方病，而大多数孩子因为在很小的时候曾患病而具有免疫能力。因此，A型肝炎大规模爆发的机率通常就低一些。而在有E型肝炎病例的地区，该疾病通常会随暴雨和洪水的发生而爆发；这种疾病通常比较温和，而且自限病程，但是患病孕妇的死亡率可能高达25%（24）。在2005年巴基斯坦地震后，零星的E型肝炎在那些缺乏安全水源的地区时有发生。迁移的灾民中，发现了超过1200例急性黄疸，其中很多被确认为E型肝炎（25）。印尼亚齐省在2004年12月海啸之后，也有集中的A型和E型肝炎病例。
Hepatitis A and E are also transmitted by the fecal-oral route, in association with lack of access to safe water and sanitation. Hepatitis A is endemic in most developing countries, and most children are exposed and develop immunity at an early age. As a result, the risk for large outbreaks is usually low in these settings. In hepatitis E–endemic areas, outbreaks frequently follow heavy rains and floods; the illness is generally mild and self-limited, but for pregnant women case-fatality rates can reach 25% (24). After the 2005 earthquake in Pakistan, sporadic hepatitis E cases and clusters were common in areas with poor access to safe water. Over 1,200 cases of acute jaundice, many confirmed as hepatitis E, occurred among the displaced (25). Clusters of both hepatitis A and hepatitis E were noted in Aceh after the December 2004 tsunami (26).
细螺旋体病是一种通过动物传染的细菌性流行病，并可通过直接接触受污染的水进行传播。啮齿动物（鼠类）的尿液中含有大量的细螺旋体病菌，其传播途径包括皮肤和粘膜与水、潮湿的土壤及蔬果接触（如甘蔗），接触被这种尿液污染的泥土也会感染此病。洪水后啮齿动物的大量繁殖，以及人类与啮齿动物共居高地造成的近距离接触，加剧了这种病菌的传播。2001 年中国台湾的 Nali 台风（27）、2000 年印度孟买的洪水（28）、1998 年阿根廷的洪水（29）以及 1997 年俄罗斯克拉斯诺达尔的洪水（30），都与细螺旋体病的爆发密不可分。1996 年巴西发生了细螺旋体病传染，之后的地域分析显示，在里约热内卢遭受洪水的区域，细螺旋体病的发病率增加了两倍之多（31）。
Leptospirosis is an epidemic-prone zoonotic bacterial disease that can be transmitted by direct contact with contaminated water. Rodents shed large amounts of leptospires in their urine, and transmission occurs through contact of the skin and mucous membranes with water, damp soil or vegetation (such as sugar cane), or mud contaminated with rodent urine. Flooding facilitates spread of the organism because of the proliferation of rodents and the proximity of rodents to humans on shared high ground. Outbreaks of leptospirosis occurred in Taiwan, Republic of China, associated with Typhoon Nali in 2001 (27); in Mumbai, India, after flooding in 2000 (28); in Argentina after flooding in 1998 (29); and in the Krasnodar region of the Russian Federation in 1997 (30). After a flooding-related outbreak of leptospirosis in Brazil in 1996, spatial analysis indicated that incidence rates of leptospirosis doubled inside the flood-prone areas of Rio de Janeiro (31).
