E N D
1. ???????? ???????? ???G??? ????O??O?6? ???S???????? ??????? ???G??S ??S????????O? ????O??O????f?”??e?? ??s?”ata se ?????? pa????? ??e?a?
?a??a ?????????
??d???? ?a??????? ???”?????????, G.?.?????? «?pp????te??»
3 ??eӧ???? 2006
2. ???f?”??e?? ??s?”ata
3. ??sa????-?p?d?”??????a ? ???f?”??e?? ??s?”ata p??sß????? pe??p?? 76 e?at?”???a ?t?”a ”e 325000 ??s??e?e? ?at ?t?? st?? ?.?.?. (?p?????s”?? CDC)
??? ? ??s???t?ta e??a? p??? ”e???? ? ???t?t?ta e??a? ”???? (pe??p?? 5000 ?t?”a pe?a????? ?at ?t??). S?????? p??? ??a ? ??????”??a ?t?”a ? ?t?”a ”e ?p??e?”e?? a??s??atast???.
?? p??sfate? a??a??? st?? t??p? ???? (ta??t?ta ”etaf????) ?a??? ?a? ?? te??st?e? a??a??? p?? e??a? ?? ap?t??es”a t?? ”a????p???s? st?? pa?a???? ?a? st?? d?a??”? t??f?”?? ?p?? ep?s?? ?a? ? a?t??? t?? ”????ß??? ????? ?? ap?t??es”a t?? e”f???s? ???? ”a?? ”e t?? p???? pa?ad?s?a??? ”??f?? t?? t??f?”??e??? ???”??e??.
Practice Guidelines for the Management of Infectious Diarrhea. IDSA. CID 2001;32:331-351
4. ??sa????-?p?d?”??????a ?? ?? ????? pa????? ??e?a? ???? ”a????? pa?a????? ?a? d?a????s?? t??f?”?? ?a? pa???s?a? ?d?a?te?a e?pa??? at?”?? e??a? s???? ped?? e”f???s?? e???se?? ????s”?t?? t?f?”??e??? ???”??e??.
?a t??f?”??e?? ??s?”ata de? d?af????? ?? p??? t?? e?d???se?? e?te af????? t?? ?????t?ta e?te ?????? pa????? ??e?a?.
????te?? d?af????? d?????s? st??? ?????? pa????? ??e?a? d??t? ?p?????? p???? ???a a?t?a ?ast?e?te??t?da?-?d?a?te?a p??ß??”ata
????? d??t?a ep?t???s?? ?a? ?ata??af?? pa?????? s?st?”at??? ep?d?”???????? st???e?a p?? af????? t?? ?????t?ta se p????? ???e?.(p?.FOOD-NET st?? ???, ???????, ?F??)
?p? ?????? pa????? ??e?a?: p????? ”e”???”??e? pe????af?? ”????ep?d?”??? ”e t?? e?a??es? ”e????? p???? s?st?”at???? st???e??? ap? ???s”??e? ???e?( ?e?. ??etta??a ? ??st?a??a)
5. ?p?d?”??????a-??st??
??st??: St?? ?e?. ??etta??a $ 1.488 e? ?? ???”??e?? s?et???”e?e? ”e ?????? pa????? ??e?a?.
?p?d?”???? e???se?? ?ast?e?te??t?da?: 12,5% t?? s???????? ??st??? (sta ep?peda t?? ???????”??e??): $ 184 e?. (2002-2003)
6. ?p?pt?se??
????a e?d???s? e??a? ? ?ast?e?te??t?da p??????? e?t?se?? (?????? ??s???t?ta-? ???t?t?ta e??a? s?????? ”????)
?? ???”?de?? pa?????te? p?? p???a???? t??f?”??e?e?? ???”??e?? s?????? ”etad?d??ta? p??? e????a ”e ?”es? ? ?”es? epaf? ap? ?t?”? se ?t?”? e?te ”e t? ?e?? ?a? ta t??f?”a (t??f?”??e?e?? ???”??e??) ?a? s???? p???a???? de?te???e?e?? ep?d?”???? e???se?? ????s”?t?? a? de? a?a?????s???? ???a??a Current Opinion in Pharmacology 2005;5:559-565
7. ???e? ep?pt?se??
S?st?”at??? ??s?? ?p?? ? t?f?e?d?? p??et??, ??ste???s? (”??????t?da, s???), ?e??ta??? p??et??, ????p?as”a, t??????s?
?e????????? ??s??: ???a?t?as?, ??ste???s? (”??????t?da), nvCreutzefelt-Jakobs(??s?? t?e??? a?e??d??), ”a??t???a, tet?ad?t?????
S?ßa??? ”a????????e? ep?p????? :
a?”???t??? ???a?”??? s??d??”? ?a? ?ef???? a?ep???e?a s?et???”e?? ”e E.Coli 0-157 ?:7 (STEC ? e?te??a?”???a???? ? VTEC)
s??d??”? Guillain-Barre ”et? ap? ???”??? ”e C. jejuni
Diagnosis and Management of foodborne illnesses CDC MMWR 2004;53(No RR-4)
8. S?”pt?”ata
9. ???f???? d???t????se??
10. ?a?????a p?? p???a???? t??f?”??e?e?? ???”??e?? ?p? ta 250 ?a? p???? pa?????a p?? p???a???? t??f?”??e?e?? ???”??e?? ta s????te?a e??a?:
?a?t???a: Salmonella spp ,Shigella spp, .Campylobacter spp E Coli ?:157 ?7. Listeria spp Yersinia, Clostiridium perfingens
?a??s?ta: Cryptosporidium, Giardia Lamblia, Entamoeba histolytica
???: Norwalk virus Rotavirus, Adenovirus,, ?epatitis A virus
S????te?a ta?t?p?????ta? ?? ”????ß?a??? pa?????te? a? ?a? s????te?e? e??a? ?? ???e?e?? t?f?”??e?e?? ???”??e?? a??? ?? ??? ta?t?p?????ta? d?s???a.
Diagnosis and Management of foodborne illnesses CDC MMWR 2004;53(No RR-4)
11. S????? a?t?a t??f?”??e??? ???”??e??
12. S????? a?t?a t??f?”??e??? ???”??e??
14. ?? ???”?d? a?t?a t??f?”??e??? ???”??e??
15. ?p?d?”???? e???se?? (outbreak) ??????? st?? ?????a ?a? ?e?. ??etta??a 1990-5
16. ?p?d?”???? e???se?? ??????? st?? ?????a ?a? ?e?. ??etta??a 1990-5
17. ?p?d?”???? e???se?? ???”?d??? ?ast?e?te??t?da? sta ??s???”e?a st?? ?????a ?a? ?e?. ??etta??a 1992-200
19. ?p?d?”???? e???se?? ???”?d??? ?ast?e?te??t?da? sta ??s???”e?a st?? ?????a ?a? ?e?. ??etta??a 1992-2000???f?”??e?e?? ???”??e??
20. ?p?d?”???? e???se?? ???”?d??? ?ast?e?te??t?da? sta ??s???”e?a st?? ?????a ?a? ?e?. ??etta??a 1992-2000T??t?t?ta
24. ???s”?? ???????a: ????s? t?? ß????? t?? ??p????? > 250gr a?? 24???.
????s? t?? ?e?st?t?ta? t?? ??p????? (”a?a?? ? ?da?? ??p?a?a) e?te a???s? t?? ????? t??? e?te a???s? t?? s????t?ta? t?? ?e??se?? se pe??ss?te?e? ap? t?e?? ?”e??s???
??s???”e?a?? ???????a: ?”f???s? 72 ??e? ”et? t?? e?s?d? t?? as?e???? st? ??s???”e??
«??? d?a?????? s??d??”?»: ?????e?a < 14 ?”??e? (? ?a? ”???? t?e?? ßd?”?de? ?at ???s”?????).
«?p?”??? d?a?????? s??d??”?»: >14 ?”??e?
«?????? d?a?????? s??d??”?»: > 1 ”??a
«F?e?”???d?? d??????a»: ?????a?? ?????, te??es”??, pa???s?a a?”at?? , ?e?????t???? st? ??p?a?a
25. ???t???a ??a t? d?????s? t?? ?ast?e?te??t?da? ???t?? ??????? ??d???? ???”??e??
???t???? 1 (???a??): ? as?e??? e”fa???e? ap?t?”? d??????a (?da?? ??p?a?a ??a pa?ap??? ap? 12 ??e?) ”e ? ????? e”?t??? ? p??et? (>38 ?C), ?a? ????? t?? pa???s?a e”fa???? ”? ???”?d??? a?t?a? (p?. ??????s? fa?”????, ??e?a pa?????s? ?????a? ??s?? ? ?????????? stress)
26. ???t???a ??a t? d?????s? t?? ?ast?e?te??t?da? ???t?? ??????? ??d???? ???”??e?? ???t???? 2 (?eßa??”???):? as?e??? e”fa???e? 2 t??????st?? ap? ta a??????a s?”e?a s?”e?a ? s?”pt?”ata ????? ?a ?p???e? ???? a?a?????s”??? a?t?a:
???et?? (>38 ?C,?a?t?a, ?”et?? ,?????a?? ????? ,? e?a?s??s?a)
?a? t??????st?? 1 ap? ta a??????a
1. Tet??? ?a??????e?a ??a e?te???? pa?????? ap? ta ??p?a?a ? ap? de??”at?????a ????? ”e st??e?
2. ??e??es? e?te????? pa??????? ”e ”????s??p?s? (”e ????? ? ??e?t?????? ”????s??p?? )
3. ??e??es? e?te????? pa??????? ”?s? a?t???????? ? a?t?s?”at???? a????s?? st? a?”a ? sta ??p?a?a
4. ??de??e?? ??a t?? pa???s?a e?te????? pa??????? p?? a????e?eta? d?a ?st???? ?a??????e?a? (a????e?s? t??????)
5. ??a???st??? ”????? t?t?? a?t?s?”?t?? (IgM) ? tet?ap?as?as”? t?? t?t??? t?? e?d???? ??a t? pa?????? a?t?s?”?t?? .(IgG)
27. ??e?e???s? s?????? ????s”?t?? t??f?”??e??? ???”??e?? ???e ??a?s? ????s”?t?? a????e? ”e ??a as?e?? p?? ”p??e? ?a ”?? e??a? ?d?a?te?a p?s???
?a s?”pt?”ata e??a? s?????? p??? ????? (e?d???se?? ?ast?e?te??t?d??) ????? ?a ap???e???ta? ?a? p???? s?st?”at???.
S?”a?t??? st???e?a:
?????? ep?as?? (p??s??? a? e??a? ”a????)
?????e?a ?p???e?””at???? ??s??
????a ??????? s?”e?a ?a? s?”pt?”ata
?p?pte? t??f??
? p????s”?? p?? e?t????e
???a ?t?”a ”e s????? se ?????, ???? ”e pa??”??a s?”pt?”ata
?p???????? ??s??-f??e?a
28. ?ata????s? ?p?pt?? t??f??
???f?? p?? ?ata?a?????ta? f??s??e? ? a?epa???? ??”??e?:
F??s?a ? ”?s???”??a a??? (”a??????a), ?st?a?a, ???ata (??t?p???a, ??”??), ????a, ”? paste???”??a ???ata ? p?????ta ???a?t?? ? f???t???”??, ???s??ße?, ?a?a???? ? ”a?a?? t???? ap? ”? paste???”??? ???a
29. ??de??? ??s???”e?a??? ep?d?”?a? ?ast?e?te??t?da? ? e”f???s? d?? ? pe??ss?te??? pe??pt?se?? ??s???”e?a??? ???”?d??? ?ast?e?te??t?da? p?? p????????a? ap? t?? ?d?? ”???????a??s”? ”?sa se ”e????? ßd?”?de? ?a p??pe? ?a ??t??? ?p????a t???? s?s??t?s?? ”eta?? t???.
? d?e?e???s? t?? pe??stat???? ”p??e? ?a ”?? a?ade??e? t?? p??? t?? ???”??e??. ? pa?a???????s? t?? ?a???e??e??? ????? ??s??e??”???? as?e??? st?? ?d?e? pe?????? ??s??e?t???? f???t?da? t?? as?e?? ”e ?ast?e?te??t?da, ß???? st?? a?a?????s? t?? as?”t?”at???? as?e???.
S???pa??? pe??pt?se?? ?ast?e?te??t?da? se p??s?p??? ?a? as?e?e??
??????????ta? ?? ?a???e? d?e?e???s?? ??s???”e?a??? ep?d?”?a?
30. ??????s?
31. ??????s?
32. ????????s? as?e???? ”e ?p????a t??f?”??e???? ??s???”e?a??? ?ast?e?te??t?da?
33. ??te p??pe? ?a st???eta? ?a??????e?a ??p?????;???? e??a? t? s?st?;
34. ??te p??pe? ?a st???eta? ?a??????e?a ??p????? ??a ????? e?te???? pa?????a;
35. ??te st????”e ?a??????e?a ??p????????te s???st?ta? d?a???st??? d?e?e???s??
36. ??a??t?s? p???”??f?p??????
37. ??a???st??? p??s????s? se s?ßa?? d?a?????? s??d??”?? s?”as?a t?? ?a??????e?a? ??p?????
38. ??a???st??? p??s????s? se s?ßa?? d?a?????? s??d??”?? s?”as?a t?? ?a??????e?a? ??p?????
39. ??????s? ?e t?? ?a??????e?a ??p????? ap?”??????ta? ??????:
Salmonella spp , Campylobacter jejuni, Shigella spp., ste???? ?. Coli.
?e t?? s????e?? ?a??????e?e? ??p????? de? d?a???????ta?
ta ??te??a?”???a???? (STEC) ap? t? ETEC ?a? EAEC ap? t?? ”? pa?????? E. Coli.
???pe? ?a a?a??t???ta? ”e e?d???? te?????? ?p?? ?a? ?? t????e?
”????ß???
?? ??? ep?s?? de? ?a???e?????ta? se ?a??????e?a ??p?????.
40. ??a???st??? p??s????s? se ?p????a t??f?”??e???? ??s???”e?a??? ?ast?e?te??t?da?-?
41. ??a???st??? p??s????s? se ?p????a t??f?”??e???? ??s???”e?a??? ?ast?e?te??t?da?-??
42. ??a???st??? p??s????s?-Real time PCR
43. ??????s? Se pa?ateta”??a p??e??????ta s?”pt?”ata ap? t? a??te?? pept??? (?a?t?a ,e?????) pa?as?t??????? ??p????? ??a G. lamblia ?a? cyclospora .
?et? ap? pa???e?s? ?”e??? ?a? e””??? s?”pt?”?t?? > 7 ?,
???s? ??e??t??? ? t?p?p???”??? ??e??t???? Cryptosporidium, Isospora, and Cyclospora.
Se a??s??atesta?”??a ?t?”a (AIDS ”e CD4 c<100 cells/”L, t?????”?? ???s? ??a Microsporidium
44. Te?ape?t??? p??s????s? se t??f?”??e???? ??s???”e?a??? ?ast?e?te??t?da?
45. Te?ape?t??? p??s????s? t??f?”??e???? ??s???”e?a??? ?ast?e?te??t?da? S?”pt?”at??? a?t?d?a?????? a????. ??te;
46. Te?ape?t??? p??s????s? t??f?”??e???? ??s???”e?a??? ?ast?e?te??t?da? ?”pe????? a?t?ß??t??? a????. ??te;
47. Te?ape?t??? p??s????s? t??f?”??e???? ??s???”e?a??? ?ast?e?te??t?da? ?”pe????? a?t?ß??t??? a????. ????;
48. Te?ape?t??? p??s????s? t??f?”??e???? ??s???”e?a??? ?ast?e?te??t?da? ??t?ß??t??? a????. Se p??? pa?????a e??a? apa?a?t?t?;
49. Te?ape?t??? p??s????s? se d?a?????? s??d??”? ??t?ß??t??? a????. ??te de? ?????e?ta?;
50. Salmonella entericaGast?e?te??t?da
51. Salmonella entericaGast?e?te??t?da
52. Salmonella-2004 Whonet. gr
53. ????pa??? d??t?? ep?t???s?? Sa?”??e???se???a? E.coli (STEC ? VTEC ? e?te???a?”???a????)
54. Salmonella-2004 Whonet. gr
58. Shigella A??”? ?a? ?a”??? d?s? t?? ???a??s”?? a?t?? e??a? ???”??????.
?p??e? ?a pa???s???eta? ”e a?”at???? d??????e?
Ge????
s?”pt?”ata
???et?.
????t?da,
te??es”? ,
t?s? ??a af?de?s?,
?????a?? ?????.
59. Campylobacter jejuni
Campylobacter :e”fa?????ta? ”e a?”at??? d??????a ?a? p??et?.
???ß??”a ? a?t?stas? t?? ????????? ?a? a?????”??????.
????t?da,te??es”? ,t?s? ??a af?de?s?,?????a?? ????? ?a? a?”a sta ??p?a?a (s????)
62. Meat Products Associated with Transmission of E. coli O157(e?te??a?”???a????) Ground beef products
Other red meats
Roast beef
Dry cured salami
Cooked meat products
Turkey meat
63. Dairy Products and other Foods Associated with Transmission of E. coli O157 (e?te??a?”???a????) Raw milk
Pasteurised milk
Yoghurt
Cheese
Cream
64. ?aӧ??as?
65. Vibrio spp.
?? ????? Vibrio parahaemolyticus ?a? non-O-group 1 Vibrio cholerae ”p??e? ?a s??d?eta? ”e t? ß??s? ?”?? ? ?a?? ”a?e??e”???? ?a????.
.
66. ?a??s?ta ?? s????te??? ???a??s”?? t?? ?at?????a? a?t?? e??a? :
Giardia intestinalis,
Cryptosporidium parvum,
Cyclospora cayetanensis,
Entamoeba histolytica,
?a? Dientamoeba fragilis.
Entamoeba histolytica
69. ???????
70. S???st?”e??? (recommended)
??f?e?d?? p??et??: ?. ?s?a (pe????? ??d???), ?f???? (a??”? ?a? ???e???) ?a? ?at????? ?”e????. ????a??e?t??? ste???? Salmonella. ??te??st?”at??? ?d?? ”etad?se??. S????t?ta: 6 -118 pe??pt?se?? /106 ta??d??te? a??”a ?a? ”???? d????e?a ta??d??? se ???a ?????? ???d????
?????? ?a??d??te? se a?apt?ss?”e?? ???a ”e pa?ateta”??? ???es? se ”???s”??a t??f?”a ?a? ?e??. ???”a ?a? business travelers (?e????? ??d??? > 2 ßd?”?de?)
?ӧ???a
1. ?p? t?? st?”at?? (Viv?tif Berna). ??? e?as?e??”??? Ty21 st??e??? S. Typhi > 6 et??. 4 ??????e?. ???a pa?? ”??a d?? ßd?”?de? p?? t?? a?a????se??. ???s???! ???e??. ??? ”a?? ”e a?t?ß??t??? ? ”ef??????
2. ????sa??a??d??? e”ß???? ????? ??a pa?e?te???? ???s? (Typhim Vi, Aventis Pasteur 1 d?s? e?d?”????? > 2 et??
?p?te?es”at???t??: 50-80% ??f?e?d?? p??et??
71. ??? eӧ???? ??a?t? t?? ??ta???
72. ???: www.who.int
London school of hygiene and
tropical medicine www. lshtm.ac.uk
Eurosurveillance www.eurosurv.org/update
Centers for disease Control and www.cdc.gov/foodsafety
prevention (CDC)
H?? Foodsafety Information www.foodsafety.gov
??????? mednet/whonet.gr whone ??de??t???? p???? p????f????? ??? t?? ??at??
73. S?”pe??s”ata-? ???a??? a?a?????s? t?? p??a??t?ta? t??f?”??e???? ???”??e?? st? ??s? e??? as?e??.
??a??t?s? ?a? ????? ????s”?t??. ???t?????? d?e?e???s?? ??s???”e?a??? ep?d?”?a?
?at? ?a???a a??? ??? p??ta ????a????? ta ?ast?e?te???? s?”pt?”ata
???a??? ap?st??? ?a???e??e??? ??p????? a??? ?a? a?aa??t?s? e?d???? pa??????? ”e e?d???? d?a???st???? d???”as?e? (E.Coli 0157-H7, Vibrio spp.)
?at? pe??pt?s? ?a??????e?a ?p?pt?? t??f?? ? a?a??t?s? t??????
74. S?”pe??s”ata-?? ??af??? st?? ep?t??p? ??s???”e?a??? ???”??e?? ?a? st?? ?p??es?e? ??”?s?a? ??e?a?
???e as?e??? ”e t??f?”??e?? ???”??? ”p??e? ?a ap?te?e? t?? p??t? e?de??t??? pe??pt?s? ”??? ”e?a??te??? s?????? ????s”?t??
?pa?a???????s? t?? ”?t??? e?????? ?a? p???????
75. S?”pe??s”ata
?e t?? pa???s”??p???s? ?a? t?? ”a????p???s? t?? pa?a????? t?? pa?a????? t??f?”?? ?a?
t?? a?t??? sta a?t?ß??t???
ta t??f?”??e?? ??s?”ata st??? ?????? pa????? ??e?a? ap?te???? ??a s?ßa?? pa???s”?? p??ß??”a ??e?a? p?? af??? e??s?? a?apt??”??e? ?a? a?apt?ss?”e?e? ???e?
76. ?as???? p??f????e?? (standards precautions)