Xác định mầm bệnh ký sinh trùng gây bệnh cho người trong rau và thuỷ sản được nuôi trồng từ nguồn nước thải tại một số thành phố và nông thôn miền bắc

1
2010
iWln!IIKl»IWIMWMU!W^
li|lV<*>ii||il)ji>M'^Wi;)My
mnG
BAI
HOC:
¥
iHn^IBll
9
I'
'%&
ii SZS»»«i«4M,Wrf«SE5».llMa»ilS»Yit^
BOYTE
BAG CAO KET QUA NGHIEN
ClTU
DE TAI
CAP
BQ
Ten de
tai:
XAC DEVH MAM BENH
KY
SINH
TRUNG GAY
BENH CHO
NGU'CM
TRONG RAU VA THUY
SAN
DUOC
NUOI

TRONG TlT NGUON
NUdC
THAI
TAI
MQT
SO
THANH PHO
VA NONG
THON
MIEN BAC
HOI
DONG NGHIEM
THU CAP
BO
Chu tich Hoi dong:
Uy
vien nhan xet 1:
TS.
Tran Nhu Du(mg
GS.TS.
Phan
Thi
Kim
Uy vien nhan xet 2:
TS.
Nguyen Mgnh
Hiing
Ha Noi-4/2010
BOYTE
BAO

CAO
KET QUA NGHIEN
CtTU
DE
TAX
CAP
BO
rri
A
J.
A
.
>
•
Ten de
tai:
XAC DINH
MAM
BENH
KY
SINH TRUNG GAY
BENH CHO
NGlTCXl
TRONG RAU VA THUY SAN
Dirac
NUOI TRONG
TlT
NGUON
NUdC
THAI

TAI
MOT SO THANH PHO
VA
NONG THON
MIEN BAC
Chu nhiem de
tai:
PGS.TS. Nguyen Van De
Ca quan chu tri
de
tai:
Trncmg Dai
hoc
Y
Ha Noi
Cap
<^uan
ly:
Bo Y te
Ma so de tai (neu co):
Thai gian thuc
hien:
tu
thang 01
nam 2008
d%n
thang
12
nam 2009
T6ng

kinh
phi
thuc hien
de tai
1.400
trieu dong
Trong
do:
kinh
phi
S>iKH
1.400
trieu ddng
Nguon khac (neu c6) trieu dong
Ha Noi
4/2010
BOYTE
CONG
HOA
XA
HOI
CHU NGHIA VIET NAM
Dpc lap
Tir
do Hanh phiic
So:
/iHIJ
/QD-BYT
Hd Npi, ngdy
o2^

thdng U
ndm 2008
QUYET DINH
Ve viec phe duyet nhiem vu bao ve moi
trucrng
trong nganh y te
BO TRUONG BO Y TE
Can cu Nghi dinh so
188/2007/ND-CP
ngay 27/12/2007 cua CMnh phii quy dinh
chuc nang, nhiem vu, quyen han va co
ca'u
t6 chiic Bo Y te;
Can
cii
Bien ban hpp ngay 27/3/2008 cua Hoi d6ng tham dinh nhiem vu bao ve
moi trudng duoc thanh lap theo Quyet dinh so 667/QD-BYT ngay 27/02/2008 cua Bo
trudng Bo Y te;
Theo de nghi cua
Cue
truang
Cue
Y te du phong va Moi truang,
QUYET DINH:
Dieu 1. Phe duyet nhiem vu "Xac dinh mam benh ky sinh triing gay benh cho
ngucfi
trong rau va thuy san duac nuoi trong
tir
nguon
nude

thai tai mot sd thanh phd va
ndng thdn Mien Bac"
- Dan vi chu
tri
thue hien: Trudng Dai hoe Y Ha Ndi.
- Thdi gian thue hien: 2008-2009.
- Kinh
phi
thuc hien: 1.400.000.000d (Mdt ty bdn tram trieu dong chan)
trr
nguon
su nghiep mdi trudng.
Dieu 2. Thu truang dan vi chu tri thuc hien nhiem vu cd trach nhiem: ehi dao,
trien khai thuc hien cac ndi dung nhiem vu bao ve mdi trudng theo de cuang da duae
Hpi dong tham dinh thdng qua (de cuang chi tiet kem theo); thuc hien diing eac quy
dinh hien hanh cua nha nude ve hoat ddng bao ve mdi trudng va chi tieu tai ehinh; dinh
ky bao cao ket qua thuc hien ve
Cue
Y te du phdng va Mdi trudng de tong hap bao cao
Lanh
dao
Bd.
Dieu 3. Quyet dinh nay cd hieu luc ke tii ngay ky ban hanh.
Dieu 4. Cac Ong, Ba: Cue trudng
Cue
Y te du phdng va Mdi trudng, Vu trudng
Vu Ke' hoach Tai chinh, Thu trudng dan vi chu tri thuc hien nhiem vu va cae dan vi
lien quan chiu trach nhiem thi hanh
Quye't
dinh nay./.

Noi nhan:
^„ ===^iyB6
TRU6NG
Nhir Digu
4;
J^-i
^p^'^.^
, ^^T.,^
BT.
Nguyin Quoc Trieu (de
b/c);
/
/."^^fi?^*^^^^^
Liru:VT,DPMT f
/W^^
""^Tf
mh Quan Huan
Phu luc 4
Danh sach tac gia cua de
tai/nhiem
vu KH&CN cap Bo
(Danh sach nhung ca nhan da dong gdp sang tao
chil
ylu cho de tai
dupe
sap
xep
theo
thii
tu da thoa thuan)

1.
Ten De tai/nhiem vu: Xdc dfnh mam
b^nh
ky sinh
triing
gdy
b$nh
cho
ngu&i
trong rau vd thuy sdn
du^c
nuoi trong
tir
nguon
nu&c
thdi tgi mpt
sd
thdnh pho va
nong thon mien Bdc
• Md so:
2.
Thuoc
ChuoTig
trinh
(neu
c6):
3.
Thdi gian
th\rc
hien: Tu thang

01/2008 den
12/2009
4.
Ca quan chu
tri:
Trudng
Dai hpc Y Ha Npi
5.
Bp chu quan: Bp Y te/Cuc Y
te
Du phdng va Mdi trudng Viet Nam
6. Danh sach
nhiing
ngudi tham gia (tac gia):
TT
8
10
11
HQC
h^m,
hgc vj, ho va ten
PGS.TS Nguyen Van
De
ThS.
Phan Thi Huang Lien
PGS.TS Le Thanh Hda
GS.TS.
Phung Dac Cam
CN. Le Thanh Phuang
ThS.

Truong Thi Kim Phuang
KTVY. Do Duong Thang
TS.
Pham Ngpc Minh
CN. Pham
VSn
Khiem
CN. Nguyen Thj Hau
CN. Cao Van Huyen
Chitky
^Jj^u^j/lU/^fZ/t
~^S^
Thu
truOTig c(y
quan chu tri de tai/nhiem vu
jfTOr^u'
ky vaiddng
d^u)
BO
Y TE CONG HOA XA
HQI
CHU NGHIA VIET NAM
TRUONG
DAI
HOC Y HA
NOI
Dpc lap - Tu do - Hanh phiic
Ha Npi, ngay 30 thang
12
nam 2009

GIAY XAC NHAN CHI TIEU TAI CHINH DE TAI NCKH
Ten
de
tai: Xdc dinh mdm benh ky sinh
triing
gdy benh cho ngu&i trong rau vd
thuy sdn duoc nudi trdng tit ngudn
nu&c
thdi tgi mpt so thdnh pho vd nong thdn
miin Bac
Chii
nhiem dh tai: Nguyin Van Be
Co quan
chii
tri dl tai: Trudng Dai hoc Y Ha Npi
Co quan quan ly dh tai: Bh tai
c4p
bp Y tl
Thdi gian thuc hien dl tai theo quylt dinh phe duyet
ciia
BYT:
01/2008-12/2009
Tdng kinh phi duac duyet: 1.400.000.000 ddng
Tdng kinh phi da
cSp:
1.400.000.000 ddng
Tdng kinh phi da quylt toan:
f
4o\).
o

rO
.
l^X)
\ -y
Cac hoat ddng chi tieu
ciia
de tai dam bao diing theo de cuang da duyet va dam bao
qui
dinh
ve
tai chinh
ciia
Nha
nude.
F •> \ F
Sd kinh
phi
cdn lai: (chi
de
khoang 20 - 25 trieu ddng) phuc vu cho nghiem thu cap
CO
sd va nghiem thu
c4p
BYT:
^
XAC NHAN CUA PHONG TAI CHINH
TRUONG
DAI HOC Y
HA
NOI

\£lS'
\
Y^
CHU NHIEM DE TAI
PGS.TS Nguyin Van
De
BAO CAO KET QUA NGHIEN
ClfU
BE TAI/NHIEM VU
CAP
BQ
Chii
nhiem dl
tai:
Nguyen Van De
Co quan
chii
tri
de
tai:
Trirotig
Dai hoc Y Ha Noi
Cap
quan ly: Bo Yte
F -y F
Ma sd
de
tai (neu cd):
1.
Ten

de
tai:
Xdc dinh mdm benh ky sinh
triing
gdy
b$nh
cho
ngu&i
trong rau
vd thuy sdn duoc nudi trdng
tie
ngudn
nu&c
thdi tgi mpt
sd
thdnh pho
vd
ndng
thdn miin Bdc
2.
Chii
nhiem dl
tai:
PGS.TS. Nguyin Van
DI
3.
Co quan
chii
tri dl
tai:

Trudng Dai hpc Y Ha Ndi
4.
Co quan quan ly dd
tai:
Bp Y te
5.
Thu ky dl
tai:
ThS. Phan Thi Huong Lien
6. Phd
chii
nhiem
de
tai hoac ban
chii
nhiem
de
tai
(neu
cd):
7.
Danh sach nhiJng ngudi thuc hien chinh:
- Nguyin Van
DI
Trudng Dai hoc Y Ha Ndi
- Phan Thi Huong
Lidn
Trudng Dai hpc Y Ha Ndi
-
Le

Thanh Hda Vien Cdng nghe sinh hpc
- Phung
Die
Cam Vien Ve sinh Dich te Trung uong
Tmong Thi Kim Phuang Trudng Dai hpc Y Ha Ndi
- Tap
thi
Bd mdn Ky sinh tning, Trudng Dai hpc Y Ha Ndi
8. Cac dl tai nhanh (dl muc)
ciia
de tai (neu cd)
(a)
DI
tai nhanh
1
(de muc 1)
Tdn
de
tai nhanh:
- Chu nhiem de tai nhanh:
(b) Dl tai nhanh 2
-
Ten
dl tai nhanh
Chii
nhiem dl tai nhanh
9. Thdi gian thuc hien
dh
tai tu thang
01

nam 2008
din
thang
12
nam 2009
r
e
Nhung chCr
viet tat
ADN
ATSLa
BM
cs
C. sinensis
D
KST
Hp
Ht
M
NCKH
L
PCR
S. erinacei
SLRN
SLGN
TP
T
WHO
Acide Deoxyribonucleic
Au trung san la

Bdmdn
Cdng su (cdng tac vidn)
Clonorchis
sinensis
Tning giun dGa
Ky sinh tning
Haplorchis pumilio
Haplorchis
taichui
Trung/Su
trung giun mdc
Nghien cuu khoa hpc
Au tning giun luan
Angiostrongylus
Polymerase Chain Reaction
Spirometra erinacei
San la mdt nhd
San la gan nhd
Thanh phd
Tning giun tdc
World Health Organization
Muc luc
Noi dung Trang
Bao cao
kdt
qua nghien
ciiu de
tai cap Bd 3
Nhirng chu
vidt

tat 4
Cac san pham dat duac
ciia
de tai/du an 6
Ban tu danh gia 7
Chuang
1:
Dat
v4n de 10
Muc
tieu
13
Chuang
2:
Tdng quan tai lieu
14
F
Chuong
3:
Ddi tuang
va
phuang
phap
22
Chuang
4:
Kdt
qua nghien cuu 28
Tai thanh phd 28
Tai ndng thdn

31
Chuang
5:
Ban luan 37
Chuang
6:
Kit
luan 43
Khuyin nghi 46
Tai lieu tham
khao 47
Phu
luc:
Mdt sd hinh anh sinh dia canh va
Ky sinh triing trong nghien cuu 49
CAC
SAN PHAM DAT DlTQC CUA
DE
TAI/NHIEM
VU
1.
Bang ket qua sd lieu nghien cuu (xem
kit
qua bao cao kem theo)
2.
Bao cao ket qua xac dinh loai
ciia
mam benh ky sinh tning trong thiiy san va rau
tuoi
sdng sir dung nude thai (xem ket qua

bdo
cao
kem
theo)
3.
Cac bao cao khoa hpc duac dang tai:
Cd 3 bai bao khoa hpc dang tren cac tap chi nhu sau:
- Nguyin Van
DI,
Phan Thi Huang lien, Truang Thi Kim Phuang, Pham Ngpc
Minh va cs. O nhiem
m4m
benh tren ca nudi
bSng nude
thai tai thanh phd va
ndng thdn tinh Nam Dinh.
Tgp
chi Thdng tin
YDupc.
Sd 8/ 2009.
Tr.
19-21
Nguyin Van De, Phan Thi Huong lien, Truang Thi Kim Phuang, Pham Ngpc
Minh, Le Thanh Phuang, Pham Van Khiem, Nguyen Thi Hau. Danh gia d
nhidm
mam benh giun san
ciia
mdt sd loai thuy san duac nudi trong ao bang
nude thai sinh hoat. Tgp chi
YDuac

hoc Qudn su. Sd 9/ 2009. Tr.29-32
- Le Thanh Phuang, Nguyen Van Dd, Pham Ngpc Minh, Phan Thi Huong lien,
Truang Thi Kim
Phugng
va cs. Mam benh ky sinh tning
tren
rau duac tudi bang
nude
thai tai thanh phd va ndng thdn tinh Nam Dinh. Tgp chi
YDiepc
hpc Qudn
su.
Sd 9/ 2009. Tr.29-32
4.
Cac khda luan tdt nghiep Y khoa
vd
van de
lien
quan
den
nhiem vu.
Hai khoa luan tdt nghiep
Cii
nhan Y hpc (Le Thi Thanh Loan va Dinh Cdng
Tru) bao ve nam 2009 (cd ban phd td bia kem theo) va se cd 2 khda luan tdt
nghiep bao ve nam 2010.
5.
DI
xuat cac giai phap phii hgp.
r

^
F
Giai phap cho ngudi san
xuat:
De san xuat thiiy san va rau dam bao an toan thuc
phim
la khdng su dung nude thai chua duac xu ly diing quy trinh d ca ndng thdn
va thanh phd.
- Giai phap cho ngudi tieu
dung:
Hien nay, viec
sijr
dung
nude
thai dk nudi trdng
thiiy san va tudi rau cdn phd
bidn
nen ngudi tieu dung khdng
nen
an thuy san
sdng va rau sdng (chua duac nau chin).
BAN Tir DANH
GIA
Vg tinh hinh
thue
hien
va
nhirng ddng gdp mdi
cda
dg tai

KH&CN
cip bp
1.
Tgn dg
tai:
Xdc dinh mdm benh ky sinh
tritng
gay benh cho
ngieoi
trong rau
vd
thuy
san
dupe
nudi trong
tir nguon nu&c
thdi
tai mpt
so thanh phd vd nong than
mien
Bdc
Masd:
2.
TTiupc
Chuong trinh (ngu cd):
3.
Chu nhiem dl
tai:
Nguygn Van Dg
4.

Co quan
chd
tri dl tai: Tnrdng Dai hpc Y ha Npi
5.
Thdi gian
thue
hign (BD-KT): tir thang 01/2008
din
12/2009
6. Tdng kinh phi thvc hien
DI
tai:
1.400.000.000d6ng
Trong dd, kinh phi tir NSNN:
1.400.000.000d6ng
7.
Tinh hinh thvc hien dg tai so vdi dg
cuong:
Theo dung npi dung dg
cuoiig
7.1/Vg
mire
dp hoan thanh khoi luong edng
viec:
100%
Mvc
tigu dg ra
la:
-
xac

djnh
cac mam
benh
k>'
sinh
triing
(giun,
san va don
bao) trong san pham phuc
vv con ngudi (rau, thuy san) dupe nudi trong bang
nude
thai tai mpt sd thanh phd
va
ndng thdn mign Bic.
- Djnh loai cac
mam
benh
k)''
sinh tning nay bang hinh thai hpc va sinh hoc
phan tir.
- Dg xuat mdt sd giai phap nham bao vg ngudi
sir diing mpt
so thue pham cd nguy
CO
nhigm ky sinh trimg
Kgt qua thvc hien
la:
a) Xgt nghigm cho 2.700 ca thg ca, luon, torn, cua, gch va
1.800
dc tai 6 digm nudi

thuy san sir dung nude thai d thanh phd
va
ndng thdn kgt qua cho thay:
Thuy san dupe nudi bang nude thai ca d nong thon va thanh phd dgu bi 6 nhiem bdi
mam benh ky sinh trung gay benh nguy hiem cho ngudi. Thanh phan loai mam
benh ky sinh trung trong thiiy san duoc xac dinh la
du
trung san la gan nhd
Clonorchis
sinensis,
san la mdt nhd hp Heterophyidae, giun dau gai
Gnathostoma
spinigerum,
au triing san nhai
Spirometra
erinacei;
dc nhilm lu trung san la thudc
nhdm san la gan nhd va san la mpt nhd
{Parapleurolophocercous
cercaria).
Ridng
tai Hda Binh tim thay au tning san
la phdi Paragonimus
trdn cua va dc.
b) Xet nghiem cho 1.980 mlu rau tuoi sdng tai 6 diem sir dung
nude
thai d thanh
r
r
t

phd va ndng thdn kdt qua cho thay:
Rau tuai sdng
dupe
tudi bang
nude
thai ca d
ndng
thdn va thanh phd
diu
bj
d
nhilm
bdi mam benh ky sinh trung gay benh nguy hilm cho ngudi. Thanh
phin
loai
mim
benh ky sinh trung trong rau va
nude
duac xac dinh la trung giun
diia Ascaris
lumbricoides,
giun
tdc Trichuris
trichiura,
san
la
gan nhd
Clonorchis
sinensis,
san la

mpt nhd hp Heterophyidae, au trung giun mdc hp
Ancylostomatidae,
au tning giun
luan
Angiostrongylus;
dan bao gay benh cho ngudi bao gdm amip
Entamoeba
histolytica,
triing roi
Giardia lamblia
va bao
tii
tning
Cryptosporidium,
Cyclospora
F
va mdt sd dan
bao
khac.
c) Xet nghiem cho 900 mau
nude
thai
sii
dung
de
nudi thiiy san va tudi rau (tai
3
vi
\
f

F F
tri:
nude bd mat,
nude
b day va bun) tai 6 diem d thanh phd va ndng thdn kdt qua
F
cho thay:
F
y
ov
>
Trong
nude
thai ca d
ndng
thdn va thanh phd cung ddu bi
d
nhidm bdi mam benh ky
sinh trung gay benh nguy hiem cho ngudi. Thanh phan loai mam benh ky sinh trung
trong
nude dugc
xac dinh
la
tning giun diia
Ascaris
lumbricoides,
giun tdc
Trichuris
trichiura,
san la gan nhd

Clonorchis
sinensis,
san la mdt nhd hp Heterophyidae, au
F
triing
giun mdc hp
Ancylostomatidae,
au trung giun luan
Angiostrongylus;
dan bao
gay benh cho ngudi bao gdm
amip Entamoeba
histolytica,
E.coli,
trung roi
Giardia
F
lamblia
va
bao tii
triing
Cryptosporidium,
Cyclospora
va mdt sd dan bao khac.
d) Giai phap cho ngudi san
xuit
la khdng
sii
dung
nude

thai ca b ndng thdn va
thanh phd dl nudi trdng thiiy san va tudi rau dd dam bao an toan thuc
phim.
Cin
cd
quy trinh
xur
ly
nude
thai dam
bao chit
lugng chuyen mdn vl
y
tl.
Giai phap cho ngudi tieu diing la
vi
hien nay viec
sii
dung
nude
thai chua qua
xii
ly
con phd bidn nen ngudi tieu dung khdng
ndn
an thiiy san sdng hay an rau sdng
(chua nlu chin).
7.2/ Ve cac
ydu
cau khoa hpc va chi tieu co ban

ciia
cac san pham KHCN:
San
phim ciia
dl tai/nhiem vy dam bao khdi lugng cdng vide va
chit
lugng chuyen
mdn.
7.3/
vl tiln dg thuc hien:
Nira nam dau thuc hien cham do chua cd kinh phi, nhung sau dd theo kip tien dg.
8.
ve
nhung ddng gdp mdi ciia
de
tai:
f
Ft
Tren
ca sd so sanh vdi nhiing thdng tin da dugc cdng bd tren cac an pham trong
va ngoai nude ddn thdi diem
kit
thiic de tai,
de
tai cd nhiing diem mdi sau day:
Cd dugc nhiing thdng tin mdi va xdc
thye
ve mam benh ky sinh tning tren
thiiy san va mu tuoi sdng ma trudc day
chii

yeu cac thdng tin vd hda chat va vi
khuan. Dac biet cd ca sd khoa hgc cho nganh thiiy san va ndng nghiep khac phuc
trong
nudi
trdng thiiy san sach va trdng rau sach phuc vu ddi sdng dan sinh.
8.1/
ve
giai phap khoa hgc - cdng nghe:
Dua ra dugc giai phap cu the va cd tinh kha thi cho cac nganh chuyen mdn, cac nha
quan ly cung vdi cdng ddng can phai thuc hien quan ly va
xii
ly ngudn
nude
thai.
8.2/
ve
phuang phap nghien
ciiu:
t F F F
Phuang phap chuan qudc gia va qudc td dam bao do chinh xac cao.
8.3/
Nhung ddng gdp mdi khac:
F
y
- Mdt sd loai ky sinh triing da dugc xac dinh bang sinh hgc phan
tii
so sanh vdi
chiing chuin qudc td vdi do chinh xac cao.
- Ddng gdp cho khoa hgc va cho dao tao, trong dd cd 4 khda luan tdt nghiep
cii

nhan (2 da bao ve va 2 chuin bi bao ve nam
2010)
va 3 bai bao khoa hgc da dang
tren
tap chi qudc gia cd uy tin.
Hd
Ndi,
ngdy
10
thdng
12
ndm 2009
CHU
NHIEM
DETAI
(Hg, tdn va
chu:
ky)
PGS.TS Nguyen van
Dl
XAC
DINH MAM BENH
KY
SINH
TRUNG GAY
BENH
CHO
NGU'On
TRONG
RAU

VA THUY
SAN DU^OC NUOI
TRONG
TlT
NGUON
NU^OfC THAI TAI MQT SO
THANH PHO VA NONG
THON
MIEN
BAG
Chirong
1
DAT VAN DE
F
r
F
y
Mdi
trudng sdng ludn ludn tac dgng ddn cudc sdng con ngudi d nhieu khia
canh va
miic
dg khac nhau. Mdi tmdng tdn tai vd sd nhirng tac nhan gay benh tac
ddng ldn con
ngudi,
lam con ngudi nhidm bdnh va gay anh hudng ldn ddn
siic
khoe,
tham chi cdn gay
tii
vong.

Trong
nhiing
tac nhan gay benh dd cd mam benh ky sinh
tning.
Cac tac nhan gay benh nay cd
thi
tdn tai d mgi noi nhu dat, nude, thuc vat,
ddng vat dudi nude, trdn can, tham chi chim trdn trdi hay
thii
vat trong rung
diu
cd
nguy
CO
chiia
mam
bdnh
ky
sinh trung tmydn lay cho ngudi.
PSI
y
t
F
Ngudi nhiem cac mam bdnh nay cd the gay thanh dich ndu chiing ta khdng
F F
y
y F
1^
^
cd

bidn phap
khdng chd kip
thdi,
dac
biet cd nhieu
benh,
mam benh rat san cd d
Viet
Nam nhung gidi y hgc lai khdng quan tam day
dii
dan den chan doan nham dang
tile.
>
F F F
Nhung mam benh d dau? Loai gi? Cach phdng chdng ra sao? Khdng chd hay
F
y
tidu diet nhu thd nao cho phu hgp vdi tiing dia phuang ca vd chuyen mdn va kinh
tl? Dd la
nhung
cau hdi
cin
dugc giai dap vdi nhimg con sd biet ndi thd hien trong
dl tai nay.
Ndu chiing ta cd dugc nhiing thdng tin day dii va cu thd ve cac mam bdnh
tang trii, luu hanh trong mdi trudng tai cac tilu vung dia ly trong
timg
qudc gia,
trong tiing viing miln hay trong
timg

tinh thi se han chd
hoSc
khdng chd dugc tac
hai ddn
siic
khoe con
ngudi,
anh hudng lau dai
din
gidng
ndi,
lidn
quan chat che vdi
phat triln kinh
td -xa
hpi,
du
lich
va
an
ninh
qudc
phdng.
Mim
bdnh ky sinh trung tii mdi tmdng xam nhap vao con ngudi
chii
ylu qua
dudng an udng hay dudng
da/nidm
mac. Dd la cac benh giun diia vdi 1,4 ty ngudi

10
F F
mac va hang nam bi
tii
vung 60 trieu ngudi; benh giun tdc vdi 1,4 ty ngudi mac va
hang nam
tii
vong 10 trieu ngudi; benh giun mdc vdi 1,5 ty ngudi mac va
tii
vong
hang nam 65 trieu ngudi; bdnh san mang vdi hon 200 trieu ngudi mac; cd trdn 40
trieu ngudi nhidm san la tmyen qua thiic an; cd trdn 100 trieu ngudi nhidm san day
/au triing san lgn; cd hang ty ngudi mac cac bdnh don bao va bdnh ky sinh tning
khac tren toan
thi
gidi (Td chiic Y tl
thi
gidi, 1995). Nhilu tac gia trdn
thi
gidi nhu
M.V.K. Sukhdeo va cs, 1994; R. C. Tinsley & L. H. Chappell, 2000 da nghidn
ciiu
mam benh ky sinh tning tii mdi tmdng tac dpng ldn
siic
khoe con ngudi.
Giun san
tmyIn
qua ddng vat thuy sinh (ca, cua, tdm, luan, Ich) gay benh
cho ngudi bao gdm
chii

ydu la san la gan nhd, sdn la mdt nhd, giun dau gai, san
nhai Bdnh cd lien quan den tap quan
sii
dung thuy san sdng nhu an gdi ca, ca
' /
F y
F
\
nau chua ky hoac dap nhai vao mat San la tmydn qua ca chii
yeu
gdm 7 loai
san la gan nhd thugc hg Opisthorchidae (gdm Clonorchis sinensis, Opisthorchis
felineus, Opisthorchis viverrini, Amphimerus norverca, Amphimerus
pseudofelineus, Metorchis conjunctus vd Pseudamphistomum trancatum) va 69
loai san la mdt nhd (gdm cd 31 loai thudc hg Heterophyidae, 21 loai thudc hp
Echinostomatidae, 5 loai thudc ho Leicithodendriidae, 4 loai thudc hg
Plagiorchiidae, hg Diplostomidae, Nanophyetidae va Paramphistomatidae mdi
hg cd 2 loai, hg Gastrodiscidae, Gymnophallidae, Microphllidae va Strigeidae
mdi hg cd 1 loai). Ngoai ra, luan va ca cd the nhidm giun dau gai Gnathostoma
(cd tren
10
loai ky sinh d ddng vat, trong dd da xac dinh 4 loai ky sinh d ngudi
nhu Gnathostoma spinigerum, G. hispidum,
Gdoloresi
vd
G.
niponicum; ba loai
G spinigerum, G hispidum vd Gdoloresi da dugc xac dinh cd mat d Viet Nam.
Ech cd the bi nhilm lu triing san nhai Spirometra erinacei.
Tai Viet Nam, benh ky sinh tning chung giiia ngudi va ddng vat phd biln

trong toan qudc. Tinh hinh nhilm giun diia va giun tdc d miln Bac cao han miln
Nam, cd noi d miln
BIC
ty le nhilm 2 loai giun nay
Id
80-90%. Tinh hinh nhilm
giun mdc cao tren pham vi ca nude, cd noi 70-80%. San
Id
gan nhd phan bd d it
nhit
32 tinh, cd dia phuang ty
Id
nhidm tren 30% nhu Nam Dinh, Ninh Binh, Ha
Tay, Thanh Ho4
Phii
Yen,
Binh Dinh; cd noi benh luu hanh
tren
toan tinh nhu Hod
u
Binh.
san
la gan
Idn
phan bd d it nhat trgn 47 tinh vdi so luong benh nhan tren
5.000
ngudi, cd ncri
tyle
nhiem
ll,l%nhudKhanhHoa.

San
la
mpt
Idn luu hanh
d
it nhat 16 tinh, cd ndi
t)
lg nhiem 3,8% nhu Dae Lac.
San
la mpt nhd da xac dinh
luu hanh d it nhit 18 tinh vdi 5 loai, cd ncri ty le nhiim tdi 52,4% nhu Nam Dinh,
cd bgnh nhan nhiem trgn 4.000 san. San la phdi phan
bl
d it nhit
10
tinh, cd ncri ty
lg
nhilm
15%
nhu Son La. San
day
/iu tning san
Ipn
luu hanh d it nhit 50 tinh, cd
nai ty le nhiim
san
day 12%
va
nhiim iu trimg san
Ion

7,2% (Nguyin Van Dg
va
cs,
1998-2006).
Giun diu gai
Gnathostoma
cung da duoc phat hien hang tram ca
trgn ngudi (Lg Thj Xuan
va
cs, 2003). Hang chuc benh nhan nhiim giun
luon
nao
gay viem mang nao tang bach ciu ai toan trong nhimg nam gan
day
(Pham Nhat
An, 2004
va
Nguyen Van Dg, 2005) do an phai iu triing tir moi trudng. Hang
chyc
trieu ngudi nhilm
cac
loai don bao tir mdi traong sdng. Da cd mpt s6 digu tra d
nhigm thue pham bdi
mam
bgnh ky sinh triing nhung chua day du. Thit
Ion
nhiim
iu triing san day 0,02-0,9%
(Kilu
Timg Lam). Thit bd nhiim iu triing

san
day
0,03%
(Trin Thuat); Co 7/10 loai ca
nude
ngpt nhiim iu triing san la
1,7-21,7%
(Nguygn Van 0l, 2005); Cua da nhiim iu triing san la phdi
16-98,1 %
(Nguyin Van
Dg,
2000); Luon nhiim iu trimg Gnathostoma
11,4%
(Nguyin Van Dg, 2000);
Rau nhigm trimg giun 35,7%
va
nhigm don bao Cyclospora
8,4-11,8%
(Nguyen
Thuy Tram, 2007).
Trong moi trudng,
nude
thai duoc xem la ngudn
lay
lan mam bgnh quan
trpng
nhat,
trong do cd mam benh ky sinh triing.
Nude
thai bi 6 nhiem tir nhigu

ngudn bao gdm nude thai sinh boat,
nude
thai benh vien, nha may,
nude
thai tu
nhign dgu chira dvng trong do nhigu nguygn nhan gay benh cho ngudi.
Nhigm vu
nay
danh gia d nhiem mam benh ky sinh trimg trgn rau, thuy san
dupe
nudi trong tir nguon nude thai mpt sd thanh pho
va
ndng thdn mign Bic sg gdp
phan tra
idi
cho cau hdi: i)trong
nirdc
thai thanh phd va ndng thdn chira mam
b|nh
ky sinh trimg
nao
truygn cho ngudi; ii) trong moi loai thirc pham lign quan dgn
nude
thai (rau, ca, torn, cua, dc )
chiia
mam bgnh gi
gay
nhiim cho ngudi; iii)
bing phuong phap nao, truygn thong hay hien dai hay phdi hpp de xac dinh chinh
xac tac nhan

gay
benh? iv) dg xuat giai phap nao khdng chg hay xoa bd dupe mim
benh dd trong dilu kien Viet Nam? Tu do gdp
phin
dua ra dugc ke hoach phdng
F
y
Ft
chdng hieu qua cho nhieu dia phuang trong toan qudc de dam bao
siic
khoe cdng
\ ^
t F
ddng, dac biet phdi hgp vdi cac ngdnh thuy san, ndng nghiep,
thii
y dd sdn xuat
thuc pham sach phuc vu ddi sdng dan sinh.
Sii
dung nude thai dd mdi rau vd nudi cd
Id
phd bidn d Viet Nam, cd d
thdnh phd vd ndng thdn. Vi vay, can tiln hdnh ddnh gid d nhidm mam benh ky
sinh
trung tren rau va thuy sdn nudi trdng bang nude thai d thdnh phd vd ndng
y
f
\
F
y
thdn mien Bac vd dd xuat gidi phdp nudi trdng rau vd thuy sdn sach phuc vu

ngudi tidu
dung^
bdo ve
siic
khde.
MUC TIEU
\
7
Xdc dinh cdc mam benh ky sinh triing (giun, sdn vd don bdo) trong sdn pham phuc
A >
F F
VU
con ngudi (rau, thuy sdn) dugc nudi trdng bang
nude
thdi tai mgt sd thdnh phd vd
\
F
ndng thdn mien Bac.
Dinh loai cdc mam benh ky sinh tning ndy bang hinh thai hgc vd sinh hgc
phan
tii.
-
De
xuat mot sd giai phap nham bao
ve
ngudi
sii dung
mot sd
thuc
pham cd nguy ca

nhiem ky
sinh
trung.
13
Chuang 2
TONG QUAN TAI LIEU
Mdi tmdng sdng xung quanh con ngudi ludn chiia dung vd so nhung mam bdnh ddi
vdi con ngudi vd da vd dang gay ra nhieu benh tat ldm dnh hudng
din siic
khoe con
ngudi, tham chi cdn gay
tii
vong khdng chi cho tung cd nhan md cho cd tap the cgng
ddng.
CMoi
trudng
)
Mam
b§nh \ / Mim
benh
"\ /
Hoa chat
yi
trijng/virus
v,ky
sinh
trung \
doc hai
I
(Con

ngirdi^
1.
Dircmg
truyen lay mam benh ky sinh triing voi con nguoi
Bdnh ky sinh tning tmydn lay tu mdi tmdng vdo ngudi cd thd true tiep hoac qua
vat
chii
trung gian va dugc phan nhdm mdt each tuong ddi dua vdo dudng lay
>
7
F
tmyen dd thirc hien cdc bidn phap phdng chdng cd hieu qua.
1.1.
Benh ky sinh triing
Uuyin
qua thuc dn
Id
thit (Foodbome Parasite by meat
products).
Nhdm ndy cd bdnh sdn day Taeniasis {Taenia
solium,
Taenia
saginata.
Taenia
F
asiatica);
bdnh giun xoan Trichinelliasis; bdnh Sarcocystosis, bdnh dan bdo
Toxoplasmosis.
1.2. Benh ky sinh triing truyen qua thuc dn cd nguon gdc thuy sdn (Foodbome
Parasite by aquatic products).

t
y
Nhdm nay cd bdnh san
Id
phdi Paragonimiasis (gdm 50 lodi dugc thdng bdo gay
bdnh d ngudi); bdnh san la gan nhd (Clonorchiasis, Opisthorchiasis); benh san
Id
mdt nhd (Heterophyiasis, Echinostomiasis); bdnh san
Id
Alariasis, Fibricoliasis;
bdnh san nhai Sparganosis; benh san day chd Diphyllobothriasis, Mesocestoidiasis;
benh giun luan nao Angiostrongyliasis; benh giun da ddy Anisakiasis, benh giun
14
Gnathostomiasis, Dioctophymiasis.
1.3. Benh ky sinh triing truyen qua
du&ng
mieng nhung khdng phdi thuc dn
(Parasitic diseases transmitted through the mouth with non-food).
Nhdm ndy cd bdnh Eurytreniasis; sdn
Id
gan nhd tmydn qua kidn Dicrocoeliasis;
benh san day chd Dipylidiasis; Rodentolepiasis; sdn day chugt Hymenolepiasis
diminuta; Pseudanoplocephaliasis crawfordi; benh san day
tmyIn
qua kien
Rainllietiniasis celebensis;
Bertielloesis;
benh giun Acanthocephaliasis;
Gongylonemiasis; Dracunculiasis.
1.4.

Benh ky
sinh
triing truyin qua thuc vgt (Plantbome Parasite).
Nhdm ndy cd benh sdn la mgt ldn Fasciolopsiasis; sdn
Id
gan ldn Fascioliasis;
Paramphistomeiasis;
Philophthakniasis.
1.5.
Benh ky
sinh triing
truyin
qua ddt
(Soil-transmitted Parasite).
/
y
F
Nhdm nay
chii yeu Id
giun sdn tmyen qua dat (Soil-transmitted Helminthiasis) vd
don bdo (Protozoa) gdm benh giun diia ngudi Ascariasis, bdnh giun tdc Trichuriasis,
F F
bdnh au tning san lgn Cysticercosis cellulosae; Bdnh au tning sdn chd
Echinococcosis
(Hydratidosis),
Coenurosis; bdnh au trung san day
ciia
lgn
t
Cysticercosis tenuicollis; bdnh giun phdi cdo Capillariasis; bdnh giun luon

Trichostrongyliasis; Oesophagostomiasis; Rhabditiasis;
Linguamliasis;
benh tning
roi dudng tieu hod Giardiasis; benh dan bao Cryptosporidiasis; benh amip
Amebiasis, benh trung ldng Balantidiasis.
1.6. Binh ky sinh triing truyen qua da (Parasitic diseases transmitted through the
skin).
Nhdm nay gdm 2 nhdm nhd:
•\ F y
1.6.1.
Benh ky sinh triing tniyen qua da trong mdi
tru&ng nu&c
vd ddt bao gdm:
benh san mang Schistosomiasis; bdnh Orientobilharziasis, Trichobilharziasis va
bdnh viem da do lu tning (cercarial dermatitic); benh giun luon Strongyloidiasis;
benh giun mdc/md Ancylostomiasis.
y
r
y
1.6.2.
Benh ky sinh trung truyen qua da do cdn trimg tiet tuc bao gdm: benh
Babesiasis, benh giun chi bach huylt Filariasis, benh giun chi td chiic
Dirofilariasis,
benh trung roi dudng mau Leishmaniasis, Trypanosomiasis; bdnh giun Thelaziasis;
15
benh Physalopteriasis; bdnh sdt ret Malaria.
1.6.3.
Benh ky sinh triing truyen qua da do tiep xuc true tiep
v&i
tiet tuc bao gdm:

bdnh ve ky sinh, benh ghe Scabies; benh Gastrophilid myiasis; benh Hypodermatid
myiasis.
1.7.
Binh ky sinh triing
truyen
qua khdng khi (Air-bome diseases). Nhdm nay cd
benh
Pneumocystosis
carinii.
Dircmg lay nhiem cua Icy sinh triing truyen lay giira ngirdi
v^
dong vat the
hien moi lien quan giira ngirdi
v^
dQng
vat dugc sa do hoa nhu sau:
a) Ngudi vd dgng vat
diu
bi lay nhilm
mim
benh tu mdi tmdng. Vi du giun
>
F
tmydn qua dat
ciia
ngudi vd dgng vat.
NGUdl
DONG VAT
MOITRUtiNG
m^

y
y
b) Ngudi bi nhiem benh thdi mam benh ky sinh tning ra mdi tmdng, mam benh
nhidm vdo ddng vat vd ngudi an thit ddng vat se bj nhiem bdnh. Vi du: san
day
DONG
VAT
MOITRUtiNG
c) Ngudi vd ddng vat bi nhilm benh ky sinh tning thdi
mim
benh ra mdi tmdng,
mim
benh nhilm vao vat
chii
trung gian va ngudi (ddng vat) an vat
chii
tmng gian
se bi nhilm benh. Vi du: san la va mdt sd loai giun. Ddi khi ddng vat la vat
chii
16
chiia, ngudi an phdi ky sinh trung trong vat chii chiia se bi nhidm bdnh. Vi du: an
thit lgn rung sdng bi nhidm san la phdi.
d)
' ' Vat
chu chiia
DONG
VAT
MOI
TRUONG
VAT

CHU TRUNG GIAN
e) Ngudi vd ddng vat bi nhidm
b?nh
ky sinh tning thai mam
b^nh
ra mdi
y
i-v
y
tmdng, mam benh nhiem vdo
v$t chii
trung gian rdi gidi phdng vdo mdi
F
tmdng vd au trung xam nhap vdo ngudi (ddng
vat).
Vi du: sdn mdng.
MOI
TRUdNG
VAT
CHU TRUNG GIAN
MOITRUtJNG
fv
y
f
f)
Ngudi va ddng vat bi nhiem bdnh ky sinh trung, mam bdnh
true
tiep vdo
^
F

tmng gian tmydn benh vd
tCr
vat
chii
trung gian, ky sinh tning true tiep xam
F
nhap vdo ngudi (ddng
vat).
Vi
du:
giun
chi,
ky sinh tning sdt ret.
NGUDi DONG
VAT
W
VAT
CHU TRUNG GIAN
17
g) Ngudi va ddng vat bi nhilm benh ky sinh tning,
mim
bdnh qua nhieu vat
chii
tmng gian vd ngudi (ddng vat) an phdi mdt trong cac vat
chii
trung gian nay
se bi nhilm bdnh. Vi du bdnh giun
Gnathostoma
t
VAT

CHU TRUNG GIAN
DONG VAT
VAT
CHU TRUNG GIAN
VAT CHU TRUNG
GLVN
F
y F
h) Mdt sd ky sinh tning lay tmyen tryc tiep giiia ngudi vd ngudi. Vi du benh
ghe,
benh trung roi am dao.
2.
Thuc trang ve benh ky sinh triing lay tir moi tnrcmg vao con ngirdi
2.1.
Tinh
hinh benh tren
the
gi&i
y
F
Benh ky sinh triing tmyen lay
tir
mdi tmdng vdo con ngudi phan bd rdng rai
trdn
thi
gidi, thudng phan bd theo dia ly, khi hau vd dilu kien kinh
tl-xa
hdi
ciia
con

y F
t
F
ngudi. Hau het bdnh ky sinh tning phd bidn d vung nhiet ddi, cd tap quan lac hau vd
kinh tl kem phat triln, do
Id
cac vung chau A, chau Phi, chau My la tinh. Tai cac
khu vuc nay, khu he ky sinh triing
hit siic
da dang vd phong
phii
cung vdi tham thye
vat vd khu he ddng vat phat triln. Cd nhiing lodi ky sinh tning phan bd rdng khdp
trdn todn thd gidi, nhung ciing cd lodi chi phan bd trong nhiing khu vuc
nhit
dinh.
18
^
F
7
/
'
Tuy vay, do bidn ddng dan cu trong phdt trien kinh td vd du lich ciing nhu xuat nhap
khau ddng vat, thye pham rdng rai
Id
dilu kien thuan lgi cho sy phat tan vd lan rdng
mam bdnh ky sinh trung trdn nhieu vung lanh thd khdc nhau, tu dd benh ky sinh
tning cd dilu kien lan rdng.
Trdn thd gidi, nam
1995

cd gan 4 ty ngudi nhiem giun dua, giun tdc vd giun
mdc;
cd trdn 200 trieu ngudi nhidm sdn mang; cd trdn 40 trieu ngudi nhilm sdn
Id
tmyen qua thiic an; cd
tren
100 trieu ngudi nhiem sdn day/au tning san lgn; cd
120
trieu ngudi d 80
nude
nhilm benh giun chi
b^ch
huyet vd 1,1 ty ngudi (khodng 20%
F F \
dan sd) sdng trong vung cd bdnh luu hdnh; cd 2,4 ty ngudi d
100
nude nam trong
vung luu hdnh sdt ret va hang nam cd 300 500 trieu ngudi mac sdt ret, ldm chet
1,2-2,7
trieu ngudi; benh Leishmaniasis luu hdnh d 82
nude
(trong dd cd
10
nude
phdt trien vd 72
nude
dang phdt trien) vdi khoang
12
trieu ngudi mac vd 350 trieu
ngudi nam trong vung nguy co nhiem benh; vd cd hang ty ngudi mac cdc benh dan

bdo vd benh ky sinh tning khdc
tren
todn the gidi.
2.2.
Tinh hinh
binh
& Viet
Nam
Tai Viet Nam, benh ky smh tning tmyen lay tu mdi tmdng vdo con ngudi
t F F F y
phd bidn trong todn qudc, nhung bdnh phan bd khdng ddu giiia cdc dja phuang.
Tinh hinh nhilm giun diia vd giun tdc d mien Bac cao hon mien Nam, cd noi
d
midn
Bac ty le nhilm 2 loai giun ndy la 80-90% (Hodng Thj Kim vd cs, 1998),
nhung
4ong
bang Nam bd cd ty
Id
nhidm thap (nhiem giun dGa dudi 5%, nhiem
giun tdc dudi 2%), nhiem giun diia cd xu hudng gidm nhanh. Tinh hinh nhiem giun
mdc cao trdn pham vi cd
nude,
cd nai 70-80%,
my
vay, ddng bang sdng
Ciiu
Long
f.^
F

F
r
cd ty
Id
nhidm thap nhat (dudi
10%).
Tu tmdc ddn nay, da ghi nhan 14 tinh cd bdnh
giun chi bach huyet vdi 6.339 ngudi nhilm nhu Hd Nam Ninh ty
Id
nhiem 13,37%,
Hai Hung 9,94%, Quang Binh
11,70%,
Ha Ndi 5,40%, Thdi Binh 4,90%, Qudng
Ninh 2,50%, Ha Bdc 2,30%, Hd Son Binh
2,01%,
Bdc Thdi
1,50%,
Nghe Tinh
1,10%,
VTnh
Phii
0,30%, Hd Tuyen 0,13%, Khdnh Hod 9,3-13,3%, Ninh Thuan 2%
(Nguydn Duy Todn, 2000). San la gan nhd phan bd d it nhat 24 tinh, cd dia phuang
ty
Id
nhidm tren 30% nhu Nam Dinh, Ninh Binh, Hd Tay, Thanh Hod,
Phii
Ydn,
Binh Dinh; cd nai bdnh luu hdnh trdn todn tinh nhu Hod Binh (Nguyen Van
DI

vd
19
cs,
2005). San la gan ldn phan bd d it
nhit
trdn 47 tinh vdi sd lugng benh nhan tren
5.000
ngudi, cd noi ty le nhilm
11,1%
nhu d Khdnh Hod ( Nguyin Van
DI
vd cs,
2002,
2006). Sdn
Id
mdt ldn luu hdnh d it
nhit
16 tinh, cd noi ty
Id
nhilm 3,8% nhu
Dac Lac (Nguyen Van
DI
vd cs, 1998, 2006). San
Id
mdt nhd da xdc dmh luu hanh
d it nhdt 18 tinh vdi 5 lodi, cd noi ty
I?
nhidm tdi 52,4% nhu Nam Dinh (Nguyin
Van Dl vd cs, 2006). San
day/lu

tning sdn lgn luu hdnh d it
nhit
50 tinh, cd noi ty
Id
nhidm sdn day 12% vd nhilm lu tning san lgn 7,2% (Nguydn Vdn Bh vd cs,
f
F F
2001).
Cd 43,4 trieu ngudi sdng trong viing sdt ret, trong dd cd
15
trieu ngudi sdng
trong vung sdt ret nang;
tir
nam 1991-2000 cd
10.184
ngudi
chit
vi sdt ret vdi 309
F
VU
dich sdt ret (Ld Xuan Hung vd cs, 2005). Benh Leishmaniasis da phdt hien 3
tmdng hgp d Qudng Ninh ndm
2001
(Nguyin Nggc Ham vd cs, 2001), da phdt hien
dc trung gian tmydn benh sdn mdng d Viet Nam (Nguyen Van
De
vd cs, 2000).
Benh giun xoan trichinelliasis da gay ra 4 vu dich: tai Mu Cdng Chdi (Yen Bdi) nam
1970
cd 26 ngudi mdc vd

chit 4
ngudi (Kieu Tung Lam,
1973);
tai
Tuin
Gido (Dien
Bien) nam 2002 cd 22 ngudi mac vd
chit
2 ngudi, nam 2004 cd 20 ngudi mac
(Nguyin Van
DI
vd cs, 2004, 2006), tai Bdc
Yen
(San La) nam 2008 cd 22 ngudi
mdc,
chit
2 ngudi. Da cd hang tram benh nhan nhilm giun Gnathostoma
y y
spinigerum {Le Thi Xuan,
2001),
cd nhieu tre em viem mdng nao tang bach cau ai
toan do nhiem giun luon
Angiostrongylus
cantonensis (Nguyen Van De, 2005,
2007).
Da xdc dinh cd giun chi
Dirofilaria
repens vd
Thelazia callipaeda
ky sinh d

mat ngudi (Nguyen Van
DI
vd
cs,
2007, 2008).
3.
Nguyen tac phong chong benh ky sinh trung truyen
lay
tir moi
trirong
vao
con
ngiroi
Mudn phdng chdng bdnh ky sinh tning tmyen lay
tir
mdi tmdng vdo con
ngudi cd hieu qua,
cin
dua
vdo
dac tinh sinh ly, sinh thai
ciia
ky sinh trung, tinh
/*^ ^
y F
trang d nhidm mam bdnh d mdi tmdng vd didu kien sdng
ciia
vat
chii.
3.1.

Ddnh gid dugc tinh hinh tung benh ky sinh tning trdn ngudi vd d nhilm
mim
benh
ciia
chiing trong mdi tmdng va dieu kien luu hanh
ciia
chiing trong tung dia
phuong, tiing khu vuc de lya chgn ddi tugng uu tien, khu vyc uu tien va giai phdp
tdiuu.
20
3.2. Chuan
bj
day
dii
nhan
lyc,
vat lyc
vd
mdng ludi boat dgng phdng chdng.
3.4. Tidn hanh phdng chdng trdn quy md rdng ldn vi bdnh ky sinh tning
Id
bdnh xa
hdi,
thudng ca cgng ddng nhilm
b?nh
vd
dd
lay lan.
3.5.
Phdng chdng can tidn hdnh lau dai, cd kd hoach ndi tilp, lidn hoan do bdnh ky

sinh trung thudng keo
ddi,
dai ddng vd dl
tdi
nhilm.
^
y
F
3.6.
Kdt hop
chat che nhidu bidn
phdp
phdng chdng vdi nhau.
\ f ^ ,
3.7. Ldng ghep cdng tac phdng chdng ky sinh trung vdi nhieu boat dgng
Y
te vd van
hoa-xa hdi khdc, dac biet dua cdng tac phdng chdng ky sinh trung vdo chuang trinh
cham sdc
siic
khoe ban dau,
nhit Id
d myln co sd.
3.8.
Xa hgi hod cdng tac phdng chdng ky sinh tning, ldi cudn cgng ddng ty gide
tham gia.
F F F
3.9. Phdi hgp phdng chdng ky sinh tning trong
y
td vdi cdc ngdnh lien quan nhu

Thii
Y, Thuy
sdn,
Ndng nghiep va
cdc
ngdnh lien quan khdc.
t \ /^
7
X
3.10.
Day manh cdng tdc nghidn cuu khoa hgc vd dich td, chan dodn, dieu trj vd
phdng chdng
X
F
3.11.
Tao ngudn lyc cho boat ddng phdng chdng bdnh ky sinh triing trong nude vd
F F
md
rdng
tiing budc hgp
tdc qudc
td.
t F
3.12. Kiem tra va giam sdt cdc boat ddng phdng chdng ky sinh trung tii tmng uong
den
dia
phuang.
F F F
3.13.
Quan ly chuang trinh boat ddng cd hieu qua: Cd he thdng thdng nhat tu trung

uang
din
tan ca sd dl ndm
bit
nhiing kdt qud cap nhat, kip thdi bd sung nhiing bat
\
F y y F
cap,
nham nang cao hieu qua phdng chdng. Ddng thdi dd cap
chidn luge
mdt cdch
9
y
F^
F F
tdng hgp va cd phan tich vd dich td hgc, ca hdi, vat lyc hien cd vd cdc
yeu
td dnh
hudng
din
tinh
bin vung ciia
hoat ddng phdng chdng de qudn ly chuang trinh cd
hieu qua nhat.
21