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

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

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

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

B O Y T E C O N G H O A XA H O I CHU NGHIA VIET NAM

Dpc lap Tir do H a n h phiic So: /iHIJ /QD-BYT

Hd Npi, ngdy o2^ thdng U ndm 2008

Q U Y E T D I N H

Ve viec phe duyet nhiem vu bao ve moi trucrng trong nganh y te

B O T R U O N G B O Y T E 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 T R U 6 N G

BT Nguyin Quoc Trieu (de b/c); / / " ^ ^ f i ? ^ * ^ ^ ^ ^ ^

Liru:VT,DPMT f /W^^

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):

ThS Truong Thi Kim Phuang

KTVY Do Duong Thang

Thu truOTig c(y quan chu tri de tai/nhiem vu

jfTOr^u' ky vaiddng d^u)

BO Y TE CONG HOA XA H Q I CHU NGHIA VIET NAM

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)

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

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

T R U O N G 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 D I

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 D I 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) D I tai nhanh 1 (de muc 1)

Nhung chCr viet tat

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 T A I / N H I E M 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 D I , 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 D I 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)

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 D I 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

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

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/ v l tiln dg thuc hien:

Nira nam dau thuc hien cham do chua cd kinh phi, nhung sau dd theo kip tien dg

8 v e nhung ddng gdp mdi ciia de tai:

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/ v e 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/ v e 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 D E T A I

(Hg, tdn va chu: ky)

PGS.TS Nguyen van Dl

XAC DINH M A M 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

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

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

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

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 0 l , 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)

benh dd trong dilu kien Viet Nam? Tu do gdp phin dua ra dugc ke hoach phdng

chdng hieu qua cho nhieu dia phuang trong toan qudc de dam bao siic khoe cdng

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

- De xuat mot sd giai phap nham bao ve ngudi sii dung mot sd thuc pham cd nguy ca

nhiem ky sinh trung

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 \ / M i m benh "\ / Hoa chat

y i 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

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;

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;

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

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

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

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

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,

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 D I 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 D I 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 D I 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 D I 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

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

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

Chuong 3 DOI Tl^QNG VA PHlTONG PHAP NGHIEN ClTU

1 Dia diem thuc hien:

• • •

Ba thdnh phd:

- Thdnh phd ddng bdng: TR HdNoi

- Thanh phd ddng bdng ven biln: TP Nam Djnh

- Thdnh phd miln niii: TP Hod Binh

Ba viing ndng thdn:

- Vung ndng thdn ddng bdng: xa-Hdi bdi, huy?n Ddng Anh -Hd Ngi

> X 7

- Vung ndng thdn ddng bang ven bien: xa Hdi Hda, huyen Hdi Hdu- Nam Dinh

- Vung ndng thdn mien niii: xa Hgp thinh, huyen Ky Son, tinh Hod Binh

Dinh loai bdng hinh thdi hgc tai BM Ky sinh tning, Dai hgc Y Ha ndi

7 \

Tham dinh lodi bang sinh hgc phan tii tai Vidn Cdng nghe sinh hgc

2 Doi tirong nghien cun:

- Cdc mlu nude, bun tai ao/hd nghien ciiu

- Cac mau ky sinh trung thu dugc

3 Thiet kl nghien cihi:

Nghidn ciiu ngang md td, khdng cd ddi chiing

4 Chon dilm dieu tra va c& miu:

+ Chgn dilm cd chii dich: tai thdnh phd chgn cdc hd/ao sii dung nude thai thdnh phd

dl nudi thuy sdn va cac mdng rau tudi bang nude thdi thanh phd; tai ndng thdn chpn

cdc ao sii dung nude thai sinh boat de nudi thuy san vd cdc mpng rau tudi bdng

nude thai

+ Cac thuy san dugc nudi chii ylu gdm nhdm 1: cd chep, ca trim, cd me, ca rd phi

va ca trdi (5 lodi) va nhdm 2: luan, tdm, cua, Ich, dc (5 lodi)

+ Cd mau cho mdi nhdm ddi tugng dugc tinh theo cdng thiic (WHO 1991):

n = ZVa/2xP(l-P)/d^

Trong do, n = ca mlu tdi thilu cin dat dugc

P = Ty If nhiem dy kiln

Z i-a/2 = he sd tin cay 95%, cd gid tri 1,96

d = sai sd tuyet ddi = 0,05

Ty le nhiem lu tning sdn tren cd khodng 20% = P (Nguyen Van DI, 2005) vd ty If

trimg giun tren rau khoang 30% = P (Nguyen Thuy Tram, 2007) Ta cd sd mlu cd n

= 246, quy trdn 250 mdu cho 5 lodi, moi lodi 50 cd the /ao (5 lodi x 2 nhdm x 50

mau X 6 ao == 3.000 mau) Cd mau rau n = 323, quy trdn 330 mdu cho 6 lodi rau,

moi lodi 55 mau/mdng (6 loai x 55 mau x 6 dilm = 1.980 mau) Cd mau nude thdi

tai bd mdt, nude d day va bun, mdi vi tri 50 mau (3 vi tri x 50 mdu x 6 diem = 900

mdu)

+ Chgn hd/ao nudi cd sii dyng nude thdi:

Tai thdnh phd: Hd Ndi chgn hd Tay sii dyng nude thdi thdnh phd; tai thdnh

phd Nam Dinh chgn hd Ldc Vugng, sii dyng nude thdi thdnh phd; tai thdnh phd

Hod Binh chpn hd Tmng Tam, sir dyng nude thdi thdnh phd Nude thdi thdnh phd

t F y \ y

dugc dd xudng hd bao gdm ngudn nude thdi sinh boat, nude thdi nhd mdy, bdnh

vidn va nude mua tu nhien

Tai ndng thdn chgn 3 ao d Ddng Anh -Hd Ndi (ddng bdng); Hdi Hau -Nam

Dinh (ven bidn) vd Ky San -Hod Binh (midn niii) la nhimg ao sii dyng nude thai

sinh boat ndng thdn cd ca ngudn nude mua ty nhien Day Id nhiing xa thudn ndng,

trdng liia, rau mau vd cd chan nudi gia siic, gia cam, nudi cd

Mdi hd/ao chgn 5 loai ca chinh: cd chep {Cyprinus carpio), cd tram

{Ctenopharyngodon idella), cd me {Hypophthalmichthys molitrix), cd rd phi

{Oreochromis niloticus) va ca trdi {Cirrhina molitorella) Tai cung khu vyc thu

thdm luan (Fluta allia), tdm, cua {Parathelphusa spp/Potamiscus spp), ech {Rana

F F F /<W < w

rugulosa) va dc (dc miit Melanoides spp/oc dd Angulyagra spp) Mdi loai trong mdi

ao thu thap 50 cd thd (ridng dc mdi dilm 200-300 cd thd cdc lodi) Cdc mlu diu

dugc thu bat tai chd do chii hp nudi cd bdt va chiing kiln ciia can bd nghidn ciiu

Cung dia dilm tuang iing thu thap cdc mdu rau dugc tudi bdng nude thai thdnh phd va ndng thdn bao gdm: rau mudng, rau can, rau ngd, rau edi soong, rau cai, rau didp Mdi loai 55 mau cho mdi diem dieu tra Cac mdng rau nay ddu ndm

•* , > y t

gan vdl hd/ao nghidn ciiu vd dugc sii dung nude hd/ao ndy dd mdi rau

Ciing dia didm tuang iing, mdi hd/ao diu dugc thu thdp mdu nude thai de xet

nghiem tai 3 vi tri: bl m^t, nude d ddy va bim, mdi vi tri 50 mau

4 Thu thap mau:

+ Cdc loai rau (tren can, thuy sinh), thu thap tai cdc vi tri (mdng) da chgn nhu trdn vdi cdc lodi vd sd lugng mdi lodi 500 gam Didu kien thu mau Id trong vdng 1 tuan cd tudi bang nude thai vd khdng mua

+ Thuy sdn (ca, tdm, cua, luon, ech, dc ), thu thap tai cdc vi tri hd/ao da chgn nhu trdn, sii dyng nude thdi sinh boat, dii sd lugng vd la nhung thuy sdn thjt (mua thu hoach),

+ Mdu nude thdi tai cdc hd/ao ciia dia didm nghidn ciiu da chgn tai cdc vi tri: nude be mat, nude d day va bun, mdi mdu nude 1 lit vd bun 500gam Vj tri thu mdu

CO chidu sau it nhat Imet

5 Cac phirong phap va I^ thuat su* dung trong nghien cihi

Mdi ca do chiiu dai Lo va L: (LQ-L)

LQ: tii mom ca din ranh gidi ca-vay d dudi cd

L: tii mom cd din chdt dudi

(khdng can do chidu ngang cd: chi do ehilu dai vd can ndng)

- Caned

- Tiln hdnh xet nghiem cd:

• Tieu CO tiing cd thi cd

• Bam nhd va xay rihd cd timg mdu cho vdo dung dich tidu co, thudng de trong

lp 100ml chiia 50ml dung dich tidu co gdm: HCl 8 ml + 6 g pepsin + nude

cdt vua dii 1.000 ml

Trdn ky va dl tii Im 37°C trong 4 gid

Cho thdm 50 ml nude vd lac ldn

Lpc todn bd mdu bdng ludi cd kich thudc Id 1 x 1 mm vd nia bdng nude

au trung bang pipet pasmer

Thu au tning cho ien lam kinh de dinh loai bdng hinh thdi hpc

F F

Bao quan au tning trong nude mudi sinh ly 0,85%

Bao quan lau dai trong formalin 10% dd dinh loai bang hinh thdi hpc

\ 7 \

Bdo qudn lau ddi trong cdn 70% de dinh loai bdng sinh hpc phan tii

5.2 Ky thugt xet nghiim tim au triing sdn Id trong oc:

- Md dc lay gan-tuy ddt ldn lam kinh, day lamen vd soi

Ndu dc nhd cd thd ep cd dc dudi 2 lam kinh

/ F F F

- Vdi dc miit (Melanoides.,,) dung kim nhd be dudi dc, an nap cho nude len lam

kinh, day lamen va soi

- Co dinh cercaria dd dinh loai hinh thdi, ta cho it ldng trang tning

5.5 Xet nghiim rau tim tritng/du triing giun sdn vd don bdo:

Riia rau dk thu thap tning giun sdn vd bdo nang dan bdo tii nude nia

- Lly 500 gam rau nia trong chau chiia 2 lit nude sach

- Riia tiing la, tung cudng rau, khdng bd sdt

- Mdi mdu rau nia 3 - 4 lln

- Nude nia dl ldng 6-10 gid

^ y F

- Gan lay phan nude dudi cho vdo dng ly tdm

' 7

- Lay can xet nghiem Luu y cho vdo vdi gipt lugol trong 50% glyxerin de phdt

hien bao nang don bdo

5.4 Xet nghiem biln tim trimg giun sdn vd don bdo bdng ky thugt Romanenko:

F

Tidn hdnh:

Can 100 gam bun, cho vao dng ly tdm to, ndu dng nhd cho vdo nhidu dng

Cho KOH hodc NaOH vdo vdi ty le 1/3 hodc 1/5 vd dl 30 phiit, trong thdi gian

ndy khuiy diu 4 lln

- Sau dd lai khuiy 5 phiit vd ly tam 5 phiit (500-1000 vdng/phiit)

- Tnit bd nude vd cho NaN03 bdo hod vdo can, khuiy diu vd ly tdm 5 phiit (1000

vdng/phiit)

y F F 7

- Nhd NaN03 day den mieng vd day phien kinh ien, de 20 phiit

F

- Nhae lam kinh ien, nhd 1 gipt glyxerin 50%, day Id kinh vd soi

5.5 Ky thugt xet nghiim nu&c tim trimg giun sdn vd don bdo:

Cdc mdu nude xet nghiem dugc xii ly nhu sau:

- Lly mau nude ddnh phen, de ldng 1 gid

- Gan bd nude phia tren

F t t F

- Lay can cho vao cdc thdt ddy cd chan, dd lang 2-4 gid

- Diing dng hiit bd nude trong phia tren

- Hiit can soi tim tning ky sinh tning

- Chii y soi hit toan bd can

6 Cac ch! sd dieu tra bao gom:

+ Tning va lu triing giun dudng mdt, giun ddu gai, giun xoan

+ Au triing sdn la gan (sdn la gan ldn, sdn Id gan nhd), sdn Id mdt (sdn Id mdt ldn,

san la mdt nhd), san la phdi vd mdt sd au tning giun sdn khdc

+ Bao nang don bao gay benh (amip, trimg roi, bao hi trimg )

7 Xac djnh loai cac mim benh:

+ Phuong phap thu thap mam bgnh ky sinh trimg bao gdm ep sol tuai, tigu co bang

pepsin axit va ly tam lang can hoac phuong phap ndi Romanenko

-I- Xac djnh loai bing hinh thai hpc theo khoa djnh loai ciia Ichiro Miyazaki, Prayong Radomyos va Johannes Kaufinann

+ Tham djnh mpt so loai bang sinh hpc phan tu sir dvng gen nhan va gen t) thg Bao gdm cac budc: tach chigt ADN tdng so, chpn mdi (primer) dac hieu, thvc hien phan img PCR, ddng hda san pham, giai trinh tu chudi gen, xir ly chudi gen bang may chuygn dung AsemblyLIGN 1.9 va Mac Vector 6.5.3 (Oxford Molecular Inc.), xir ly

sd ligu bang sinh-tin hoc So sanh chudi mau trong ngan hang gen hay chiing chuan qudc tl (chiing Quang Tay Trang Qudc, ngan hang gen AF184619 va chiing Nam Han Qudc, ngan hang gen AF 181889)

8 De xuat mpt so giai phap de bao ve ngudi sir dung nhung thue pham co mam bgnh ky sinh trimg

9 Xir ly so li?u bing loan thdng kg Y - sinh hpc

Chuong 4 KET QUA NGHIEN CUtJ

1 Tai thanh pho

1.1 Mdm benh ky sinh triing tren cd

2 (4%)

3 (12%) 25(10%)

Lo^i s^n

Hp+Hl Hp+Ht Hp+Hl

Hp Hp+Ht

TP H6a Binh

So (+)/%

2(4%) 2(4%) 3(6%)

0 1(2%)

8(3,2%)

Lo^i sdn

Hp

Hp Hp+Ht

Ghi chii: Hp = Haplorchis pumilio; Ht = Haplorchis taichui

Nhan xet: TP Nam Dinh cdch xa vung luu hdnh bdnh sdn Id tmydn qua cd khodng

50 km, nhung ciing cd ty Id cd nhidm lu tning sdn cao ban d Hda Binh vd Hd Ndi,

sy khdc nhau nay cd y nghia thdng kd tren cd trdm vdi p<0,05, my Hda Binh cung

cd benh sdn la tmyIn qua cd luu hanh Ddc biet tai cd 3 thdnh phd ddu chua thiy du

Loai KST

Loai KST

0

0

Paragonimus spp

S erinacei

ATa^*va

Paragonimus spp**

Gnathostoma

0

0

S erinacei

Ghi chii: ATSLa* = Parapleurolophocercous cercaria (thudc nhdm sdn la gan nhd vd

sdn la mdt nhd); S.erinacei= Spirometra erinacei; **= Au triing sdn Id phdi

Nhan xet: Tai 3 thdnh phd diu phdt hien lu triing san nhdi tren ech, tai TP Nam

28

Dinh va Hd Ndi da phdt hi?n giun diu gai trdn luon, ddc biet tai TP Hda Binh da phdt hien lu tning sdn la phoi tren cua da vd tren dc miit Sy khdc nhau giiia cdc

7 ^

didm khdng cd y nghia thdng ke vdi p>0,05

1.3 Mdm binh giun sdn tren rau tuoi sdng

Bang 3 Ty le rau 6 nhiem b&i mdm b?nh giun sdn tgi diem thdnh phd

27(8,2%)

Lodi KST

D,T^I D,M T,M D,T D.TM, SLRN

11(3,3%)

Lodi

KST

D D,T

T

T D,T D,T

Ghi chii: D = tning giun diia; T = Tning giun tdc; M = Au tning giun mdc; SLRN =

tning san Id mpt nhd; L = Au tning giun luon Angiostrongylus spp

F > ^

Nhan xet: Trdn tat cd cdc loai rau tai TP Nam Dinh va Tp Hd Ndi ddu cd mam benh giun sdn, rieng TP Hda Binh chi cd 3 loai rau cd mam benh giun san Sy khac nhau giua cdc dilm cd y nghia thdng ke vdi rau dilp vd rau mudng, p<0,05

1.4 Mdm binh dan bdo tren rau tuoi song

Bdng 4 Ty le rau d nhiem b&i mdm benh dan bdo tai diem thdnh phd

E Jiis, Crypto, Cyclo, Giardia, ^ EJiis, Qypto, Cyclo, Giardia, ^ EJiis, Crypto, Cyclo

Giardia, # Ellis, Qypto, Cyclo, Giardia, ^ EJiis, Qypto, cycle,

Giardia,

4-EJiis, Qypto, Cyclo, Giardia,?^

EJiis, Cryp)to

Cyclo

Giardia,/

E.his, Crypto, Cyclo,

Giardia, i^

E.his, Qypto, Cyclo, # Qypto, Cyclo 5t

EJiis, Crypto, Cyclo, Giardia, / EJiis, Qypto, Cyclo, Giardia, /

E.his, Crypto, Cyclo, Giardia, / EJiis, Crypto, Cyclo, Giardia, # EJiis, Qypto,

Cyclo, t

EJiis, Eco, Qypto, Cyclo, Giardia,/ EJiis, Qypto, Cyclo, Giardia, / EJiis, Crypto, Cyclo, Giardia, /

Ghi chii: E.his = Entamoeba histolytica; Crypto = Cryptosporidium; Cyclo =

29

Cyclospora; i^ = don bdo khac

- Trong dd, tai Nam Dinh ty Id nhilm amip 14 (4,2%), Cryptosporidium 98

(29,7%), Cyclospora 53 (16,1%), Giardia 45 (13,6%) vd don bdo khdc 49 (14,8%) Tai Hda Binh ty le nhilm amip 6 (1,8%), Cryptosporidium 17 (5,2%)), Cyclospora

22 (6,7%), Giardia 9 (2,7%) va dan bdo khdc 27 (8,2%)

- Tai Ha Ndi ty Id nhidm amip 9 (2,7%), Cryptosporidium 38 (11,5%), Cyclospora

26 (7,9%), Giardia 10 (3,0%) va don bdo khdc 25 (7,6%)

Nhdn xet: Tai cd 3 thdnh phd rau diu d nhilm mdm bdnh don bdo vdi ty le cao vd bao gdm nhidu don bdo gay b$nh nguy hiem Ty le nhilm don bdo d TP Nam Dmh cao ban d TP Hd Ndi cd y nghia thdng kd vdi p<0,01 vd p<0,05

1.5 Mdm binh giun sdn trong nu&c thdi su dung nudi thuy sdn vd tu&i rau

Bdng 5 Ty le mdu nu&c nhiem mdm b?nh giun sdn tgi hd thdnh phd

Lodi KST

D,T,M, SLRN D.T^I

Lodi KST

NQi Lodi KST

D D,T

nude d ddy vd bun ddu thay mam bdnh giun san.Ty le nhidm mam bdnh giun sdn d

TP Nam Dinh cao ban d TP Hd Ndi cd y nghia thdng kd vdi p<0,01 va p<0,05

1.6 Mdm binh dan bdo trong nu&c thdi su dung nudi thuy sdn vd tu&i rau

Bdng 6 Ty le nu&c d nhiem b&i mdm benh dan bdo tgi diem thdnh pho

Lodi KST

Crypto, Cyclo, Giardia, ^ EJiis, Qypto, Cyclo, Giardia, ^ E.his, Crypto, Cyclo, Giardia, ^

TP Hda Binh s6(+)/%

Lodi KST

E.his,?t

E.his, Qypto, Cyclo, Giardia, # E.his, Qypto, Cyclo, ?t

E.his, Crypto,

EJiis, Qypto, Cyclo, Giardia, # E.his, Crypto, Cyclo, ?t

30

Ghi chii: E.his = Entamoeba histolytica; Crypto = Cryptosporidium; Cyclo =

Cyclospora; ^ = don bdo khdc

Nhdn xet: Trong nude thai sir dung nudi thuy sdn vd m'di rau, cd 3 vi tri deu phat

hien dan bao gay bdnh, trong do nude bl mat nhilm it ban Ty le nhilm mam benh

don bdo d TP Nam Dinh cao ban d TP Ha Ndi cd y nghia thdng kd vdi p<0,01 vd

p<0,05

2 Tai ndng thdn

2.1 Mdm bfnh ky sinh triing tren cd

Bdng 7 Ty le cd nhiem du triing sdn Id tgi ao ndng thdn

SLGN Hp+Ht Hp+Ht

1(2%)

0 8(3,2%)

benh sdn la tmyen qua cd, nen cd ty le cd nhiem du trung sdn cao ban d xa Hdi Bdi,

Hd Ndi, ddc biet tai 2 dilm nay diu tim thdy du trung sdn Id gan nhd, la benh cd ty

Id nhilm tren ngudi cao Ty le nhilm au trung san la trdn ca chep, ca trdm va ca rd

phi d didm Nam Dinh cao ban d didm Hod Binh vd Hd Ndi cd y nghia thdng kd vdi

p<0,01

2.2 Mdm binh giun sdn ky sinh tren luan, cua, tdm, ich, dc

Bdng 8 Ty le luan, tdm, cua, ech vd dc nhiem du triing giun sdn tgi diem ndng thdn

Lodi KST

Lodi KST

Gnathostoma

S.erinacei

Ghi chii: ATSLa* = Parapleurolophocercous cercaria (nhdm sdn la gan nhd vd san Id

mdt nhd); S.erinacei= Spirometra erinacei; Gnathostoma=au tnmg giun ddu gai

t y F F F

Nhan xet: Tai 3 diem ndng thdn ddu phdt hien au trung san nhdi tren ech vd au

tning giun ddu gai tren luon; ddng thdi tun thdy au tmng sdn Id trdn dc Ech nhidm

F t ' '

du trung san nhdi d didm Ha Ndi cao ban d didm Nam Dinh vd diem Hod Binh vdi

t t

p<0,05 va d didm Nam Dinh cao ban d diem Hod Binh vdi p<0,05

2.3 Mdm benh giun sdn tren rau tuoi sdng

Bdng 9 Ty le rau d nhiem b&i mdm benh giun sdn tgi diem ndng thdn

9 (16,4%) 33(10%)

un diia; T =

Lodi KST

D , T M SLRN

M

T.SLRN D.T^I D,T,H

L, SLGN D.TM

?iun tdc; N

Lodi KST D,T

D,T

0

0 D,T

4(7,3%) 25(7,6%)

e eiun mdc

Lodi KST

D.TAl

D,T T,M D,T

D,T,M

D,TM, SLRN

;SLRN = tning san Id mdt nhd; SLGN= tning san la gan nhd; L = Au trung giun luan

Angiostrongylus spp

32

Nhan xet: Trdn tdt ca cdc loai rau tai Hai Hda, Nam Dinh vd Hdi Bdi, Hd Ndi diu

cd mam benh giun sdn, ridng Hap Thinh, Hda Binh chi cd 4 loai rau cd mam benh

giun sdn Ddc biet tai dilm ndng thdn Nam Dinh da tim thdy tning sdn Id gan nhd

F ,

vd du triing giun luan nao trong rau Su khdc nhau giiJa cdc didm khdng cd y nghia

thdng kd vdi p>0,05

2.4 Mdm binh dan bdo trin rau tuai song

Bdng 10 Tyle rau 6 nhiem bai mdm benh dan bdo tai diem ndng thdn

E.his, Crypto, Cyclo,

Giardia, ^

EJiis, Qypto, Cyclo,

Giardia, i=

EJiis, Qypto, Cyclo, Giardia, T^

EJils, Crypto, Cyclo, Giardia, ^ EJiis, Crypto, Cyclo,

Giardia, ^

EJiis, Crypto, Cyclo, Giardia, /

E.his, Crypto, Cyclo, Giardia, # E.his, Crypto, Cyclo, Giardia, ^ E.his, Crypto, Cyclo, #

E.his, Qypto, Cyclo, ?i

EJiis, Qypto, Cyclo, Giardia, # EJiis, Qypto, Cyclo, Giardia, #

Hai Boi, Ha Npi

E.his, Crypto, Cyclo,

Giardia, i^

E.his, Crypto, Cyclo, Giardia, # E.his, Crypto, Cyclo, Giardia, 9^

E.his, Qypto, Cyclo, Giardia, 9^

E.his, Crypto, Cyclo, Giardia, ^ EJiis, Crypto, Cyclo, Giardia, #

Ghi chii: E.his = Entamoeba histolytica; Crypto = Cryptosporidium; Cyclo =

Cyclospora; 7^ = dan bdo khdc

- Trong dd, tai Hdi Hda (ndng thdn) Nam Dinh ty le nhilm amip 22 (6,7%),

Cryptosporidium 116 (35,2%), Cyclospora 61 (18,5%), Giardia 46 (13,9%) vd don

bdo khdc 65 (19,7%)

- Tai xa Hpp Thinh, Hda Binh ty le nhilm amip 14 (4,2%), Cryptosporidium 23

(7,0%), Cyclospora 27 (8,2%), Giardia 11 (3,3%) va dan bdo khdc 50 (15,2%)

33

Tai Hdi Bdi (Ndng thdn) Ha Ndi ty Id nhilm amip 14 (4,2%), Cryptosporidium 16 (23,0%), Cyclospora 48 (14,5%), Giardia 23 (7,0%) vd don bdo khac 37 (11,2%)

Nhan xet: Tai cd 3 diem ndng thdn, rau diu d nhilm mdm bdnh don bdo vdi ty le cao va bao gdm nhidu don bdo gay bdnh nguy hiem Ty le nhiem don bdo tren rau tai dilm Nam Dinh cao ban dilm Hod Binh vdi p<0,01 vd cao ban dilm Hd Ndi vdi p<0,05

2.5 Mdm binh giun sdn trong nu&c thdi su dung nudi thdy sdn vd tu&i rau

Bdng 11 Tyle mdu nuac nhiem mdm b?nh giun sdn tgi ndng thdn

D,T D,T,H SLRN, SLGN

B,TM,

SLRN, SLGN

H9P Thjnh, Hda Binh s6 (+)/%

1 (2%) 11(22%)

13 (26%)

25(16,7%)

Lodi KST

D D,T

SLRN

Ghi chii: D = tning giun dGa; T = Tning giun tdc; M = Au trung giun mdc; SLRN = tning sdn Id mdt nhd; SLGN= tning sdn la gan nhd

Nhan xet: Tai 3 dilm nghidn ciiu, nude bl mat chi cd dilm Hdi Bdi, Hd Npi Id

khdng thdy mdm bdnh giun sdn, nude d ddy va bun ddu thdy mam bdnh giun san, ddc biet da tim thdy tning sdn Id gan nhd tai Hdi Hda, Nam Dinh va sdn Id mdt nhd tai Hdi Hda vd Hop Thinh Ty Id nhilm giun sdn d nude ddy vd bun tai diem Nam Dinh cao ban dilm Hod Binh vdi p<0,01 va 0,05; va ty Id nhidm don bdo nude d day tai dilm Nam Dinh cao ban dilm Ha Ndi cd y nghia vdi p<0,05

2.6 Mdm benh dan bdo trong nu&c thdi su dung nudi thdy sdn vd tu&i rau

Bang 12 Ty le ^<^hd nhiem b&i mdm binh dan bdo tgi diem ndng thon

34

35 (70%)

38 (76%)

81(54,0%)

Lodi KST

EJiis, Crypto, Cyclo, Giardia, / E.his, Crypto, Cyclo, Giardia, ^ E.his, Crypto, Cyclo, Giardia, /

Hgp Thjnh, Hda Binh

So (+)/%

2 (4%)

6 (12%)

8 (16%)

16(10,7%)

Lodi KST

E.his, 5^

E.his, Crypto, Cyclo,

Giardia, -^

E.his, Crypto, Cyclo, Giardia, ?t

Hai Boi, Hd Noi

So (+)/%

5 (10%)

15

(30%)

19 (38%) 39(26%)

Lodi KST

E.his, Crypto, Cyclo,

Giardia, f

E.his, Crypto, Cyclo, Giardia, ?^ E.his, Crypto, Cyclo,

nude day vd bun tai didm Nam Dinh cao ban diem Hod Binh va Hd Ndi vdi p<0,01

va ty Id nhidm don bdo nude d be mat tai didm Nam Dinh cao ban diem Hod Binh

cd y nghia vdi p<0,05

3 Tong hop so sdnh cac dilm nghien cmi

Bang 13 Mam benh KST tren thuy san

- Tai S^m thdnh ph6: Ty Id nhilm du trung sdn la d ca tai diem Nam Dinh cao ban

dilm Hod Binh va Ha Ndi cd y nghia thdng kd vdi p<0,01

Tai diim ndng thon: Ty le nhiem du triing sdn la d cd tai dilm Nam Dinh ciing cao

ban dilm Hoa Binh va Ha Npi cd y nghia thdng kd vdi p<0,01 Ech tai dilm Nam dinh cao hon dilm Hod Binh cd y nghia vdi p<0,05

35

Bang 14 M^m benh KST tren rau

8,2%

53%

N8ng thon 10%

72,7%

Hod Binh Th^nh pho

1,2%

23,6

Ndng thon 6,1%

23,9%

HdNoi Thanh pho 3,3%

30,6%

Nong thon 7,6%

48,8%

Nhan xet:

- Tai mim thdnh pho: Ty Id rau nhilm mdm benh giun sdn vd don bdo tai dilm Nam

Dinh cao ban dilm Hod Binh vd Hd Npi ed y nghia thdng kd vdi p<0,01

- Tai diem ndng thdn: Ty l^ rau nhidm mdm b?nh giun sdn vd dan bdo tai didm Nam

Dinh cOng cao ban dilm Hod Binh vd Ha Npi cd y nghia thdng ke vdi p<0,01

Bang 15 M&n benh KST trong nude thdi

Lodi KST

Giun san

Dan bao

Nam Djnh Th&nh pho

4,7%

22,0%

Ndng thdn 16,7%

10,7%

HdNoi Th^nh pho 14,7%

- Tai diim thdnh phS: Ty le nude thdi d nhiem mam bdnh giun sdn va don bdo tai diem

Nam Dinh cao ban dilm Hod Binh vd Ha Npi cd y nghia thdng kd vdi p<0,01

» ^ ^ FV y t

Tai diem ndng thdn: Ty le rau nhiem mam benh giun sdn va dan bdo tai diem Nam

Dinh ciing cao ban diem Hod Binh va Hd Ndi ed y nghia thdng ke vdi p<0,01

Rieng ty le nhilm mdm benh giun sdn giiia dilm ndng thdn Nam Dinh vd Ha Ndi

khdng cd su khdc nhau vdi p>0,05

3 TMm dinh mgt so loai ky sinh trung bing sinh hoc phan tv

Cdc mdu au tning sdn la gan nhd thu thap tii cd tai cac didm nghidn cuu duac

thdm dinh lodi bdng sinh hpc phan tu (ky thudt PCR) su dung chudi gen coxl he

gen ty thi Cac gidi trinh tu nucleotid va acid amin duac so sanh vdi cac chuoi mau

da biet tmdc nhu vdi cdc chuoi coxl ciia cdc chung tren thd gidi Kit qud cho thdy,

vdi 446 nucleotid vd 148 acid amin trong chudi Coxl ciia mdu Clonorchis sinensis

y ' '

Viet nam tuang ddng nucleotid vdi Clonorchis sinensis Trung C^dc vd Han Qudc

la 99,6% va tuomg ddng acid amin 100%

Cac mdu du triing sdn la mdt nhd thu thap ttr cd tai cac dilm nghien ciiu ciing da

duac thdm dinh loai bdng sinh hpc phan tii sii dung chi thi di tmyIn phdn tu la doan