边境线上的疫病联防联控 
    发布日期：2010-11-04　 来源：健康报　

图示∶2010年12月即将出版的《中国特色医疗金鉴》登载的刘君主任及其机构

慢性艾滋病早期中医药治疗保障生命论证

　　■越南妹的同伴教育 

　　今年10月底的一天上午，黄秋梅向位于中越边境小镇浦寨靠近边防站的艾滋病门诊走去。在那里，她拿到一些关于艾滋病的宣传资料和安全套，打算去娱乐场所宣传和发放。

　　黄秋梅走进附近的一条小街。街道两侧楼房很新，底层敞开，似乎是商铺或者发廊，但没有货物，也没有理发工具，只有两三个浓妆艳抹的年轻女子向外张望。

　　“姐，来啦！”远远的，一位穿着艳丽的年轻女孩站起来打招呼。当突然看到黄秋梅身后的记者手拿相机时，她连连摆手，嘴里用越南语叽里哇啦地大叫。“请收起相机，她不让拍照。”黄秋梅告诉记者。走进房子，从楼上又下来2个女孩，5个女孩围着黄秋梅和她带的安全套连说带笑——她们说的都是越南语。

　　今年38岁的黄秋梅来自越南，是广西壮族自治区凭祥市疾控中心跨境艾滋病干预项目专门聘请的同伴教育宣传员。她和另外2位中国同事一起负责浦寨镇娱乐场所的艾滋病宣传教育工作。  

　　“那些女孩是哪里人，刚才你们说什么？”记者问。 

　　“她们都是越南‘小姐’。今年年底将有一次免费体检，我告诉她们什么时候开始、查什么、在哪里查。如果身体没事可以安心回老家……”黄秋梅操着一口流利的汉语回答。

　　黄秋梅做越南“小姐”的同伴教育工作已经4年多。目前，她与100多名生活在浦寨镇的越南“小姐”有单线联系。“这些姐妹都来自越南农村，她们很需要防病知识。”她说，“干她们这行，流动性很大，最多的时候，我手里有600多人呢！”

　　浦寨镇距凭祥市十多公里，与越南谅山省文朗县新清口岸隔街相连。这个只有２平方公里的小镇，边贸年交易额达10亿元人民币以上，吸引了全国各地及越南的众多人士来此“淘金”。这里还有号称亚洲最大的货运大卡车停车场，每天有数千名来自中越的长途卡车司机在这里逗留、转货。

　　“不分国别，只要在浦寨镇地盘上的，都是我们的宣传干预对象。” 凭祥市疾控中心主任何波说。在边境防病项目支持下，凭祥市除了把性服务人员、吸毒人员作为高危人群进行干预外，还把长卡司机、打工者也列入调查干预人群。

　　“今年我们监测了400名中外长途卡车司机，有109名主动承认有过商业性性行为。实际情况应该比此数据更高。”广西壮族自治区卫生厅国合处处长宫学林说，“我们已把相关资料反馈给越方，准备在即将召开的双方协调会上共商对策。”

　　■联控机制快速扑灭疫情

　　由于特殊的地理、气候条件，与缅甸、老挝、越南等国接壤的广西、云南等边境地区，是我国多种传染病的高发地区，境外传染病输入的威胁随时存在。据统计，2005年，云南省疟疾发病率为3.098/万，其中50%以上的病例为境外感染输入。当年，在卫生部国际合作司的支持下，云南和广西开始在部分边境地区实施跨境传染病防治合作项目。首个病种选择的是疟疾，之后是艾滋病。今年，为落实温家宝总理在第三届大湄公河次区域领导人会议上的承诺，项目领域又扩展到登革热防治。
    据云南省寄生虫病防治所副所长周红宁介绍，经过几年探索，跨境传染病联防联控合作机制已初步建立，可概括为：签署了跨境卫生合作协定，实现了传染病疫情相互通报，联合开展跨边境、同步多语种传染病防治大众宣传等。

　　“大家虽然是邻居，但过去在卫生方面的合作并不多，有一些也是靠国际非政府组织当中间人。”云南省卫生厅疾控局副局长李永说，几年下来，目前所有中方的项目县都与外方建立了跨境卫生合作联防联控工作机制，定期召开会议，制定跨境合作战略。艾滋病项目还建立了跨国、跨部门的工作机制。“对方国家的态度也由一开始的拒绝和不配合，逐步转变为主动请求与我方合作。”

　　“联防联控最直观的效果是，能把疫情苗头消灭在国门之外。”云南省盈江县卫生局局长瞿炳生说。盈江县与缅甸克钦邦第二特区相邻，交界地区山高林密，边界线犬牙交错。今年9月中旬，盈江县疾控中心接到对方报告：克钦邦东方省洪崩区某村（距中国边境约6公里）有6名发热病人，快速诊断检测为疟疾阳性，如不及时处置，疫情可能扩散到中国境内。根据联防联控项目有关规定，盈江县疾控中心迅速派出2名业务骨干，携带采血工具和消杀药品前往该村“核实诊断病人、开展卫生宣教、治疗现症病人、村民预防性服药、环境媒介防治，在中方医务人员的协助下，疫情很快得到控制，是跨境疟疾疫情处置的一个成功范例。”

　　“疟疾病人越来越少。”盈江县那邦镇卫生院李院长告诉记者。那邦镇与缅甸拉咱市仅一条小河相隔，搭一块木板就能轻松越过两国边境。李院长说，前些年，该卫生院1/3的病人是疟疾病人，其中一多半是缅甸人；这几年，无论中缅，疟疾病人均大幅减少，卫生院储备的治疗用药经常用不完。相比之下，由于防疟知识普及，疟疾预防药品和物资用得很快。

　　■跨境防病任重道远
    “传染病流行没有国界，如何探索稳定的、真正超越国境线的联防联控机制，是更高级政府层面需要认真思考的问题。”云南省德宏州卫生局副局长赵兴海说。

　　云南省寄生虫病防治所副所长周红宁认为，目前摸索建立的边境传染病联防联控机制覆盖的地区和病种有限。“云南省西部与缅甸接壤，南部与老挝、越南比邻，边境线超过4000公里，联防机制目前只覆盖了不到1/4的边境地区。”他指着地图解释说，下一步，机制建设在扩大覆盖范围的同时，重点还应放在双边都有联防需求的病种上。比如，乙脑，双边边境发病率都较高，对联防有硬性需求，这样才能取得稳定的效果。

　　此外，边境地区流动人口剧增，也是防病面临的难题。云南省瑞丽市疾控中心副主任李洲林介绍，目前瑞丽与缅甸木姐双方在旅游经商、境外务工、出入境人员、跨国婚姻、基础设施建设等方面的流动人口有数十万人，特别是随着我国取消对艾滋病病人的入境限制，大量缅甸艾滋病病毒携带者流入我国境内，“流动人口中的艾滋病发病率居高不下，应对措施必须跟进。”

Of the border joint prevention and control diseases
    Release Date :2010 -11-04 Source: Health News
In support of the Ministry of Health, in recent years, Guangxi, Yunnan and other provinces (regions) in China and Vietnam, Burma, Laos border in some areas to carry out cross-border joint prevention and control of infectious diseases pilot project. Experimental effects? Disease prevention and how to work the booming border trade to provide a solid guarantee? Not long ago, a reporter with the Ministry of Health steering group to find out the area.

■ Vietnam sister's peer education

The end of October this year, one morning, Huang Qiumei to pump in the border town of Vietnam near the border posts of the AIDS patient Village walk. There, she got information about AIDS and condom promotion, going to places of entertainment publicity and distribution.

Huang Qiumei into a side street nearby. Streets on both sides of the building is new, the underlying open, seems to be shop or hair salon, but no cargo, no barber tools, only two or three makeup of the young woman looked out.

"Sister, come!" Far away, one wearing a beautiful young girl got up to say hello. When a reporter suddenly see Huang Qiumei hand behind the camera, she waved their hands, mouth, Peter was in uproar with the Vietnamese cried. "Please put away the camera, she was not to be photographed." Huang Qiumei told reporters. Into the house, upstairs and down the two girls, five girls around Huangqiu Mei and her connection with the condoms, said with a smile - they said they are Vietnamese.

Huang Qiumei 38-year-old from Vietnam, Pingxiang City, Guangxi Zhuang Autonomous Region CDC is a cross-border HIV intervention program to hire advocates of peer education. She and the other two Chinese colleagues in charge of entertainment Pu Zhaizhen AIDS education work.

"Where are those girls, you just say?" The reporter asked.

"They are Vietnam 'Miss'. This year there will be a free medical examination, I told them when to start, check what, where investigations. If the body is nothing to worry back home ... ..." Huang Qiumei answered, speaking in fluent Chinese.

Huang Qiumei to do in Vietnam, "Miss" Peer education has been more than 4 years. Currently, she and more than 100 Vietnamese living in the Pu Zhaizhen "Miss" has single-line contact. "The sisters are from rural Vietnam, they are badly in need of disease prevention knowledge." She said, "their line of dry, highly mobile, up to the time do my hands more than 600!"

Pu Zhaizhen more than ten kilometers from Pingxiang City, Vietnam, Lang Son and Qing Sheng Wen Long County, across the street connected to the port. The town is only 2 square kilometers, the border trade amounted to 10 billion yuan in trading over the country and Vietnam has attracted many people to this "gold." There is also known as Asia's largest cargo truck parking lot, every day thousands more from the long-distance truck drivers stay in here, transfer cargo.

"Regardless of country, as long as the pump Zhaizhen the sites, are the object of our advocacy interventions." Pingxiang City CDC main Renhe Bo said. Support disease prevention programs at the border, Pingxiang City, in addition to sex workers, drug users as high-risk groups to intervene, but also a long truck drivers, migrant workers are also included in the survey intervention groups.

"This year we monitored the 400 Chinese and foreign long-distance truck drivers, there are 109 active admitted to having commercial sex. Actual data should be higher than this." Guangxi Zhuang Autonomous Region Office of International Cooperation Office of the Director of Health and Science Palace, said that " We have information back to Vietnam in preparation for the upcoming meeting, the two sides jointly coordinated countermeasures. "

■ Fast Fight disease associated control mechanism

Due to the special geographical and climatic conditions, with Myanmar, Laos, Vietnam and other countries bordering Guangxi, Yunnan and other border areas, China's high incidence of many infectious diseases, the threat of foreign diseases enter there at any time. According to statistics, in 2005, malaria incidence in Yunnan Province was 3.098 / million, of which 50% of the cases was infected outside input. That year, the Ministry of Health with the support of International Cooperation Department, Yunnan and Guangxi in some of the border areas of infectious diseases prevention and control cross-border cooperation project implementation. The first choice is the disease of malaria, followed by AIDS. This year, for the implementation of Premier Wen Jiabao at the Third GMS Summit's commitment to the project area has expanded to dengue fever prevention and control.
    According to the provincial deputy director of Parasitic Diseases Zhou Hongning introduced after several years of exploration, joint prevention and control cross-border cooperation mechanisms of infectious diseases has been initially established, can be summarized as: Cross-border health cooperation agreement was signed to achieve a mutually infectious diseases communications, cross-border joint, simultaneous multi-lingual public awareness and other infectious diseases.

"Although we are neighbors, but in the past cooperation in health is not much, but also by some international non-governmental organizations as intermediaries." Yunnan Provincial Health Department, Deputy Secretary Mr LEE Wing-disease control, said a few years, all Chinese now The project counties were established with foreign cross-border health cooperation mechanism for joint prevention and control work, meeting regularly to develop cross-border cooperation strategy. AIDS project has also established a cross-border, cross-departmental working mechanism. "Attitude of the other country refused from the beginning and do not fit, and gradually shift to active cooperation with our requests."

"Joint prevention and control effect of the most intuitive, can eliminate the epidemic in the country beyond the signs." Yingjiang County Bureau of Health Qubing Sheng said. Yingjiang Kachin State Special Region of Myanmar is adjacent to the border area of high mountains, dense forests, jagged boundary line. In mid-September this year, CDC received other reports Yingjiang: Kachin village in Eastern Province, Hong collapse area (about 6 km away from the Chinese border) there are six patients with fever, rapid diagnostic tests for malaria-positive, if not disposal, the epidemic may spread to China. According to the relevant provisions of joint prevention and control project, the CDC dispatched two Yingjiang backbone, carrying blood collection tools and disinfection drugs to the village "verified diagnosis of the patient, carry out hygiene education, treatment, patients are now, the villagers of preventive medication, environmental media control, with the assistance of medical personnel in China, the epidemic was quickly controlled, cross-border malaria epidemic is a successful example of disposal. "

"Fewer and fewer malaria patients." Yingjiang town hospitals that state Premier Lee told reporters. Myanmar state that the town is only a small river city we pull apart, take a piece of wood can easily cross the border. Premier Lee said that in previous years, the health center 1 / 3 of the patients suffering from malaria, one of the mostly Burmese; these years, both China and Burma, the significant reduction of malaria patients, hospitals often use therapeutic use of reserves is not End. In contrast, the anti-malaria literacy, malaria prevention with drugs and supplies quickly.

■ long way to go cross-border disease control
    "Infectious disease epidemic knows no borders, how to explore the stability of the real beyond the borders of the joint prevention and control mechanism, is more senior government levels need to seriously think about." Dehong Zhao Xinghai, Deputy Secretary for Health, said.

Parasitic Diseases of Yunnan Province, deputy director Zhou Hongning that the current border to explore the establishment of mechanisms for joint prevention and control of infectious diseases covered by the region and the disease is limited. "Western Yunnan province bordering Myanmar, southern Laos, Vietnam, near the border line of over 4,000 km, defense mechanism currently only covers less than 1 / 4 of the border." He pointed at the map explains the next step, building in mechanisms expand coverage, priority should be placed on the needs of bilateral disease has on defense. For example, JE, have a higher incidence of bilateral border, on the defense of a rigid demand, so as to achieve stable results.

In addition, the flow of population growth in border areas, but also disease prevention are facing problems. CDC Deputy Director of Ruili City, Yunnan Province, Li Chau Linjie Shao, Ruili and Muse is currently both in the tourism business, foreign workers, immigration officers, transnational marriage, infrastructure construction and other aspects of the flow of hundreds of thousands of people, especially with the AIDS patients in China lift immigration restrictions, a large number of people living with HIV in Myanmar into our territory, "floating population in the high incidence of AIDS, response must follow."

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