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‫‪ ‬‬
‫א‪‬א‪ ‬‬
‫ﺍﻟﺘﻌﺭﻴﻑ‪:‬‬
‫ﺍﻟﺘﺭﺼﺩ ﺍﻟﻭﺒﺎﺌﻲ ﻫﻭ ﻤﻤﺎﺭﺴﺔ ﺍﻟﺘﻔﺤﺹ ﺍﻟﻤﺴﺘﻤﺭ ﻭﺍﻟﻤﺭﺍﻗﺒﺔ ﻟﺘﻭﺯﻉ ﻭﺍﻨﺘﺸﺎﺭ ﺍﻷﺨﻤﺎﺝ ﺃﻭ ﺍﻟﻌﻭﺍﻤل ﺍﻟﻤﻤﺭﻀﺔ‬
‫ﺃﻭ ﻟﻌﻭﺍﻤل ﺍﻟﺒﻴﺌﺔ ﺍﻟﺘﻲ ﺘﺅﺜﺭ ﻋﻠﻰ ﺘﻭﺯﻉ ﻭﺍﻨﺘﺸﺎﺭ ﺍﻷﺨﻤﺎﺝ ﺃﻭ ﺍﻟﻌﻭﺍﻤل ﺍﻟﻤﻤﺭﻀﺔ ﻤﻥ ﺃﺠل ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ‬
‫ﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﻨﺎﺴﺒﺔ ﻭﺍﻟﻔﻌﺎﻟﺔ‪.‬‬

‫ﺃﻫﺩﺍﻑ ﺍﻟﺘﺭﺼﺩ‪:‬‬
‫• ﺘﺤﺩﻴﺩ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺨﻤﺠﻴﺔ ﺫﺍﺕ ﺍﻷﻫﻤﻴﺔ ﺍﻟﺼﺤﻴﺔ ﺍﻟﻌﺎﻤﺔ‪.‬‬
‫• ﻤﻌﺭﻓﺔ ﺍﺘﺠﺎﻫﺎﺕ ﺍﻟﻤﺭﺽ ﻟﺘﺤﺩﻴﺩ ﺍﻻﻨﺤﺭﺍﻓﺎﺕ ﻏﻴﺭ ﺍﻟﻌﺎﺩﻴﺔ ﻋﻥ ﺍﻷﻨﻤﺎﻁ ﺍﻟﻤﺘﻭﻗﻌﺔ ﻤﺜل‪ :‬ﺍﻟﺘﻐﻴﺭﺍﺕ ﺍﻟﻔﺼﻠﻴﺔ ﺃﻭ‬
‫ﻓﻲ ﺨﺼﺎﺌﺹ ﺍﻟﻌﻤﺭ ﻭﺍﻟﺠﻨﺱ‪.‬‬
‫• ﺘﺤﺩﻴﺩ ﺍﻟﻤﺠﻤﻭﻋﺎﺕ ﺍﻟﺴﻜﺎﻨﻴﺔ ﺍﻷﻜﺜﺭ ﺘﻌﺭﻀﹰﺎ ﻟﺨﻁﺭ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﻤﺭﺽ ﻭﺍﻟﻭﻓﺎﺓ‪.‬‬
‫• ﺍﻟﺘﻌﺭﻑ ﺍﻟﺴﺭﻴﻊ ﻋﻠﻰ ﺤﺩﻭﺙ ﺍﻷﻭﺒﺌﺔ ﺃﻭ ﺍﻟﻔﺎﺸﻴﺎﺕ ﻤﻥ ﺃﺠل ﺍﺘﺨﺎﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻭﻗﺎﺌﻴﺔ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﺒﺼﻭﺭﺓ‬
‫ﻤﺒﻜﺭﺓ ﻟﻠﺴﻴﻁﺭﺓ ﻋﻠﻴﻬﺎ ﻗﺒل ﺘﻔﺸﻴﻬﺎ‪.‬‬
‫• ﺘﺤﺩﻴﺩ ﺍﻷﻭﻟﻭﻴﺎﺕ ﻓﻲ ﺨﻁﻁ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﺍﻟﻭﻗﺎﻴﺔ‪.‬‬
‫• ﺘﻘﻭﻴﻡ ﻨﺸﺎﻁﺎﺕ ﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﺭﺽ ﺍﻟﺤﺎﻟﻴﺔ ﻭﻓﻌﺎﻟﻴﺔ ﺍﻟﺘﺩﺨﻼﺕ ﺍﻟﻨﻭﻋﻴﺔ ﻭﺍﻟﺒﺭﺍﻤﺞ ﺍﻟﻭﻗﺎﺌﻴﺔ ﻓﻲ ﺇﻨﻘﺎﺹ ﺍﻟﻤﺭﺍﻀﺔ‬
‫ﻭﺍﻟﻭﻓﻴﺎﺕ‪.‬‬

‫ﻋﻨﺎﺼﺭ ﺍﻟﺘﺭﺼﺩ‪:‬‬
‫• ﺘﺭﺼﺩ ﺍﻟﻤﺭﺍﻀﺔ ﻭﺍﻟﻭﻓﻴﺎﺕ‪.‬‬
‫• ﺘﺭﺼﺩ ﺍﻟﺒﻴﺌﺔ‪ :‬ﻤﺎﺀ‪ ،‬ﻏﺫﺍﺀ‪ ،‬ﻗﻭﺍﺭﺽ‪ ،‬ﻨﻭﺍﻗل ﺤﺸﺭﻴﺔ‪ ...‬ﺇﻟﺦ‪.‬‬
‫• ﺘﺭﺼﺩ ﺍﻟﻤﻭﺍﺭﺩ ﺍﻟﻤﺴﺘﻌﻤﻠﺔ ﻓﻲ ﺍﻟﻤﻜﺎﻓﺤﺔ‪ :‬ﺍﻟﻤﺼﻭل‪ ،‬ﺍﻟﻠﻘﺎﺤﺎﺕ‪ ،‬ﺍﻟﻤﺒﻴﺩﺍﺕ‪ ،‬ﺍﻟﺼﺎﺩﺍﺕ‪.‬‬
‫• ﺘﺭﺼﺩ ﺍﻟﻌﻭﺍﻤل ﺍﻟﺨﺎﻤﺠﺔ‪ :‬ﻭﻴﺸﻤل ﻨﻭﻋﻬﺎ ﻭﺍﻟﺘﻐﻴﺭﺍﺕ ﺍﻟﻁﺎﺭﺌﺔ ﻋﻠﻴﻬﺎ ﻭﺤﺴﺎﺴﻴﺘﻬﺎ ﻟﻠﺼﺎﺩﺍﺕ‪.‬‬
‫• ﺘﺭﺼﺩ ﺍﻟﻔﺌﺎﺕ ﺍﻟﺴﻜﺎﻨﻴﺔ ﺍﻟﻤﺴﺘﻬﺩﻓﺔ ﻭﺤﺎﻟﺘﻬﺎ ﺍﻟﻤﻨﺎﻋﻴﺔ‪.‬‬
‫• ﺘﺭﺼﺩ ﺍﻟﻨﺘﺎﺌﺞ ﺍﻟﻤﺨﺒﺭﻴﺔ‪.‬‬
‫• ﺘﺭﺼﺩ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻭﻗﺎﻴﺔ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‪.‬‬

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 ‫ﻤﻘﻭﻤﺎﺕ ﺍﻟﺘﺭﺼﺩ ﺍﻟﻨﺎﺠﺢ‪:‬‬
‫• ﺃﻥ ﻴﺘﻭﺠﻪ ﻨﺤﻭ ﺍﻷﺤﺩﺍﺙ ﺍﻟﺼﺤﻴﺔ ﺫﺍﺕ ﺍﻷﻫﻤﻴﺔ ﺍﻟﻜﺒﻴﺭﺓ ﻴﺒﻴﻥ ﺍﻟﻌﻤﻭﻡ ﺃﻱ ﺍﻟﺘﻲ ﺘﺴﺒﺏ ﻗﺩﺭﹰﺍ ﻜﺒﻴﺭﹰﺍ ﻤﻥ ﺍﻟﻤﺭﺍﻀﺔ‬
‫ﻭ‪ /‬ﺃﻭ ﺍﻟﻭﻓﻴﺎﺕ‪ ،‬ﻭﻫﻲ ﺒﻨﻔﺱ ﺍﻟﻭﻗﺕ ﻗﺎﺒﻠﺔ ﻹﺠﺭﺍﺀﺍﺕ ﻋﻤﻠﻴﺔ ﻤﻥ ﺍﻟﻭﻗﺎﻴﺔ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‪.‬‬
‫• ﺃﻥ ﻴﻜﻭﻥ ﻤﺒﺴﻁﺎﹰ‪ ،‬ﻓﺎﻟﻤﺸﻜﻠﺔ ﺍﻷﺴﺎﺴﻴﺔ ﻓﻲ ﻤﻌﻅﻡ ﺃﻨﻅﻤﺔ ﺍﻟﺘﺭﺼﺩ ﺃﻨﻬﺎ ﻤﻌﻘﺩﺓ ﺠﺩﺍﹰ‪ ،‬ﻭﺒﺎﻟﺘﺎﻟﻲ ﻴﻬﺩﺭ ﺍﻟﻭﻗﺕ ﻓﻲ‬
‫ﺠﻤﻊ ﻤﻌﻠﻭﻤﺎﺕ ﻜﺜﻴﺭﺓ ﻭﻤﻔﺼﻠﺔ ﺒﺤﻴﺙ ﻻ ﻴﺒﻘﻰ ﻫﻨﺎﻙ ﻭﻗﺕ ﻟﺘﺤﻠﻴﻠﻬﺎ ﻭﺍﺘﺨﺎﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻜﻔﻴﻠﺔ ﺒﺎﻟﺴﻴﻁﺭﺓ ﻋﻠﻰ‬
‫ﺍﻟﻤﺭﺽ‪.‬‬
‫• ﻓﺎﻟﻘﺎﻋﺩﺓ ﺍﻷﺴﺎﺴﻴﺔ ﺃﻥ ﻻ ﻴﺘﻡ ﺠﻤﻊ ﺇﻻ ﺍﻟﻤﻌﻠﻭﻤﺎﺕ ﺍﻟﻼﺯﻤﺔ ﻭﺍﻟﺘﻲ ﺴﻴﺘﻡ ﺍﺴﺘﺨﺩﺍﻤﻬﺎ‪.‬‬
‫• ﺇﻥ ﺍﺘﺨﺎﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ ﻴﺠﺏ ﺃﻥ ﻴﺘﻡ ﺒﻨﻔﺱ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﺫﻱ ﻴﺠﻤﻊ ﺍﻟﻤﻌﻠﻭﻤﺎﺕ‪ ،‬ﻓﺎﺘﺨﺎﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻨﺎﺴﺒﺔ‬
‫ﻟﻠﺴﻴﻁﺭﺓ ﻋﻠﻰ ﺍﻟﻭﺒﺎﺀ ﺃﻭ ﺍﻟﻔﺎﺸﻴﺔ ﻴﺠﺏ ﺃﻥ ﻴﺘﻡ ﻤﻥ ﻗﺒل ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﻷﻥ ﺍﻨﺘﻅﺎﺭ ﺍﻟﺭﺩ ﻤﻥ ﺍﻟﻤﺴﺘﻭﻴﺎﺕ‬
‫ﺍﻷﻋﻠﻰ ﻗﺩ ﻴﺅﺩﻱ ﺇﻟﻰ ﻓﻭﺍﺕ ﺍﻷﻭﺍﻥ ﻭﻀﻴﺎﻉ ﺍﻟﻔﺭﺼﺔ ﻻﺤﺘﻭﺍﺀ ﺍﻟﻭﺒﺎﺀ‪.‬‬
‫• ﻴﺘﺄﻟﻑ ﻤﻥ ﻤﻜﻭﻨﺎﺕ ﺘﺸﻤل ﺘﻌﺎﺭﻴﻑ ﻭﺍﻀﺤﺔ ﻟﻸﺤﺩﺍﺙ ﺍﻟﺼﺤﻴﺔ ﺘﺤﺕ ﺍﻟﺘﺭﺼﺩ‪ ،‬ﻤﻊ ﻤﺴﺎﺭ ﻭﺍﻀﺢ ﻟﺴﻴﺭ ﺍﻟﺒﻴﺎﻨﺎﺕ‬
‫ﻭﻤﻌﺭﻓﺔ ﻜﺎﻓﻴﺔ ﺒﺎﻟﺠﻤﻬﺭﺓ ﺘﺤﺕ ﺍﻟﺘﺭﺼﺩ ﻭﻁﺭﺍﺌﻕ ﻤﺤﺩﺩﺓ ﻭﻤﻨﺎﺴﺒﺔ ﻟﺠﻤﻊ ﺍﻟﺒﻴﺎﻨﺎﺕ ﻭﺘﺤﻠﻴﻠﻬﺎ ﻭﺘﻔﺴﻴﺭﻫﺎ ﻭﺍﻟﺘﻐﺫﻴﺔ‬
‫ﺍﻟﺭﺠﻌﺔ‪.‬‬
‫• ﺃﻥ ﻴﺅﺩﻱ ﺇﻟﻰ ﺇﺠﺭﺍﺀﺍﺕ ﺼﺤﻴﺔ ﻜﺎﻓﻴﺔ ﻭﻓﻌﺎﻟﺔ ﻤﻌﺘﻤﺩﺓ ﻋﻠﻰ ﺍﻟﺒﻴﺎﻨﺎﺕ ﺍﻟﺘﻲ ﺘﻤﺕ ﻤﻌﺎﻟﺠﺘﻬﺎ‪.‬‬
‫• ﻴﺯﻭﺩ ﺒﻤﻌﻠﻭﻤﺎﺕ ﺴﺭﻴﻌﺔ ﻭﻜﺎﻓﻴﺔ ﻻﺘﺨﺎﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻔﻌﺎﻟﺔ‪.‬‬
‫• ﻴﻀﻤﻥ ﻤﺴﺘﻭﻯ ﻋﺎﻟﻲ ﻤﻥ ﺍﻟﻤﺸﺎﺭﻜﺔ‪.‬‬
‫• ﻗﺎﺒل ﻟﻠﺘﻜﻴﻑ ﻭﻴﺴﺘﺠﻴﺏ ﻟﻠﻤﺘﻁﻠﺒﺎﺕ ﺍﻟﺤﺩﻴﺜﺔ‪.‬‬
‫• ﻴﺘﻁﻠﺏ ﻤﻭﺍﺭﺩ ﻗﻠﻴﻠﺔ ﻭﻤﻨﺎﺴﺒﺔ‪.‬‬

‫ﻁﺭﻕ ﺍﻟﺘﺭﺼﺩ‪:‬‬
‫ﻫﻨﺎﻙ ﺃﺭﺒﻊ ﻁﺭﻕ ﻟﺠﻤﻊ ﻤﻌﻠﻭﻤﺎﺕ ﻜﻤﻴﺔ ﺤﻭل ﻭﻗﻭﻉ ﺍﻷﻤﺭﺍﺽ ﻭﺍﻟﻭﻓﻴﺎﺕ‪:‬‬
‫• ﻨﻅﺎﻡ ﺍﻹﺒﻼﻍ ﺍﻟﺭﻭﺘﻴﻨﻲ )ﺍﻟﺸﺎﻤل ﻷﻓﺭﺍﺩ ﺍﻟﻤﺠﺘﻤﻊ(‪ :‬ﻭﻴﺘﻡ ﻓﻴﻪ ﺠﻤﻊ ﻤﻌﻠﻭﻤﺎﺕ ﺤﻭل ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺭﻀﻴﺔ‬
‫ﺍﻟﻭﺍﺠﺏ ﺍﻹﺒﻼﻍ ﻋﻨﻬﺎ ﻭﻋﺩﺩ ﺍﻟﻭﻓﻴﺎﺕ ﻭﺃﺤﻴﺎﻨﹰﺎ ﺍﻟﺘﻭﺯﻉ ﺍﻟﻌﻤﺭﻱ‪ ،‬ﻭﻴﺸﻤل ﻜﺎﻓﺔ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﻨﻅﺎﻡ ﺍﻹﺒﻼﻍ ﺍﻟﺨﻔﺭ‪ :‬ﻴﺘﻡ ﻓﻴﻪ ﺍﻨﺘﻘﺎﺀ ﻋﺩﺩ ﺼﻐﻴﺭ ﻤﻥ ﺍﻟﻭﺤﺩﺍﺕ ﺍﻟﺼﺤﻴﺔ ﻟﺘﺴﺠﻴل ﺤﺎﻻﺕ ﺍﻟﻤﺭﺽ ﺃﻭ ﺍﻟﻭﻓﺎﺓ ﺍﻟﺘﻲ‬
‫ﺘﺸﺎﻫﺩ ﺃﻭ ﺘﺸﺨﺹ ﻤﻜﺎﻥ ﺍﻟﻭﺤﺩﺓ‪.‬‬
‫ﻭﻗﺩ ﻴﻁﻠﺏ ﻤﻨﻬﺎ ﻤﻌﻠﻭﻤﺎﺕ ﺇﻀﺎﻓﻴﺔ ﻟﻌﺩﺩ ﺍﻟﺤﺎﻻﺕ ﻭﺘﻭﺯﻋﻬﺎ ﺍﻟﻌﻤﺭﻱ ﻜﺎﻟﺤﺎﻟﺔ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ ﻟﻸﻁﻔﺎل ﺍﻟﻤﻌﺎﻟﺠﻴﻥ‬
‫ﺒﺎﻟﻭﺤﺩﺓ‪ ،‬ﻭﻏﺎﻟﺒﹰﺎ ﻤﺎ ﻴﺘﻡ ﺍﻨﺘﻘﺎﺀ ﺍﻟﻤﺸﺎﻓﻲ ﻜﻤﻭﺍﻗﻊ ﺨﻔﺭ ﻨﻅﺭﹰﺍ ﻷﻨﻬﺎ ﺘﺼﺎﺩﻑ ﺤﺎﻻﺕ ﻨﻭﻋﻴﺔ ﺃﻜﺜﺭ ﻤﻥ ﺍﻟﻤﺭﺍﻜﺯ‬
‫ﺍﻟﺼﺤﻴﺔ‪ ،‬ﻭﻓﻴﻬﺎ ﺇﻤﻜﺎﻨﻴﺎﺕ ﺘﺸﺨﻴﺼﻴﺔ ﻋﺎﻟﻴﺔ ﺍﻟﺠﻭﺩﺓ‪ ،‬ﻭﻓﻴﻬﺎ ﺘﺸﺎﻫﺩ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻭﺨﻴﻤﺔ ﻭﺘﺤﺩﺙ ﻭﻓﻴﺎﺕ ﺍﻟﺭﻀﻊ‬
‫ﻭﺍﻷﻤﻬﺎﺕ‪ ،‬ﺇﻀﺎﻓﺔ ﻟﻭﺠﻭﺩ ﻁﺎﻗﻡ ﺃﻜﺜﺭ ﺘﺩﺭﻴﺒﹰﺎ ﻋﻠﻰ ﻭﻀﻊ ﺍﻟﺘﺸﺨﻴﺹ ﻭﻤﻌﺎﻟﺠﺔ ﺍﻟﺒﻴﺎﻨﺎﺕ ﻭﺒﺎﻟﺘﺎﻟﻲ ﺩﻗﺔ ﻭﻤﻭﺜﻭﻗﻴﺔ‬
‫ﺍﻟﺒﻴﺎﻨﺎﺕ‪.‬‬

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‫ﻼ ﻋﻥ ﻨﻅﺎﻡ ﺍﻹﺒﻼﻍ‬
‫• ﺍﺴﺘﻘﺼﺎﺀ ﺍﻟﺤﺎﻟﺔ ﺃﻭ ﺍﻟﻔﺎﺸﻴﺔ‪ :‬ﻴﺤﺎﻭل ﺘﺤﺩﻴﺩ ﺃﺴﺒﺎﺏ ﺍﻟﻤﺭﺍﻀﺔ ﺃﻭ ﺍﻟﻭﻓﺎﺓ‪ ،‬ﻭﻫﻭ ﻟﻴﺱ ﺒﺩﻴ ﹰ‬
‫ﺍﻟﺭﻭﺘﻴﻨﻲ ﺃﻭ ﺍﻟﺨﻔﺭ‪ ،‬ﺒل ﻴﺴﺘﻌﻤل ﻜﺨﻁﻭﺓ ﺘﺎﻟﻴﺔ‪ ،‬ﻭﺒﺸﻜل ﻋﺎﻡ ﻓﺈﻥ ﺍﺴﺘﻘﺼﺎﺀ ﺍﻟﺤﺎﻟﺔ ﻫﻭ ﺍﺴﺘﻘﺼﺎﺀ ﺤﺎﻟﺔ ﻭﺍﺤﺩﺓ‬
‫ﺒﻴﻨﻤﺎ ﺍﺴﺘﻘﺼﺎﺀ ﺍﻟﻔﺎﺸﻴﺔ ﻫﻭ ﺍﺴﺘﻘﺼﺎﺀ ﻋﺩﺓ ﺤﺎﻻﺕ‪.‬‬
‫• ﺍﻟﻤﺴﻭﺡ ﻭﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﺨﺎﺼﺔ‪ :‬ﻏﺎﻟﺒﹰﺎ ﻤﺎ ﺘﺴﺘﺨﺩﻡ ﻤﺴﻭﺡ ﺍﻟﻌﻴﻨﺔ‪ ،‬ﻭﻫﻲ ﺘﺯﻭﺩ ﺒﺘﻘﺩﻴﺭ ﻋﺎﻡ ﻋﻥ ﻭﻗﻭﻉ ﻭﺍﻨﺘﺸﺎﺭ‬
‫ﺍﻟﻤﺭﺽ ﻭﻴﻤﻜﻥ ﺃﻥ ﺘﺴﺘﺨﺩﻡ ﻟﺘﻘﺩﻴﺭ ﻤﻌﺩل ﺍﻟﻭﻓﻴﺎﺕ ﺒﺸﺭﻁ ﺃﻥ ﻴﻜﻭﻥ ﺤﺠﻡ ﺍﻟﻌﻴﻨﺔ ﻜﺒﻴﺭﺍﹰ‪ ،‬ﻭﺘﺤﺘﺎﺝ ﺍﻟﻤﺴﻭﺡ ﻷﻥ‬
‫ﺘﻜﻭﻥ ﺩﻭﺭﻴﺔ )ﻤﺭﺓ ﺒﺎﻟﺴﻨﺔ ﻋﻠﻰ ﺍﻷﻗل( ﻟﻠﺤﺼﻭل ﻋﻠﻰ ﺒﻴﺎﻨﺎﺕ ﺤﻭل ﻨﺯﻋﺔ ﺍﻟﻤﺭﺽ ﺭﻏﻡ ﻜﻠﻔﺘﻬﺎ‪.‬‬
‫• ﺍﻹﺒﻼﻍ ﺍﻟﺼﻔﺭﻱ‪ :‬ﺍﻹﺒﻼﻍ ﻋﻥ ﻋﺩﻡ ﻭﺠﻭﺩ ﺤﺎﻻﺕ‪ ،‬ﺍﻟﻬﺩﻑ ﻤﻨﻪ ﺍﻟﺘﺄﻜﺩ ﺃﻥ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ ﺘﻘﻭﻡ ﺒﺘﺭﺼﺩ‬
‫ﺍﻟﻤﺭﺽ ﺍﻟﺴﺎﺭﻱ ﻭﺍﻹﺒﻼﻍ ﺍﻟﻔﻌﻠﻲ ﻋﻨﻪ ﺃﻭ ﻻ ﺘﻘﻭﻡ‪.‬‬

‫ﻨﻬﺞ ﻋﻤﻠﻴﺔ ﺍﻟﺘﺭﺼﺩ‪:‬‬

‫ﻫﻨﺎﻙ ﻋﺩﺓ ﺨﻁﻭﺍﺕ ﺭﺌﻴﺴﻴﺔ ﻟﻠﺘﺭﺼﺩ ﻭﻫﻲ‪:‬‬
‫• ﺍﻟﺘﺨﻁﻴﻁ ﻟﻠﺘﺭﺼﺩ‪.‬‬
‫• ﺠﻤﻊ ﺍﻟﺒﻴﺎﻨﺎﺕ‪.‬‬
‫• ﺘﺴﺠﻴل ﻭﺘﺼﻨﻴﻑ ﻭﺠﺩﻭﻟﺔ ﺍﻟﺒﻴﺎﻨﺎﺕ‪.‬‬
‫• ﺘﺤﻠﻴل ﺍﻟﺒﻴﺎﻨﺎﺕ‪.‬‬
‫• ﺍﺴﺘﻘﺼﺎﺀ ﺍﻟﻤﺴﺒﺏ‪.‬‬
‫• ﺍﺘﺨﺎﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻨﺎﺴﺒﺔ ﻭﺍﻟﻔﻌﺎﻟﺔ‪.‬‬
‫• ﺍﻟﻤﺭﺍﻗﺒﺔ ﻭﺍﻟﺘﻘﻭﻴﻡ‪.‬‬

‫ﺍﻟﺘﺨﻁﻴﻁ ﻟﻠﺘﺭﺼﺩ‪:‬‬
‫ﻓﻲ ﻫﺫﻩ ﺍﻟﺨﻁﻭﺓ ﻴﺠﺏ ﺃﻥ ﻨﺤﺩﺩ ﻤﺎ ﻴﻠﻲ‪:‬‬
‫• ﻁﺭﻴﻘﺔ ﺍﻟﺘﺭﺼﺩ ﺍﻟﻤﺘﺒﻌﺔ‪.‬‬
‫• ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﺸﻤﻭﻟﺔ ﺒﻌﻤﻠﻴﺔ ﺍﻟﺘﺭﺼﺩ‪.‬‬
‫• ﺍﺴﺘﻤﺎﺭﺍﺕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻼﺯﻤﺔ‪.‬‬
‫• ﺍﻟﺘﻘﺎﺭﻴﺭ ﻭﺍﻟﺴﺠﻼﺕ ﺍﻟﻤﻁﻠﻭﺒﺔ‪.‬‬
‫• ﺍﻟﻘﺎﺌﻤﻭﻥ ﺒﻌﻤﻠﻴﺔ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﺘﻘﺼﻲ‪.‬‬
‫• ﺍﻟﻁﺭﻴﻘﺔ ﻭﺍﻟﺯﻤﻥ ﺍﻟﻼﺯﻡ ﻹﺭﺴﺎل ﺍﻟﺘﻘﺎﺭﻴﺭ ﺃﻭ ﺍﻹﺒﻼﻏﺎﺕ‪.‬‬
‫• ﻟﻤﻥ ﺴﺘﺭﺴل ﺍﻟﺘﻘﺎﺭﻴﺭ ﺃﻭ ﺍﻹﺒﻼﻏﺎﺕ‪.‬‬
‫• ﺍﻟﺘﻌﺎﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻴﺔ ﻟﻸﻤﺭﺍﺽ‪.‬‬

‫‪١١‬‬
 ‫ﺠﻤﻊ ﺍﻟﺒﻴﺎﻨﺎﺕ‪:‬‬
‫ﺘﺠﻤﻊ ﺍﻟﺒﻴﺎﻨﺎﺕ ﺍﻟﺨﺎﺼﺔ ﺒﻤﺠﻤﻭﻋﺔ ﺴﻜﺎﻨﻴﺔ ﻤﻌﻴﻨﺔ ﻭﻤﻨﻁﻘﺔ ﺠﻐﺭﺍﻓﻴﺔ ﻤﺤﺩﺩﺓ ﺨﻼل ﻓﺘﺭﺓ ﺯﻤﻨﻴﺔ ﻤﺤﺩﺩﺓ‪ ،‬ﻭﻫﻨﺎﻙ‬
‫ﻤﺼﺎﺩﺭ ﻤﺘﻌﺩﺩﺓ ﺃﻫﻤﻬﺎ‪:‬‬
‫• ﺘﻘﺎﺭﻴﺭ ﺍﻟﻤﺭﺍﻀﺔ ﻭﺍﻟﻭﻓﻴﺎﺕ‪.‬‬
‫• ﺘﻘﺎﺭﻴﺭ ﺍﻷﻭﺒﺌﺔ ﻭﺍﻟﻔﺎﺸﻴﺎﺕ‪.‬‬
‫• ﺘﻘﺎﺭﻴﺭ ﺼﺎﺩﺭﺓ ﻋﻥ ﺍﻟﻤﺨﺎﺒﺭ‪.‬‬
‫• ﺘﻘﺎﺭﻴﺭ ﺼﺎﺩﺭﺓ ﻋﻥ ﺍﻻﺴﺘﻘﺼﺎﺀﺍﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﻭﺍﺴﺘﻘﺼﺎﺀﺍﺕ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻔﺭﺩﻴﺔ‪.‬‬
‫• ﺘﻘﺎﺭﻴﺭ ﺍﻟﻤﺴﻭﺤﺎﺕ ﺃﻭ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﺨﺎﺼﺔ‪.‬‬
‫• ﻤﻌﻠﻭﻤﺎﺕ ﻤﺘﻭﻓﺭﺓ ﻋﻥ ﻤﺴﺘﻭﺩﻋﺎﺕ ﻋﻭﺍﻤل ﺍﻟﺨﻤﺞ ﻭﺍﻟﻨﻭﺍﻗل‪ ،‬ﻭﻏﻴﺭﻫﺎ‪.‬‬
‫• ﻤﻌﻠﻭﻤﺎﺕ ﺴﻜﺎﻨﻴﺔ ﻭﺒﻴﺌﻴﺔ ﻭﻋﻥ ﺠﺎﻫﺯﻴﺔ ﺍﻟﻤﻭﺍﺭﺩ ﺍﻟﻤﺴﺘﺨﺩﻤﺔ ﻓﻲ ﺍﻟﻤﻜﺎﻓﺤﺔ‪.‬‬

‫ﺘﺴﺠﻴل ﻭﺘﺼﻨﻴﻑ ﻭﺠﺩﻭﻟﺔ ﺍﻟﺒﻴﺎﻨﺎﺕ‪:‬‬

‫ﻴﻤﻜﻥ ﺘﺴﺠﻴل ﺍﻟﺒﻴﺎﻨﺎﺕ ﻭﺘﺼﻨﻴﻔﻬﺎ ﻭﺠﺩﻭﻟﺘﻬﺎ ﻓﻲ ﺠﺩﺍﻭل ﻤﺨﺘﻠﻔﺔ ﺘﺒﻴﻥ ﻋﺩﺩ ﺍﻹﺼﺎﺒﺎﺕ‪ ،‬ﻭﺯﻤﻥ ﻭﻤﻜﺎﻥ ﺤﺩﻭﺜﻬﺎ‪،‬‬
‫ﻋﻤﺭ ﺍﻟﻤﺭﻴﺽ ﻭﺠﻨﺴﻪ‪ ،‬ﻤﻜﺎﻥ ﺇﻗﺎﻤﺘﻪ ﻭﻤﻬﻨﺘﻪ‪ ،‬ﻜﻤﺎ ﻴﻤﻜﻥ ﻋﺭﺽ ﺍﻟﺒﻴﺎﻨﺎﺕ ﺒﺸﻜل ﻤﺨﻁﻁﺎﺕ ﺒﻴﺎﻨﻴﺔ ﺃﻭ ﺨﺭﺍﺌﻁ‪.‬‬

‫ﻭﺘﺨﺘﻠﻑ ﺍﻟﺒﻴﺎﻨﺎﺕ ﺍﻟﻤﻁﻠﻭﺒﺔ ﺠﻤﻌﻬﺎ ﻭﺘﺴﺠﻴﻠﻬﺎ ﻭﺠﺩﻭﻟﺘﻬﺎ ﺤﺴﺏ ﻁﺭﻕ ﺍﻟﺘﺭﺼﺩ ﺍﻟﻤﺨﺘﻠﻔﺔ ﻭﻜﻤﺎ ﻫﻭ ﻭﺍﺭﺩ ﻓﻲ ﺍﻟﺠﺩﻭل‪.‬‬
‫ﺠﺩﻭل ﺒﺎﻟﺒﻴﺎﻨﺎﺕ ﺍﻟﺘﻲ ﻴﻤﻜﻥ ﺠﻤﻌﻬﺎ ﻤﻥ ﺨﻼل ﻁﺭﻕ ﺍﻟﺘﺭﺼﺩ ﺍﻟﻤﺨﺘﻠﻔﺔ‬
‫ﺍﻟﺒﻴﺎﻨﺎﺕ ﺍﻟﺘﻲ ﻴﻤﻜﻥ ﺠﻤﻌﻬﺎ‬ ‫ﻁﺭﻕ ﺍﻟﺘﺭﺼﺩ‬
‫ﻋﺩﺩ ﺍﻹﺼﺎﺒﺎﺕ‬ ‫ﺍﻹﺒﻼﻍ ﺍﻟﺭﻭﺘﻴﻨﻲ )ﺍﻟﺸﺎﻤل ﻟﻠﻤﺠﺘﻤﻊ(‬
‫ﻋﺩﺩ ﺍﻹﺼﺎﺒﺎﺕ‬ ‫ﺍﻹﺒﻼﻍ ﺍﻟﺭﻗﺎﺒﻲ )ﺍﻟﺨﻔﺭﻱ(‬
‫ﺍﻟﻌﻤﺭ‬
‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ‬
‫ﻋﺩﺩ ﺍﻟﻭﻓﻴﺎﺕ‬
‫ﻋﺩﺩ ﺍﻹﺼﺎﺒﺎﺕ‬ ‫ﺘﻘﺼﻲ ﺍﻟﺤﺎﻻﺕ ‪ /‬ﺍﻷﻭﺒﺌﺔ‬
‫ﺍﻟﻌﻤﺭ‬
‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ‬
‫ﺍﻻﺴﻡ ﻭﺍﻟﻌﻨﻭﺍﻥ ﺍﻟﺘﻔﺼﻴﻠﻲ‬
‫ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‬
‫ﻋﺩﺩ ﺍﻟﻭﻓﻴﺎﺕ‬
‫ﻋﺩﺩ ﺍﻹﺼﺎﺒﺎﺕ‬ ‫ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﺨﺎﺼﺔ‬
‫ﻋﺩﺩ ﺍﻟﻭﻓﻴﺎﺕ‬
‫ﻤﻌﻠﻭﻤﺎﺕ ﻋﻥ ﺍﻟﻭﻀﻊ ﺍﻻﺠﺘﻤﺎﻋﻲ ﺍﻻﻗﺘﺼﺎﺩﻱ‬
‫ﻋﻭﺍﻤل ﺍﻟﺨﻁﺭ‬

‫‪١٢‬‬
 ‫ﺘﺤﻠﻴل ﺍﻟﺒﻴﺎﻨﺎﺕ‪:‬‬
‫ﻴﺘﻡ ﺘﺤﻠﻴل ﺍﻟﺒﻴﺎﻨﺎﺕ ﻭﺇﻋﺩﺍﺩ ﻓﺭﻀﻴﺔ ﻋﻥ ﺍﺘﺠﺎﻫﺎﺕ ﺍﻟﻤﺭﺽ ﻭﺃﺴﺒﺎﺏ ﺍﻟﻌﺩﻭﻯ‪ ،‬ﺤﻴﺙ ﺘﺘﻡ ﺩﺭﺍﺴﺔ ﺍﻟﺨﺼﺎﺌﺹ‬
‫ﺍﻟﻭﺒﺎﺌﻴﺔ ﻟﻠﻤﺭﺽ ﺤﺴﺏ ﻤﺘﻐﻴﺭﺍﺕ ﺍﻟﺸﺨﺹ ‪ -‬ﺍﻟﺯﻤﺎﻥ ‪ -‬ﺍﻟﻤﻜﺎﻥ ‪ -‬ﺍﻟﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ ‪ -‬ﺍﻟﺒﻴﺌﺔ ‪ -‬ﺍﻟﺜﻭﻱ ﺍﻟﻤﺴﺘﻌﺩ‪.‬‬

‫ﻴﺘﻀﻤﻥ ﺍﻟﺘﺤﻠﻴل ﺤﺴﺎﺏ ﻤﻌﺩﻻﺕ ﺍﻟﻭﻗﻭﻉ ﻭﺍﻻﻨﺘﺸﺎﺭ ﻭﻤﻘﺎﺭﻨﺘﻬﺎ ﺒﺎﻟﺴﻨﻴﻥ ﻭﺍﻷﺸﻬﺭ ﺍﻟﺴﺎﺒﻘﺔ )ﻤﻥ ﺍﻟﻤﻌﺘﺎﺩ ﺇﺠﺭﺍﺀ‬
‫ﺍﻟﻤﻘﺎﺭﻨﺔ ﻤﻊ ﺍﻟﺴﻨﻭﺍﺕ ﺍﻟﺨﻤﺱ ﺍﻟﺴﺎﺒﻘﺔ ﻭﻟﻨﻔﺱ ﺍﻟﻔﺘﺭﺓ ﺍﻟﺯﻤﻨﻴﺔ(‪.‬‬

‫ﻜﻤﺎ ﻴﺘﻀﻤﻥ ﺇﻋﺩﺍﺩ ﺨﺭﻴﻁﺔ ﻭﺒﺎﺌﻴﺔ ﻟﻠﻤﺭﺽ ﻟﺭﺼﺩ ﺍﻟﺘﻭﺯﻉ ﺍﻟﺠﻐﺭﺍﻓﻲ ﻟﻠﺤﺎﻻﺕ ﺍﻟﻤﺭﻀﻴﺔ )ﺘﺴﺎﻋﺩ ﻋﻠﻰ ﻤﻌﺭﻓﺔ‬
‫ﺇﺫﺍ ﻜﺎﻨﺕ ﺍﻟﺤﺎﻻﺕ ﺘﺘﺠﻤﻊ ﺒﻤﻨﻁﻘﺔ ﻭﺍﺤﺩﺓ ﺃﻭ ﻤﻨﺘﺸﺭﺓ ﺒﻌﺩﺓ ﻤﻨﺎﻁﻕ( ﻭﺍﻟﺘﻭﺯﻉ ﺍﻟﺯﻤﻨﻲ‪ .‬ﻭﻴﻤﻜﻥ ﺇﻋﺩﺍﺩ ﻤﺨﻁﻁﺎﺕ‬
‫ﺒﻴﺎﻨﻴﺔ ﺒﻬﺫﺍ ﺍﻟﺨﺼﻭﺹ‪.‬‬

‫ﻴﺘﻁﻠﺏ ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﺘﻭﻓﺭ ﺨﺭﻴﻁﺔ ﺠﻐﺭﺍﻓﻴﺔ ﻭﺴﻜﺎﻨﻴﺔ ﻟﻠﻤﻨﻁﻘﺔ ﺍﻟﻤﺩﺭﻭﺴﺔ‪ ،‬ﻭﻴﺠﺏ ﺃﻥ ﻴﺘﻡ ﻋﻠﻰ ﻜﺎﻓﺔ‬
‫ﺍﻟﻤﺴﺘﻭﻴﺎﺕ ﺃﻱ ﻓﻲ ﻨﻔﺱ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﺫﻱ ﻴﺘﻡ ﻓﻴﻪ ﺠﻤﻊ ﺍﻟﻤﻌﻠﻭﻤﺎﺕ‪.‬‬

‫ﺍﺴﺘﻘﺼﺎﺀ ﺍﻟﻤﺴﺒﺏ‪:‬‬
‫ﺍﻨﻅﺭ ﺍﻟﺼﻔﺤﺔ )‪.(١٩‬‬

‫ﺍﺘﺨﺎﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻨﺎﺴﺒﺔ ﻭﺍﻟﻔﻌﺎﻟﺔ‪:‬‬

‫ﻋﻥ ﺍﺘﺨﺎﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ ﻴﻌﺘﻤﺩ ﻋﻠﻰ ﺴﺒﺏ ﺍﻟﻤﺸﻜﻠﺔ ﺍﻟﺘﻲ ﻟﺯﻴﺎﺩﺓ ﺤﺎﻻﺕ ﺍﻟﻤﺭﺽ ﻭﻫﻨﺎﻙ ﺃﺭﺒﻊ ﺨﻁﻭﺍﺕ ﺭﺌﻴﺴﻴﺔ‬
‫ﻴﺠﺏ ﺇﺘﺒﺎﻋﻬﺎ‪.‬‬
‫• ﺘﺤﺩﻴﺩ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﺘﺨﺫﺓ ﺤﺴﺏ ﺴﺒﺏ ﺍﻟﻤﺸﻜﻠﺔ‪.‬‬
‫• ﺘﻁﺒﻴﻕ ﻫﺫﻩ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺒﺄﺴﺭﻉ ﻤﺎ ﻴﻤﻜﻥ‪.‬‬
‫• ﺇﺭﺴﺎل ﺘﻘﺭﻴﺭ ﻋﻨﻬﺎ ﻟﻠﻤﺴﺘﻭﻯ ﺍﻟﻌﻠﻰ‪.‬‬
‫• ﺇﺭﺴﺎل ﺘﻐﺫﻴﺔ ﺭﺍﺠﻌﺔ ﻟﻠﻤﺴﺘﻭﻯ ﺍﻷﺩﻨﻰ‪.‬‬

‫ﻋﻨﺩ ﻭﻀﻊ ﺨﻁﺔ ﺍﻟﻌﻤل ﻻ ﺒﺩ ﻤﻥ ﺘﺤﺩﻴﺩ ﻤﺎ ﻴﻠﻲ‪:‬‬

‫• ﺍﻹﺠﺭﺍﺀﺍﺕ ﻭﺍﻷﻨﺸﻁﺔ ﺍﻟﺘﻲ ﺴﺘﻨﻔﺫ ﺒﺸﻜل ﻭﺍﻀﺢ‪.‬‬
‫• ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﺴﺅﻭﻟﻴﻥ ﻋﻥ ﺘﻨﻔﻴﺫ ﻜل ﻨﺸﺎﻁ ﺒﺎﻻﺴﻡ ﺃﻭ ﺍﻟﻤﻨﺼﺏ ﺍﻟﻭﻅﻴﻔﻲ‪.‬‬
‫• ﺘﺎﺭﻴﺦ ﺍﻟﺒﺩﺀ ﻭﺍﻻﻨﺘﻬﺎﺀ ﻤﻥ ﺍﻷﻨﺸﻁﺔ ﺍﻟﺘﻲ ﺴﺘﻨﻔﺫ‪.‬‬
‫• ﺍﻷﻤﻜﻨﺔ ﺍﻟﺘﻲ ﺴﺘﻨﻔﺫ ﻓﻴﻬﺎ ﺍﻷﻨﺸﻁﺔ‪.‬‬
‫• ﻤﻭﺠﺯ ﻋﻥ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﻲ ﺴﻴﺘﻡ ﺘﻨﻔﻴﺫﻫﺎ‪.‬‬
‫• ﺍﻟﻤﻭﺍﺭﺩ ﺍﻟﺘﻲ ﺴﺘﻭﻓﺭ ﻟﺘﻨﻔﻴﺫ ﺍﻟﻨﺸﺎﻁﺎﺕ‪.‬‬

‫‪١٣‬‬
 ‫ﻨﻅﺎﻡ ﺍﻟﺘﺭﺼﺩ ﻓﻲ ﺴﻭﺭﻴﺔ‪:‬‬
‫ﻴﻌﺘﻤﺩ ﺍﻟﻨﻅﺎﻡ ﻋﻠﻰ ﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪:‬‬

‫• ﺍﻟﺘﻌﺭﻴﻑ‪:‬‬

‫ﻫﻭ ﺒﻴﺎﻥ ﺭﺴﻤﻲ ﻹﺨﻁﺎﺭ ﺍﻟﺴﻠﻁﺔ ﺍﻟﺼﺤﻴﺔ ﺒﺤﺩﻭﺙ ﻤﺭﺽ ﺴﺎﺭﻱ ﻤﻌﻴﻥ ﻓﻲ ﺇﻨﺴﺎﻥ ﺃﻭ ﺤﻴﻭﺍﻥ ﻭﻓﻲ ﻤﻨﻁﻘﺔ‬
‫ﺠﻐﺭﺍﻓﻴﺔ ﻤﻌﻴﻨﺔ ﺨﻼل ﺯﻤﻥ ﻤﻌﻴﻥ‪.‬‬

‫• ﺍﻟﻬﺩﻑ‪:‬‬

‫ﺘﻘﺩﻴﻡ ﻤﻌﻠﻭﻤﺎﺕ ﻀﺭﻭﺭﻴﺔ ﻋﻥ ﻤﺭﺽ ﺴﺎﺭﻱ ﻓﻲ ﺍﻟﻭﻗﺕ ﺍﻟﻤﻨﺎﺴﺏ ﻟﻠﺴﻠﻁﺔ ﺍﻟﺼﺤﻴﺔ ﺒﺤﻴﺙ ﻴﺴﻤﺢ ﻟﻬﺎ ﺒﺎﺘﺨﺎﺫ‬
‫ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻼﺌﻤﺔ ﻭﺍﻟﻔﻌﺎﻟﺔ‪ ،‬ﻜﻤﺎ ﻴﺴﻤﺢ ﻟﻬﺎ ﺒﻌﻤل ﻤﻘﺎﺭﻨﺔ ﻟﻠﺒﻴﺎﻨﺎﺕ ﻓﻲ ﻨﻁﺎﻕ ﺴﻠﻁﺎﺕ ﺼﺤﻴﺔ ﻤﺨﺘﻠﻔﺔ ﺩﺍﺨل ﺍﻟﺒﻠﺩ‬
‫ﻭﺒﻴﻥ ﺍﻟﺒﻠﺩﺍﻥ‪.‬‬

‫• ﻁﺭﻕ ﺍﻹﺒﻼﻍ‪:‬‬

‫ﺤﺴﺏ ﻗﺎﻨﻭﻥ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻟﻌﺎﻡ ‪ ٢٠٠٧‬ﻭﺘﻌﻠﻴﻤﺎﺘﻪ ﺍﻟﺘﻨﻔﻴﺫﻴﺔ )ﻗﺭﺍﺭ ﺘﻨﻅﻴﻤﻲ ﺭﻗﻡ ‪ (٣٨‬ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(١‬‬
‫ﻴﻘﺴﻡ ﺍﻹﺒﻼﻍ ﺇﻟﻰ‪:‬‬
‫‪ -‬ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﺃﻭ ﺨﻼل ‪ ٢٤‬ﺴﺎﻋﺔ‪ :‬ﺒﺎﻟﻬﺎﺘﻑ ﺃﻭ ﺒﺎﻟﻔﺎﻜﺱ‪ ،‬ﻭﻴﺘﻀﻤﻥ ﺍﻟﻤﻌﻠﻭﻤﺎﺕ ﺍﻷﺴﺎﺴﻴﺔ ﺍﻟﻤﻁﻠﻭﺒﺔ ﻜﺎﻻﺴﻡ‪،‬‬
‫ﺍﻟﻌﻤﺭ‪ ،‬ﺍﻟﺠﻨﺱ‪ ،‬ﺍﺴﻡ ﺍﻷﺏ ﻭﺍﻷﻡ‪ ،‬ﻤﻜﺎﻥ ﺍﻟﺴﻜﻥ ﻭﺍﻟﻌﻤل‪ ،‬ﺍﻟﺘﺸﺨﻴﺹ ﻭﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﺘﺨﺫﺓ‪.‬‬
‫ﻭﻫﻭ ﻤﺨﺼﺹ ﻟﻸﻤﺭﺍﺽ ﺸﺩﻴﺩﺓ ﺍﻟﺴﺭﺍﻴﺔ ﺃﻭ ﻤﻌﺩﻻﺕ ﺍﻟﺨﻁﻭﺭﺓ ﻭﺍﻟﻭﻓﺎﺓ ﺍﻟﻤﺭﺘﻔﻌﺔ ﺃﻭ ﺍﻟﺘﻲ ﻟﻬﺎ ﺒﺭﺍﻤﺞ ﺍﺴﺘﺌﺼﺎل‬
‫)ﺍﻟﻜﻭﻟﻴﺭﺍ‪ ،‬ﺍﻟﺤﻤﻰ ﺍﻟﻤﺨﻴﺔ ﺍﻟﺸﻭﻜﻴﺔ‪ ،‬ﻜﺯﺍﺯ ﺍﻟﻭﻟﻴﺩ‪ ،‬ﺸﻠل ﺍﻷﻁﻔﺎل‪ ،‬ﺍﻟﺩﻓﺘﺭﻴﺎ‪ ،‬ﺍﻟﺤﺼﺒﺔ‪ ،‬ﺍﻟﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ‪،‬‬
‫ﺍﻟﻤﻼﺭﻴﺎ‪ ،‬ﺍﻟ ﹶﻜﻠﹶﺏ‪ (...‬ﻜﺫﻟﻙ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻋﻨﺩ ﺤﺩﻭﺙ ﺃﻭﺒﺌﺔ ﺃﻭ ﻓﺎﺸﻴﺎﺕ ﻭﺘﻘﻭﻡ ﺒﻪ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ‪،‬‬
‫ﺇﻀﺎﻓﺔ ﺇﻟﻰ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﺴﺘﺠﺩﺓ‪.‬‬
‫‪ -‬ﺍﻹﺒﻼﻍ ﺍﻟﺸﻬﺭﻱ‪ :‬ﺒﻭﺍﺴﻁﺔ ﺘﻘﺭﻴﺭ ﺨﺎﺹ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ‪ (٤-٣ :‬ﻭﻴﻘﺴﻡ ﺇﻟﻰ‪:‬‬
‫ƒ ﺇﺒﻼﻍ ﺭﻭﺘﻴﻨﻲ‪ :‬ﻴﺘﻀﻤﻥ ﻓﻘﻁ ﻋﺩﺩ ﺤﺎﻻﺕ ﺍﻟﻤﺭﺽ ﺍﻟﻤﺒﻠﻎ ﻋﻨﻬﺎ ﻭﻴﺘﻡ ﺘﺤﻠﻴﻠﻬﺎ ﻭﺇﺭﺴﺎﻟﻬﺎ ﻟﻠﻤﺴﺘﻭﻯ ﺍﻷﻋﻠﻰ‬
‫ﻭﻴﺘﻀﻤﻥ ﺍﻷﻤﺭﺍﺽ ﻏﻴﺭ ﺍﻟﻤﺸﻤﻭﻟﺔ ﺒﺎﻟﻁﺭﻴﻘﺔ ﺍﻷﻭﻟﻰ‪ ،‬ﻭﺘﻘﻭﻡ ﺒﻪ ﻜﺎﻓﺔ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫ƒ ﺇﺒﻼﻍ ﺨﻔﺭﻱ‪ :‬ﻴﺘﻀﻤﻥ ﻤﻌﻠﻭﻤﺎﺕ ﺇﻀﺎﻓﻴﺔ ﻜﺎﻟﻌﻤﺭ ﻭﺍﻟﺠﻨﺱ‪ ،‬ﺍﻟﺤﺎﻟﺔ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ‪ ،‬ﺘﺼﻨﻴﻑ ﺍﻟﻤﺭﺽ‪ ...‬ﺇﻟﺦ‪ .‬ﻴﻘﻭﻡ‬
‫ﺒﺎﻟﺘﺒﻠﻴﻎ ﻤﺭﺍﻜﺯ ﺇﺒﻼﻍ ﻤﺨﺘﺎﺭﺓ ﻜﺎﻟﻤﺸﺎﻓﻲ ﻭﻟﺒﻌﺽ ﺍﻷﻤﺭﺍﺽ )ﻜﺎﻟﺸﻠل ﺍﻟﺭﺨﻭ ﺍﻟﺤﺎﺩ‪ ،‬ﻜﺯﺍﺯ ﺍﻟﻭﻟﻴﺩ‪ ،‬ﺍﻟﺘﺩﺭﻥ‪(...‬‬
‫ﻭﻴﻤﻜﻥ ﺍﻋﺘﺒﺎﺭ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺘﺨﺼﺼﻴﺔ )ﺘﺩﺭﻥ‪ ،‬ﻤﻼﺭﻴﺎ‪ ،‬ﻻﻴﺸﻤﺎﻨﻴﺎ‪ ،‬ﺒﻠﻬﺎﺭﺴﻴﺎ‪ (...‬ﻜﻤﺭﺍﻜﺯ ﺇﺒﻼﻍ ﻤﺨﺘﺎﺭﺓ‪.‬‬
‫ƒ ﺍﻹﺒﻼﻍ ﺍﻟﺼﻔﺭﻱ‪ :‬ﺃﻱ ﻋﺩﻡ ﻭﺠﻭﺩ ﺤﺎﻻﺕ‪ ،‬ﻭﺍﻟﻬﺩﻑ ﻤﻨﻪ ﺍﻟﺘﺄﻜﺩ ﻤﻥ ﺃﻥ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ ﺘﻘﻭﻡ ﺒﺎﻹﺒﻼﻍ‬
‫ﺍﻟﻔﻌﻠﻲ ﻋﻥ ﺍﻟﻤﺭﺽ ﺍﻟﺴﺎﺭﻱ ﺃﻭ ﻻ ﺘﻘﻭﻡ ﺒﻪ‪.‬‬
‫ƒ ﺍﻹﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ‪ :‬ﻟﻸﻤﺭﺍﺽ ﺍﻟﻭﺍﺠﺏ ﺍﻹﺒﻼﻍ ﻋﻨﻬﺎ ﻓﻭﺭﻴﹰﺎ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻭﺍﺠﺏ ﺍﻹﺒﻼﻍ ﻋﻨﻬﺎ ﺸﻬﺭﻴﹰﺎ ﻋﻨﺩ‬
‫ﺤﺩﻭﺙ ﺍﻷﻭﺒﺌﺔ ﻭﺍﻟﻔﺎﺸﻴﺎﺕ ﻭﻟﻸﻤﺭﺍﺽ ﺍﻟﻤﺴﺘﺠﺩﺓ‪.‬‬

‫‪١٤‬‬
 ‫• ﺍﺴﺘﻤﺎﺭﺍﺕ ﺍﻻﺴﺘﻘﺼﺎﺀ‪:‬‬

‫ﺘﻤﻸ ﻤﻥ ﻗﺒل ﻓﺭﻴﻕ ﺍﻻﺴﺘﻘﺼﺎﺀ ﻟﻸﻤﺭﺍﺽ ﺍﻟﻤﺸﻤﻭﻟﺔ ﺒﺎﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻭﺘﺭﺴل ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪.‬‬

‫ﻭﻋﻨﺩ ﺤﺩﻭﺙ ﺍﻷﻭﺒﺌﺔ ﻭﺍﻟﻔﺎﺸﻴﺎﺕ ﻟﻸﻤﺭﺍﺽ ﻏﻴﺭ ﺍﻟﻤﺸﻤﻭﻟﺔ ﺒﺎﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻴﺘﻡ ﺇﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺍﺕ‬
‫ﺍﻻﺴﺘﻘﺼﺎﺀ‪ ،‬ﺜﻡ ﺘﺤﻠل ﻭﺒﺎﺌﻴﹰﺎ ﻭﻴﺭﺴل ﺘﻘﺭﻴﺭ ﻴﻭﻤﻲ ﺃﻭ ﺃﺴﺒﻭﻋﻲ ﻋﻥ ﺍﻟﻤﺭﺽ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﺍﻟﻭﻗﺎﻴﺔ‬
‫ﺍﻟﻤﺘﺨﺫﺓ‪ ،‬ﻜﻤﺎ ﺘﻤﻸ ﻟﻸﻤﺭﺍﺽ ﺍﻟﻤﺴﺘﺠﺩﺓ‪.‬‬
‫• ﺘﻌﺭﻴﻑ ﺍﻟﺤﺎﻟﺔ‪:‬‬

‫ﻴﺘﻡ ﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﻭﻓﻘﹰﺎ ﻟﻤﻌﺎﻴﻴﺭ ﺘﺸﺨﻴﺼﻴﺔ ﻤﻌﺘﻤﺩﺓ ﻭﻤﻭﺤﺩﺓ ﺘﺴﻤﻰ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ ﻟﻠﻤﺭﺽ‪.‬‬
‫ﻭﻴﺨﺘﻠﻑ ﻤﻥ ﺒﻠﺩ ﻵﺨﺭ ﺤﺴﺏ ﺍﻨﺘﺸﺎﺭ ﺍﻟﻤﺭﺽ ﻭﺨﻁﻭﺭﺘﻪ ﻭﺘﻭﻓﺭ ﺍﻟﺘﻘﻨﻴﺎﺕ ﺍﻟﺘﺸﺨﻴﺼﻴﺔ‪.‬‬

‫ﻭﻫﻨﺎﻙ ﺜﻼﺜﺔ ﺃﻨﻭﺍﻉ ﻟﻠﺘﻌﺎﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻴﺔ‪ :‬ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ ـ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺭﺠﺤﺔ ـ ﻭﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺅﻜﺩﺓ‪.‬‬

‫ﻴﺘﻡ ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻥ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺭﻀﻴﺔ ﻜﺤﺎﻟﺔ ﻤﺸﺘﺒﻬﺔ ﺩﻭﻥ ﺍﻨﺘﻅﺎﺭ ﻨﺘﻴﺠﺔ ﺍﻟﻔﺤﺹ ﺍﻟﻤﺨﺒﺭﻱ ﻓﻲ ﺍﻷﻤﺭﺍﺽ‬
‫ﺫﺍﺕ ﺍﻟﺴﺭﺍﻴﺔ ﻭﺍﻟﺨﻁﻭﺭﺓ ﺍﻟﻤﺭﺘﻔﻌﺔ ﻭﺫﻟﻙ ﻻﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻔﻌﺎﻟﺔ ﺒﺄﺒﻜﺭ ﻭﻗﺕ‪.‬‬
‫• ﻤﺴﺘﻭﻴﺎﺕ ﺍﻟﺘﺭﺼﺩ‪:‬‬

‫ﻴﻌﻤل ﻨﻅﺎﻡ ﺍﻟﺘﺭﺼﺩ ﻓﻲ ﺨﻤﺱ ﻤﺴﺘﻭﻴﺎﺕ‪:‬‬

‫‪ -‬ﺍﻟﻤﺴﺘﻭﻯ ﺍﻷﻭل‪ :‬ﻴﺘﻡ ﻓﻴﻪ ﺠﻤﻊ ﺍﻟﺒﻴﺎﻨﺎﺕ ﻭﺠﺩﻭﻟﺘﻬﺎ ﻭﺘﺤﻠﻴﻠﻬﺎ ﺜﻡ ﺘﺒﻠﻎ ﻟﻠﻤﺴﺘﻭﻯ ﺍﻟﺜﺎﻨﻲ‪ ،‬ﻭﻴﺘﺄﻟﻑ ﻤﻥ ﺍﻟﻤﺭﺍﻜﺯ‬
‫ﺍﻟﺼﺤﻴﺔ ﻭﺍﻟﻤﺸﺎﻓﻲ ﻜﻤﺎ ﻴﺘﻀﻤﻥ ﻋﻴﺎﺩﺍﺕ ﺍﻟﻘﻁﺎﻉ ﺍﻟﺨﺎﺹ ﻭﻤﺸﺎﻓﻴﻪ‪.‬‬
‫‪ -‬ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﺜﺎﻨﻲ‪ :‬ﻤﺭﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺼﺤﻴﺔ‪ ،‬ﻴﺘﻠﻘﻰ ﺘﻘﺎﺭﻴﺭ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻷﻭل ﻭﻴﺤﻠﻠﻬﺎ ﻭﻴﺭﺴﻠﻬﺎ ﺇﻟﻰ ﺍﻟﻤﺴﺘﻭﻯ‬
‫ﺍﻷﻋﻠﻰ‪.‬‬
‫‪ -‬ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﺜﺎﻟﺙ‪ :‬ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﻭﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ ﻭﺍﻟﻤﺭﺍﻜﺯ‬
‫ﺍﻟﺘﺨﺼﺼﻴﺔ ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ )ﺍﻟﺘﺩﺭﻥ ﻭﺍﻟﻠﻴﺸﻤﺎﻨﻴﺎ ﻭﺍﻹﻴﺩﺯ‪ ...‬ﺇﻟﺦ (‪ ،‬ﻴﺘﻠﻘﻰ ﺘﻘﺎﺭﻴﺭ ﻤﺭﺍﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ‬
‫ﻭﻴﺤﻠﻠﻬﺎ ﻭﻴﺭﺴﻠﻬﺎ ﻟﻠﻤﺴﺘﻭﻯ ﺍﻷﻋﻠﻰ‪.‬‬
‫‪ -‬ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﺭﺍﺒﻊ‪ :‬ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ ﻭﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﺒﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ )ﺩﻭﺍﺌﺭ ﻤﻜﺎﻓﺤﺔ‬
‫ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﺴﺘﺠﺩﺓ ﻭﺩﺍﺌﺭﺓ ﺍﻹﺤﺼﺎﺀ ﻭﺍﻟﺠﻭﺩﺓ ﺍﻟﺘﻲ ﺘﺘﻠﻘﻰ‬
‫ﺍﻟﻤﻌﻠﻭﻤﺎﺕ ﻤﻥ ﻤﺩﻴﺭﻴﺎﺕ ﺍﻟﺼﺤﺔ ﻭﺒﺎﻗﻲ ﺍﻟﺩﻭﺍﺌﺭ ﻭﺘﻘﻭﻡ ﺒﺩﺭﺍﺴﺘﻬﺎ ﻭﺘﺤﻠﻴﻠﻬﺎ(‪.‬‬
‫‪ -‬ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﺨﺎﻤﺱ‪ :‬ﺘﻘﻭﻡ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﺒﺈﺒﻼﻍ ﻤﻨﻅﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ ﻭﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ ﺍﻷﺨﺭﻯ‬
‫ﻜل ﺜﻼﺜﺔ ﺃﺸﻬﺭ ﻭﺴﻨﻭﻴﺎﹰ )ﻭﻜل ﺃﺴﺒﻭﻉ ﻓﻲ ﺤﺎﻟﺔ ﺍﻷﻭﺒﺌﺔ ﻭﺍﻟﺠﺎﺌﺤﺎﺕ‪ ،(..‬ﻭﺤﺴﺏ ﻤﺎ ﺘﻘﺭﻩ ﺍﻟﻠﻭﺍﺌﺢ‬
‫ﺍﻟﺼﺤﻴﺔ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬

‫ﻼ ﻟﻠﻭﻀﻊ‬
‫ﻤﻥ ﺍﻟﻀﺭﻭﺭﻱ ﻭﺠﻭﺩ ﺘﻐﺫﻴﺔ ﺭﺍﺠﻌﺔ ﻤﻥ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻷﻋﻠﻰ ﺇﻟﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻷﺩﻨﻰ‪ ،‬ﺘﺘﻀﻤﻥ ﺘﺤﻠﻴ ﹰ‬
‫ﺍﻟﻭﺒﺎﺌﻲ ﻭﺘﻘﻴﻴﻤﹰﺎ ﻟﻺﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﺘﺨﺫﺓ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻭﻗﺎﻴﺔ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﻤﺴﺘﻘﺒﻼﹰ‪ ،‬ﻟﺨﻔﺽ ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﻭﻤﻨﻊ ﺤﺩﻭﺜﻬﺎ‪.‬‬

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 ‫ﻤﺭﺍﻗﺒﺔ ﻨﻅﺎﻡ ﺍﻟﺘﺭﺼﺩ‪:‬‬
‫• ﺍﻟﺩﻗﺔ‪:‬‬

‫ﻴﺠﺏ ﻤﺭﺍﻗﺒﺔ ﺍﻟﺩﻗﺔ ﻓﻲ ﺍﻟﺘﺸﺨﻴﺹ ﻭﺍﻹﺒﻼﻍ ﺒﺸﻜل ﻤﻨﺘﻅﻡ‪ ،‬ﺘﻘﻴﻡ ﺍﻟﺩﻗﺔ ﻓﻲ ﺍﻟﺘﺸﺨﻴﺹ ﺨﻼل ﺍﻟﺯﻴﺎﺭﺍﺕ‬
‫ﺍﻹﺸﺭﺍﻓﻴﺔ ﺒﺴﺅﺍل ﺍﻷﻁﺒﺎﺀ ﻋﻥ ﺍﻟﺘﻌﺎﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻴﺔ ﻭﻤﻼﺤﻅﺘﻬﻡ ﻋﻨﺩﻤﺎ ﻴﻀﻌﻭﻥ ﺍﻟﺘﺸﺨﻴﺹ‪ ،‬ﻜﻤﺎ ﺘﻘﻴﻡ ﺩﻗﺔ ﺍﻟﻔﺤﻭﺹ‬
‫ﺍﻟﻤﺨﺒﺭﻴﺔ ﺍﻟﻤﺸﺨﺼﺔ ﺒﺈﺭﺴﺎل ﻨﺴﺒﺔ ﻤﻥ ﺍﻟﻌﻴﻨﺎﺕ ﺍﻹﻴﺠﺎﺒﻴﺔ ﻭﺍﻟﺴﻠﺒﻴﺔ ﺇﻟﻰ ﻤﺨﺒﺭ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ ﻓﻲ ﺍﻟﻭﺯﺍﺭﺓ‬
‫ﻟﻔﺤﺼﻬﺎ‪.‬‬

‫ﺃﻤﺎ ﺍﻟﺩﻗﺔ ﻓﻲ ﺍﻹﺒﻼﻍ ﻓﺘﺘﻡ ﺒﻤﺭﺍﺠﻌﺔ ﺍﻟﺴﺠﻼﺕ ﻭﻤﻘﺎﺭﻨﺔ ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺴﺠﻠﺔ ﺒﻌﺩﺩ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺒﻠﻐﺔ‪ ،‬ﻭﻜﻔﺎﻴﺔ‬
‫ﺍﻟﺒﻴﺎﻨﺎﺕ ﺍﻟﻤﺴﺠﻠﺔ‪.‬‬

‫• ﺍﻻﻜﺘﻤﺎل ﻭﺍﻟﻤﻭﻗﻭﺘﻴﺔ‪:‬‬

‫ﻼ ﻋﻨﺩﻤﺎ ﺘﺼل ﺘﻘﺎﺭﻴﺭ ﻜﺎﻓﺔ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﺍﻟﻤﻔﺘﺭﺽ ﺃﻥ ﺘﺒﻠﻎ ﺇﻟﻰ ﻤﺭﺍﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ‬
‫ﻴﻌﺘﺒﺭ ﺍﻹﺒﻼﻍ ﻤﻜﺘﻤ ﹰ‬
‫ﻭﻤﻨﻬﺎ ﻟﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪ ،‬ﻜﺫﻟﻙ ﺘﺼل ﺘﻘﺎﺭﻴﺭ ﻜﺎﻓﺔ ﺍﻟﻤﺸﺎﻓﻲ ﻭﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺘﺨﺼﺼﻴﺔ ﻟﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪ .‬ﻜﻤﺎ ﻴﻌﺘﺒﺭ‬
‫ﺍﻹﺒﻼﻍ ﻓﻲ ﻭﻗﺘﻪ ﻋﻨﺩﻤﺎ ﺘﺼل ﺘﻘﺎﺭﻴﺭ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ ﻀﻤﻥ ﺍﻟﻭﻗﺕ ﺍﻟﻤﺤﺩﺩ ﻟﻺﺒﻼﻍ ﻭﻴﺠﺏ ﺃﻥ ﺘﺼل‬
‫ﺍﻟﺘﻘﺎﺭﻴﺭ ﻟﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ ﺨﻼل ﻋﺸﺭﺓ ﺃﻴﺎﻡ ﻋﻠﻰ ﺍﻷﻜﺜﺭ ﻤﻥ ﺒﺩﺍﻴﺔ ﺍﻟﺸﻬﺭ ﺍﻟﺘﺎﻟﻲ ﻟﻠﺸﻬﺭ ﺍﻟﺫﻱ ﻴﻌﺩ ﻋﻨﻪ ﺍﻟﺘﻘﺭﻴﺭ‪،‬‬
‫ﻭﺃﻥ ﻴﺘﻡ ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﺨﻼل ﻓﺘﺭﺓ ﻻ ﺘﺘﺠﺎﻭﺯ ﺇﻟﻰ ‪ ٢٤‬ﺴﺎﻋﺔ ﻤﻥ ﺍﻻﺸﺘﺒﺎﻩ‪.‬‬

‫ﺇﻥ ﺍﻟﻤﺸﻌﺭ ﺍﻷﻜﺜﺭ ﺘﻌﺒﻴﺭﹰﺍ ﻋﻥ ﻓﻌﺎﻟﻴﺔ ﻨﻅﺎﻡ ﺍﻟﺘﺭﺼﺩ ﻫﻭ ﺍﺠﺘﻤﺎﻉ ﺍﻜﺘﻤﺎل ﻭﻤﻭﻗﻭﺘﻴﺔ ﺍﻹﺒﻼﻍ‪ ،‬ﻭﻴﺘﻡ ﺍﻟﻘﻴﺎﺱ‬
‫ﺒﻤﻘﺎﺭﻨﺔ ﻋﺩﺩ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﻤﺒﻠﻐﺔ ﺒﻌﺩﺩ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﻤﻔﺘﺭﺽ ﺃﻥ ﺘﺒﻠﻎ ﻭﺒﻤﻘﺎﺭﻨﺔ ﻋﺩﺩ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﻤﺒﻠﻐﺔ ﺨﻼل‬
‫ﺍﻟﻭﻗﺕ ﺍﻟﻤﺤﺩﺩ ﺒﻌﺩﺩ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﻤﻔﺘﺭﺽ ﺃﻥ ﺘﺒﻠﻎ ﺨﻼل ﻫﺫﺍ ﺍﻟﻭﻗﺕ‪.‬‬

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 ‫‪‬‬
‫א‪‬א‪‬א‪‬א‪‬א‪‬א‪‬א‪ ‬‬
‫ﻤﻌﺩل ﺍﻟﺤﺩﻭﺙ )ﺍﻟﻭﻗﻭﻉ( )‪:(Incidence Rate‬‬
‫ﻴﻘﻴﺱ ﻤﻌﺩل ﺍﻟﺤﺩﻭﺙ ﺘﻜﺭﺍﺭ )ﻋﺩﺩ( ﻭﻗﻭﻉ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺠﺩﻴﺩﺓ ﻤﻥ ﻤﺭﺽ ﻤﺎ ﻓﻲ ﻤﺠﻤﻭﻋﺔ ﺴﻜﺎﻨﻴﺔ ﻤﺤﺩﺩﺓ ﺨﻼل‬
‫ﺯﻤﻨﻴﺔ ﻤﻌﻴﻨﺔ‪.‬‬

‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺠﺩﻴﺩﺓ ﻤﻥ ﻤﺭﺽ ﻤﻌﻴﻥ ﻭﺍﻟﻤﺴﺠﻠﺔ ﺨﻼل ﻓﺘﺭﺓ ﺯﻤﻨﻴﺔ ﻤﺤﺩﺩﺓ ﻓﻲ ﻤﻨﻁﻘﺔ ﺠﻐﺭﺍﻓﻴﺔ ﻤﺤﺩﺩﺓ‬
‫× ‪١٠٠٠٠٠‬‬
‫ﺘﻘﺩﻴﺭ ﻋﺩﺩ ﺍﻟﺴﻜﺎﻥ ﺍﻟﻤﻌﺭﻀﻴﻥ ﻟﻠﺨﻁﺭ ﻓﻲ ﻤﻨﺘﺼﻑ ﺍﻟﻌﺎﻡ ﺨﻼل ﻨﻔﺱ ﺍﻟﻔﺘﺭﺓ ﺍﻟﺯﻤﻨﻴﺔ ﻓﻲ ﻨﻔﺱ ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺠﻐﺭﺍﻓﻴﺎ‬

‫ﻤﻌﺩل ﺍﻻﻨﺘﺸﺎﺭ )‪:(Pervalence Rate‬‬

‫ﻴﻘﻴﺱ ﻤﻌﺩﺩ ﺍﻻﻨﺘﺸﺎﺭ ﺘﻜﺭﺍﺭ )ﻋﺩﺩ( ﻭﺠﻭﺩ ﺠﻤﻴﻊ ﺍﻟﺤﺎﻻﺕ )ﺍﻟﺠﺩﻴﺩﺓ ﻭﺍﻟﻘﺩﻴﻤﺔ( ﻤﻥ ﻤﺭﺽ ﻤﺎ ﻓﻲ ﻤﺠﻤﻭﻋﺔ‬
‫ﺴﻜﺎﻨﻴﺔ ﻤﺤﺩﺩﺓ ﺨﻼل ﻓﺘﺭﺓ ﺯﻤﻨﻴﺔ ﻤﻌﻴﻨﺔ‪ .‬ﻭﻴﻜﻭﻥ ﻤﻌﺩل ﺍﻻﻨﺘﺸﺎﺭ ﺒﺄﺤﺩ ﺸﻜﻠﻴﻥ‪:‬‬

‫ﻤﻌﺩل ﺍﻨﺘﺸﺎﺭ ﺍﻟﻨﻘﻁﺔ )‪:(Point Pervalence Rate‬‬

‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻜﻠﻲ )ﺍﻟﺠﺩﻴﺩﺓ ﻭﺍﻟﻘﺩﻴﻤﺔ( ﻤﻥ ﻤﺭﺽ ﻤﻌﻴﻥ ﻓﻲ ﻨﻘﻁﺔ ﺯﻤﻨﻴﺔ ﻤﻌﻴﻨﺔ ﻓﻲ ﻤﻨﻁﻘﺔ ﺠﻐﺭﺍﻓﻴﺔ ﻤﺤﺩﺩﺓ‬
‫× ‪١٠٠٠٠٠‬‬
‫ﺘﻘﺩﻴﺭ ﻋﺩﺩ ﺍﻟﺴﻜﺎﻥ ﺍﻟﻤﻌﺭﻀﻴﻥ ﻟﻠﺨﻁﺭ ﻓﻲ ﻤﻨﺘﺼﻑ ﺍﻟﻌﺎﻡ ﻓﻲ ﻨﻔﺱ ﺍﻟﻔﺘﺭﺓ ﺍﻟﺯﻤﻨﻴﺔ ﻓﻲ ﻨﻔﺱ ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺠﻐﺭﺍﻓﻴﺎ‬

‫ﻤﻌﺩل ﺍﻨﺘﺸﺎﺭ ﺍﻟﻤﺩﺓ )‪:(Period Pervalence Rate‬‬

‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻜﻠﻲ )ﺍﻟﺠﺩﻴﺩﺓ ﻭﺍﻟﻘﺩﻴﻤﺔ( ﻤﻥ ﻤﺭﺽ ﻤﻌﻴﻥ ﻭﺍﻟﻭﺍﻗﻌﺔ ﺨﻼل ﻓﺘﺭﺓ ﺯﻤﻨﻴﺔ ﻤﻌﻴﻨﺔ ﻓﻲ ﻤﻨﻁﻘﺔ ﺠﻐﺭﺍﻓﻴﺔ ﻤﺤﺩﺩﺓ‬
‫‪١٠٠٠٠٠‬‬ ‫×‬
‫ﺘﻘﺩﻴﺭ ﻋﺩﺩ ﺍﻟﺴﻜﺎﻥ ﺍﻟﻤﻌﺭﻀﻴﻥ ﻟﻠﺨﻁﺭ ﻓﻲ ﻤﻨﺘﺼﻑ ﺍﻟﻌﺎﻡ ﺨﻼل ﻨﻔﺱ ﺍﻟﻔﺘﺭﺓ ﺍﻟﺯﻤﻨﻴﺔ ﻓﻲ ﻨﻔﺱ ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺠﻐﺭﺍﻓﻴﺎ‬

‫ﻤﻌﺩل ﺍﻟﻬﺠﻤﺔ )‪:(Attak Rate‬‬

‫ﻴﺩﻋﻰ ﻤﻌﺩل ﺍﻟﻭﻗﻭﻉ ﻓﻲ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺨﻤﺠﻴﺔ ﻭﻴﺴﺘﺨﺩﻡ ﻋﻨﺩﻤﺎ ﺘﻜﻭﻥ ﺍﻟﺠﻤﻬﺭﺓ ﺍﻟﻤﻌﺭﻀﺔ ﻟﻠﺨﻁﺭ ﻟﻔﺘﺭﺓ ﺯﻤﻨﻴﺔ‬
‫ﻗﺼﻴﺭﺓ‪ ،‬ﻜﻤﺎ ﻫﻭ ﺍﻟﺤﺎل ﺃﺜﻨﺎﺀ ﺍﻷﻭﺒﺌﺔ‪ ،‬ﻭﻴﻌﺒﺭ ﻋﻨﻪ ﺒﻨﺴﺒﺔ ﻤﺌﻭﻴﺔ‪.‬‬

‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺠﺩﻴﺩﺓ ﻤﻥ ﻤﺭﺽ ﻤﻌﻴﻥ ﺨﻼل ﻓﺘﺭﺓ ﺯﻤﻨﻴﺔ ﻤﺤﺩﺩﺓ ﻓﻲ ﻤﻨﻁﻘﺔ ﺠﻐﺭﺍﻓﻴﺔ ﻤﺤﺩﺩﺓ‬
‫× ‪١٠٠‬‬
‫ﻋﺩﺩ ﺍﻟﺴﻜﺎﻥ ﺍﻟﻤﻌﺭﻀﻴﻥ ﻟﻠﺨﻁﺭ ﺨﻼل ﻨﻔﺱ ﺍﻟﻔﺘﺭﺓ ﺍﻟﺯﻤﻨﻴﺔ‬

‫‪١٧‬‬
 ‫ﻤﻌﺩل ﺍﻟﻬﺠﻤﺔ ﺍﻟﺜﺎﻨﻭﻴﺔ )‪:(secondary attack rate‬‬
‫ﻴﻘﻴﺱ ﻤﻌﺩل ﺍﻟﻬﺠﻤﺔ ﺍﻟﺜﺎﻨﻭﻴﺔ ﻤﺩﻯ ﺇﺨﻤﺎﺝ ﺍﻟﻤﺭﺽ ﻭﻗﺩﺭﺘﻪ ﻋﻠﻰ ﺍﻻﻨﺘﺸﺎﺭ‪ .‬ﻭﻫﻭ ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻭﺍﻗﻌﺔ ﺒﻴﻥ‬
‫ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﺨﻼل ﻓﺘﺭﺓ ﺤﻀﺎﻨﺔ ﺒﻌﺩ ﺍﻟﺘﻌﺭﺽ ﻟﻠﺤﺎﻟﺔ ﺍﻷﻭﻟﻴﺔ ﻤﻥ ﺍﻟﻌﺩﺩ ﺍﻟﻜﻠﻲ ﻟﻠﻤﺨﺎﻟﻁﻴﻥ ﺍﻟﻤﺘﻤﺎﺴﻴﻥ ﻤﻊ ﺍﻟﺤﺎﻟﺔ‪،‬‬
‫ﻭﺇﻥ ﺍﻟﻤﺨﺭﺝ ﻴﺠﺏ ﺃﻥ ﻴﻘﺘﺼﺭ ﻋﻠﻰ ﺍﻟﻤﺘﻤﺎﺴﻴﻥ ﺍﻟﻤﺴﺘﻌﺩﻴﻥ ﻓﻘﻁ ﺇﻥ ﺃﻤﻜﻥ ﺘﻤﻴﻴﺯﻫﻡ‪.‬‬
‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺜﺎﻨﻭﻴﺔ ﻤﻥ ﺍﻟﻤﺭﺽ ﺍﻟﺤﺎﺩﺜﺔ ﺒﻌﺩ ﺍﻟﺤﺎﻟﺔ ﺍﻷﻭﻟﻴﺔ ﺨﻼل ﻓﺘﺭﺓ ﻤﺤﺩﺩﺓ‬
‫× ‪١٠٠‬‬
‫ﺍﻟﺴﻜﺎﻥ ﺍﻟﻤﻌﺭﻀﻴﻥ ﻟﻠﺨﻁﺭ )ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﺘﻤﺎﺴﻴﻥ ﺍﻟﻤﺴﺘﻌﺩﻴﻥ(‬

‫ﻤﻌﺩل ﺇﻤﺎﺘﺔ ﺍﻟﺤﺎﻟﺔ )‪:(case fatality rate‬‬

‫ﻴﻘﻴﺱ ﻫﺫﺍ ﺍﻟﻤﻌﺩل ﻤﺩﻯ ﺸﺩﺓ ﻭﺨﻁﻭﺭﺓ ﺍﻟﻤﺭﺽ‪ .‬ﻤﻌﺩل ﺍﻹﻤﺎﺘﺔ ﻤﻥ ﻤﺭﺽ ﻤﻌﻴﻥ ﻴﻘﻴﺱ ﻨﺴﺒﺔ ﺤﺎﻻﺕ‬
‫ﺍﻟﻤﺭﻀﻰ ﺍﻟﺘﻲ ﺘﻨﺘﻬﻲ ﺒﺎﻟﻭﻓﺎﺓ ﻭﻴﻌﺒﺭ ﻋﻨﻪ ﺒﻨﺴﺒﺔ ﻤﺌﻭﻴﺔ‪.‬‬
‫ﻋﺩﺩ ﺍﻟﻭﻓﻴﺎﺕ ﺍﻟﻨﺎﺘﺠﺔ ﻋﻥ ﻤﺭﺽ ﻤﻌﻴﻥ ﻭﺍﻟﺤﺎﺩﺜﺔ ﺨﻼل ﻓﺘﺭﺓ ﺯﻤﻨﻴﺔ ﻤﻌﻴﻨﺔ‬
‫‪١٠٠ x‬‬
‫ﺍﻟﻌﺩﺩ ﺍﻟﻜﻠﻲ ﻟﺤﺎﻻﺕ ﻨﻔﺱ ﺍﻟﻤﺭﺽ ﺍﻟﺤﺎﺩﺜﺔ ﺨﻼل ﻨﻔﺱ ﺍﻟﻔﺘﺭﺓ ﺍﻟﺯﻤﻨﻴﺔ‬

‫‪١٨‬‬
 ‫‪‬‬
‫א‪‬א‪‬א‪ ‬‬
‫ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ‪:‬‬
‫ﺍﻟﺘﻌﺭﻑ ﻋﻠﻰ ﻤﺼﺎﺩﺭ ﺍﻟﺨﻤﺞ ﻭﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل ﻭﻤﻥ ﺜﻡ ﺘﺤﺩﻴﺩ ﺍﻟﻭﺴﺎﺌل ﺍﻟﻀﺭﻭﺭﻴﺔ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻔﺎﺸﻴﺔ‬
‫ﻭﻤﻨﻊ ﺤﺩﻭﺙ ﺘﻔﺸﻴﺎﺕ ﻤﻤﺎﺜﻠﺔ ﻓﻲ ﺍﻟﻤﺴﺘﻘﺒل‪.‬‬

‫ﻤﺭﺍﺤل ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ‪:‬‬

‫• ﺍﻟﺘﺤﻘﻕ ﻤﻥ ﺼﺩﻕ ﺍﻟﺘﺸﺨﻴﺹ‪.‬‬
‫• ﺍﻟﺘﺄﻜﺩ ﻤﻥ ﻭﺠﻭﺩ ﻭﺒﺎﺀ‪.‬‬
‫• ﺠﻤﻊ ﺍﻟﻤﻌﻠﻭﻤﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ )ﺤﺴﺏ ﻤﺘﻐﻴﺭﺍﺕ ﺍﻟﺸﺨﺹ‪ ،‬ﺍﻟﺯﻤﺎﻥ‪ ،‬ﺍﻟﻤﻜﺎﻥ(‪.‬‬
‫• ﺤﺴﺎﺏ ﺒﻌﺽ ﺍﻟﻤﺅﺸﺭﺍﺕ ﺍﻹﺤﺼﺎﺌﻴﺔ‪:‬‬
‫ﻤﻌﺩﻻﺕ ﺍﻟﺤﺩﻭﺙ ﺃﻭ ﺍﻻﻨﺘﺸﺎﺭ ﺃﻭ ﺍﻟﻭﻓﻴﺎﺕ ﺒﺎﻻﺴﺘﻨﺎﺩ ﺇﻟﻰ ﺍﻟﻤﻌﻠﻭﻤﺎﺕ ﺍﻟﺴﻜﺎﻨﻴﺔ‪.‬‬
‫• ﺩﺭﺍﺴﺔ ﺍﻟﻅﺭﻭﻑ ﺍﻟﺒﻴﺌﻴﺔ ﻭﻗﺕ ﻭﻗﻭﻉ ﺍﻟﻭﺒﺎﺀ‪.‬‬
‫• ﺘﺤﻠﻴل ﺍﻟﻤﻌﻠﻭﻤﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ‪:‬‬
‫ﻭﻓﻕ ﺍﻟﺜﺎﻟﻭﺙ ﺍﻟﻭﺼﻔﻲ‪) :‬ﺍﻟﺸﺨﺹ‪ ،‬ﺍﻟﻤﻜﺎﻥ‪ ،‬ﺍﻟﺯﻤﺎﻥ = ﻤﻥ‪ ،‬ﺃﻴﻥ‪ ،‬ﻤﺘﻰ(‪.‬‬
‫• ﺼﻴﺎﻏﺔ ﺍﻟﻔﺭﻀﻴﺔ‪:‬‬
‫ﻤﻥ ﺩﺭﺍﺴﺔ ﺍﻟﺘﻭﺯﻉ ﻭﻓﻕ ﺍﻟﺯﻤﺎﻥ ﻭﺍﻟﻤﻜﺎﻥ ﻭﺍﻟﺸﺨﺹ ﺘﺼﺎﻍ ﺍﻟﻔﺭﻀﻴﺔ ﻟﺘﻔﺴﻴﺭ ﺍﻟﻭﺒﺎﺀ ﻭﻓﻘﹰﺎ ﻟﻠﻨﻘﺎﻁ‪:‬‬
‫‪ -‬ﺍﻟﻤﺼﺩﺭ ﺍﻟﻤﺤﺘﻤل‪.‬‬
‫‪ -‬ﺍﻟﻌﺎﻤل ﺍﻟﻤﺴﺒﺏ‪.‬‬
‫‪ -‬ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل ﺍﻟﻤﺤﺘﻤﻠﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻘﻕ ﻤﻥ ﺼﺤﺔ ﺍﻟﻔﺭﻀﻴﺔ )ﺍﺨﺘﺒﺎﺭ ﺍﻟﻔﺭﻀﻴﺔ(‪:‬‬
‫ﺒﺈﺠﺭﺍﺀ ﻤﻘﺎﺭﻨﺎﺕ ﻟﻤﻌﺩﻻﺕ ﺍﻟﻬﺠﻤﺔ ﻓﻲ ﻤﺠﻤﻭﻋﺎﺕ ﻤﺨﺘﻠﻔﺔ ﺒﻴﻥ ﺍﻟﻤﺘﻌﺭﻀﻴﻥ ﻭﻏﻴﺭ ﺍﻟﻤﺘﻌﺭﻀﻴﻥ ﻟﻜل ﺴﻭﺍﻍ‬
‫ﻤﺸﺘﺒﻪ‪ ،‬ﻭﻤﺭﺍﺠﻌﺔ ﺍﻟﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ‪ ،‬ﺍﻟﺒﻴﺌﺔ‪ ،‬ﺍﻟﺜﻭﻱ ﻟﻤﻌﺭﻓﺔ ﺍﻟﻤﺴﺅﻭل ﻋﻥ ﺘﻐﻴﺭ ﺍﻟﺘﻭﺍﺯﻥ ﺍﻹﻴﻜﻭﻟﻭﺠﻲ ﻓﻲ‬
‫ﺍﻟﺘﺎﺭﻴﺦ ﺍﻟﻁﺒﻴﻌﻲ ﻟﻠﻤﺭﺽ‪.‬‬
‫• ﻤﻜﺎﻓﺤﺔ ﺍﻟﻭﺒﺎﺀ ﻭﺍﻟﺴﻴﻁﺭﺓ ﻋﻠﻴﻪ‪ :‬ﺒﺎﻟﺘﺩﺨل ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﺩﻉ‪ ،‬ﺍﻟﺒﻴﺌﺔ‪ ،‬ﺍﻟﺜﻭﻱ‪.‬‬
‫• ﻜﺘﺎﺒﺔ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﻨﻬﺎﺌﻲ‪.‬‬

‫‪١٩‬‬
 ‫ﺸﺭﺡ ﺠﻤﻴﻊ ﻤﺭﺍﺤل ﺍﻟﻌﻤل‪:‬‬
‫• ﻤﻘﺩﻤﺔ ﻋﻥ ﺍﻟﻤﻭﻀﻭﻉ‪.‬‬
‫• ﻭﺼﻑ ﻟﻠﺩﺭﺍﺴﺔ ﺍﻟﺘﻲ ﺘﻡ ﺇﺠﺭﺍﺅﻫﺎ‪.‬‬
‫• ﺘﺤﻠﻴل ﺍﻟﻨﺘﺎﺌﺞ‪.‬‬
‫• ﺍﻟﻔﺭﻀﻴﺔ ﺍﻟﺘﻲ ﻭﻀﻌﺕ ﺒﻌﺩ ﺍﺴﺘﺨﻼﺹ ﺍﻟﻨﺘﺎﺌﺞ‪.‬‬
‫• ﻭﺼﻑ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﺘﺨﺫﺓ ﻟﻤﻨﻊ ﺍﻨﺘﺸﺎﺭ ﺍﻟﺨﻤﺞ‪.‬‬
‫• ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻭﺼﻰ ﺒﻬﺎ ﻟﺘﺤﺴﻴﻥ ﺘﺭﺼﺩ ﻭﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﺭﺽ‪.‬‬

‫‪٢٠‬‬
 ‫‪‬‬
‫‪‬א‪‬א‪‬א‪ ‬‬
‫ﺇﺠﺭﺍﺀﺍﺕ ﺨﺎﺼﺔ ﺒﺎﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫• ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﺒﺎﻜﺭ‪.‬‬
‫• ﺍﻟﺘﺒﻠﻴﻎ‪ :‬ﻭﻓﻕ ﺍﻟﻘﺭﺍﺭ ﺍﻟﺘﻨﻅﻴﻤﻲ ﻟﻸﻤﺭﺍﺽ ﺍﻟﻭﺍﺠﺏ ﺍﻹﺒﻼﻍ ﻋﻨﻬﺎ‪.‬‬
‫• ﺍﻟﻌﺯل‪ :‬ﻟﺤﻤﺎﻴﺔ ﺍﻟﻤﺠﺘﻤﻊ )ﻋﻥ ﻁﺭﻴﻕ ﻤﻨﻊ ﺍﻨﺘﻘﺎل ﺍﻟﺨﻤﺞ ﻤﻥ ﺍﻟﻤﺴﺘﻭﺩﻉ ﺇﻟﻰ ﺍﻷﺜﻭﻴﺎﺀ ﺍﻟﻤﺤﺘﻤﻠﻴﻥ(‪.‬‬
‫ﻴﺠﺏ ﺘﺤﺩﻴﺩ‪ - :‬ﻤﻜﺎﻥ ﺍﻟﻌﺯل )ﻤﺴﺘﺸﻔﻰ – ﻤﻨﺯل – ﻋﺯل ﻗﺭﻴﺔ‪.(...‬‬
‫‪ -‬ﻨﻭﻉ ﺍﻟﻌﺯل )ﺘﻨﻔﺴﻲ – ﺘﻤﺎﺱ – ﻫﻀﻤﻲ‪.(...‬‬
‫‪ -‬ﻤﺩﺓ ﺍﻟﻌﺯل‪ :‬ﺤﺘﻰ ﺍﻟﺘﺄﻜﺩ ﻤﻥ ﺴﻠﺒﻴﺔ ﺍﻟﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ ﺒﻌﺩﺓ ﻓﺤﻭﺹ ﻤﺨﺒﺭﻴﺔ )ﻓﺘﺭﺓ ﺍﻟﺴﺭﺍﻴﺔ(‪.‬‬
‫• ﺍﻟﺤﺠﺭ‪ :‬ﺘﺤﺩﻴﺩ ﺤﺭﻜﺔ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﻟﻔﺘﺭﺓ ﻤﻥ ﺍﻟﺯﻤﻥ ﻤﺴﺎﻭﻴﺔ ﻟﻠﺤﺩ ﺍﻷﻋﻅﻤﻲ ﻟﺩﻭﺭ ﺤﻀﺎﻨﺔ ﺍﻟﻤﺭﺽ )ﺍﻟﻁﺎﻋﻭﻥ‬
‫ﻻ ﻋﻨﻬﺎ ﺍﻟﺘﺭﺼﺩ‪.‬‬
‫ﺍﻟﺭﺌﻭﻱ‪ ،‬ﺍﻟﻜﻭﻟﻴﺭﺍ ﺴﺎﺒﻘﹰﺎ‪ (...‬ﻓﻘﺩﺕ ﻗﻴﻤﺘﻬﺎ ﻭﺤل ﺒﺩ ﹰ‬
‫• ﺍﻟﺘﺭﺼﺩ‪ :‬ﻭﻀﻊ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﺘﺤﺕ ﺍﻟﻤﺭﺍﻗﺒﺔ ﺍﻟﻁﺒﻴﺔ ﺍﻟﻤﺒﺎﺸﺭﺓ )ﺒﺩﻭﻥ ﺘﺤﺩﻴﺩ ﺤﺭﻜﺘﻬﻡ( ﺒﻐﺎﻴﺔ ﺍﻟﻜﺸﻑ ﺍﻟﻤﺒﻜﺭ‬
‫ﻭﺍﻟﺘﺩﺨل )ﻓﺘﺭﺓ ﺍﻟﻤﺭﺍﻗﺒﺔ ﻫﻲ ﻓﺘﺭﺓ ﺍﻟﺤﻀﺎﻨﺔ ﺍﻟﻘﺼﻭﻯ(‪.‬‬
‫• ﺍﻟﻤﻌﺎﻟﺠﺔ‪ :‬ﺘﺨﺘﺼﺭ ﻤﺩﺓ ﺍﻟﻤﺭﺽ‪ ،‬ﺘﻘﻠل ﺍﻟﺴﺭﺍﻴﺔ‪ ،‬ﺘﻤﻨﻊ ﺤﺩﻭﺙ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺜﺎﻨﻭﻴﺔ‪ ،‬ﻋﻼﺝ ﺍﻟﺤﺎﻻﺕ ﻭﺍﻟﺤﻤﻠﺔ )ﻗﺩ‬
‫ﻴﻜﻭﻥ ﺼﻌﺒﹰﺎ ﺃﺤﻴﺎﻨﹰﺎ(‪ ،‬ﻴﺠﺏ ﺃﻥ ﻴﺤﻘﻕ ﺍﻟﺸﻔﺎﺀ ﺍﻟﺠﺭﺜﻭﻤﻲ ﻭﻟﻴﺱ ﺍﻟﺴﺭﻴﺭﻱ ﻓﻘﻁ‪.‬‬
‫• ﺍﻟﺘﻁﻬﻴﺭ‪ :‬ﻭﻫﻭ ﻗﺘل ﺍﻟﻌﻭﺍﻤل ﺍﻟﻤﻤﺭﻀﺔ ﺍﻟﻤﻭﺠﻭﺩﺓ ﻓﻲ ﻤﻔﺭﺯﺍﺕ ﻭﻤﻔﺭﻏﺎﺕ ﺍﻟﻤﺨﻤﻭﺝ ﻭﺃﺩﻭﺍﺘﻪ ﺍﻟﻤﻠﻭﺜﺔ‪ ،‬ﻴﺠﺏ ﺃﻥ‬
‫ﻴﻜﻭﻥ ﺍﻟﺘﻁﻬﻴﺭ ﻤﻼﺯﻡ ﻭﻨﻬﺎﺌﻲ‪.‬‬
‫• ﺍﻻﺴﺘﺌﺼﺎل‪ :‬ﺇﺫﺍ ﻜﺎﻥ ﺍﻟﻤﺴﺘﻭﺩﻉ ﺤﻴﻭﺍﻨﹰﺎ )ﺍﻟﺴل ﺍﻟﺒﻘﺭﻱ – ﺍﻟﻜﻠﺏ – ﺍﻟﺒﺭﻭﺴﻴﻼ‪.(...‬‬
‫• ﺇﺠﺭﺍﺀﺍﺕ ﺨﺎﺼﺔ ﺒﺎﻟﺤﻤﻠﺔ‪ :‬ﺘﻘﺼﻲ ﻓﻲ ﺤﺎل ﺘﻭﺍﺠﺩﻫﻡ ﻓﻲ ﻤﺠﺘﻤﻌﺎﺕ ﻤﻐﻠﻘﺔ )ﻤﻌﺴﻜﺭﺍﺕ‪ -‬ﻤﺩﺍﺭﺱ‪ (...‬ﻴﻤﻜﻥ‬
‫ﺍﻟﻭﺼﻭل ﺇﻟﻴﻬﻡ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺨﺎﺼﺔ ﺒﺎﻟﺜﻭﻱ ﺍﻟﻤﺴﺘﻌﺩ‪:‬‬

‫ﺍﻟﺘﻤﻨﻴﻊ )ﺍﻟﻔﺎﻋل ﻭﺍﻟﻤﻨﻔﻌل( – ﺍﻟﻭﻗﺎﻴﺔ ﺍﻟﻜﻴﻤﻴﺎﺌﻴﺔ – ﺍﻟﺘﻭﻋﻴﺔ ﺍﻟﺼﺤﻴﺔ – ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺠﻴﺩﺓ‪.‬‬
‫• ﺍﻟﺘﻤﻨﻴﻊ‪:‬‬
‫ﻓﺎﻋل )ﺍﻟﻠﻘﺎﺡ( ﺃﻭ ﻤﻨﻔﻌل‪.‬‬

‫ﺘﻌﺘﻤﺩ ﻓﻌﺎﻟﻴﺔ ﺍﻟﺘﻤﻨﻴﻊ ﻓﻲ ﻭﻗﺎﻴﺔ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﻋﻠﻰ ﺍﻟﻌﻼﻗﺔ ﺒﻴﻥ‪ :‬ﻓﺘﺭﺓ ﺤﻀﺎﻨﺔ ﺍﻟﻤﺭﺽ‪ ،‬ﻭﺍﻟﻤﺩﺓ ﺍﻟﻼﺯﻤﺔ ﻹﺤﺩﺍﺙ‬
‫ﺍﻟﻤﻨﺎﻋﺔ ﺒﺎﻟﻠﻘﺎﺡ‪.‬‬

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 ‫‪ -‬ﺍﻟﻤﻨﺎﻋﺔ ﺍﻟﻤﻨﻔﻌﻠﺔ‪ - :‬ﺍﻟﻤﺼﻭل ﺍﻟﻤﻀﺎﺩﺓ )ﺍﻟﺤﻴﻭﺍﻨﻴﺔ(‪ :‬ﺍﻟﺨﻨﺎﻕ‪ ،‬ﺍﻟﻜﺯﺍﺯ‪ ،‬ﺍﻟﻜﻠﺏ‪.‬‬
‫‪ -‬ﻏﺎﻤﺎ ﻏﻠﻭﺒﻭﻟﻴﻥ ﺇﻨﺴﺎﻨﻲ‪) :‬ﺍﻟﻌﺎﺩﻱ ﻭﺍﻟﻨﻭﻋﻲ(‪.‬‬
‫• ﺍﻟﻭﻗﺎﻴﺔ ﺍﻟﻜﻴﻤﻴﺎﺌﻴﺔ‪:‬‬
‫ﺇﻋﻁﺎﺀ ﻋﻘﺎﺭ ﻤﻌﻴﻥ )ﻟﻸﺸﺨﺎﺹ ﺍﻟﻤﺴﺘﻌﺩﻴﻥ( ﻗﺒل ﻭﻗﻭﻉ ﺍﻟﻤﺭﺽ ﻟﺘﺤﻘﻴﻕ ﺍﻟﻭﻗﺎﻴﺔ ﺍﻷﻭﻟﻴﺔ‪.‬‬
‫‪ -‬ﺍﺴﺘﺨﺩﺍﻤﻬﺎ‪ -١ :‬ﻓﻲ ﺤﺎل ﻋﺩﻡ ﺘﻭﻓﺭ ﻭﺴﻴﻠﺔ ﺘﻤﻨﻴﻌﻴﺔ‪.‬‬
‫‪ -٢‬ﺍﻟﻭﺴﻴﻠﺔ ﺍﻟﺘﻤﻨﻴﻌﻴﺔ ﻤﺤﺩﻭﺩﺓ ﺍﻟﻔﻌﺎﻟﻴﺔ )ﺍﻟﻜﻭﻟﻴﺭﺍ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺒﺎﻟﻤﻜﻭﺭﺓ ﺍﻟﺴﺤﺎﺌﻴﺔ(‪.‬‬
‫‪ -٣‬ﻟﻠﻭﻗﺎﻴﺔ ﻤﻥ ﻋﻘﺎﺒﻴل ﺍﻟﻤﺭﺽ )ﺍﻟﺤﻤﻰ ﺍﻟﺭﺜﻭﻴﺔ(‪.‬‬
‫‪ -٤‬ﻟﺤﻤﺎﻴﺔ ﺍﻟﻘﺎﺩﻤﻴﻥ ﻤﻥ ﻤﻨﺎﻁﻕ ﻨﻅﻴﻔﺔ ﺇﻟﻰ ﻤﻨﺎﻁﻕ ﻴﺘﻭﻁﻥ ﻓﻴﻬﺎ ﻤﺭﺽ ﻤﻌﻴﻥ )ﺍﻟﻤﻼﺭﻴﺎ(‪.‬‬
‫‪ -‬ﻤﺴﺎﻭﺌﻬﺎ‪ -١ :‬ﻤﻜﻠﻔﺔ‪.‬‬
‫‪ -٢‬ﻓﺘﺭﺓ ﺍﻟﻭﻗﺎﻴﺔ ﻟﻤﺩﺓ ﻤﺤﺩﻭﺩﺓ )ﻤﺭﺘﺒﻁﺔ ﺒﺘﻨﺎﻭل ﺍﻟﺩﻭﺍﺀ(‪.‬‬
‫‪ -٣‬ﻴﻤﻜﻥ ﻟﻠﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ ﺃﻥ ﻴﺸﻜل ﻤﻘﺎﻭﻤﺔ‪.‬‬
‫‪ -٤‬ﺫﺍﺕ ﺘﺄﺜﻴﺭﺍﺕ ﺠﺎﻨﺒﻴﺔ ﺴﻤﻴﺔ‪.‬‬
‫‪ -٥‬ﻗﺩ ﺘﺅﺩﻱ ﺇﻟﻰ ﺘﺜﺒﻴﻁ ﺍﻟﺘﻔﺎﻋل ﺍﻟﻤﻨﺎﻋﻲ‪.‬‬
‫• ﺍﻟﺘﻭﻋﻴﺔ ﺍﻟﺼﺤﻴﺔ‪:‬‬
‫ﺘﻘﺩﻴﻡ ﻤﻌﻠﻭﻤﺎﺕ ﻟﻠﺠﻤﻬﻭﺭ ﻟﺨﻠﻕ ﻭﻋﻲ ﺤﻭل ﺍﻟﻤﺸﻜﻠﺔ ﻭﻀﻤﺎﻥ ﺘﻌﺎﻭﻥ ﻭﻤﺴﺎﻫﻤﺔ ﺍﻟﺠﻤﻬﻭﺭ )ﺍﻟﻨﻅﺎﻓﺔ ﺍﻟﺸﺨﺼﻴﺔ‪،‬‬
‫ﺍﻟﺘﺒﻠﻴﻎ‪ ،‬ﺍﻻﻨﺘﺒﺎﻩ ﻟﻤﺼﺎﺩﺭ ﺍﻟﻤﻴﺎﻩ ‪ ...‬ﺇﻟﺦ(‪ ،‬ﻜﻤﺎ ﻴﻬﺩﻑ ﺍﻟﺘﺜﻘﻴﻑ ﺇﻟﻰ ﺇﺤﺩﺍﺙ ﺘﻐﻴﻴﺭ ﻓﻲ ﺍﻟﺴﻠﻭﻙ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺨﺎﺼﺔ ﺒﺎﻟﺒﻴﺌﺔ‪:‬‬

‫ﺒﺈﺼﺤﺎﺡ ﺍﻟﺒﻴﺌﺔ‪:‬‬
‫‪ -‬ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﻨﻘﻭﻟﺔ ﺒﺎﻟﺴﻭﺍﻍ‪ - :‬ﻀﺒﻁ ﺍﻟﻁﺭﻴﻕ ﺍﻟﻤﺎﺌﻲ‪ :‬ﺘﺄﻤﻴﻥ ﻤﺎﺀ ﺃﻤﻴﻥ ﻟﻠﺸﺭﺏ ﺒﺎﻟﻜﻠﻭﺭﺓ‪.‬‬
‫‪ -‬ﺍﻟﺘﺨﻠﺹ ﺍﻟﺴﻠﻴﻡ ﻤﻥ ﻤﻔﺭﻏﺎﺕ ﺍﻹﻨﺴﺎﻥ‪.‬‬
‫‪ -‬ﻀﺒﻁ ﺍﻟﻁﻌﺎﻡ‪ :‬ﺒﺴﺘﺭﺓ ﺍﻟﺤﻠﻴﺏ‪ ،‬ﻤﻌﺎﻴﻴﺭ ﻗﻴﺎﺴﻴﺔ ﻟﻀﺒﻁ ﻨﻭﻋﻴﺔ ﻭﻤﻜﻭﻨﺎﺕ‬
‫ﺍﻟﻁﻌﺎﻡ‪ ،‬ﺍﻟﺘﻭﻋﻴﺔ ﻓﻲ ﻗﻀﺎﻴﺎ ﺍﻟﺘﺼﺤﺢ ﺍﻟﺸﺨﺼﻲ‪.‬‬
‫‪ -‬ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﻨﻘﻭﻟﺔ ﺒﺎﻟﺤﺸﺭﺍﺕ‪ :‬ﻤﻜﺎﻓﺤﺔ ﺍﻟﺤﺸﺭﺓ ﺍﻟﻨﺎﻗﻠﺔ‪.‬‬
‫‪ -‬ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﻨﻘﻭﻟﺔ ﺒﺎﻟﻬﻭﺍﺀ‪ :‬ﻟﻴﺴﺕ ﺴﻬﻠﺔ ﺨﺎﺼﺔ ﻋﻨﺩ ﺘﻜﺩﺱ ﺍﻟﻤﺠﺘﻤﻊ )ﺍﻻﺯﺩﺤﺎﻡ(‪.‬‬
‫‪ -‬ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﻨﻘﻭﻟﺔ ﺒﺎﻟﺘﻤﺎﺱ‪ :‬ﻤﻤﺎﺭﺴﺎﺕ ﺍﻟﺘﺼﺤﺢ ﺍﻟﺸﺨﺼﻲ‪ ،‬ﻭﺇﺤﺴﺎﺱ ﺒﺎﻟﻤﺴﺅﻭﻟﻴﺔ ﻤﻥ ﻗﺒل ﺍﻟﺸﺨﺹ‬
‫ﺍﻟﻤﺭﻴﺽ ﺘﺠﺎﻩ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ‪.‬‬

‫ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﺩﻭﻟﻴﺔ‪:‬‬
‫ﺘﻁﺒﻴﻕ ﺍﻟﻠﻭﺍﺌﺢ ﺍﻟﺼﺤﻴﺔ ﺍﻟﺩﻭﻟﻴﺔ ﺨﺎﺼﺔ ﻓﻴﻤﺎ ﻴﺘﻌﻠﻕ ﺒﺎﻻﺴﺘﺠﺎﺒﺔ ﻷﻭﺒﺌﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺴﺘﺠﺩﺓ‪.‬‬

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 ‫‪‬‬
‫‪ ‬‬
‫‪ -‬ﺍﻟﺨﻤﺞ )‪ :(Infection‬ﺩﺨﻭل ﻭﺘﻁﻭﺭ ﺃﻭ ﺘﻜﺎﺜﺭ ﻋﺎﻤل ﻤﻤﺭﺽ ﻓﻲ ﺠﺴﻡ ﺇﻨﺴﺎﻥ ﺃﻭ ﺤﻴﻭﺍﻥ‪.‬‬

‫‪ -‬ﺍﻟﻤﺭﺽ ﺍﻟﺴﺎﺭﻱ )‪ :(Communicable Disease‬ﻤﺭﺽ ﻓﻲ ﺍﻹﻨﺴﺎﻥ ﺃﻭ ﺍﻟﺤﻴﻭﺍﻥ ﻴﻨﺠﻡ ﻋﻥ ﻋﺎﻤل‬

‫ﻤﻤﺭﺽ ﺃﻭ ﻤﻨﺘﺠﺎﺘﻪ‪ ،‬ﻭﻴﻤﻜﻥ ﺃﻥ ﻴﻨﺘﻘل )ﺒﺼﻭﺭﺓ ﻤﺒﺎﺸﺭﺓ ﺃﻭ ﻏﻴﺭ ﻤﺒﺎﺸﺭﺓ( ﻤﻥ ﺍﻟﻤﺴﺘﻭﺩﻉ ﺇﻟﻰ ﺍﻟﺜﻭﻱ ﺍﻟﻤﺴﺘﻌﺩ‪.‬‬

‫‪ -‬ﻓﺘﺭﺓ ﺍﻟﺤﻀﺎﻨﺔ )‪ :(Incubation Period‬ﺍﻟﻔﺎﺼل ﺍﻟﺯﻤﻨﻲ ﺒﻴﻥ ﺩﺨﻭل ﺍﻟﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ ﻭﻅﻬﻭﺭ ﺃﻭﻟﻰ‬
‫ﺃﻋﺭﺍﺽ ﺃﻭ ﻋﻼﻤﺎﺕ ﺍﻟﻤﺭﺽ‪.‬‬

‫‪ -‬ﻓﺘﺭﺓ ﺍﻟﺴﺭﺍﻴﺔ )‪ :(Period Of Communicability‬ﺍﻟﻔﺎﺼل ﺍﻟﺘﻲ ﻴﻜﻭﻥ ﻓﻴﻬﺎ ﺍﻟﻤﺴﺘﻭﺩﻉ ﻗﺎﺩﺭﹰﺍ ﻋﻠﻰ‬
‫ﻨﺸﺭ ﺍﻟﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ )ﺒﺼﻭﺭﺓ ﻤﺒﺎﺸﺭﺓ ﺃﻭ ﻏﻴﺭ ﻤﺒﺎﺸﺭﺓ( ﺇﻟﻰ ﺍﻟﺜﻭﻱ ﺍﻟﻤﺴﺘﻌﺩ‪.‬‬

‫‪ -‬ﺍﻟﻤﺴﺘﻭﺩﻉ )‪ :(Reservoir‬ﺍﻟﻤﻜﺎﻥ ﺤﻴﺙ ﻴﺄﻭﻱ ﺍﻟﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ ﻭﻴﻌﻴﺵ ﻭﻴﻨﻤﻭ ﻭﻴﺘﻜﺎﺜﺭ‪ ،‬ﻭﻴﻤﻜﻥ ﺃﻥ ﻴﻨﺘﻘل‬
‫ﻤﻨﻪ ﺇﻟﻰ ﺍﻟﺜﻭﻱ ﺍﻟﻤﺴﺘﻌﺩ )ﺇﻨﺴﺎﻥ‪ ،‬ﺤﻴﻭﺍﻥ‪ ،‬ﺘﺭﺒﺔ ‪.(...‬‬

‫‪ -‬ﺍﻟﺤﺎﻤل )‪ :(Carrier‬ﺇﻨﺴﺎﻥ ﻤﺨﻤﻭﺝ ﻴﺤﻤل ﺍﻟﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ ﺩﻭﻥ ﺃﻥ ﻴﺒﺩﻱ ﺃﻋﺭﺍﺽ ﺃﻭ ﻋﻼﻤﺎﺕ ﺴﺭﻴﺭﻴﺔ‪،‬‬
‫ﻭﻴﺨﺩﻡ ﻜﻤﺼﺩﺭ ﻤﺤﺘﻤل ﻟﻠﻌﺩﻭﻯ )ﻭﻴﻌﺘﺒﺭ ﺍﻷﺨﻁﺭ ﻓﻲ ﻨﻘل ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ(‪.‬‬

‫‪ -‬ﺍﻟﻭﺒﺎﺀ )‪ :(Epidemic‬ﻭﻗﻭﻉ ﺤﺎﻻﺕ ﻤﻥ ﺍﻋﺘﻼل ﻤﺎ ﻓﻲ ﺠﻤﺭﺓ ﺃﻭ ﻓﻲ ﻤﻨﻁﻘﺔ ﺠﻐﺭﺍﻓﻴﺔ ﻤﺤﺩﺩﺓ ﺨﻼل ﻓﺘﺭﺓ‬
‫ﺯﻤﻨﻴﺔ ﻤﺤﺩﺩﺓ ﺒﺯﻴﺎﺩﺓ ﻭﺍﻀﺤﺔ ﻋﻥ ﺍﻟﻤﺘﻭﻗﻊ ﺍﻟﻁﺒﻴﻌﻲ ﻟﺘﻠﻙ ﺍﻟﺠﻤﻬﺭﺓ ﻭﻓﻘ ﹰﺎ ﻟﻠﺨﺒﺭﺓ ﺍﻟﺴﺎﺒﻘﺔ‪.‬‬

‫‪ -‬ﺍﻟﻔﺎﺸﻴﺔ )‪ :(Outbreak‬ﻨﻔﺱ ﺘﻌﺭﻴﻑ ﺍﻟﻭﺒﺎﺀ‪.‬‬

‫‪ -‬ﺍﻟﺠﺎﺌﺤﺔ )‪ :(Pandemic‬ﻭﺒﺎﺀ ﻴﺤﺩﺙ ﻋﺒﺭ ﻤﺴﺎﺤﺔ ﻭﺍﺴﻌﺔ ﺠﺩﹰﺍ ﻭﻴﺼﻴﺏ ﻨﺴﺒﺔ ﻜﺒﻴﺭﺓ ﻤﻥ ﺍﻟﺠﻤﻬﺭﺓ‪.‬‬

‫‪ -‬ﺍﻟﻤﺭﺽ ﺍﻟﻤﺴﺘﻭﻁﻥ )‪ :(Endemic‬ﻫﻭ ﺍﻟﻤﺭﺽ ﺃﻭ ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ ﺍﻟﻤﻘﻴﻡ ﻓﻲ ﻤﻨﻁﻘﺔ ﺠﻐﺭﺍﻓﻴﺔ ﻤﻌﻴﻨﺔ ﺒﺤﻴﺙ‬
‫ﺘﺴﺘﻤﺭ ﺇﺼﺎﺒﺎﺘﻪ ﻓﻲ ﻫﺫﻩ ﺍﻟﻤﻨﻁﻘﺔ ﺤﺘﻰ ﻴﺼﺒﺢ ﻭﺠﻭﺩﻩ ﻤﻌﺘﺎﺩﹰﺍ‪.‬‬

‫‪٢٣‬‬
‫ﻓﻴﻤﺎ ﻴﻠﻲ ﺴﻨﺴﺘﻌﺭﺽ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﺍﻟﺨﺎﻀﻌﺔ ﻟﻨﻅﺎﻡ ﺍﻟﺘﺭﺼﺩ ﻓﻲ ﺴﻭﺭﻴﺔ‪ ،‬ﻭﻗﺩ ﺍﻋﺘﻤﺩ ﻓﻲ ﻋﺭﻀﻬﺎ‬
‫ﺍﻟﺨﻁﻭﺍﺕ ﺍﻟﺘﺎﻟﻴﺔ‪:‬‬

‫• ﺘﻌﺭﻴﻑ ﺍﻟﻤﺭﺽ‪.‬‬

‫• ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪.‬‬

‫• ﺍﻟﻤﺴﺘﻭﺩﻉ‪.‬‬

‫• ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪.‬‬

‫• ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﻤﻘﺎﻭﻤﺔ‪.‬‬

‫• ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪.‬‬

‫• ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪.‬‬

‫• ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻤﺨﺒﺭﻱ‪.‬‬

‫• ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ ‪.‬‬

‫• ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻭﺍﺠﺏ ﺇﺘﺒﺎﻋﻬﺎ ﻓﻲ ﻜل ﻤﻥ ﺍﻟﻤﺴﺘﻭﻴﺎﺕ ﺍﻟﻤﺫﻜﻭﺭﺓ ﺃﺩﻨﺎﻩ‪:‬‬

‫‪ o‬ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪ :‬ﻭﻴﻘﺼﺩ ﺒﻪ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﻭﻤﺭﺍﻜﺯ ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﺼﺤﻴﺔ‪ ،‬ﻭﺍﻟﻤﺴﺘﺸﻔﻴﺎﺕ‪.‬‬

‫‪ o‬ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪ :‬ﻭﻴﻘﺼﺩ ﺒﻪ ﻤﺩﻴﺭﻴﺎﺕ ﺍﻟﺼﺤﺔ‪ ،‬ﻭﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺘﺨﺼﺼﻴﺔ‪.‬‬

‫‪ o‬ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪ :‬ﻭﻴﻘﺼﺩ ﺒﻪ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪.‬‬

‫‪٢٤‬‬
٢٦
 ‫‪ ‬‬
‫א‪ ‬‬
‫‪ cholera‬‬
‫ﺍﻟﺘﻌﺭﻴﻑ‪:‬‬
‫ﻫﻭ ﻤﺭﺽ ﻤﻌﻭﻱ ﺠﺭﺜﻭﻤﻲ ﺤﺎﺩ ﻴﺒﺩﺃ ﺒﺸﻜل ﻓﺠﺎﺌﻲ ﻭﺃﻫﻡ ﺃﻋﺭﺍﻀﻪ‪ :‬ﺒﺭﺍﺯ ﻤﺎﺌﻲ‪ ،‬ﺘﺠﻔﺎﻑ ﺴﺭﻴﻊ‪ ،‬ﻭﺤﻤﺎﺽ‬
‫ﻭﻭﻫﻁ ﺩﻭﺭﺍﻨﻲ‪ ،‬ﻭﻗﺩ ﺘﺤﺩﺙ ﺇﻗﻴﺎﺀﺍﺕ‪.‬‬

‫ﻭﺍﻟﺨﻤﺞ ﺒﺩﻭﻥ ﺃﻋﺭﺍﺽ ﺃﻜﺜﺭ ﺤﺩﻭﺜﹰﺎ ﻤﻥ ﺍﻟﻤﺭﺽ ﺍﻟﺴﺭﻴﺭﻱ )ﺨﺎﺼﺔ ﻋﻨﺩ ﺍﻹﺼﺎﺒﺔ ﺒﻀﻤﺎﺕ ﺍﻟﻁﻭﺭ( ﺃﻭ‬
‫ﺍﻟﺤﺎﻻﺕ ﺍﻟﺒﺴﻴﻁﺔ ﺍﻟﺘﻲ ﺘﺘﻅﺎﻫﺭ ﺒﺈﺴﻬﺎل ﻓﻘﻁ ﺸﺎﺌﻌﺔ ﻋﻨﺩ ﺍﻷﻁﻔﺎل ﻤﻌﺩل ﺇﻤﺎﺘﺔ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺸﺩﻴﺩﺓ ﻭﻏﻴﺭ ﺍﻟﻤﻌﺎﻟﺠﺔ‬
‫‪ %٥٠‬ﺃﻭ ﺃﻜﺜﺭ‪ ،‬ﻴﻨﺨﻔﺽ ﺇﻟﻰ ﺃﻗل ﻤﻥ ‪ %١‬ﻤﻊ ﺍﻟﻌﻼﺝ ﺍﻟﺼﺤﻴﺢ‪.‬‬

‫ﺴﻠﺴﻠﺔ ﺍﻟﻌﺩﻭﻯ‪:‬‬
‫• ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪ :‬ﺍﻟﻀﻤﺔ ﺍﻟﻬﻴﻀﻴﺔ ‪ Vibriocholera‬ﻤﻥ ﺍﻟﻨﻤﻁ ﺍﻟﻤﺼﻠﻲ ‪ O1‬ﺍﻟﻤﺅﻟﻑ ﻤﻥ ﺍﻟﻨﻤﻁﻴﻥ‬
‫ﺍﻟﺤﻴﻭﻴﻴﻥ‪ :‬ﺍﻟﻀﻤﺔ ﺍﻟﻨﻤﻭﺫﺠﻴﺔ ﻭﻀﻤﺔ ﺍﻟﻁﻭﺭ )ﻭﻫﻲ ﺍﻟﺴﺎﺌﺩﺓ ﺤﺎﻟﻴﹰﺎ( ﻭﺍﻟﺫﻱ ﻴﺘﺄﻟﻑ ﻜل ﻤﻨﻬﻤﺎ ﻤﻥ ﺍﻟﻨﻤﻁﻴﻥ‬
‫ﺍﻟﻤﺼﻠﻴﻥ ﺍﻭﻏﺎﻭﺍ )ﻭﻜﺎﻥ ﺴﺎﺌﺩﹰﺍ ﻓﻲ ﺴﻭﺭﻴﺔ( ﻭﺇﻴﻨﺎﺒﺎ‪ .‬ﻭﻟﻘﺩ ﻅﻬﺭ ﻓﻲ ﺒﻌﺽ ﺩﻭل ﺁﺴﻴﺎ ﻨﻤﻁ ﻤﺼﻠﻲ ﺠﺩﻴﺩ‬
‫‪ O139‬ﻴﺴﺒﺏ ﺤﺎﻻﺕ ﻤﻤﺎﺜﻠﺔ ﺴﺭﻴﺭﻴﹰﺎ ﻭﻭﺒﺎﺌﻴﹰﺎ ﺍﻟﻬﻴﻀﺔ‪.‬‬

‫• ﺍﻟﻤﺴﺘﻭﺩﻉ‪ :‬ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﺭﻴﺽ ﻭﺍﻟﺤﺎﻤل ﻟﻠﺠﺭﺜﻭﻡ‪.‬‬

‫• ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪ :‬ﻴﻨﺘﻘل ﺍﻟﻤﺭﺽ ﺒﺼﻭﺭﺓ ﺭﺌﻴﺴﻴﺔ ﺒﺸﺭﺏ ﻤﺎﺀ ﻤﻠﻭﺙ ﺒﺒﺭﺍﺯ ﺃﻭ ﺇﻗﻴﺎﺀ ﺍﻟﻤﺭﻀﻰ ﺃﻭ ﺒﺩﺭﺠﺔ ﺃﻗل‬
‫ﺒﺒﺭﺍﺯ ﺤﻤﻠﺔ ﺍﻟﺠﺭﺜﻭﻡ‪.‬‬

‫ﻜﻤﺎ ﻴﻨﺘﻘل ﺒﺄﻜل ﻁﻌﺎﻡ ﻤﻠﻭﺙ ﺒﻤﺎﺀ ﻗﺫﺭ ﺃﻭ ﺒﺭﺍﺯ ﺃﻭ ﺃﻴﺩﻱ ﻤﻠﻭﺜﺔ ﺃﻭ ﺤﺸﺭﺍﺕ ﻨﺎﻗﻠﺔ ﻟﻠﻌﻭﺍﻤل ﺍﻟﻤﻤﺭﻀﺔ ﻜﺎﻟﺫﺒﺎﺏ‪.‬‬

‫• ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪ :‬ﻤﺘﻐﻴﺭﺍﻥ ﻭﻓﻲ ﺃﻤﺎﻜﻥ ﺘﻭﻁﻥ ﺍﻟﻤﺭﺽ ﻴﻜﺘﺴﺏ ﻤﻌﻅﻡ ﺍﻷﺸﺨﺎﺹ ﺍﻷﻀﺩﺍﺩ ﻓﻲ ﺴﻥ‬
‫ﺍﻟﺒﻠﻭﻍ‪.‬‬

‫• ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪ :‬ﻤﻥ ﺴﺎﻋﺎﺕ ﻗﻠﻴﻠﺔ ﺇﻟﻰ ﺨﻤﺴﺔ ﺃﻴﺎﻡ )ﻭﺴﻁﻴﹰﺎ ‪.(٣-٢‬‬

‫• ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪ :‬ﻁﻭﺍل ﻓﺘﺭﺓ ﺇﻴﺠﺎﺒﻴﺔ ﺍﻟﺒﺭﺍﺯ ﻭﺤﺘﻰ ﻋﺩﺓ ﺃﻴﺎﻡ ﺒﻌﺩ ﺍﻟﺸﻔﺎﺀ‪ ،‬ﻭﻗﺩ ﻴﻤﺘﺩ ﻋﺩﺓ ﺸﻬﻭﺭ ﻓﻲ ﺤﺎﻟﺔ ﺍﻟﺤﻤل‬
‫ﻭﺃﺤﻴﺎﻨﹰﺎ ﺴﻨﻭﺍﺕ )ﻋﻨﺩ ﺤﺩﻭﺙ ﺍﻟﺨﻤﺞ ﺍﻟﻤﺭﺍﺭﻱ ﺍﻟﻤﺯﻤﻥ( ﻭﺘﻘﺼﺭ ﻓﺘﺭﺓ ﺍﻟﺴﺭﺍﻴﺔ ﻤﻊ ﺍﻟﻌﻼﺝ ﺒﺎﻟﺼﺎﺩﺍﺕ‪.‬‬

‫• ﺍﻟﺘﺸﺨﻴﺹ‪ :‬ﻴﻌﺘﻤﺩ ﺘﺸﺨﻴﺹ ﺍﻟﻤﺭﺽ ﻋﻠﻰ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻭﻋﻠﻰ ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻤﺨﺒﺭﻱ ﺒﺯﺭﻉ ﻀﻤﺎﺕ‬
‫ﺍﻟﻬﻴﻀﺔ ﻤﻥ ﺍﻟﺒﺭﺍﺯ‪ ،‬ﻭﻴﻔﻴﺩ ﻓﻲ ﺘﺤﺩﻴﺩ ﺍﻟﻨﻤﻁ ﺍﻟﻤﺼﻠﻲ ﻭﺍﻟﺤﻴﻭﻱ ﻭﺩﺭﺍﺴﺔ ﺍﻟﺘﺤﺴﺱ ﻟﻠﺼﺎﺩﺍﺕ‪.‬‬

‫‪٢٧‬‬
 ‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ‬
‫ﺘﻌﺭﻑ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ ﺒﺄﻨﻬﺎ ﺤﺎﻟﺔ ﺇﺴﻬﺎل ﻤﺎﺌﻲ ﻤﻔﺎﺠﺊ ﻭﻏﺯﻴﺭ ﺃﺩﻯ ﺇﻟﻰ ﺤﺩﻭﺙ ﺘﺠﻔﺎﻑ ﺴﺭﻴﻊ ﻭﺸﺩﻴﺩ‪ ،‬ﺃﻭ‬
‫ﻭﻓﺎﺓ ﻟﺩﻯ ﺸﺨﺹ ﺒﻌﻤﺭ ﺨﻤﺱ ﺴﻨﻭﺍﺕ ﻓﻤﺎ ﻓﻭﻕ‪.‬‬

‫ﺃﻤﺎ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺅﻜﺩﺓ ﻓﻬﻲ ﺤﺎﻟﺔ ﻤﺸﺘﺒﻬﺔ ﻤﻊ ﺇﻅﻬﺎﺭ ﻀﻤﺎﺕ ﺍﻟﻬﻴﻀﺔ )‪ (O139.O1‬ﺒﺎﻟﺯﺭﻉ ﻋﻠﻰ ﺍﻷﻭﺴﺎﻁ‬
‫ﺍﻟﻤﻨﺎﺴﺒﺔ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻭﺍﺠﺏ ﺍﺘﺨﺎﺫﻫﺎ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬

‫• ﺍﻟﻜﺸﻑ ﺍﻟﺒﺎﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ ﺒﻴﻥ ﺤﺎﻻﺕ ﺍﻹﺴﻬﺎل ﺍﻟﻤﺭﺍﺠﻌﺔ ﻟﻠﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ‪ ،‬ﻭﺤﺴﺏ ﺍﻟﺘﻌﺭﻴﻑ‬
‫ﺍﻟﻘﻴﺎﺴﻲ‪.‬‬

‫• ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﺒﺎﻟﻬﺎﺘﻑ ﺃﻭ ﺒﺎﻟﻔﺎﻜﺱ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻟﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬

‫• ﺍﻟﻌﻼﺝ ﺍﻟﺴﺭﻴﻊ ﻭﺍﻟﺼﺤﻴﺢ ﻟﻠﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ ﺒﻌﺩ ﺃﺨﺫ ﻋﻴﻨﺔ ﺒﺭﺍﺯﻴﺔ ﻭﺇﺭﺴﺎﻟﻬﺎ ﻟﻤﺨﺒﺭ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ ﻟﻤﺩﻴﺭﻴﺔ‬
‫ﺍﻟﺼﺤﺔ ﺒﺸﺭﻭﻁ ﻤﻨﺎﺴﺒﺔ ﻟﺘﺄﻜﻴﺩ ﺍﻟﺘﺸﺨﻴﺹ ﻭﺇﺠﺭﺍﺀ ﺍﻟﺘﺤﺴﺱ ﻟﻠﺼﺎﺩﺍﺕ ﻭﻗﺒل ﻅﻬﻭﺭ ﺍﻟﻨﺘﻴﺠﺔ‪) .‬ﺘﹸﺭﺴل ﺍﻟﻌﻴﻨﺎﺕ‬
‫ﺍﻷﻭﻟﻴﺔ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﻤﺨﺎﺒﺭ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ ﺒﺎﻟﻭﺯﺍﺭﺓ ﻟﺘﺄﻜﻴﺩ ﺍﻟﺘﺸﺨﻴﺹ ﻭﺇﺠﺭﺍﺀ ﺍﻟﺘﻨﻤﻴﻁ ﺍﻟﺠﺭﺜﻭﻤﻲ(‪.‬‬

‫• ﻋﺯل ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻭﻴﺴﺘﺤﺴﻥ ﺇﺩﺨﺎﻟﻬﺎ ﺇﻟﻰ ﺍﻟﻤﺸﻔﻰ )ﺸﻌﺒﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ( ﻤﻊ ﺍﺘﺨﺎﺫ ﺍﻻﺤﺘﻴﺎﻁﺎﺕ‬
‫ﺍﻟﻤﻌﻭﻴﺔ‪ .‬ﻭﻓﻲ ﺤﺎﻻﺕ ﺍﻷﻭﺒﺌﺔ ﻴﻤﻜﻥ ﺘﺩﺒﻴﺭ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺨﻔﻴﻔﺔ ﺍﻟﺸﺩﺓ ﻓﻲ ﺍﻟﻨﻘﺎﻁ ﺍﻟﻁﺒﻴﺔ ﺍﻟﻤﻬﻴﺌﺔ ﻟﻬﺫﺍ ﺍﻟﻐﺭﺽ )ﻓﻲ‬
‫ﻼ( ﻓﻲ ﻤﻨﺎﻁﻕ ﺤﺩﻭﺙ ﺍﻹﺼﺎﺒﺎﺕ ﻭﺘﺤﺎل ﺍﻟﺤﺎﻻﺕ ﺍﻟﺸﺩﻴﺩﺓ ﻟﻠﻤﺸﻔﻰ‪.‬‬
‫ﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ ﻤﺜ ﹰ‬

‫• ﺍﻟﺘﻁﻬﻴﺭ ﺍﻟﻤﺭﺍﻓﻕ ﻟﺒﺭﺍﺯ ﻭﻗﻲﺀ ﺍﻟﻤﺭﻀﻰ ﻭﻤﻔﺎﺭﺵ ﺍﻷﺴﺭﺓ ﻭﺍﻷﺩﻭﺍﺕ ﺍﻟﺨﺎﺼﺔ ﺒﻬﻡ ﺒﺎﺴﺘﻌﻤﺎل ﺍﻟﺤﺭﺍﺭﺓ ﺃﻭ‬
‫ﺍﻟﻤﻁﻬﺭﺍﺕ ﻜﺎﻟﻠﻴﺯﻭل ﺃﻭ ﺤﻤﺽ ﺍﻟﻔﻴﻨﻴﻙ ﻭﻷﺭﺽ ﺍﻟﻤﺸﻔﻰ ﺃﻭ ﺍﻟﻤﺭﺍﺤﻴﺽ ﺒﺎﻟﻤﻁﻬﺭﺍﺕ ﺨﻼل ﻭﺠﻭﺩ ﺍﻟﻤﺭﻀﻰ‬
‫ﻭﺒﻌﺩ ﺘﺨﺭﺠﻬﻡ‪.‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺒﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﺒﻤﺩﻴﺭﻴﺎﺕ ﺍﻟﺼﺤﺔ ﻋﻨﺩ ﺇﺠﺭﺍﺀ ﺍﻟﺘﻘﺼﻲ‬
‫ﺍﻟﻭﺒﺎﺌﻲ ﻓﻲ ﻤﻨﻁﻘﺔ ﺤﺩﻭﺙ ﺍﻹﺼﺎﺒﺎﺕ ﻟﻠﻤﺭﻀﻰ ﻭﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﻭﺩﺭﺍﺴﺔ ﺍﻟﻭﻀﻊ ﺍﻟﺒﻴﺌﻲ ﻭﺍﺘﺨﺎﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ‬
‫ﺍﻟﻭﻗﺎﺌﻴﺔ )ﺇﻋﻁﺎﺀ ﺍﻟﻌﻼﺝ ﺍﻟﻭﻗﺎﺌﻲ ﻟﻠﻤﺨﺎﻟﻁﻴﻥ ‪ (...‬ﻭﻴﻘﻭﻡ ﺒﻪ ﻋﻨﺎﺼﺭ ﻤﻥ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ ﻓﻲ ﻤﻨﻁﻘﺔ ﺍﻹﺼﺎﺒﺔ‪،‬‬
‫ﻤﻜﻠﻔﺔ ﺒﺎﻟﺘﻘﺼﻲ‪.‬‬

‫• ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﺤﻭل ﺍﻟﻤﺭﺽ ﻭﻁﺭﻕ ﺍﻟﻭﻗﺎﻴﺔ ﻤﻨﻪ‪.‬‬

‫• ﺍﻟﺘﺭﺼﺩ ﺍﻟﺒﻴﺌﻲ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻟﻤﺤﻠﻴﺔ ﺫﺍﺕ ﺍﻟﻌﻼﻗﺔ )ﺍﻟﺒﻠﺩﻴﺔ‪ ،‬ﻤﺅﺴﺴﺔ ﺍﻟﻤﻴﺎﻩ ‪ (..‬ﻭﻴﺘﻀﻤﻥ ﺍﻟﺭﻗﺎﺒﺔ ﻋﻠﻰ‬
‫ﺴﻼﻤﺔ ﺍﻟﻤﻴﺎﻩ ﻭﻜﻠﻭﺭﺘﻬﺎ‪ ،‬ﺴﻼﻤﺔ ﺍﻟﻐﺫﺍﺀ ﻭﺍﻟﻌﺎﻤﻠﻴﻥ ﺒﺎﻟﻤﻁﺎﻋﻡ‪ ،‬ﺍﻟﻤﺴﺎﺒﺢ ‪ ...‬ﺇﻟﺦ‪.‬‬

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 ‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬
‫• ﺘﻠﻘﻲ ﺍﻹﺒﻼﻏﺎﺕ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻭﺍﻟﻤﺅﻜﺩﺓ ﻤﻥ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ‪.‬‬

‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﻤﺭﻀﻰ ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﻭﻟﻠﻤﺨﺎﻟﻁﻴﻥ ﻓﻲ ﺍﻟﻤﻨﺯل ﺃﻭ ﺃﻤﺎﻜﻥ ﺍﻟﻌﻤل ﻭﺇﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ‬
‫ﻟﻤﻌﺭﻓﺔ ﻤﺼﺩﺭ ﺍﻟﻌﺩﻭﻯ ﻭﺘﺤﺭﻜﺎﺕ ﺍﻟﻤﺭﻴﺽ ﺨﻼل ﻓﺘﺭﺓ ﺍﻟﺤﻀﺎﻨﺔ‪ ...‬ﺇﻟﺦ‪ .‬ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(١٢‬‬

‫• ﺇﻋﻁﺎﺀ ﺍﻟﻌﻼﺝ ﺍﻟﻭﻗﺎﺌﻲ ﻟﻠﻤﺨﺎﻟﻁﻴﻥ ﺍﻟﻘﺭﻴﺒﻴﻥ ﺍﻟﻤﺸﺎﺭﻜﻴﻥ ﻟﻠﻤﺭﻴﺽ ﻓﻲ ﺍﻟﻁﻌﺎﻡ ﺴﻭﺍﺀ ﻓﻲ ﺍﻟﻤﻨﺯل ﺃﻭ ﻤﻜﺎﻥ‬
‫ﺍﻟﻌﻤل‪ :‬ﺍﻟﺩﻭﻜﺴﻴﺴﻴﻜﻠﻴﻥ ﺠﺭﻋﺔ ﻭﺍﺤﺩﺓ ‪ ٣٠٠‬ﻤﻠﻎ )‪ ٣‬ﺤﺒﺎﺕ( ﻟﻠﻜﺒﺎﺭ‪ ،‬ﻭﺍﻻﻴﺭﻴﺘﺭﻭﻤﻴﺴﻴﻥ ‪ ٣٠‬ﻤﻠﻎ‪/‬ﻜﻎ‪ /‬ﻴﻭﻡ‬
‫ﻤﻘﺴﻤﺔ ﻋﻠﻰ ﺃﺭﺒﻊ ﺠﺭﻋﺎﺕ ﻟﻤﺩﺓ ‪ ٣‬ﺃﻴﺎﻡ ﻟﻸﻁﻔﺎل ﺒﻌﻤﺭ ﺩﻭﻥ ﺍﻟﻌﺸﺭ ﺴﻨﻭﺍﺕ‪ ،‬ﻭﺍﻟﻔﻭﺭﺍﺯﻭﻟﻴﺩﻭﻥ ‪ ١٠٠‬ﻤﻠﻎ‪٦ /‬‬
‫ﺴﺎﻋﺎﺕ ﻟﻤﺩﺓ ‪ ٣‬ﺃﻴﺎﻡ ﻟﻠﺤﻭﺍﻤل‪.‬‬

‫• ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﺤﻭل ﺍﻟﻤﺭﺽ ﻭﻁﺭﻕ ﺍﻟﻭﻗﺎﻴﺔ ﻤﻨﻪ )ﺍﻟﺘﺼﺤﺢ ﺍﻟﺸﺨﺼﻲ‪ ،‬ﺴﻼﻤﺔ ﺍﻟﺒﻴﺌﺔ‪ (...‬ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ‬
‫ﻭﺴﺎﺌل ﺍﻹﻋﻼﻡ ﺍﻟﻤﺤﻠﻴﺔ‪.‬‬

‫• ﺩﺭﺍﺴﺔ ﺍﻟﻭﻀﻊ ﺍﻟﺒﻴﺌﻲ‪ :‬ﺍﻟﻤﻴﺎﻩ‪ ،‬ﺍﻟﺼﺭﻑ ﺍﻟﺼﺤﻲ‪ ،‬ﺍﻟﻐﺫﺍﺀ‪ ...‬ﺇﻟﺦ ﻭﺃﺨﺫ ﻋﻴﻨﺎﺕ ﻟﻠﻔﺤﺹ ﺍﻟﺠﺭﺜﻭﻤﻲ ﻭﺇﺒﻼﻍ‬
‫ﺍﻟﺠﻬﺎﺕ ﺍﻟﻤﻌﻨﻴﺔ ﻋﻥ ﻤﺼﺩﺭ ﺍﻟﺘﻠﻭﺙ‪.‬‬

‫• ﻜﺘﺎﺒﺔ ﺘﻘﺭﻴﺭ ﻤﻔﺼل ﻋﻤﺎ ﺴﺒﻕ ﻤﺘﻀﻤﻨ ﹰﺎ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﺘﺨﺫﺓ ﻭﺭﻓﻌﻪ ﻤﻊ ﺍﺴﺘﻤﺎﺭﺍﺕ ﺍﻟﺘﻘﺼﻲ ﺇﻟﻰ ﺩﺍﺌﺭﺓ‬
‫ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﺎﺭﺌﺔ ﺒﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪.‬‬

‫• ﻋﻨﺩ ﺤﺩﻭﺙ ﻓﺎﺸﻴﺔ ﺃﻭ ﻭﺒﺎﺀ‪ :‬ﻴﺘﻡ ﺇﺭﺴﺎل ﺘﻘﺭﻴﺭ ﻴﻭﻤﻲ ﻴﺘﻀﻤﻥ ﻋﺩﺩ ﺤﺎﻻﺕ ﺍﻹﺴﻬﺎل ﻭﺍﻹﻴﺠﺎﺒﻲ ﻤﻨﻬﺎ‪ ،‬ﻋﺩﺩ‬
‫ﻋﻴﻨﺎﺕ ﺍﻟﻤﻴﺎﻩ ﻭﺍﻟﺼﺭﻑ ﺍﻟﺼﺤﻲ ﻭﺍﻟﻐﺫﺍﺀ ﺍﻟﻤﻔﺤﻭﺼﺔ ﻭﺍﻹﻴﺠﺎﺒﻲ ﻤﻨﻬﺎ ﻤﻊ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﺘﺨﺫﺓ‪ ،‬ﻴﺭﺴل ﺍﻟﺘﻘﺭﻴﺭ‬
‫ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪ ،‬ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪ ،‬ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﺎﺭﺌﺔ‪.‬‬

‫• ﺍﻟﺘﺭﺼﺩ ﺍﻟﺒﻴﺌﻲ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺫﺍﺕ ﺍﻟﻌﻼﻗﺔ )ﺇﺩﺍﺭﺓ ﻤﺤﻠﻴﺔ‪ ،‬ﺒﻴﺌﺔ‪ ،‬ﺍﻗﺘﺼﺎﺩ ﻭﺘﺠﺎﺭﺓ‪ ،‬ﺇﺴﻜﺎﻥ ﻭﺘﻌﻤﻴﺭ‪(..‬‬
‫ﻭﻴﺘﻡ ﺍﻟﺘﻨﺴﻴﻕ ﻭﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﻫﺫﻩ ﺍﻟﺠﻬﺎﺕ ﻤﻥ ﺨﻼل ﺍﻟﻤﺠﻠﺱ ﺍﻟﺼﺤﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬

‫• ﺍﻟﺘﺩﺭﻴﺏ ﻋﻠﻰ ﻭﺒﺎﺌﻴﺎﺕ ﺍﻟﻤﺭﺽ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻤﺨﺒﺭﻱ‪.‬‬

‫• ﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﻋﻤل ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ ﻭﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ‪.‬‬

‫• ﻭﻀﻊ ﺨﻁﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﺤﻠﻴﺔ )ﻤﺘﻀﻤﻨﺔ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﺴﻴﺭﻭﻤﺎﺕ‪ ...‬ﺇﻟﺦ( ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ‬
‫ﺘﻨﻔﻴﺫﻫﺎ ﻭﺍﻟﺘﻘﻴﻴﻡ ﻭﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﻟﻠﻤﺴﺘﻭﻯ ﺍﻷﺩﻨﻰ ﻭﺭﻓﻊ ﺍﻟﺘﻘﺎﺭﻴﺭ ﻋﻥ ﻨﺸﺎﻁ ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫ﻤﻊ ﺍﻟﻭﻀﻊ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻟﻠﻤﺴﺘﻭﻯ ﺍﻷﻋﻠﻰ ﻭﺘﻭﻓﻴﺭ ﻤﺴﺘﻠﺯﻤﺎﺕ ﺘﻨﻔﻴﺫ ﺍﻟﺨﻁﺔ‪.‬‬

‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻟﺔ ﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(٣‬‬

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 ‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬
‫• ﺘﻠﻘﻲ ﺍﻹﺒﻼﻏﺎﺕ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﻭﺍﻟﺘﻘﺎﺭﻴﺭ ﻋﻥ ﺍﻟﻭﻀﻊ ﺍﻟﻭﺒﺎﺌﻲ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‪ ،‬ﻭﺇﺠﺭﺍﺀ ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ‬
‫ﻭﺘﻘﻴﻴﻡ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﻟﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬

‫• ﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﻋﻤﻠﻴﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﺩﻋﻤﻬﺎ ﻭﺍﻟﻤﺸﺎﺭﻜﺔ ﺒﻬﺎ ﻋﻨﺩ ﺍﻟﻠﺯﻭﻡ‪.‬‬

‫• ﻭﻀﻊ ﺨﻁﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻋﻠﻰ ﻤﺴﺘﻭﻯ ﺍﻟﻘﻁﺭ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺘﻨﻔﻴﺫﻫﺎ‪.‬‬

‫• ﺘﺄﻤﻴﻥ ﺍﺤﺘﻴﺎﺠﺎﺕ ﻋﻤﻠﻴﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻤﻥ ﺃﺩﻭﻴﺔ ﻭﺴﻴﺭﻭﻤﺎﺕ ﻭﻅﺭﻭﻑ ﺇﻤﺎﻫﺔ ﻭﻤﻭﺍﺩ ﻤﺨﺒﺭﻴﺔ ‪ ...‬ﺇﻟﺦ‪.‬‬

‫• ﺍﻟﺘﺩﺭﻴﺏ ﺒﺎﻟﺘﻌﺎﻭﻥ ﺒﻴﻥ ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﻭﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﻭﻤﺨﺎﺒﺭ ﺍﻟﺼﺤﺔ‬
‫ﺍﻟﻌﺎﻤﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻭﻤﺩﻴﺭﻴﺎﺘﻬﺎ‪.‬‬

‫• ﺇﻋﺩﺍﺩ ﻭﺴﺎﺌل ﻭﻤﻭﺍﺩ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪.‬‬

‫• ﺘﻘﻭﻴﻡ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﻋﻤﻠﻴﺔ ﺘﻨﻔﻴﺫ ﺍﻟﺨﻁﺔ ﻭﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ‪.‬‬

‫• ﺍﻟﺘﻨﺴﻴﻕ ﻭﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ )ﻭﺯﺍﺭﺕ ﺍﻹﺴﻜﺎﻥ ﻭﺍﻟﺘﻌﻤﻴﺭ‪ ،‬ﺍﻻﻗﺘﺼﺎﺩ ﻭﺍﻟﺘﺠﺎﺭﺓ‪ ،‬ﺍﻹﺩﺍﺭﺓ ﺍﻟﻤﺤﻠﻴﺔ‪،‬‬
‫ﺍﻟﺒﻴﺌﺔ ‪ ...‬ﺇﻟﺦ( ﻭﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬

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 ‫ﺨﻁﺔ ﻤﻌﺎﻟﺠﺔ ﺍﻟﻤﺼﺎﺏ ﺒﺎﻟﻜﻭﻟﻴﺭﺍ‬
‫ﻴﻌﺘﻤﺩ ﺘﺩﺒﻴﺭ ﻤﺭﻴﺽ ﺍﻟﻜﻭﻟﻴﺭﺍ ﻋﻠﻰ ﻨﻘﻁﺘﻴﻥ ﺭﺌﻴﺴﻴﺘﻴﻥ‪ :‬ﺘﻌﻭﻴﺽ ﺍﻟﺴﻭﺍﺌل ﻭﺍﻟﺸﻭﺍﺭﺩ ﻭﺇﻋﻁﺎﺀ ﺍﻟﺼﺎﺩﺍﺕ‪.‬‬

‫ﺘﻌﻭﻴﺽ ﺍﻟﺴﻭﺍﺌل ﻭﺍﻟﺸﻭﺍﺭﺩ‪:‬‬

‫ﻴﺠﺏ ﺇﻋﻁﺎﺀ ﺍﻟﻌﻼﺝ ﺍﻟﻔﻭﺭﻱ ﺒﺎﻟﺴﻭﺍﺌل ﻭﺍﻟﺸﻭﺍﺭﺩ ﺒﻜﻤﻴﺔ ﻜﺎﻓﻴﺔ ﻟﺘﻌﻭﻴﺽ ﺍﻟﺘﺠﻔﺎﻑ ﻭﺍﻟﺤﻤﺎﺽ ﻭﻨﻘﺹ‬
‫ﺍﻟﺒﻭﺘﺎﺴﻴﻭﻡ ﻭﻴﻤﻜﻥ ﺘﺤﻘﻴﻕ ﺫﻟﻙ ﻓﻲ ﻏﺎﻟﺒﻴﺔ ﺍﻟﻤﺭﻀﻰ ﺒﺎﺴﺘﻌﻤﺎل ﻤﻐﻠﻔﺎﺕ ﺍﻹﻤﺎﻫﺔ ﻋﻥ ﻁﺭﻴﻕ ﺍﻟﻔﻡ )ﺍﻟﻐﻠﻭﻜﻭﺯ‪:‬‬
‫‪٢٠‬ﻍ‪/‬ﻟﻴﺘﺭ ﻜﻠﻭﺭ ﺍﻟﺼﻭﺩﻴﻭﻡ ‪٣.٥‬ﻍ‪/‬ﻟﻴﺘﺭ‪ ،‬ﺒﻴﻜﺭﺒﻭﻨﺎﺕ ﺍﻟﺼﻭﺩﻴﻭﻡ ‪٢.٥‬ﻍ‪/‬ﻟﻴﺘﺭ‪ ،‬ﻜﻠﻭﺭ ﺍﻟﺒﻭﺘﺎﺴﻴﻭﻡ ‪١.٥‬ﻍ‪/‬ﻟﺘﺭ( ﺒﻜﻤﻴﺔ‬
‫ﺘﻌﺎﺩل ﺍﻟﺴﺎﺌل ﺍﻟﻤﻘﺩﺭ ﻓﻘﺩﻩ‪.‬‬

‫• ﻓﻲ ﺤﺎل ﻋﺩﻡ ﻭﺠﻭﺩ ﻋﻼﻤﺎﺕ ﺘﺠﻔﺎﻑ ﻴﻌﻁﻰ ﺍﻟﻤﺭﻴﺽ ﻜﻤﻴﺔ ﺘﻜﻔﻲ ﻤﺩﺓ ﻴﻭﻤﻴﻥ ﺒﺤﻴﺙ ﻴﺘﻡ ﺘﻨﺎﻭﻟﻬﺎ ﺤﺴﺏ ﺍﻟﺠﺩﻭل‬
‫ﺍﻟﺘﺎﻟﻲ‪:‬‬
‫ﻜﻤﻴﺔ ﺍﻟﻤﺤﻠﻭل ﺍﻟﻭﺍﺠﺏ ﺘﻨﺎﻭﻟﻬﺎ ﺒﻌﺩ ﻜل ﺘﺒﺭﺯ ﻤﺎﺌﻲ‬ ‫ﺍﻟﻌﻤﺭ‬

‫‪ ١٠٠-٥٠‬ﻤل‬ ‫ﺃﻗل ﻤﻥ ‪ ٢٤‬ﺸﻬﺭﹰﺍ‬

‫‪ ٢٠٠-١٠٠‬ﻤل‬ ‫ﻤﻥ ﻋﺎﻤﻴﻥ ﻟﻌﺸﺭﺓ ﺃﻋﻭﺍﻡ‬

‫ﺤﺴﺏ ﺍﻟﺤﺎﺠﺔ )‪ ٣٠٠‬ﻤل ﻋﻠﻰ ﺍﻷﻗل(‬ ‫ﺃﻜﺜﺭ ﻤﻥ ‪ ١٠‬ﺃﻋﻭﺍﻡ‬

‫• ﻓﻲ ﺤﺎل ﻭﺠﻭﺩ ﻋﻼﻤﺎﺕ ﺘﺠﻔﺎﻑ ﺨﻔﻴﻑ ﻴﻌﻁﻰ ﺍﻟﻤﺭﻴﺽ ‪ ١٠٠-٧٥‬ﻤل‪/‬ﻜﻎ ﺨﻼل ﺃﺭﺒﻊ ﺴﺎﻋﺎﺕ ﻭﺘﻘﻴﻴﻡ ﺤﺎﻟﺘﻪ‬
‫ﺒﻌﺩﻫﺎ ﺒﺤﻴﺙ ﻴﺴﺘﻤﺭ ﻓﻲ ﺍﻟﻌﻼﺝ ﺤﺴﺏ ﺍﻟﺨﻁﺔ )ﺏ( ﺃﻭ ﻴﺤﻭل ﻟﻠﺨﻁﺔ )ﺃ( ﺃﻭ )ﺕ( ﺤﺴﺏ ﺩﺭﺠﺔ ﺍﻟﺘﺠﻔﺎﻑ‪.‬‬

‫• ﻓﻲ ﺤﺎﻟﺔ ﻭﺠﻭﺩ ﻋﻼﻤﺎﺕ ﺍﻟﺘﺠﻔﺎﻑ ﺍﻟﺸﺩﻴﺩ ﻓﻴﺠﺏ ﺇﻋﻁﺎﺀ ﻤﺤﺎﻟﻴل ﻭﺭﻴﺩﻴﺔ ﺒﺄﺴﺭﻉ ﻤﺎ ﻴﻤﻜﻥ ﻜﻤﺤﻠﻭل‬
‫ﺭﻨﻔﺭﻻﻜﺘﺎﺕ‪ ،‬ﻴﺠﺏ ﺇﻋﻁﺎﺀ ‪١٠٠‬ﻤل‪/‬ﻜﻎ ﻤﻥ ﺍﻟﻤﺤﺎﻟﻴل ﺍﻟﻭﺭﻴﺩﻴﺔ ﺨﻼل ‪ ٦/٣‬ﺴﺎﻋﺎﺕ ﺤﺴﺏ ﺍﻟﻌﻤﺭ ﻭﻓﻕ‬
‫ﺍﻟﻤﺨﻁﻁ ﺍﻟﺘﺎﻟﻲ‪:‬‬
‫ﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﺜﺎﻨﻴﺔ ‪ ٧٠‬ﻤل‪/‬ﻜﻎ‬ ‫ﺍﻟﻤﺭﺤﻠﺔ ﺍﻷﻭﻟﻰ ‪ ٣٠‬ﻤل‪/‬ﻜﻎ‬ ‫ﺍﻟﻌﻤﺭ‬

‫ﻓﻲ ﺍﻟﺨﻤﺱ ﺴﺎﻋﺎﺕ ﺍﻟﺘﺎﻟﻴﺔ‬ ‫ﻓﻲ ﺍﻟﺴﺎﻋﺔ ﺍﻷﻭﻟﻰ‬ ‫ﺃﻗل ﻤﻥ ﺴﻨﺔ‬

‫ﻓﻲ ﺍﻟﺴﺎﻋﺘﻴﻥ ﻭﺍﻟﻨﺼﻑ ﺍﻟﺘﺎﻟﻴﺔ‬ ‫ﻓﻲ ﻨﺼﻑ ﺍﻟﺴﺎﻋﺔ ﺍﻷﻭﻟﻰ‬ ‫ﺴﻨﺔ ﻓﻤﺎ ﻓﻭﻕ‬

‫ﻭﺒﻌﺩ ﺍﻨﺘﻬﺎﺀ ﺍﻟﻤﺭﺤﻠﺔ ﺍﻷﻭﻟﻰ ﻤﻥ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺇﺫﺍ ﺘﺒﻴﻥ ﺃﻥ ﺍﻟﻨﺒﺽ ﻤﺎ ﻴﺯﺍل ﻀﻌﻴﻔ ﹰﺎ ﺃﻭ ﻏﻴﺭ ﻤﺤﺴﻭﺱ ﻓﻴﺠﺏ‬
‫ﺇﻋﺎﺩﺓ ﺍﻟﻤﺭﺤﻠﺔ ﺍﻷﻭﻟﻰ ﻤﻥ ﺍﻟﻌﻼﺝ ﻤﺭﺓ ﺜﺎﻨﻴﺔ ﺜﻡ ﺍﻻﻨﺘﻘﺎل ﻟﺘﻁﺒﻴﻕ ﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﺜﺎﻨﻴﺔ‪ .‬ﻭﻴﺠﺏ ﺇﻋﺎﺩﺓ ﺘﻘﻴﻴﻡ ﺍﻟﻤﺭﻴﺽ ﻜل‬
‫‪ ٢-١‬ﺴﺎﻋﺔ ﻓﺈﺫﺍ ﻭﺠﺩ ﺃﻥ ﺍﻟﺘﺠﻔﻑ ﻻ ﻴﺘﺤﺴﻥ ﻴﺠﺏ ﺘﺴﺭﻴﻊ ﺍﻟﺴﻴﺭﻭﻤﺎﺕ ﺍﻟﻤﻌﻁﺎﺓ‪.‬‬

‫ﻭﺘﻌﻁﻰ ﻤﺤﺎﻟﻴل ﺍﻹﻤﺎﻫﺔ ﺍﻟﻔﻤﻭﻴﺔ ﺤﺎﻟﻤﺎ ﻴﺼﺒﺢ ﺍﻟﻤﺭﻴﺽ ﻗﺎﺩﺭﹰﺍ ﻋﻠﻰ ﺍﻟﺸﺭﺏ ﺒﻤﻘﺩﺍﺭ )‪ ٥‬ﻤل‪/‬ﻜﻎ ﺴﺎﻋﺔ(‪.‬‬

‫‪٣١‬‬
 ‫ﺇﻋﻁﺎﺀ ﺍﻟﺼﺎﺩﺍﺕ‪:‬‬
‫ﺇﻥ ﺍﻟﻌﻼﺝ ﺒﺎﻟﺼﺎﺩﺍﺕ ﻴﻘﺼﺭ ﻓﺘﺭﺓ ﺍﻹﺴﻬﺎل ﻜﻤﺎ ﻴﻘﺼﺭ ﻤﺩﺓ ﺇﻓﺭﺍﻍ ﺍﻟﻀﻤﺎﺕ )ﺍﻟﺴﺭﺍﻴﺔ( ﻴﻘﺘﺼﺭ ﺍﻟﻌﻼﺝ ﻋﻠﻰ‬
‫ﺍﻟﺤﺎﻻﺕ ﺍﻟﺸﺩﻴﺩﺓ )ﻭﺠﻭﺩ ﻋﻼﻤﺎﺕ ﺍﻟﺘﺠﻔﺎﻑ ﺍﻟﺸﺩﻴﺩ(‪ ،‬ﺤﻴﺙ ﺃﻥ ﻋﻼﺝ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺨﻔﻴﻔﺔ ﻭﺍﻟﻤﺘﻭﺴﻁﺔ ﻴﺴﺎﻋﺩ ﻋﻠﻰ‬
‫ﻅﻬﻭﺭ ﺍﻟﻤﻘﺎﻭﻤﺔ ﺍﻟﺩﻭﺍﺌﻴﺔ‪ .‬ﻴﺠﺏ ﺇﻋﻁﺎﺀ ﺍﻟﺼﺎﺩﺍﺕ ﺤﺎﻟﻤﺎ ﻴﺼﺒﺢ ﺍﻟﻤﺭﻴﺽ ﻗﺎﺩﺭﹰﺍ ﻋﻠﻰ ﺘﻨﺎﻭل ﺍﻟﻌﻼﺝ ﻋﻥ ﻁﺭﻴﻕ‬
‫ﺍﻟﻔﻡ ﻭﺒﻌﺩ ﺃﺨﺫ ﺍﻟﻤﺴﺤﺔ ﺍﻟﺸﺭﺠﻴﺔ‪.‬‬

‫ﺇﻥ ﺍﻟﺩﻭﻜﺴﻴﺴﻜﻠﻴﻥ ﻫﻭ ﺍﻟﺩﻭﺍﺀ ﺍﻟﻤﺨﺘﺎﺭ ﻟﺩﻯ ﺍﻟﻜﺒﺎﺭ ﺃﻤﺎ ﻟﺩﻯ ﺍﻷﻁﻔﺎل ﻴﺴﺘﻌﻤل ﺍﻻﻴﺭﻴﺘﺭﻭﻤﻴﺴﻴﻥ ﺒﻴﻨﻤﺎ ﻴﺴﺘﻌﻤل‬
‫ﺍﻟﻔﻭﺭﺍﺯﻭﻟﻴﺩﻭﻥ ﻟﺩﻯ ﺍﻟﻨﺴﺎﺀ ﺍﻟﺤﻭﺍﻤل ﻭﻴﻌﺘﺒﺭ ﺍﻟﺘﺘﺭﺍﺴﻴﻜﻠﻴﻥ ﻭﺍﻟﻜﻠﻭﺭﺍﻨﻔﻴﻨﻴﻜﻭل ﻭﺍﻷﻤﺒﻴﺴﻴﻠﻴﻥ ﻜﺄﺩﻭﻴﺔ ﺒﺩﻴﻠﺔ‪.‬‬

‫ﻭﺍﻟﺠﺩﻭل ﺍﻟﺘﺎﻟﻲ ﻴﺒﻴﻥ ﺃﻫﻡ ﺍﻷﺩﻭﻴﺔ ﺍﻟﻤﺴﺘﻌﻤﻠﺔ ﻓﻲ ﻋﻼﺝ ﺍﻟﻜﻭﻟﻴﺭﺍ‪:‬‬

‫ﺍﻟﻜﺒﺎﺭ‬ ‫ﺍﻷﻁﻔﺎل‬ ‫ﺍﻟﺼﺎﺩ‬

‫‪ ٣٠٠‬ﻤﻠﻎ‬ ‫ـ‬ ‫ﺍﻟﺩﻭﻜﺴﻴﺴﻴﻜﻠﻴﻥ ﺠﺭﻋﺔ ﻭﺍﺤﺩﺓ‬

‫‪ ٥٠٠‬ﻤﻠﻎ‬ ‫‪ ١٢,٥‬ﻤﻠﻎ‪/‬ﻜﻎ‬ ‫ﺍﻟﺘﺘﺭﺍﺴﻴﻜﻠﻴﻥ ‪ ٤‬ﻤﺭﺍﺕ‪/‬ﻴﻭﻡ ﻤﺩﺓ ‪ ٣‬ﺃﻴﺎﻡ‬

‫‪ ٢٥٠‬ﻤﻠﻎ‬ ‫‪ ٧,٥‬ﻤﻠﻎ‪/‬ﻜﻎ‬ ‫ﺍﻹﻴﺭﻴﺘﺭﻭﻤﻴﺴﻴﻥ ‪ ٤‬ﻤﺭﺍﺕ‪/‬ﻴﻭﻡ ﻤﺩﺓ ‪ ٣‬ﺃﻴﺎﻡ‬

‫‪ ١٠٠‬ﻤﻠﻎ‬ ‫‪ ١,٢٥‬ﻤﻠﻎ‪/‬ﻜﻎ‬ ‫ﺍﻟﻔﻭﺭﺍﺯﻭﻟﻴﺩﻭﻥ ‪ ٤‬ﻤﺭﺍﺕ‪/‬ﻴﻭﻡ ﻤﺩﺓ ‪ ٣‬ﺃﻴﺎﻡ‬

‫ﺇﻥ ﺍﺨﺘﻴﺎﺭ ﺍﻟﺼﺎﺩ ﺍﻟﻤﻨﺎﺴﺏ ﻴﻌﺘﻤﺩ ﻋﻠﻰ ﻨﺘﺎﺌﺞ ﺍﻟﺯﺭﻉ ﻭﺍﻟﺘﺤﺴﺱ ﺍﻟﺠﺭﺜﻭﻤﻲ‪.‬‬

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 ‫‪‬‬
‫‪‬א‪ ‬‬
‫‪ Poliomyelitis‬‬
‫ﻤﻘﺩﻤﺔ‪:‬‬
‫ﺸﻠل ﺍﻷﻁﻔﺎل ﻤﺭﺽ ﻓﻴﺭﻭﺴﻲ ﺤﺎﺩ‪ ،‬ﺘﺘﺭﺍﻭﺡ ﺸﺩﺘﻪ ﻤﻥ ﻋﺩﻭﻯ ﻏﻴﺭ ﻤﺘﻅﺎﻫﺭﺓ ﺇﻟﻰ ﻋﻠﺔ ﺤﻤﻭﻴﺔ ﻻ ﺸﻠﻠﻴﺔ‪ ،‬ﺇﻟﻰ‬
‫ﺍﻟﺘﻬﺎﺏ ﺴﺤﺎﻴﺎ ﻋﻘﻴﻡ‪ ،‬ﺇﻟﻰ ﻤﺭﺽ ﺸﻠﻠﻲ ﻗﺩ ﻴﺅﺩﻱ ﺇﻟﻰ ﺍﻟﻭﻓﺎﺓ‪.‬‬

‫ﺴﻠﺴﻠﺔ ﺍﻟﻌﺩﻭﻯ‪:‬‬
‫‪Entero‬‬ ‫• ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪ :‬ﻓﻴﺭﻭﺴﺎﺕ ﺸﻠل ﺍﻷﻁﻔﺎل ‪ Polio Viruses‬ﻭﻫﻲ ﻤﻥ ﺯﻤﺭﺓ ﺍﻟﻔﻴﺭﻭﺴﺎﺕ ﺍﻟﻤﻌﻭﻴﺔ‬
‫‪ Viruses‬ﻭﻟﻬﺎ ﺜﻼﺜﺔ ﺃﻨﻤﺎﻁ ‪ ،III ،II ،I‬ﻭﺍﻟﻨﻤﻁ ‪ I‬ﻫﻭ ﺍﻟﻤﺴﺅﻭل ﻋﻥ ﺤﺩﻭﺙ ﻤﻌﻅﻡ ﺍﻷﻭﺒﺌﺔ ﻭﺍﻟﺤﺎﻻﺕ ﺍﻟﺸﻠﻠﻴﺔ‪،‬‬
‫ﺒﻴﻨﻤﺎ ﺍﻟﻨﻤﻁﻴﻥ ‪ III ،II‬ﻤﺴﺅﻭﻟﺔ ﻋﻥ ﻤﻌﻅﻡ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻨﺎﺠﻤﺔ ﻋﻥ ﺍﻟﻠﻘﺎﺡ‪.‬‬
‫• ﺍﻟﻤﺴﺘﻭﺩﻉ‪ :‬ﺍﻹﻨﺴﺎﻥ ﻓﻘﻁ‪ ،‬ﺴﻭﺍﺀ ﺤﺎﻤل ﺃﻭ ﺤﺎﻟﺔ‪.‬‬
‫• ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪ :‬ﺍﻹﻨﺴﺎﻥ ﺍﻟﻁﺭﻴﻕ ﺍﻟﺒﺭﺍﺯﻱ ﺍﻟﻔﻤﻭﻱ‪ ،‬ﺍﻹﻨﺴﺎﻥ ﺍﻟﻁﺭﻴﻕ ﺍﻟﺘﻨﻔﺴﻲ‪ ،‬ﺍﻹﻨﺴﺎﻥ ﺍﻟﺘﻤﺎﺱ ﻏﻴﺭ ﺍﻟﻤﺒﺎﺸﺭ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﻌﺩﻭﻯ ﻋﺎﻡ‪ ،‬ﻭﺍﻟﻤﻨﺎﻋﺔ ﺍﻟﻤﺘﺨﻠﻔﺔ ﻨﻭﻋﻴﺔ ﻟﻠﻨﻤﻁ ﺍﻟﻔﻴﺭﻭﺴﻲ ﻭﺩﺍﺌﻤﺔ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫ﻋﺎﺩﺓ )‪ (١٤-٧‬ﻴﻭﻡ ﻟﻠﺤﺎﻻﺕ ﺍﻟﺸﻠﻠﻴﺔ‪ ،‬ﻭﻀﻤﻥ ﻤﺠﺎل ﻴﺘﺭﺍﻭﺡ ﺒﻴﻥ )‪ (٣٥-٣‬ﻴﻭﻡ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻏﻴﺭ ﻤﺤﺩﺩ ﺒﺸﻜل ﺩﻗﻴﻕ‪ ،‬ﻭﻟﻜﻥ ﺴﺭﺍﻴﺔ ﺍﻟﻤﺭﺽ ﺘﻜﻭﻥ ﺃﺸﺩ ﻗﺒل ﺒﺩﺍﻴﺔ ﺍﻷﻋﺭﺍﺽ ﺒﻌﺩﺓ ﺃﻴﺎﻡ ﻭﺒﻌﺩ ﻅﻬﻭﺭﻫﺎ ﺒﻌﺩﺓ ﺃﻴﺎﻡ‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﻴﻌﺘﻤﺩ ﻋﺎﺩﺓ ﻋﻠﻰ ﺍﻷﺴﺱ ﺍﻟﺴﺭﻴﺭﻴﺔ‪ ،‬ﻭﻴﺅﻜﺩ ﺒﺎﺴﺘﻔﺭﺍﺩ ﺍﻟﻔﻴﺭﻭﺱ ﻤﻥ ﺒﺭﺍﺯ ﺍﻟﻤﺼﺎﺏ‪ ،‬ﻴﻔﻀل ﺃﺨﺫ ﺍﻟﻌﻴﻨﺔ‬
‫ﺍﻟﺒﺭﺍﺯﻴﺔ ﺨﻼل ﺍﻟـ )‪ (٧٢‬ﺴﺎﻋﺔ ﺍﻷﻭﻟﻰ ﻤﻥ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ ﺤﻴﺙ ﻴﻜﻭﻥ ﺇﻁﺭﺍﺡ ﺍﻟﻔﻴﺭﻭﺱ ﺃﻋﻅﻤﻴﺎﹰ‪ ،‬ﻭﻴﻅل ﻜﺫﻟﻙ‬
‫ﺨﻼل ﺍﻟـ )‪ (١٤‬ﻴﻭﻡ ﺍﻷﻭﻟﻰ ﺒﻌﺩ ﺍﻹﺼﺎﺒﺔ‪.‬‬
‫ﻭﻟﻘﺩ ﺍﻟﺘﺯﻤﺕ ﺴﻭﺭﻴﺎ ﺒﻬﺩﻑ ﻤﻨﻅﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ )ﺍﺴﺘﺌﺼﺎل ﺸﻠل ﺍﻷﻁﻔﺎل( ﻟﺫﺍ ﻓﺈﻨﻪ ﻤﻥ ﺍﻟﻀﺭﻭﺭﻱ‬
‫ﺘﺭﺼﺩ ﻫﺫﺍ ﺍﻟﻤﺭﺽ ﺒﺸﻜل ﻴﻜﺸﻑ ﺃﻴﺔ ﺤﺎﻟﺔ ﻗﺩ ﺘﻅﻬﺭ‪.‬‬
‫ﻜﺫﻟﻙ ﻻ ﺒﺩ ﻤﻥ ﺘﻁﺒﻴﻕ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻔﻌﺎﻟﺔ ﺨﺎﺼﺔ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﺭﻭﺘﻴﻨﻲ ﻭﺤﻤﻼﺕ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻭﻁﻨﻴﺔ‪ .‬ﻭﻤﻨﺫ‬
‫ﻋﺎﻡ ‪ ١٩٩٥‬ﻟﻡ ﺘﻌﺩ ﺘﺴﺠل ﺃﻴﺔ ﺤﺎﻟﺔ ﻤﺭﻀﻴﺔ ﻓﻲ ﺴﻭﺭﻴﺔ‪.‬‬
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‫א‪‬א‪‬א‪‬‬
‫‪ (A.F.P) Acute Flaccid Paralysis‬‬
‫ﺃﻤﺭﺍﺽ ﺍﻟﻭﺤﺩﺓ ﺍﻟﺤﺭﻜﻴﺔ ﺍﻟﺴﻔﻠﻴﺔ ﻋﻨﺩ ﺍﻟﺭﻀﻊ ﻭﺍﻷﻁﻔﺎل‪:‬‬
‫• ﺃﻤﺭﺍﺽ ﺨﻼﻴﺎ ﺍﻟﻘﺭﻥ ﺍﻷﻤﺎﻤﻲ‪:‬‬
‫‪ -‬ﺍﻟﻀﻤﻭﺭ ﺍﻟﻌﻀﻠﻲ ﺍﻟﺸﻭﻜﻲ‪.‬‬
‫‪ -‬ﺍﻟﺘﻬﺎﺏ ﺴﻨﺠﺎﺒﻴﺔ ﺍﻟﻨﺨﺎﻉ )ﺸﻠل ﺍﻷﻁﻔﺎل(‪.‬‬
‫• ﺃﻤﺭﺍﺽ ﺍﻷﻋﺼﺎﺏ ﺍﻟﻤﺤﻴﻁﻴﺔ‪:‬‬
‫‪ -‬ﺘﻨﺎﺫﺭ ﻏﻴﻼﻥ ﺒﺎﺭﻴﻪ‪.‬‬
‫‪ -‬ﺸﻠل ﺍﻟﻘﺭﺍﺩ‪.‬‬
‫‪ -‬ﻋﻭﺯ ﻓﻴﺘﺎﻤﻴﻥ ‪.B,B12,E‬‬
‫• ﺃﻤﺭﺍﺽ ﺍﻟﻭﺼل ﺍﻟﻌﺼﺒﻲ ﺍﻟﻌﻀﻠﻲ‪:‬‬
‫‪ -‬ﺍﻟﻭﻫﻥ ﺍﻟﻌﻀﻠﻲ ﺍﻟﻭﺨﻴﻡ )ﺍﻟﻤﻜﺘﺴﺏ‪ ،‬ﺍﻟﻭﻻﺩﻱ‪ ،‬ﺍﻟﻭﺭﺍﺜﻲ(‪.‬‬
‫‪ -‬ﺍﻟﺘﺴﻤﻡ ﺍﻟﻭﺸﻴﻘﻲ‪.‬‬
‫• ﺃﻤﺭﺍﺽ ﺍﻟﻌﻀﻼﺕ‪:‬‬
‫‪ -‬ﺍﻟﺤﺜﻭل ﺍﻟﻌﻀﻠﻴﺔ )ﺩﻭﺴﺘﻴﻥ‪ ،‬ﺒﻴﻜﺭ‪ ،‬ﺯﻨﺎﺭ ﺍﻟﻁﺭﻑ‪ ،‬ﻤﻔﺭﻁ ﺍﻟﻘﻭﻴﺔ‪ ،‬ﺍﻟﺨﻠﻔﻲ(‪.‬‬
‫‪ -‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﻌﻀﻼﺕ‪.‬‬
‫‪ -‬ﺍﻋﺘﻼل ﺍﻟﻌﻀﻼﺕ ﺍﻟﺨﻠﻘﻲ ﺍﻟﺒﻨﻴﻭﻱ )ﺍﻟﻠﺒﻲ ﺍﻟﻤﺭﻜﺯﻱ‪ ،‬ﻋﺼﻴﺎﺕ ﺒﻨﻤﺎﻟﻴﻥ‪ ،‬ﺍﻟﻨﻭﻭﻱ ﺍﻟﻤﺭﻜﺯﻱ‪ ،‬ﻋﺩﻡ ﺍﻟﺘﻨﺎﺴﺏ‬
‫ﺒﺎﻟﻨﻤﻁ ﺍﻟﻠﻴﻔﻲ ﺍﻟﺨﻠﻘﻲ‪ ،‬ﺍﻟﺤﺜل ﺍﻟﻌﻀﻠﻲ ﺍﻟﺨﻠﻘﻲ(‪.‬‬

‫ﺃﻤﺭﺍﺽ ﺍﺴﺘﻘﻼﺒﻴﺔ‪ ،‬ﻏﺩﻴﺔ‪ ،‬ﻤﻌﺩﻨﻴﺔ‪:‬‬

‫• ﺃﺩﻭﺍﺀ ﺨﺯﻥ ﺍﻟﻐﻠﻭﻜﻭﺠﻴﻥ‪.‬‬
‫• ﺸﺫﻭﺫﺍﺕ ﺍﺴﺘﻘﻼﺏ ﺍﻟﻜﺭﻴﺎﻨﺘﻴﻥ‪.‬‬
‫• ﺸﺫﻭﺫﺍﺕ ﺍﻟﻤﻴﺘﻭﻜﻭﻨﺩﺭﻴﺎ‪.‬‬
‫• ﻓﺭﻁ ﺃﻭ ﻨﻘﺹ ﻨﺸﺎﻁ ﺍﻟﺩﺭﻕ‪.‬‬
‫• ﻓﺭﻁ ﺃﻭ ﻨﻘﺹ ﻨﺸﺎﻁ ﺍﻟﻜﻭﺭﺘﻴﺯﻭل‪.‬‬
‫• ﻓﺭﻁ ﻨﺸﺎﻁ ﺠﺎﺭﺍﺕ ﺍﻟﺩﺭﻕ‪.‬‬
‫• ﻓﺭﻁ ﺍﻟﻜﺎﻟﺴﻴﻭﻡ‪ ،‬ﻓﺭﻁ ﺍﻟﺒﻭﺘﺎﺴﻴﻭﻡ ﺃﻭ ﻨﻘﺼﻪ‪.‬‬

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 ‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ‬

‫ﺤﺎﻟﺔ ﺸﻠل ﺍﻷﻁﻔﺎل ﺍﻟﻤﺸﺘﺒﻬﺔ‪:‬‬

‫ﻜل ﺤﺎﻟﺔ ﺸﻠل ﺭﺨﻭ ﺤﺎﺩ )ﺒﺩﺀ ﻤﻔﺎﺠﺊ(‪ ،‬ﻟﻡ ﻴﻌﺭﻑ ﻟﻬﺎ ﺴﺒﺏ‪ ،‬ﻋﻨﺩ ﻁﻔل ﺒﻌﻤﺭ ﺩﻭﻥ ﺍﻟـ )‪ (١٥‬ﺴﻨﺔ ﻤﻥ‬
‫ﺍﻟﻌﻤﺭ‪ ،‬ﺒﻤﺎ ﻓﻲ ﺫﻟﻙ ﺤﺎﻻﺕ ﺘﻨﺎﺫﺭ ﻏﻴﻼﻥ ﺒﺎﺭﻴﻪ ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﻨﺨﺎﻉ ﺍﻟﻤﻌﺘﺭﺽ ﻭﺃﺫﻴﺔ ﺍﻟﻌﺼﺏ ﺍﻟﺭﻀﻲ‪ ،‬ﺃﻭ ﺃﻱ‬
‫ﺤﺎﻟﺔ ﻴﺸﺘﺒﻪ ﺒﻬﺎ ﺍﻟﻁﺒﻴﺏ ﻋﻠﻰ ﺃﻨﻬﺎ ﺸﻠل ﺃﻁﻔﺎل ﻓﻲ ﺃﻱ ﻋﻤﺭ ﺃﻱ ﺃﻥ ﺍﻟﺸﻠل ﻟﻡ ﻴﺤﺩﺙ ﻨﺘﻴﺠﺔ ﺤﺎﺩﺙ ﻭﻟﻡ ﻴﻜﻥ‬
‫ﻤﻭﺠﻭﺩﺍﹰ ﻋﻨﺩ ﺍﻟﻭﻻﺩﺓ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻭﺍﺠﺏ ﺍﺘﺨﺎﺫﻫﺎ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬

‫• ﺍﻟﻜﺸﻑ ﺍﻟﻤﺒﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻭﺤﺴﺏ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ‪.‬‬
‫• ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ )ﺒﺎﻟﻬﺎﺘﻑ ﺃﻭ ﺒﺎﻟﻔﺎﻜﺱ( ﻋﻥ ﺍﻟﺤﺎﻟﺔ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ ﻭﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪.‬‬
‫• ﺍﻟﻤﻌﺎﻟﺠﺔ‪ :‬ﻻ ﻴﻭﺠﺩ ﻋﻼﺝ ﻨﻭﻋﻲ ﻟﻠﻤﺭﺽ‪ ،‬ﻭﺘﺘﻡ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﺩﺍﻋﻤﺔ ﻓﻲ ﺍﻟﻤﺸﺎﻓﻲ ﺍﻟﻤﺅﻫﻠﺔ‪.‬‬
‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﻓﻲ ﺸﻌﺒﺔ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﻓﺭﻴﻕ ﺍﻟﺘﻠﻘﻴﺢ ﻓﻲ ﺸﻌﺒﺔ ﺼﺤﺔ ﺍﻟﻁﻔل ﻓﻲ‬
‫ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ ﻋﻨﺩ ﺇﺠﺭﺍﺀ ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﻭﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‪.‬‬
‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﻤﺘﺎﺒﻌﺔ ﻤﻥ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ ﻋﻨﺩ ﻤﺘﺎﺒﻌﺔ ﺍﻟﺤﺎﻟﺔ ﺒﻌﺩ )‪ (٦٠‬ﻴﻭﻡ ﻤﻥ ﺍﻹﺼﺎﺒﺔ‪.‬‬
‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻟﺔ ﻓﻲ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻠﺘﺭﺼﺩ‪ ،‬ﻭﺍﻟﺘﻘﺭﻴﺭ ﺍﻷﺴﺒﻭﻋﻲ ﺍﻟﺼﻐﺭﻱ ﻭﺇﺭﺴﺎﻟﻪ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬
‫• ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻭﻗﺎﻴﺔ‪.‬‬
‫‪ -‬ﺍﻟﺘﻠﻘﻴﺢ ﺤﺴﺏ ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻭﻁﻨﻲ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(١٠‬‬
‫‪ -‬ﺍﻟﻤﺸﺎﺭﻜﺔ ﻓﻲ ﺤﻤﻼﺕ ﺘﻁﻬﻴﺭ ﺍﻟﺠﻴﻭﺏ ﻭﺍﻟﺘﻲ ﺘﺠﺭﻱ ﺴﻨﻭﻴﹰﺎ ﺒﻬﺩﻑ ﻤﻨﻊ ﻅﻬﻭﺭ ﺇﺼﺎﺒﺎﺕ ﺨﻼل ﺍﻷﺸﻬﺭ‬
‫)ﺁﺫﺍﺭ‪ ،‬ﻨﻴﺴﺎﻥ( ﻭ )ﺕ‪ ،١‬ﺕ‪ ،(٢‬ﺤﻴﺙ ﻴﻜﻭﻥ ﺍﻟﻔﻴﺭﻭﺱ ﻫﺎﺠﻌﹰﺎ‪ .‬ﻭﻓﻲ ﻜل ﺤﻤﻠﺔ ﻴﺘﻡ ﺘﻠﻘﻴﺢ ﺍﻷﻁﻔﺎل ﺒﻌﻤﺭ‬
‫ﺨﻤﺱ ﺴﻨﻭﺍﺕ ﻓﻤﺎ ﺩﻭﻥ‪ ،‬ﺒﺠﺭﻋﺘﻴﻥ ﻤﻥ ﻟﻘﺎﺡ ﺸﻠل ﺍﻷﻁﻔﺎل ﺒﻔﺎﺼﻠﺔ ﺸﻬﺭ ﺒﻴﻨﻬﻤﺎ‪ ،‬ﻭﺘﺴﺘﻤﺭ ﻜل ﺠﻭﻟﺔ ﻤﺩﺓ‬
‫ﺃﺴﺒﻭﻉ‪.‬‬
‫ﺇﻥ ﺍﻟﻬﺩﻑ ﻤﻥ ﺍﻟﺤﻤﻠﺔ ﻗﻁﻊ ﺴﻠﺴﻠﺔ ﺍﻟﻌﺩﻭﻯ ﻟﻠﻔﻴﺭﻭﺱ ﻋﻥ ﻁﺭﻴﻕ ﻨﺸﺭ ﺍﻟﻔﻴﺭﻭﺱ ﺍﻟﻤﻀﻌﻑ )ﻓﻴﺭﻭﺱ‬
‫ﺍﻟﻠﻘﺎﺡ(‪ ،‬ﻓﻲ ﺍﻟﺒﻴﺌﺔ‪ ،‬ﻫﺫﺍ ﺒﺎﻹﻀﺎﻓﺔ ﺇﻟﻰ ﺯﻴﺎﺩﺓ ﻤﻨﺎﻋﺔ ﺍﻷﻁﻔﺎل ﻀﺩ ﺍﻟﻤﺭﺽ‪ .‬ﻭﺤﺎﻟﻴﹰﺎ ﺃﺼﺒﺢ ﺍﻟﺘﺭﻜﻴﺯ ﻋﻠﻰ‬
‫ﺤﻤﻼﺕ ﺘﻁﻬﻴﺭ ﺍﻟﺠﻴﻭﺏ ﻭﺍﻟﺘﻲ ﺘﺘﻀﻤﻥ ﺍﻟﺘﻠﻘﻴﺢ ﻓﻲ ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﻌﺎﻟﻴﺔ ﺍﻟﺨﻁﻭﺭﺓ‪ ،‬ﻭﻫﻲ‪:‬‬
‫‪ o‬ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﺤﺩﻭﺩﻴﺔ ﻤﻊ ﺍﻟﺩﻭل ﺍﻟﻤﺠﺎﻭﺭﺓ‪.‬‬
‫‪ o‬ﺍﻟﻤﻨﺎﻁﻕ ﺫﺍﺕ ﻨﺴﺒﺔ ﺍﻟﺘﻐﻁﻴﺔ ﺍﻟﻤﺘﺩﻨﻴﺔ ﺒﺎﻟﻠﻘﺎﺡ‪.‬‬

‫‪٣٥‬‬
 ‫‪ o‬ﺍﻟﺘﺠﻤﻌﺎﺕ ﻜﺜﻴﺭﺓ ﺍﻟﺤﺭﻜﺔ )ﻜﺎﻟﺒﺩﻭ(‪.‬‬
‫‪ o‬ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﺘﻲ ﺘﻅﻬﺭ ﻓﻴﻬﺎ ﺤﺎﻻﺕ ﺸﻠل ﺭﺨﻭ ﻤﺸﺘﺒﻬﺔ ﺒﺸﺩﺓ‪.‬‬
‫• ﺘﺜﻘﻴﻑ ﺍﻟﺠﻤﻬﻭﺭ ﺤﻭل ﺍﻟﻤﺭﺽ ﻭﻁﺭﻕ ﺍﻟﻌﺩﻭﻯ‪ ،‬ﻭﺍﻟﻭﻗﺎﻴﺔ ﻤﻨﻪ‪ ،‬ﻭﻤﺯﺍﻴﺎ ﺍﻟﺘﻠﻘﻴﺢ ﺃﺜﻨﺎﺀ ﺍﻟﻁﻔﻭﻟﺔ ﺍﻟﻤﺒﻜﺭﺓ‬
‫ﻭﺍﺴﺘﻜﻤﺎل ﺍﻟﺠﺭﻋﺎﺕ‪ ،‬ﺇﻀﺎﻓﺔ ﻟﺴﻼﻤﺔ ﺍﻟﻠﻘﺎﺡ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫• ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ‪ -‬ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﺃﺨﺫ ﻋﻴﻨﺘﻴﻥ ﺒﺭﺍﺯﻴﺘﻴﻥ ﻤﻥ ﺍﻟﻤﺼﺎﺏ ﺒﻔﺎﺼل ‪ ٢٤‬ﺴﺎﻋﺔ ﺒﻴﻨﻬﻤﺎ ﻭﻭﻓﻕ ﺍﻟﺸﺭﻭﻁ ﺍﻟﺘﺎﻟﻴﺔ‪:‬‬
‫‪ -‬ﺘﺅﺨﺫ ﺍﻟﻌﻴﻨﺔ ﺨﻼل )‪ (١٤‬ﻴﻭﻡ ﻤﻥ ﺘﺎﺭﻴﺦ ﺍﻹﺼﺎﺒﺔ )ﺒﺩﺀ ﺍﻟﺸﻠل(‪.‬‬
‫‪ -‬ﺤﺠﻡ ﺍﻟﻌﻴﻨﺔ‪ :‬ﺒﺤﺠﻡ ﺤﺒﺔ ﺍﻟﺤﻤﺹ ﻋﻠﻰ ﺍﻷﻗل‪.‬‬
‫‪ -‬ﺘﻭﻀﻊ ﺍﻟﻌﻴﻨﺔ ﻓﻲ ﻋﺒﻭﺓ ﺨﺎﺼﺔ ﻭﺘﺭﺴل ﺨﻼل ﻓﺘﺭﺓ ﻻ ﺘﺘﺠﺎﻭﺯ )‪ (٧٢‬ﺴﺎﻋﺔ ﻤﻥ ﺘﺎﺭﻴﺦ ﺃﺨﺫﻫﺎ ﻀﻤﻥ ﺤﺎﻤل‬
‫ﻟﻘﺎﺡ ﻭﺒﺩﺭﺠﺔ ﺤﺭﺍﺭﺓ )‪ (٨+ ،٢+‬ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻤﺨﺒﺭ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ‪ ،‬ﻤﺭﻓﻘﺔ ﺒﺎﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ‬
‫ﺍﻟﺨﺎﺼﺔ‪.‬‬
‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﺨﻼل )‪ (٤٨‬ﺴﺎﻋﺔ ﻤﻥ ﺍﻹﺒﻼﻍ ﻭﻓﻕ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ ﺍﻟﺨﺎﺼﺔ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(١٦‬‬
‫ﻭﺇﺭﺴﺎﻟﻬﺎ ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ‪ -‬ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ ‪ -‬ﺩﺍﺌﺭﺓ ﺼﺤﺔ ﺍﻟﻁﻔل ﻭﺫﻟﻙ ﺒﻌﺩ ﺍﻻﺤﺘﻔﺎﻅ ﺒﻨﺴﺨﺔ‬
‫ﻤﻨﻬﺎ‪.‬‬
‫• ﻓﻲ ﺤﺎل ﻜﻭﻥ ﺤﺎﻟﺔ ﺍﻟﺸﻠل ﺍﻟﺭﺨﻭ ﺍﻟﺤﺎﺩ ﻤﺸﺘﺒﻬﺔ ﺒﺸﺩﺓ )ﺍﻟﺤﺎﻟﺔ ﺍﻟﺘﻲ ﺘﺒﻴﻥ ﻤﻥ ﺨﻼل ﺘﻘﺼﻴﻬﺎ ﺴﺭﻴﺭﻴﹰﺎ ﻭﻤﺨﺒﺭﻴ ﹰﺎ‬
‫ﻭﻭﺒﺎﺌﻴﹰﺎ ﺃﻨﻬﺎ ﺃﻗﺭﺏ ﺇﻟﻰ ﺸﻠل ﺍﻷﻁﻔﺎل ﻤﻥ ﺤﺎﻻﺕ ﺍﻟﺸﻠل ﺍﻟﺭﺨﻭ ﺍﻟﺤﺎﺩ ﺍﻷﺨﺭﻯ ﻭﻟﻴﺱ ﺒﺎﻟﻀﺭﻭﺭﺓ ﺤﺎﻟﺔ ﺸﻠل‬
‫ﺃﻁﻔﺎل(‪ ،‬ﺘﺘﺨﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺎﻟﻴﺔ ﻓﻲ ﻤﻨﻁﻘﺔ ﺍﻹﺼﺎﺒﺔ‪:‬‬
‫‪ -‬ﺃﺨﺫ )‪ (٥-٣‬ﻋﻴﻨﺎﺕ ﺒﺭﺍﺯﻴﺔ ﻤﻥ ﺍﻷﻁﻔﺎل ﺒﻌﻤﺭ ﺃﻗل ﻤﻥ )‪ (٥‬ﺴﻨﻭﺍﺕ )ﻋﻴﻨﺔ ﻟﻜل ﻁﻔل(‪.‬‬
‫‪ -‬ﺘﻘﻴﻴﻡ ﺍﻟﺤﺎﻟﺔ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ ﻟﻸﻁﻔﺎل ﻓﻲ ﺍﻟﻤﻨﻁﻘﺔ‪.‬‬
‫‪ -‬ﺘﻠﻘﻴﺢ ﺍﻷﻁﻔﺎل ﺒﻌﻤﺭ ﺃﻗل ﻤﻥ )‪ (٥‬ﺴﻨﻭﺍﺕ ﻓﻲ ﺍﻟﻘﺭﻴﺔ ﺍﻟﺘﻲ ﻅﻬﺭﺕ ﻓﻴﻬﺎ ﺍﻟﺤﺎﻟﺔ ﺃﻭ ﺍﻟﻤﻭﺠﻭﺩﻴﻥ ﻓﻲ )‪(٥٠‬‬
‫ﻻ ﺤﻭل ﺍﻟﺤﺎﻟﺔ ﻓﻲ ﺍﻟﻤﺩﻴﻨﺔ ﺒﺠﺭﻋﺘﻴﻥ ﻤﻥ ﺍﻟﻠﻘﺎﺡ ﺒﻔﺎﺼل ﺸﻬﺭ‪.‬‬
‫ﻤﻨﺯ ﹰ‬
‫‪ -‬ﺍﻟﺒﺤﺙ ﻋﻥ ﺤﺎﻻﺕ ﺸﻠل ﺭﺨﻭ ﺤﺎﺩ ﺃﺨﺭﻯ‪.‬‬
‫‪ -‬ﺯﻴﺎﺭﺓ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ ﻟﻠﺘﺄﻜﻴﺩ ﻋﻠﻰ ﻀﺭﻭﺭﺓ ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻥ ﺤﺎﻻﺕ ﺍﻟﺸﻠل ﺍﻟﺭﺨﻭ ﺍﻟﺤﺎﺩ‪.‬‬
‫• ﻤﺘﺎﺒﻌﺔ ﺍﻟﺤﺎﻟﺔ ﺒﻌﺩ )‪ (٦٠‬ﻴﻭﻡ ﻤﻥ ﺘﺎﺭﻴﺦ ﺍﻹﺼﺎﺒﺔ ﻭﻓﻕ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﻤﺘﺎﺒﻌﺔ‪ ،‬ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪ (١٧‬ﻭﺇﺭﺴﺎل ﻨﺴﺨﺔ‬
‫ﻤﻥ ﺍﻻﺴﺘﻤﺎﺭﺓ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺼﺤﺔ ﺍﻟﻁﻔل ﺒﻌﺩ ﺍﻻﺤﺘﻔﺎﻅ ﺒﻨﺴﺨﺔ ﻤﻨﻬﺎ‪.‬‬
‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻟﺔ ﻓﻲ ﺴﺠل ﺤﺎﻻﺕ ﺍﻟﺸﻠل ﺍﻟﺭﺨﻭ ﺍﻟﺤﺎﺩ ﻟﻠﻤﺤﺎﻓﻅﺔ‪.‬‬
‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻟﺔ ﻀﻤﻥ ﺘﻘﺭﻴﺭ ﺍﻟﺘﺭﺼﺩ ﻭﺘﻘﺭﻴﺭ ﺍﻹﺒﻼﻍ ﺍﻟﺼﻐﺭﻱ ﺍﻷﺴﺒﻭﻋﻲ ﻭﺇﺭﺴﺎﻟﻪ ﻟﻠﻤﺴﺘﻭﻯ ﺍﻷﻋﻠﻰ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻋﻠﻰ ﻭﺒﺎﺌﻴﺎﺕ ﺍﻟﻤﺭﺽ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‪.‬‬

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‫• ﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪ ،‬ﻭﺇﻋﺩﺍﺩ ﺘﻐﺫﻴﺔ ﺭﺍﺠﻌﺔ ﺒﺫﻟﻙ‪ ،‬ﻭﺇﺭﺴﺎل ﺘﻘﺭﻴﺭ ﺤﻭل ﺫﻟﻙ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺼﺤﺔ‬
‫ﺍﻟﻁﻔل ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻻﺕ ﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺇﺭﺴﺎﻟﻪ ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ – ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ‬
‫ﺍﻟﺴﺎﺭﻴﺔ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬

‫• ﺘﺴﺠﻴل ﺍﻟﻌﻴﻨﺎﺕ ﻭﺇﺭﺴﺎﻟﻬﺎ ﺇﻟﻰ ﻤﺨﺒﺭ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ‪ ،‬ﺤﻴﺙ ﺘﺘﻡ ﺩﺭﺍﺴﺘﻬﺎ ﻭﺘﺭﺴل ﺍﻟﻌﻴﻨﺎﺕ ﺍﻹﻴﺠﺎﺒﻴﺔ ﻟﻔﻴﺭﻭﺱ‬
‫ﺸﻠل ﺍﻷﻁﻔﺎل ﺇﻟﻰ ﻤﺨﺒﺭ ﻓﺎﻜﺴﻴﺭﺍ ﻓﻲ ﺍﻟﻘﺎﻫﺭﺓ ﻟﺘﺤﺩﻴﺩ ﻨﻭﻉ ﺍﻟﻔﻴﺭﻭﺱ )ﺒﺭﻱ‪ ،‬ﻟﻘﺎﺡ( ﻭﻨﻤﻁﻪ‪ ،‬ﻭﺇﻋﺩﺍﺩ ﺘﻐﺫﻴﺔ‬
‫ﺭﺍﺠﻌﺔ ﺒﻨﺘﺎﺌﺞ ﺍﻟﻌﻴﻨﺎﺕ ﺍﻟﺒﺭﺍﺯﻴﺔ‪.‬‬
‫• ﺘﺤﻠﻴل ﺍﺴﺘﻤﺎﺭﺘﻲ ﺍﻟﺘﻘﺼﻲ ﻭﺍﻟﻤﺘﺎﺒﻌﺔ ﻟﻜل ﺤﺎﻟﺔ ﻭﺇﺭﺴﺎل ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﻋﻥ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﻘﺼﻲ ﻭﺍﻟﻤﺘﺎﺒﻌﺔ‬
‫ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‪.‬‬
‫• ﻤﺘﺎﺒﻌﺔ ﻭﺘﻘﻴﻴﻡ ﻨﺸﺎﻁﺎﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻴﻴﻥ ﺍﻟﻤﺘﻭﺴﻁ ﻭﺍﻟﻤﺤﻴﻁﻲ ﻤﻥ ﺨﻼل ﺍﻟﺯﻴﺎﺭﺍﺕ‬
‫ﺍﻹﺸﺭﺍﻓﻴﺔ ﻭﻤﺅﺸﺭﺍﺕ ﺍﻟﺘﺭﺼﺩ‪ ،‬ﻭﺘﺤﺩﻴﺩ ﺍﻟﻤﻨﺎﻁﻕ ﺃﻭ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ ﺍﻟﺘﻲ ﺴﺘﺘﻡ ﻓﻴﻬﺎ ﺤﻤﻼﺕ ﺘﻠﻘﻴﺢ ﻤﺤﻠﻴﺔ ﻭﺘﻘﺩﻴﻡ‬
‫ﺍﻟﺩﻋﻡ ﻋﻨﺩ ﺍﻟﻠﺯﻭﻡ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻋﻠﻰ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ )ﻟﺠﻤﻴﻊ ﺍﻟﻤﺴﺘﻭﻴﺎﺕ ﻭﺠﻤﻴﻊ ﺍﻟﻘﻁﺎﻋﺎﺕ(‪.‬‬
‫• ﻭﻀﻊ ﺨﻁﺔ ﺍﻟﻌﻤل ﺍﻟﺴﻨﻭﻴﺔ ﻟﻠﺒﺭﻨﺎﻤﺞ‪.‬‬
‫• ﺍﻟﺘﻨﺴﻴﻕ ﻭﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ )ﺍﻟﻘﻁﺎﻋﺎﺕ ﺍﻟﺼﺤﻴﺔ‪ ،‬ﺍﻹﻋﻼﻡ‪ ،‬ﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺸﻌﺒﻴﺔ ﻭﺍﻟﺩﻭﻟﻴﺔ(‪.‬‬

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 ‫‪‬‬
‫א‪‬א‪ ‬‬
‫‪ Typhoid Fever‬‬
‫ﻤﺭﺽ ﺠﺭﺜﻭﻤﻲ ﻋﺎﻡ‪ ،‬ﻴﺘﻤﻴﺯ ﻋﺎﺩﺓ ﺒﺒﺩﺀ ﻤﺨﺎﺘل‪ -‬ﺤﻤﻰ – ﺼﺩﺍﻉ‪ -‬ﻓﺘﻭﺭ ﻭﻗﻬﻡ‪ -‬ﺁﻻﻡ ﺒﻁﻨﻴﺔ‪ -‬ﺇﻤﺴﺎﻙ )ﺃﻜﺜﺭ‬
‫ﺤﺩﻭﺜﹰﺎ ﻤﻥ ﺍﻹﺴﻬﺎل( – ﺃﻟﻡ ﻤﻔﺎﺼل – ﺍﻟﺘﻬﺎﺏ ﺒﻠﻌﻭﻡ‪ -‬ﺴﻌﺎل ﺠﺎﻑ‪ -‬ﺭﻋﺎﻑ‪ -‬ﺒﻁﺀ ﻗﻠﺏ ﻨﺴﺒﻲ‪ -‬ﻀﺨﺎﻤﺔ ﻁﺤﺎل‪-‬‬
‫ﺒﻘﻊ ﻭﺭﺩﻴﺔ ﻋﻠﻰ ﺍﻟﺠﺫﻉ )ﺘﻅﻬﺭ ﻓﻲ ﺤﻭﺍﻟﻲ ‪ %١٠‬ﻤﻥ ﺍﻟﺤﺎﻻﺕ( – ﺇﺼﺎﺒﺔ ﺍﻟﻨﺴﺞ ﺍﻟﻠﻤﻔﺎﻭﻴﺔ‪ ،‬ﺃﻜﺜﺭ ﺍﻻﺨﺘﻼﻁﺎﺕ‬
‫ﺸﻴﻭﻋﹰﺎ ﺍﻟﻨﺯﻑ ﺍﻟﻤﻌﻭﻱ ﻭﺍﻨﺜﻘﺎﺏ ﺍﻷﻤﻌﺎﺀ ﻭﺘﺤﺩﺙ ﻋﺎﺩﺓ ﻋﻨﺩ ﻏﻴﺭ ﺍﻟﻤﻌﺎﻟﺠﻴﻥ ﺃﻭ ﻋﻨﺩ ﺘﺄﺨﺭ ﺍﻟﻤﻌﺎﻟﺠﺔ‪ ،‬ﻤﻌﺩل‬
‫ﺍﻹﻤﺎﺘﺔ ﺒﺩﻭﻥ ﻤﻌﺎﻟﺠﺔ )‪ (%١٠‬ﻭﻟﻜﻨﻬﺎ ﺘﻨﺨﻔﺽ ﺒﺎﻟﻤﻌﺎﻟﺠﺔ ﺇﻟﻰ ﺃﻗل ﻤﻥ )‪.(%١‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﺍﻟﺴﺎﻟﻤﻭﻨﻴﻼ ﺍﻟﺘﻴﻔﻴﺔ )‪ ،(salmonella Typhi‬ﻭﻴﻤﻜﻥ ﺘﻤﻴﻴﺯ ﺃﻜﺜﺭ ﻤﻥ)‪ (١٠٧‬ﻨﻤﻁ ﻤﺼﻠﻲ‪.‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﺭﻴﺽ ﻭﺍﻟﺤﺎﻤل‪ ،‬ﻗﺩ ﺘﺤﺩﺙ ﺤﺎﻟﺔ ﺍﻟﺤﻤل ﺒﻌﺩ ﻤﺭﺽ ﺤﺎﺩ ﺃﻭ ﺨﻤﺞ ﺨﻔﻴﻑ ﺃﻭ ﺨﻤﺞ ﺘﺤﺕ ﺴﺭﻴﺭﻱ‪،‬‬
‫ﺍﻟﺤﻤل ﺃﺸﻴﻊ ﻓﻲ ﻤﺘﻭﺴﻁﻲ ﺍﻟﻌﻤﺭ ﻭﻻﺴﻴﻤﺎ ﺍﻹﻨﺎﺙ‪ ،‬ﻭﻜﺜﻴﺭﹰﺍ ﻤﺎ ﻴﻜﻭﻥ ﻟﺩﻯ ﺍﻟﺤﻤﻠﺔ ﺍﻟﻤﺯﻤﻨﻴﻥ ﺍﻟﺘﻬﺎﺏ ﻤﺭﺍﺭﺓ ﺘﻴﻔﻲ‬
‫ﻤﺯﻤﻥ‪ ،‬ﻭﻫﻡ ﺃﻜﺜﺭ ﻋﺭﻀﺔ ﻟﻺﺼﺎﺒﺔ ﺒﺴﺭﻁﺎﻥ ﺍﻟﻜﺒﺩ ﻭﺍﻟﻤﺠﺎﺭﻱ ﺍﻟﺼﻔﺭﺍﻭﻴﺔ‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﺘﻨﺎﻭل ﻤﺎﺀ ﺃﻭ ﻏﺫﺍﺀ ﻤﻠﻭﺙ ﺒﺒﺭﺍﺯ ﺃﻭ ﺒﻭل ﺸﺨﺹ ﻤﺭﻴﺽ ﺃﻭ ﺤﺎﻤل )ﺍﻟﻔﻭﺍﻜﻪ ﻭﺍﻟﺨﻀﺭﻭﺍﺕ‪ -‬ﺍﻷﻟﺒﺎﻥ‬
‫ﻭﻤﻨﺘﺠﺎﺘﻬﺎ ﺍﻟﻨﻴﺌﺔ ﻭﺍﻟﻤﻠﻭﺜﺔ ﺒﺄﻴﺩﻱ ﺤﻤﻠﺔ ﺍﻟﺠﺭﺜﻭﻡ ﺃﻭ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﻐﻔﻠﺔ(‪ ،‬ﻴﻤﻜﻥ ﺃﻥ ﻴﺨﻤﺞ ﺍﻟﺫﺒﺎﺏ ﺍﻷﻁﻌﻤﺔ ﻋﻥ‬
‫ﻁﺭﻴﻕ ﺍﻟﻨﻘل ﺍﻟﻤﻴﻜﺎﻨﻴﻜﻲ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﺨﻤﺞ ﻋﺎﻡ‪ ،‬ﻴﺯﻴﺩ ﻓﻲ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﺎﻨﻌﺩﺍﻡ ﺃﻭ ﻨﻘﺹ ﺤﻤﻭﻀﺔ ﺍﻟﻤﻌﺩﺓ‪ ،‬ﻫﻨﺎﻙ ﻤﻘﺎﻭﻤﺔ ﻨﺴﺒﻴﺔ‬
‫ﺨﻔﻴﻔﺔ ﺘﺤﺩﺙ ﻋﻘﺏ ﺍﻟﺨﻤﺞ ﺍﻟﺴﺭﻴﺭﻱ ﺃﻭ ﺍﻟﻤﺴﺘﺘﺭ ﺃﻭ ﺍﻟﺘﻤﻨﻴﻊ ﺍﻟﻔﺎﻋل‪.‬‬
‫ﺘﻨﺨﻔﺽ ﻤﻌﺩﻻﺕ ﺍﻟﻬﺠﻤﺎﺕ ﻓﻲ ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﻤﺘﻭﻁﻨﺔ ﻋﺎﺩﺓ ﻤﻊ ﺘﻘﺩﻡ ﺍﻟﻌﻤﺭ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫‪ ٣-١‬ﺃﺴﺎﺒﻴﻊ‪ ،‬ﺤﺴﺏ ﺤﺠﻡ ﺍﻟﺠﺭﻋﺔ ﺍﻟﺨﺎﻤﺠﺔ‪.‬‬

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 ‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻤﺎ ﺩﺍﻤﺕ ﺍﻟﻌﺼﻴﺎﺕ ﺍﻟﺘﻴﻔﻴﺔ ﺘﻁﺭﺡ ﻤﻊ ﺍﻟﻤﻔﺭﻏﺎﺕ‪ ،‬ﻤﻨﺫ ﺍﻷﺴﺒﻭﻉ ﺍﻷﻭل ﻋﺎﺩﺓ ﻭﻟﻤﺩﺩ ﻤﺨﺘﻠﻔﺔ ﺒﻌﺩ ﺫﻟﻙ‪ ،‬ﻭﻴﺼﺒﺢ‬
‫ﺤﻭﺍﻟﻲ ‪ %٥-٢‬ﻤﻥ ﺍﻟﻤﺨﻤﻭﺠﻴﻥ ﺤﻤﻠﺔ ﺩﺍﺌﻤﻴﻥ‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﺍﻋﺘﻤﺎﺩﹰﺍ ﻋﻠﻰ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻭﺒﻤﻌﺎﻭﻨﺔ ﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺨﺒﺭﻴﺔ‪.‬‬
‫• ﻨﻘﺹ ﺍﻟﻜﺭﻴﺎﺕ ﺍﻟﺒﻴﺽ ﻤﻊ ﺭﺠﺤﺎﻥ ﻨﺴﺒﻲ ﻟﻠﻤﻔﺎﻭﻴﺎﺕ‪.‬‬
‫• ﻋﺯل ﺍﻟﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ ﻤﻥ ﺍﻟﺩﻡ )ﻓﻲ ﺍﻷﺴﺒﻭﻉ ﺍﻷﻭل ﻓﻘﻁ(‪ ،‬ﺍﻟﺒﺭﺍﺯ ﻭﺍﻟﺒﻭل )ﺒﻌﺩ ﺍﻷﺴﺒﻭﻉ ﺍﻷﻭل(‪.‬‬
‫• ﺃﻜﺜﺭ ﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺨﺒﺭﻴﺔ ﺍﻟﻤﻌﺘﻤﺩﺓ ﻓﻲ ﺍﻟﺘﺸﺨﻴﺹ ﻫﻲ ﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺼﻠﻴﺔ )ﺘﻔﺎﻋل ﻓﻴﺩﺍل(‪ ،‬ﺍﻟﺫﻱ ﻴﺼﺒﺢ ﺇﻴﺠﺎﺒﻴ ﹰﺎ‬
‫ﺃﺜﻨﺎﺀ ﺍﻷﺴﺒﻭﻉ ﺍﻟﺜﺎﻨﻲ )ﻭﻟﻜﻨﻪ ﻤﺤﺩﻭﺩ ﺍﻟﺤﺴﺎﺴﻴﺔ ﻭﺍﻟﻨﻭﻋﻴﺔ(‪ ،‬ﻴﺴﻤﺢ ﺒﺎﻟﺘﺸﺨﻴﺹ ﻋﻨﺩﻤﺎ ﻴﺤﺩﺙ ﺍﺭﺘﻔﺎﻉ ﻤﻠﺤﻭﻅ ﻓﻲ‬
‫ﻋﻴﺎﺭ ﺍﻷﻀﺩﺍﺩ ﻓﻲ ﺃﻤﺼﺎل ﻤﺯﺩﻭﺠﺔ ﺸﺭﻴﻁﺔ ﺃﻻ ﻴﻜﻭﻥ ﺍﻟﻠﻘﺎﺡ ﻗﺩ ﺃﻋﻁﻲ ﺤﺩﻴﺜﹰﺎ‪.‬‬

‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ ﻟﻠﺤﻤﻰ ﺍﻟﺘﻴﻔﻴﺔ‬

‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ‪ :‬ﺤﺎﻟﺔ ﻤﺭﻴﺽ ﻴﺸﻜﻭ ﻤﻥ ﺤﻤﻰ ﻤﻊ ﻭﺍﺤﺩ ﺃﻭ ﺃﻜﺜﺭ ﻤﻥ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺘﺎﻟﻴﺔ ﺼﺩﺍﻉ‪،‬‬
‫ﻓﺘﻭﺭ‪ ،‬ﺁﻻﻡ ﺒﻁﻨﻴﺔ‪ ،‬ﺇﻤﺴﺎﻙ‪ ،‬ﺴﻌﺎل ﺠﺎﻑ‪ ،‬ﻀﺨﺎﻤﺔ ﻁﺤﺎل‪ ،‬ﻀﺨﺎﻤﺔ ﻜﺒﺩ‪ ،‬ﺒﻘﻊ ﻭﺭﺩﻴﺔ ﻋﻠﻰ ﺍﻟﺠﺫﻉ‪.‬‬
‫• ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺭﺠﺤﺔ‪ :‬ﺤﺎﻟﺔ ﻤﺸﺘﺒﻬﺔ ﻤﻊ ﻋﻴﺎﺭ ﺃﻀﺩﺍﺩ ﻤﺭﺘﻔﻊ )ﺘﻔﺎﻋل ﻓﻴﺩﺍل <‪ (٨٠/١‬ﺃﻭ ﺍﺭﺘﻔﺎﻉ ﺍﻷﻀﺩﺍﺩ‬
‫ﺒﻔﺤﺼﻴﻥ ﻤﺘﺘﺎﻟﻴﻴﻥ‪.‬‬
‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺅﻜﺩﺓ‪ :‬ﻫﻲ ﺤﺎﻟﺔ ﻤﺭﺠﺤﺔ ﻤﻊ ﻋﺯل ﺍﻟﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ ﻤﻥ ﺍﻟﺩﻡ ﺃﻭ ﺍﻷﻨﺴﺠﺔ ﺍﻷﺨﺭﻯ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬

‫• ﺍﻟﻜﺸﻑ ﺍﻟﻤﺒﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻻﺕ‪.‬‬
‫• ﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺭﺠﺤﺔ )ﻭﻓﻕ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ( ﻓﻲ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ )ﻓﻲ‬
‫ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺘﻔﺭﻗﺔ(‪ ،‬ﻭﺭﻓﻊ ﻫﺫﺍ ﺍﻟﺘﻘﺭﻴﺭ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﻓﻲ ﺍﻟﻤﺩﻴﺭﻴﺔ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪-٢‬‬
‫‪ (٣‬ﻭﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻟﻔﺎﺸﻴﺎﺕ ﺃﻭ ﺍﻷﻭﺒﺌﺔ ﺒﺸﻜل ﻓﻭﺭﻱ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﻓﻲ ﺍﻟﻤﺩﻴﺭﻴﺔ‪.‬‬
‫• ﺍﻟﻌﻼﺝ ﺍﻟﻨﻭﻋﻲ‪ :‬ﺤﺴﺏ ﺍﻟﺨﻁﺔ ﺍﻟﻤﺭﻓﻘﺔ‪.‬‬

‫‪٣٩‬‬
‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ‪ :‬ﻟﻠﻔﺎﺸﻴﺎﺕ ﻭﺍﻷﻭﺒﺌﺔ ﻓﻘﻁ‪ ،‬ﻭﺩﺭﺍﺴﺔ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﻭﺍﻟﺒﺤﺙ ﻋﻥ ﺤﺎﻻﺕ ﺃﺨﺭﻯ‪ ،‬ﻭﺩﺭﺍﺴﺔ‬
‫ﺍﻟﻅﺭﻭﻑ ﺍﻟﺒﻴﺌﻴﺔ )ﻤﺼﺩﺭ ﺍﻟﻤﺎﺀ ﻭﺍﻟﻐﺫﺍﺀ‪ (...‬ﻭﺃﺨﺫ ﻋﻴﻨﺎﺕ ﻤﻥ ﻫﺫﻩ ﺍﻟﻤﺼﺎﺩﺭ ﻟﻠﺯﺭﻉ ﺍﻟﺠﺭﺜﻭﻤﻲ‪ ،‬ﻭﺭﻓﻊ‬
‫ﺍﺴﺘﻤﺎﺭﺍﺕ ﺍﻟﺘﻘﺼﻲ ﺇﻟﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻷﻋﻠﻰ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﻔﺎﺸﻴﺎﺕ ﺃﻭ ﺍﻷﻭﺒﺌﺔ ﻟﻤﻌﺭﻓﺔ ﻤﺼﺩﺭ ﺍﻟﻌﺩﻭﻯ‪.‬‬
‫• ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺤﺴﺏ ﻨﺘﺎﺌﺞ ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ )ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻟﺤﻜﻭﻤﻴﺔ ﻭﺍﻟﺨﺎﺼﺔ‬
‫ﺍﻷﺨﺭﻯ( ﻭﻫﻲ ﻋﺎﺩﺓ‪:‬‬
‫‪ -‬ﺘﺄﻤﻴﻥ ﻤﺎﺀ ﻨﻅﻴﻑ )ﻓﻲ ﺤﺎل ﺇﻴﺠﺎﺒﻴﺔ ﺍﻟﺴﺎﻟﻤﻭﻨﻴﻼ ﻓﻲ ﺍﻟﻤﺎﺀ( ﻋﻥ ﻁﺭﻴﻕ ﻜﻠﻭﺭﺓ ﺍﻟﻤﻴﺎﻩ ﺃﻭ ﺍﺴﺘﺒﺩﺍل ﻤﺼﺩﺭ‬
‫ﻤﻴﺎﻩ ﺍﻟﺸﺭﺏ ﺍﻟﻤﻠﻭﺙ ﺒﺂﺨﺭ ﺴﻠﻴﻡ ﺃﻭ ﻏﻠﻲ ﺍﻟﻤﺎﺀ ﻓﻲ ﺤﺎل ﻋﺩﻡ ﺘﻭﻓﺭ ﺒﺩﻴل‪ ،‬ﺍﻟﺘﺨﻠﺹ ﺍﻟﺴﻠﻴﻡ ﻤﻥ ﺍﻟﺒﺭﺍﺯ‬
‫ﺍﻟﺒﺸﺭﻱ ﻭﺍﻟﻘﻤﺎﻤﺔ‪ ،‬ﻭﻤﻜﺎﻓﺤﺔ ﺍﻟﺫﺒﺎﺏ‪.‬‬
‫‪ -‬ﺘﺜﻘﻴﻑ ﺍﻟﺠﻤﻬﻭﺭ ﺒﻤﺒﺎﺩﺉ ﺍﻟﺘﺼﺤﺢ ﺍﻟﺸﺨﺼﻲ ﻭﻀﺭﻭﺭﺓ ﺍﻟﺘﻘﻴﺩ ﺒﺎﻟﻨﻅﺎﻓﺔ ﺍﻟﺘﺎﻤﺔ ﻋﻨﺩ ﺇﻋﺩﺍﺩ ﻭﺘﺩﺍﻭل ﺍﻟﻁﻌﺎﻡ‪،‬‬
‫ﻭﺒﺴﺘﺭﺓ ﺃﻭ ﻏﻠﻲ ﺠﻤﻴﻊ ﺍﻷﻟﺒﺎﻥ ﻭﻤﻨﺘﺠﺎﺘﻬﺎ‪ ،‬ﻭﺘﺸﺠﻴﻊ ﺍﻹﺭﻀﺎﻉ ﺍﻟﻭﺍﻟﺩﻱ‪.‬‬
‫‪ -‬ﺘﺜﻘﻴﻑ ﻤﺘﺩﺍﻭﻟﻲ ﺍﻟﻁﻌﺎﻡ ﻭﺍﻟﻤﺭﺽ ﻭﺍﻟﻨﺎﻗﻬﻴﻥ ﻭﺍﻟﺤﻤﻠﺔ ﻭﺍﻟﺘﺄﻜﻴﺩ ﻋﻠﻰ ﻏﺴل ﺍﻷﻴﺩﻱ ﺒﻌﺩ ﺍﻟﺘﺒﺭﺯ ﻭﻗﺒل ﺇﻋﺩﺍﺩ‬
‫ﺍﻟﻁﻌﺎﻡ ﺃﻭ ﺘﻘﺩﻴﻤﻪ‪.‬‬
‫‪ -‬ﺍﺴﺘﺒﻌﺎﺩ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﺨﻤﻭﺠﻴﻥ )ﻤﺭﻀﻰ ﺃﻭ ﺤﻤﻠﺔ( ﻤﻥ ﺘﺩﺍﻭل ﺍﻟﻁﻌﺎﻡ‪ ،‬ﻭﺍﻜﺘﺸﺎﻑ ﺍﻟﺤﻤﻠﺔ ﺍﻟﺘﻴﻔﻴﻴﻥ‬
‫ﻭﻋﻼﺠﻬﻡ‪ ،‬ﻭﻤﻨﻌﻬﻡ ﻤﻥ ﺘﺩﺍﻭل ﺍﻟﻁﻌﺎﻡ ﺤﺘﻰ ﻴﺘﻡ ﺍﻟﺤﺼﻭل ﻋﻠﻰ ‪ ٣‬ﻤﺯﺍﺭﻉ ﺴﻠﺒﻴﺔ ﻤﺘﺘﺎﺒﻌﺔ ﻟﻌﻴﻨﺎﺕ ﺒﺭﺍﺯﻴﺔ‬
‫ﺘﺠﻤﻊ ﺒﻔﺎﺼل ﺸﻬﺭ ﺒﻴﻥ ﻋﻴﻨﺔ ﻭﺃﺨﺭﻯ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻤﺤﻠﻲ ﻓﻲ ﺤﺎل ﺤﺩﻭﺙ ﺍﻟﻔﺎﺸﻴﺎﺕ ﻭﺍﻷﻭﺒﺌﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬
‫• ﺭﻓﻊ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺸﻬﺭﻴﺔ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻭﺇﺒﻼﻍ ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﻋﻥ‬
‫ﺤﺩﻭﺙ ﺍﻷﻭﺒﺌﺔ‪ .‬ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(٣‬‬
‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﻟﻠﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﻭﻤﺭﺍﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﻋﻤل ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﻭﻤﺭﺍﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﻭﺘﻭﺯﻴﻊ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﻭﺍﺩ ﺍﻟﻤﺨﺒﺭﻴﺔ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻤﻥ ﺨﻼل ﺍﻟﻤﺠﻠﺱ ﺍﻟﺼﺤﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻁﺎﺭﺌﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻘﻁﺭ‪.‬‬

‫‪٤٠‬‬
 ‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﺇﻟﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﻭﺴﺎﺌل ﻭﻤﻭﺍﺩ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪.‬‬
‫• ﺘﻘﺩﻴﺭ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﻭﺍﺩ ﺍﻟﻤﺨﺒﺭﻴﺔ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﺍﻟﺩﺭﺍﺴﺎﺕ ﻭﺍﻟﺒﺤﻭﺙ ﺃﻭ ﺍﻟﻤﺴﻭﺡ ﻟﻤﻌﺭﻓﺔ ﻤﻌﺩل ﺍﻻﻨﺘﺸﺎﺭ‪ ،‬ﻭﻋﻭﺍﻤل ﺍﻟﺨﻁﺭ ﺍﻟﻤﺭﺘﺒﻁﺔ ﺒﺤﺩﻭﺙ ﺍﻟﻤﺭﺽ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻤﻥ ﺨﻼل ﺍﻟﻠﺠﻨﺔ ﺍﻟﻭﻁﻨﻴﺔ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﺸﺘﺭﻜﺔ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬

‫ﺨﻁﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ‬

‫ﺍﻟﺼﺎﺩﺍﺕ‪:‬‬
‫ﺘﻌﻁﻰ ﺍﻟﺼﺎﺩﺍﺕ ﺤﺴﺏ ﻤﺎ ﻫﻭ ﻭﺍﺭﺩ ﻓﻲ ﺍﻟﺠﺩﻭل‪:‬‬

‫ﺍﻟﻤﺩﺓ‬ ‫ﺠﺭﻋﺔ ﺍﻷﻁﻔﺎل‬ ‫ﺠﺭﻋﺔ ﺍﻟﻜﺒﺎﺭ‬ ‫ﻁﺭﻴﻕ ﺍﻹﻋﻁﺎﺀ‬ ‫ﺍﻟﺩﻭﺍﺀ‬

‫ﺤﺘﻰ ﺍﻨﺨﻔﺎﺽ‬ ‫‪ ٥٠‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ‬ ‫‪ ٣‬ﻍ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ ﻋﻠﻰ‬ ‫ﻓﻤﻭﻱ ﺃﻭ ﻭﺭﻴﺩﻱ‬ ‫ﺍﻟﻜﻠﻭﺭ ﺍﻨﻔﻴﻨﻴﻜﻭل‬
‫ﺍﻟﺤﺭﺍﺭﺓ )‪(٥-٢‬‬ ‫ﻋﻠﻰ ‪ ٦-٤‬ﺠﺭﻋﺎﺕ‬ ‫‪ ٦-٤‬ﺠﺭﻋﺎﺕ‪.‬‬ ‫ﺃﻭ ﻋﻀﻠﻲ‬
‫ﺃﻴﺎﻡ‬

‫ﺤﺘﻰ ﺇﻜﻤﺎل ﺍﻟﻤﺩﺓ‬ ‫‪ ٣٠‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ‬ ‫‪ ٢‬ﻍ‪ /‬ﻤﻘﺴﻤﺔ ﻋﻠﻰ‬

‫‪ ١٤‬ﻴﻭﻡ‬ ‫ﻋﻠﻰ ‪ ٦-٤‬ﺠﺭﻋﺎﺕ‬ ‫‪ ٦-٤‬ﺠﺭﻋﺎﺕ‬

‫‪ ١٤‬ﻴﻭﻡ‬ ‫‪ ٢٠٠-١٠٠‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ‬ ‫‪ ٨-٤‬ﻍ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ ﻋﻠﻰ‬ ‫ﻋﻀﻠﻲ‬ ‫ﺍﻷﻤﺒﻴﺴﻴﻠﻴﻥ‬

‫ﻤﻘﺴﻤﺔ ﻋﻠﻰ ‪ ٤‬ﺠﺭﻋﺎﺕ‬ ‫‪ ٤‬ﺠﺭﻋﺎﺕ‬ ‫ﺃﻭ ﺃﻭﻭﺭﻴﺩﻱ‬

‫‪ ١٤‬ﻴﻭﻡ‬ ‫‪ ١٠٠‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ‬ ‫‪ ٦-٤‬ﻍ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ ﻋﻠﻰ‬ ‫ﻋﻀﻠﻲ ﺃﻭ‬ ‫ﺍﻷﻤﻭﻜﺴﻴﺴﻠﻠﻴﻥ‬

‫ﻋﻠﻰ ‪ ٣‬ﺠﺭﻋﺎﺕ‬ ‫‪ ٣‬ﺠﺭﻋﺎﺕ‬ ‫ﻭﺭﻴﺩﻱ ﺃﻭ ﻓﻤﻭﻱ‬

‫‪ ١٤‬ﻴﻭﻡ‬ ‫ﺴﻠﻔﺎﻤﻴﺘﻭﻜﺴﺎﺯﻭل‬ ‫ﺴﻠﻔﺎﻤﻴﺘﻭﻜﺴﺎﺯﻭل ‪ ٣-٢‬ﻍ‪/‬ﻴﻭﻡ‬ ‫ﻓﻤﻭﻱ‬ ‫ﺍﻟﻜﻭﺘﺭﻴﻤﻭﻜﺴﺎﺯﻭل‬

‫‪ ٨٠‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ‬ ‫ﻤﻘﺴﻤﺔ ﻋﻠﻰ ‪ ٣-٢‬ﺠﺭﻋﺎﺕ‬ ‫)ﺘﺭﻴﻤﻴﺘﻭﺒﺭﻴﻡ‪+‬‬
‫ﻋﻠﻰ ‪ ٣-٢‬ﺠﺭﻋﺎﺕ‬ ‫)‪ ٤‬ﺤﺒﺎﺕ ﻋﻴﺎﺭ ﻓﻭﺭﺕ(‬ ‫ﺴﻠﻔﺎﻤﻴﺘﻭﻜﺎﺯﻭل(‬

‫‪ ١٤‬ﻴﻭﻡ‬ ‫‪-‬‬ ‫‪ ١‬ﻍ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ ﻋﻠﻰ ﺠﺭﻋﺘﻴﻥ‬ ‫ﻓﻤﻭﻱ‬ ‫ﺍﻟﺴﻴﺒﺭﻓﻠﻭﻜﺴﺎﺴﻴﻥ‬

‫‪ ١٤‬ﻴﻭﻡ‬ ‫‪-‬‬ ‫‪ ٤٠٠‬ﻤﻠﻎ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ ﻋﻠﻰ‬ ‫ﻭﺭﻴﺩﻱ‬

‫ﺠﺭﻋﺘﻴﻥ‬

‫‪ ٥‬ﺃﻴﺎﻡ‬ ‫‪ ٨٠-٥٠‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ‬ ‫‪ ٤-٢‬ﻍ‪ /‬ﻴﻭﻡ ﺠﺭﻋﺔ ﻭﺍﺤﺩﺓ‬ ‫ﻭﺭﻴﺩﻱ‬ ‫ﺍﻟﺴﻴﻔﺘﺭﻴﺎﻜﺴﻭﻥ‬

‫‪٤١‬‬
 ‫ﻤﻼﺤﻅﺎﺕ‪:‬‬
‫• ﻟﻡ ﻴﻌﺩ ﻴﻌﺘﺒﺭ ﺍﻟﻜﻠﻭﺭﺍﻨﻔﻴﻨﻴﻜﻭل ﺍﻟﺩﻭﺍﺀ ﺍﻟﺭﺌﻴﺴﻲ ﻓﻲ ﺍﻟﻤﻌﺎﻟﺠﺔ‪ ،‬ﻭﺤل ﻤﺤﻠﻪ ﺍﻟﺴﻴﺒﺭﻭﻓﻠﻭﻜﺴﺎﺴﻴﻥ‪.‬‬
‫• ﻴﻔﻴﺩ ﺍﻟﻜﻭﺘﺭﻴﻤﻭﻜﺴﺎﺯﻭل ﻭﺍﻷﻤﺒﻴﺴﻴﻠﻴﻥ ﻭﺍﻷﻤﻭﻜﺴﻴﺴﻠﻠﻴﻥ ﻓﻲ ﻤﻌﺎﻟﺠﺔ ﺍﻟﺤﻤل ﺍﻟﻤﺯﻤﻥ ﻓﻲ ﺍﻟﻤﺭﺍﺭﺓ‪.‬‬
‫• ﻴﻌﻁﻰ ﺍﻟﻜﻠﻭﺭﺍﻨﻔﻴﻨﻴﻜﻭل ﻋﻨﺩ ﺍﻟﺭﻀﻊ ﺩﻭﻥ ﺃﺴﺒﻭﻋﻴﻥ ﺒﻤﻘﺩﺍﺭ ‪ ٢٥‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ‪.‬‬
‫• ﻋﻨﺩ ﺍﻷﻁﻔﺎل ﻨﺎﻗﺼﻲ ﺍﻟﺘﻐﺫﻴﺔ ﻭﻓﻲ ﺤﺎل ﻭﺠﻭﺩ ﺍﺨﺘﻼﻁﺎﺕ ﺘﻤﺩﺩ ﻓﺘﺭﺓ ﺍﻟﻌﻼﺝ ﻟﻤﺩﺓ ﺃﺴﺒﻭﻉ ﺁﺨﺭ ﺒﺤﻴﺙ‬
‫ﺘﺼﺒﺢ ‪ ٣‬ﺃﺴﺎﺒﻴﻊ‪.‬‬

‫ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﺩﺍﻋﻤﺔ‪:‬‬
‫ﺭﺍﺤﺔ‪ ،‬ﺘﻐﺫﻴﺔ ﺠﻴﺩﺓ ﻤﻊ ﺘﻐﻴﻴﺭ ﺍﻷﻁﻌﻤﺔ‪ ،‬ﺘﺠﻨﺏ ﺍﻟﺴﺎﻟﻴﺴﻴﻼﺕ ﻭﺍﻟﻤﺴﻬﻼﺕ ﻭﺍﻟﺤﻘﻥ ﺍﻟﺸﺭﺠﻴﺔ ﻴﻤﻜﻥ ﺍﺴﺘﻌﻤﺎل‬
‫ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺨﻼﻟﻴﺔ‪ ،‬ﺇﻋﺎﻀﺔ ﺍﻟﺴﻭﺍﺌل ﻭﺍﻟﺸﻭﺍﺭﺩ‪.‬‬

‫ﻭﻓﻲ ﺤﺎل ﺤﺩﻭﺙ ﺍﺨﺘﻼﻁﺎﺕ ‪/‬ﻨﺯﻑ ﻫﻀﻤﻲ‪ ،‬ﺍﻨﺜﻘﺎﺏ ﺃﻤﻌﺎﺀ‪ /...‬ﻴﺠﺏ ﺇﺤﺎﻟﺔ ﺍﻟﻤﺭﻴﺽ ﺒﺴﺭﻋﺔ ﺇﻟﻰ‬
‫ﺍﻟﻤﺴﺘﺸﻔﻰ‪.‬‬

‫ﻤﻌﺎﻟﺠﺔ ﺍﻟﻨﻜﺱ‪:‬‬
‫ﻤﺸﺎﺒﻪ ﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﻤﺭﺽ ﺍﻟﺒﺩﺌﻲ‪ ،‬ﻤﻊ ﺍﻟﻌﻠﻡ ﺃﻥ ﻤﺩﺓ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻨﺎﺩﺭﹰﺍ ﻤﺎ ﺘﻤﺘﺩ ﺃﻜﺜﺭ ﻤﻥ ‪ ٥‬ﺃﻴﺎﻡ‪.‬‬

‫‪٤٢‬‬
٤٤
 ‫‪ ‬‬
‫א‪‬א‪‬‬
‫‪ Meningitis‬‬
‫ﻭﺘﻀﻡ ﻨﻭﻋﻴﻥ ﺭﺌﻴﺴﻴﻥ‪:‬‬
‫‪ -‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﻌﻘﻴﻡ‪.‬‬
‫‪ -‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﺠﺭﺜﻭﻤﻲ‪.‬‬

‫ﻭﺴﻨﻘﺼﺭ ﺒﺤﺜﻨﺎ ﻫﺫﺍ ﻋﻠﻰ ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺠﺎﻴﺎ ﺍﻟﺠﺭﺜﻭﻤﻲ ﻨﻅﺭﹰﺍ ﻟﺨﻁﻭﺭﺘﻪ‪.‬‬

‫ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﺠﺭﺜﻭﻤﻲ‬

‫ﻴﻤﻜﻥ ﺃﻥ ﻴﺘﺴﺒﺏ ﻋﻥ ﻋﺩﺩ ﻜﺒﻴﺭ ﻤﻥ ﺍﻟﺠﺭﺍﺜﻴﻡ‪ ،‬ﻭﺇﻥ ﺍﻟﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ ﻓﻲ ﺍﻟﺘﻬﺎﺒﺎﺕ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﺠﺭﺜﻭﻤﻴﺔ‬
‫ﺍﻟﻤﺭﺠﺢ ﺤﺴﺏ ﺍﻟﻌﻤﺭ ﻜﻤﺎ ﻴﻠﻲ‪:‬‬
‫‪ -‬ﺍﻟﻭﻟﺩﺍﻥ‪ :‬ﺍﻟﻤﺠﻤﻭﻋﺔ ‪ B‬ﻤﻥ ﺍﻟﻤﻜﻭﺭﺍﺕ ﺍﻟﻌﻘﺩﻴﺔ‪ ،‬ﺍﻻﻴﺸﺭﻴﺸﻴﺎﻜﻭﻟﻲ‪.‬‬
‫‪ -‬ﺍﻷﻁﻔﺎل‪ :‬ﺍﻟﻤﺴﺘﺩﻤﻴﺔ ﺍﻟﻨﺯﻟﻴﺔ‪ ،‬ﺍﻟﻨﺎﻴﺴﺭﻴﺎﺕ ﺍﻟﺴﺤﺎﺌﻴﺔ‪ ،‬ﺍﻟﻌﻘﺩﻴﺎﺕ ﺍﻟﺭﺌﻭﻴﺔ‪.‬‬
‫‪ -‬ﺍﻟﻜﺒﺎﺭ‪ :‬ﺍﻟﻨﺎﻴﺴﺭﻴﺎﺕ ﺍﻟﺴﺤﺎﺌﻴﺔ‪ ،‬ﺍﻟﻌﻘﺩﻴﺎﺕ ﺍﻟﺭﺌﻭﻴﺔ‪.‬‬

‫ﻭﺴﻨﺨﺼﺹ ﻓﻲ ﺒﺤﺜﻨﺎ ﻫﺫﺍ ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺒﺎﻟﻨﺎﻴﺴﻴﺭﻴﺎﺕ ﺍﻟﺴﺤﺎﺌﻴﺔ )ﺃﻭ ﺍﻟﺤﻤﻰ ﺍﻟﻤﺨﻴﺔ ﺍﻟﺸﻭﻜﻴﺔ(‪ ،‬ﻷﻨﻬﺎ‬
‫ﺍﻟﻤﺴﺅﻭﻟﺔ ﻋﻥ ﺤﺩﻭﺙ ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ‪.‬‬

‫ﻜﺫﻟﻙ ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺒﺎﻟﻤﺴﺘﺩﻤﻴﺔ ﺍﻟﻨﺯﻟﻴﺔ ﻭﺍﻟﻌﻘﺩﻴﺔ ﺍﻟﺭﺌﻭﻴﺔ‪ ،‬ﻟﺨﻁﻭﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻨﺎﺠﻤﺔ ﻋﻥ ﻫﺫﻴﻥ‬
‫ﺍﻟﺠﺭﺜﻭﻤﻴﻥ ﻭﻭﺠﻭﺩ ﻟﻘﺎﺤﺎﺕ ﻓﻌﺎﻟﺔ ﻟﻠﻭﻗﺎﻴﺔ ﻤﻥ ﺍﻹﺼﺎﺒﺔ ﺒﻬﻤﺎ‪.‬‬

‫ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺒﺎﻟﻤﻜﻭﺭ ﺍﻟﺴﺤﺎﺌﻲ‬

‫ﻤﺭﺽ ﺠﺭﺜﻭﻤﻲ ﺤﺎﺩ ﻴﺘﻤﻴﺯ ﺒﺒﺩﺀ ﻤﻔﺎﺠﺊ‪ ،‬ﻤﻊ ﺤﻤﻰ ﻭﺼﺩﺍﻉ ﻭﻏﺜﻴﺎﻥ ﻭﺇﻗﻴﺎﺀ ﻭﺘﻴﺒﺱ ﺍﻟﻌﻨﻕ‪ ،‬ﻭﻴﻤﻜﻥ ﺃﻥ ﻴﺤﺩﺙ‬
‫ﻁﻔﺢ ﺠﻠﺩﻱ ﺃﻭ ﺒﻘﻊ ﻭﺭﺩﻴﺔ‪ ،‬ﻭﻴﻤﻜﻥ ﺃﻥ ﻴﺘﻁﻭﺭ ﺇﻟﻰ ﻫﺫﻴﺎﻥ ﻭﺴﺒﺎﺕ‪.‬‬

‫ﻭﻋﻨﺩ ﺍﻟﺭﻀﻊ ﻭﺼﻐﺎﺭ ﺍﻷﻁﻔﺎل ﻴﻅﻬﺭ ﻤﻴل ﻟﻠﻨﻭﻡ ﻭﻨﻭﺒﺎﺕ ﺘﺸﻨﺠﻴﺔ ﻭﺭﻓﺽ ﺍﻟﺭﻀﺎﻋﺔ ﻭﻨﻘﺹ ﺃﻭ ﻓﺭﻁ‬
‫ﺍﻟﺤﺭﺍﺭﺓ ﻭﺘﻭﺭﻡ ﺍﻟﻴﺎﻓﻭﺥ ﻭﺍﺨﺘﻼﺠﺎﺕ‪.‬‬

‫ﻤﻌﺩل ﺍﻹﻤﺎﺘﺔ ﺒﺩﻭﻥ ﻤﻌﺎﻟﺠﺔ ﺃﻜﺜﺭ ﻤﻥ ‪ %٥٠‬ﺒﻴﻨﻤﺎ ﻴﻨﻘﺹ ﺒﺎﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﺒﺎﻜﺭﺓ ﻭﺍﻟﻔﻌﺎﻟﺔ ﺇﻟﻰ ‪.%١٠‬‬

‫‪٤٥‬‬
 ‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﺍﻟﻨﺎﻴﺴﻴﺭﻴﺔ ﺍﻟﺴﺤﺎﺌﻴﺔ ‪) Nisseria Meningiditis‬ﻤﻜﻭﺭﺍﺕ ﺴﻠﺒﻴﺔ ﺍﻟﻐﺭﺍﻡ(‪ ،‬ﻭﻫﻲ ﻤﻥ ﺍﻟﺠﺭﺍﺜﻴﻡ ﺍﻟﻬﺸﺔ‪ ،‬ﻴﻘﺴﻡ‬
‫ﺍﻟﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ ﻭﻓﻘﹰﺎ ﻟﻠﻤﺴﺘﻀﺩ ﺍﻟﻨﻭﻋﻲ )ﻋﺩﻴﺩ ﺍﻟﺴﻜﺭﻴﺩ( ﺇﻟﻰ ﻋﺩﺓ ﻤﺠﻤﻭﻋﺎﺕ )‪(A,B,C,D,X,Y,Z,W 135‬‬
‫ﺘﺴﺒﺏ ﺍﻟﻤﺠﻤﻭﻋﺎﺕ ‪ A,C,Y,W 135‬ﻤﻌﻅﻡ ﺤﻭﺍﺩﺙ ﺍﻷﻭﺒﺌﺔ‪.‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ ﻓﻘﻁ ﻋﻠﻰ ﺸﻜل ﺤﺎﻟﺔ ﺃﻭ ﺤﺎﻤل )ﺤﺎﻤل ﺼﺤﻲ(‪ ،‬ﻤﻜﺎﻥ ﺍﻟﺤﻤل ﺍﻟﺒﻠﻌﻭﻡ ﺍﻷﻨﻔﻲ ﻨﺴﺒﺔ ﺍﻟﺤﻤﻠﺔ ‪%٥٠-٥‬‬
‫ﻤﻥ ﺃﻓﺭﺍﺩ ﺍﻟﻤﺠﺘﻤﻊ )ﺘﺭﺘﻔﻊ ﻓﻲ ﺤﺎﻻﺕ ﺍﻷﻭﺒﺌﺔ(‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﺍﻨﺘﻘﺎل ﻤﺒﺎﺸﺭ ﻓﻘﻁ )ﻟﻜﻭﻥ ﺍﻟﺠﺭﺜﻭﻡ ﻫﺸﹰﺎ( ﺒﺎﻟﻘﻁﻴﺭﺍﺕ )ﻤﻥ ﺨﻼل ﺍﻟﺴﻌﺎل ﻭﺍﻟﻌﻁﺎﺱ ‪ (...‬ﺃﻭ ﺒﺎﻟﺘﻤﺎﺱ ﺍﻟﻤﺒﺎﺸﺭ‬
‫ﻤﻊ ﺍﻟﻤﻔﺭﺯﺍﺕ ﺍﻷﻨﻔﻴﺔ ﺍﻟﺒﻠﻌﻭﻤﻴﺔ ﻟﺸﺨﺹ ﻤﺨﻤﻭﺝ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﻌﺩﻭﻯ ﻋﺎﻡ‪ ،‬ﻭﻟﻜﻥ ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﻤﺭﺽ ﺍﻟﺴﺭﻴﺭﻱ ﻤﻨﺨﻔﺽ ﻭﻴﻘل ﻤﻊ ﺘﻘﺩﻡ ﺍﻟﻌﻤﺭ‪ ،‬ﻭﺘﻌﻘﺏ ﺍﻟﺨﻤﺞ‬
‫)ﺤﺘﻰ ﺩﻭﻥ ﺍﻟﺴﺭﻴﺭﻱ( ﻤﻨﺎﻋﺔ ﻟﻠﺯﻤﺭﺓ ﺍﻟﺨﺎﻤﺠﺔ ﻓﻘﻁ ﻤﺩﺓ ﻏﻴﺭ ﻤﻌﺭﻭﻓﺔ‪ ،‬ﻭﺇﻥ ﺍﻟﻤﻨﺎﻋﺔ ﺍﻟﺤﺎﺼﻠﺔ ﺒﻌﺩ ﺤﺎﻟﺔ ﺍﻟﺤﻤل‬
‫ﻀﻌﻴﻔﺔ ﻭﻤﺅﻗﺘﺔ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫‪ ١٠-٢‬ﺃﻴﺎﻡ )ﻏﺎﻟﺒﹰﺎ ‪ ٤-٣‬ﺃﻴﺎﻡ(‪ ،‬ﺘﻨﻘﺹ ﻓﻲ ﺤﺎﻻﺕ ﺍﻷﻭﺒﺌﺔ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻁﺎﻟﻤﺎ ﻭﺠﺩ ﺍﻟﺠﺭﺜﻭﻡ ﻓﻲ ﻤﻔﺭﺯﺍﺕ ﺍﻟﻔﻡ ﻭﺍﻷﻨﻑ‪ ،‬ﺘﻨﺘﻬﻲ ﺍﻟﺴﺭﺍﻴﺔ ﺒﻌﺩ ﻴﻭﻡ ﻭﺍﺤﺩ ﻓﻘﻁ ﻤﻥ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺒﺎﻟﺼﺎﺩﺍﺕ‬
‫ﺍﻟﺘﻲ ﻴﺘﺤﺴﺱ ﻟﻬﺎ ﺍﻟﺠﺭﺜﻭﻡ )ﺭﻴﻔﺎﻤﺒﻴﺴﻴﻥ‪ ،‬ﺴﻴﺒﺭﻭﻓﻠﻭﻜﺴﺎﺴﻴﻥ(‪ ،‬ﻭﺇﻥ ﺍﻟﺒﻨﺴﻠﻴﻥ ﻴﻜﺒﺕ ﺍﻟﺠﺭﺍﺜﻴﻡ ﻤﺅﻗﺘ ﹰﺎ ﻭﻟﻜﻨﻪ ﻻ ﻴﻘﻀﻲ‬
‫ﻋﻠﻴﻬﺎ ﻓﻲ ﺍﻟﺒﻠﻌﻭﻡ ﺍﻷﻨﻔﻲ‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﺍﻋﺘﻤﺎﺩﹰﺍ ﻋﻠﻰ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‪ ،‬ﻴﻜﻭﻥ ﺍﻟﺴﺎﺌل ﺍﻟﺩﻤﺎﻏﻲ ﺍﻟﺸﻭﻜﻲ ﻋﻜﺭﺍﹰ‪ ،‬ﻭﺍﻟﺒﺭﻭﺘﻴﻨﺎﺕ ﻤﺭﺘﻔﻌﺔ‪،‬‬
‫ﻭﺍﻟﺴﻜﺭ ﻤﻨﺨﻔﻀﹰﺎ ﺃﻭ ﻤﻌﺩﻭﻤﺎﹰ‪ ،‬ﻭﺍﻟﻜﺭﻴﺎﺕ ﺍﻟﺒﻴﺽ ﺯﺍﺌﺩﺓ ﻋﻠﻰ ﺤﺴﺎﺏ ﺍﻟﻤﻌﺘﺩﻻﺕ‪.‬‬

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‫ﻭﻴﺅﻜﺩ ﺍﻟﺘﺸﺨﻴﺹ ﺒﺈﻅﻬﺎﺭ ﺍﻟﺠﺭﺍﺜﻴﻡ ﻓﻲ ﻟﻁﺎﺨﺔ ﻤﻥ ﺍﻟﺴﺎﺌل ﺍﻟﺩﻤﺎﻏﻲ ﺍﻟﺸﻭﻜﻲ ﺃﻭ ﺍﻟﺯﺭﻉ ﺍﻟﺠﺭﺜﻭﻤﻲ ﺃﻭ‬
‫ﺍﻟﺘﺭﺍﺹ ﺍﻟﻼﺘﻜﺱ‪ ،‬ﻜﻤﺎ ﻴﻤﻜﻥ ﺘﺤﺩﻴﺩ ﺍﻟﺯﻤﺭ ﺍﻟﺠﺭﺜﻭﻤﻴﺔ )ﻓﻲ ﻤﺨﺎﺒﺭ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ( ﺒﺘﻤﻴﻴﺯ ﻋﺩﻴﺩﺍﺕ ﺍﻟﺴﻜﺭ‬
‫ﺍﻟﻨﻭﻋﻴﺔ ﺒﻁﺭﻕ ﺘﺭﺍﺹ ﺍﻟﻼﺘﻜﺱ ﺍﻟﻤﻨﺎﻋﻲ ﺍﻟﻤﻀﺎﺩ‪.‬‬

‫ﻭﻟﻘﺩ ﺘﻡ ﺍﻋﺘﻤﺎﺩ ﺍﻟﻤﺸﺎﻓﻲ ﺍﻟﺘﺎﻟﻴﺔ‪ :‬ﺍﻷﻁﻔﺎل ﺍﻟﺠﺎﻤﻌﻲ ﻭﺩﻤﺸﻕ ﻓﻲ ﻤﺤﺎﻓﻅﺔ ﺩﻤﺸﻕ ﻭﻤﺸﻔﻰ ﺍﻷﻁﻔﺎل ﺍﻟﺘﺎﺒﻊ‬
‫ﻟﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻓﻲ ﻤﺤﺎﻓﻅﺔ ﺤﻠﺏ ﻭﻤﺸﻔﻰ ﺍﻟﺒﺎﺴل ﻓﻲ ﻤﺤﺎﻓﻅﺔ ﻁﺭﻁﻭﺱ ﻭﻤﺸﻔﻴﻲ ﺍﻟﻭﻁﻨﻲ ﻭﺍﻷﺴﺩ ﺍﻟﺠﺎﻤﻌﻲ ﻓﻲ‬
‫ﻤﺤﺎﻓﻅﺔ ﺍﻟﻼﺫﻗﻴﺔ ﻭﻤﺠﻤﻊ ﺍﻟﺒﺎﺴل ﻓﻲ ﻤﺤﺎﻓﻅﺔ ﺤﻤﺎﻩ ﻜﻤﺸﺎﻓﻲ ﻤﺨﺘﺎﺭﺓ ﻟﻠﺘﺭﺼﺩ ﺍﻟﻤﺨﺒﺭﻱ ﻻﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ‪ ،‬ﺤﻴﺙ‬
‫ﺘﻘﻭﻡ ﺒﻌﻤﻠﻴﺔ ﺍﻟﺯﺭﻉ ﻟﻠﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ‪ ،‬ﻭﺘﺭﺴل ﺍﻟﻤﺯﺍﺭﻉ ﻤﻊ ﺍﺴﺘﻤﺎﺭﺍﺕ ﺍﻻﺴﺘﻘﺼﺎﺀ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﻤﺨﺎﺒﺭ ﺍﻟﺼﺤﺔ‬
‫ﺍﻟﻌﺎﻤﺔ ﻓﻲ ﺍﻟﻭﺯﺍﺭﺓ ﻤﻥ ﺃﺠل ﺘﺄﻜﻴﺩ ﺍﻟﺘﺸﺨﻴﺹ ﻭﺍﻟﺘﻨﻤﻴﻁ ﺍﻟﺠﺭﺜﻭﻤﻲ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬

‫• ﺍﻟﻜﺸﻑ ﺍﻟﻤﺒﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻻﺕ‪ ،‬ﺒﻔﺭﺽ ﺒﺩﺀ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻼﺌﻡ ﺒﺩﻭﻥ ﺘﺄﺨﻴﺭ‪.‬‬
‫• ﺇﺒﻼﻍ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﻓﻲ ﺍﻟﻤﺩﻴﺭﻴﺔ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ ﺃﻭ ﺍﻟﻤﺤﺘﻤﻠﺔ )ﻭﻓﻕ ﺍﻟﺘﻌﺭﻴﻑ‬
‫ﺍﻟﻘﻴﺎﺴﻲ( ﺨﻼل ﻓﺘﺭﺓ ‪ ٢٤‬ﺴﺎﻋﺔ ﺒﺎﻟﻬﺎﺘﻑ ﺃﻭ ﺍﻟﻔﺎﻜﺱ‪ ،‬ﻭﺘﺴﺠﻴل ﺍﻟﺤﺎﻻﺕ ﻓﻲ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ‬
‫ﺍﻟﺴﺎﺭﻴﺔ ﻭﺭﻓﻌﻪ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﻓﻲ ﺍﻟﻤﺩﻴﺭﻴﺔ‪.‬‬
‫• ﺍﻟﻌﻼﺝ‪:‬‬
‫ﺤﺴﺏ ﺍﻟﺨﻁﺔ ﺍﻟﻤﺭﻓﻘﺔ‪ ،‬ﺒﻌﺩ ﺃﺨﺫ ﻋﻴﻨﺔ ﻤﻥ ﺍﻟﺴﺎﺌل ﺍﻟﺩﻤﺎﻏﻲ ﺍﻟﺸﻭﻜﻲ ﻭﺇﺭﺴﺎﻟﻬﺎ ﺇﻟﻰ ﺍﻟﻤﺨﺒﺭ‪ ،‬ﻭﻗﺒل ﻭﺼﻭل‬
‫ﺍﻟﻨﺘﻴﺠﺔ ﺍﻟﻤﺨﺒﺭﻴﺔ‪ ،‬ﻓﻲ ﺍﻟﻤﺸﺎﻓﻲ ﺍﻟﻤﺨﺘﺎﺭﺓ ﻟﻠﺘﺭﺼﺩ ﺍﻟﻤﺨﺒﺭﻱ‪ ،‬ﻭﺍﺴﺘﻨﺎﺩﹰﺍ ﺇﻟﻰ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﺓ ﻓﻲ‬
‫ﺒﺎﻗﻲ ﺍﻟﻤﺸﺎﻓﻲ‪.‬‬
‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ‪:‬‬
‫ﺒﺯﻴﺎﺭﺓ ﺍﻟﻤﺭﻴﺽ ﻓﻲ ﺍﻟﻤﺴﺘﺸﻔﻰ‪ ،‬ﻭﺇﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﻤﺭﺽ‪ ،‬ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪ ،(١٣‬ﻭﺘﺭﺼﺩ‬
‫ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﻭﺍﻜﺘﺸﺎﻑ ﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﻤﺒﻜﺭﺓ ﻟﻠﻤﺭﺽ ﻭﻻ ﺴﻴﻤﺎ ﺍﻟﺤﻤﻰ ﺒﻐﺭﺽ ﺒﺩﺀ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻼﺌﻡ ﺩﻭﻥ ﺘﺄﺨﻴﺭ‪،‬‬
‫ﻭﺇﺭﺴﺎل ﺍﻻﺴﺘﻤﺎﺭﺓ ﺇﻟﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻷﻋﻠﻰ‪ ،‬ﻴﺘﻡ ﺍﻻﺴﺘﻘﺼﺎﺀ ﻤﻥ ﻗﺒل ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺒﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬
‫ﻴﺘﻡ ﻓﻲ ﺍﻟﻤﺸﺎﻓﻲ ﺍﻟﻤﺨﺘﺎﺭﺓ ﺇﻤﻼﺀ ﺍﻻﺴﺘﻤﺎﺭﺓ ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﻭﺇﺭﺴﺎﻟﻬﺎ ﻟﻠﻤﺴﺘﻭﻯ ﺍﻷﻋﻠﻰ ﻭﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻥ‬
‫ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ‪.‬‬
‫ﺩﺭﺍﺴﺔ ﺍﻟﻭﻀﻊ ﺍﻟﻭﺒﺎﺌﻲ ﺤﻴﺙ ﻴﺸﺨﺹ ﺍﻟﻭﺒﺎﺀ ﺇﺫﺍ ﻜﺎﻥ ﻤﻌﺩل ﺍﻟﻬﺠﻤﺔ ‪ ١٠٠/٥‬ﺃﻟﻑ ﻤﻥ ﺍﻟﺴﻜﺎﻥ‪ ،‬ﺨﻼل‬
‫ﺃﺴﺒﻭﻋﻴﻥ ﻤﺘﺘﺎﻟﻴﻥ ﺃﻭ ﻜﺎﻥ ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ‪ ١٠ - ٥‬ﺃﻀﻌﺎﻑ ﺍﻟﻤﺘﻭﻗﻊ ﻤﻘﺎﺭﻨﺔ ﺒﺎﻟﺴﻨﻭﺍﺕ ﺍﻟﺨﻤﺱ ﺍﻟﺴﺎﺒﻘﺔ ﻟﻨﻔﺱ‬
‫ﺍﻟﻔﺘﺭﺓ ﺍﻟﺯﻤﻨﻴﺔ ﻭﻨﻔﺱ ﺍﻟﻤﺠﻤﻭﻋﺔ ﺍﻟﺴﻜﺎﻨﻴﺔ‪ ،‬ﺃﻭ ﺘﺯﺍﻴﺩ ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ‪ ١٠ - ٥‬ﺃﻀﻌﺎﻑ ﺨﻼل ﺃﺴﺒﻭﻋﻴﻥ ﻤﺘﺘﺎﻟﻴﻥ‪.‬‬
‫ﻴﺘﻡ ﺍﻻﺴﺘﻘﺼﺎﺀ ﺨﻼل ﺍﻟﻔﺎﺸﻴﺎﺕ ﺒﺎﻟﺘﻌﺎﻭﻥ ﺒﻴﻥ ﺍﻟﻔﺭﻴﻕ ﺍﻟﻤﺤﻠﻲ )ﻤﺭﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ( ﻭﻓﺭﻴﻕ ﺍﻟﻤﺩﻴﺭﻴﺔ‪.‬‬

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 ‫• ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‪:‬‬
‫‪ -‬ﺍﻟﻌﺯل‪ :‬ﻴﻁﺒﻕ ﺍﻟﻌﺯل ﺍﻟﺘﻨﻔﺴﻲ ﻟﻤﺩﺓ ‪ ٢٤‬ﺴﺎﻋﺔ ﺒﻌﺩ ﺒﺩﺀ ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺌﻲ‪.‬‬
‫ﺘﻁﻬﻴﺭ ﻤﻔﺭﺯﺍﺕ ﺍﻷﻨﻑ ﻭﺍﻟﺒﻠﻌﻭﻡ ﻭﺍﻷﺩﻭﺍﺕ ﺍﻟﻤﻠﻭﺜﺔ ﺒﻬﺎ‪.‬‬
‫‪ -‬ﺤﻤﺎﻴﺔ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﺍﻟﺼﻤﻴﻤﻴﻥ ﻭﺍﻟﻤﺸﺎﺭﻜﻴﻥ ﻓﻲ ﻨﻔﺱ ﺍﻟﻤﺴﻜﻥ )ﻤﺜل ﺃﻓﺭﺍﺩ ﺍﻷﺴﺭﺓ ﺃﻭ ﺍﻟﺼﻑ ﺃﻭ ﺍﻟﻌﻤل(‬
‫ﺒﺈﻋﻁﺎﺌﻬﻡ ﺍﻟﻭﻗﺎﻴﺔ ﺍﻟﻜﻴﻤﻴﺎﺌﻴﺔ ﺍﻟﻤﻜﻭﻨﺔ ﻤﻥ ﺍﻟﺭﻴﻔﺎﻤﺒﻴﺴﻴﻥ ﻋﻠﻰ ﺍﻟﺸﻜل ﺍﻟﺘﺎﻟﻲ‪:‬‬
‫‪ o‬ﺍﻟﺒﺎﻟﻐﻭﻥ‪ ٦٠٠ :‬ﻤﻎ ﻤﺭﺘﻴﻥ ﻓﻲ ﺍﻟﻴﻭﻡ ﻟﻤﺩﺓ ﻴﻭﻤﻴﻥ‪.‬‬
‫‪ o‬ﺍﻷﻁﻔﺎل ﻓﻭﻕ ﺍﻟﺸﻬﺭ‪٢٠ :‬ﻤﻎ‪ /‬ﻜﻎ‪ /‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ ﻋﻠﻰ ﺠﺭﻋﺘﻴﻥ ﻟﻤﺩﺓ ﻴﻭﻤﻴﻥ‪.‬‬
‫‪ o‬ﺍﻷﻁﻔﺎل ﺍﻟﺭﻀﻊ ﺩﻭﻥ ﺍﻟﺸﻬﺭ‪١٠ :‬ﻤﻎ‪ /‬ﻜﻎ‪ /‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ ﻋﻠﻰ ﺠﺭﻋﺘﻴﻥ ﻟﻤﺩﺓ ﻴﻭﻤﻴﻥ‪.‬‬
‫ﻤﻼﺤﻅﺔ‪ :‬ﻴﻨﺼﺢ ﺒﻌﺩﻡ ﺍﺴﺘﺨﺩﺍﻡ ﺍﻟﻭﻗﺎﻴﺔ ﺍﻟﻜﻴﻤﻴﺎﺌﻴﺔ ﻋﻠﻰ ﻨﻁﺎﻕ ﻭﺍﺴﻊ ﺨﺸﻴﺔ ﻅﻬﻭﺭ ﺍﻟﻤﻘﺎﻭﻤﺔ ﺍﻟﺠﺭﺜﻭﻤﻴﺔ‬
‫ﻟﻠﺼﺎﺩﺍﺕ‪ ،‬ﻭﻴﻤﻜﻥ ﺍﺴﺘﻌﻤﺎل ﺍﻟﺴﻴﺒﺭﻭﻓﻠﻭﻜﺴﺎﺴﻴﻥ ﻓﻲ ﺍﻟﻭﻗﺎﻴﺔ ﺒﻤﻘﺩﺍﺭ ‪ /٥٠٠/‬ﻤﻠﻎ ﺠﺭﻋﺔ ﻭﺍﺤﺩﺓ‪،‬‬
‫ﻭﻴﻌﻁﻰ ﻟﻠﻜﺒﺎﺭ ﻓﻘﻁ‪.‬‬
‫‪ -‬ﺍﻟﺘﻠﻘﻴﺢ‪:‬‬
‫ﻴﺴﺘﻌﻤل ﺍﻟﻠﻘﺎﺡ ﻓﻲ ﺤﺎل ﺤﺩﻭﺙ ﻭﺒﺎﺀ ﻓﻘﻁ )ﻤﻌﺩل ﺍﻟﻬﺠﻤﺔ ﺃﻋﻠﻰ ﻤﻥ ‪ ١٠٠٠٠٠/٥‬ﻤﻥ ﺍﻟﺴﻜﺎﻥ( ﻭﻻ ﺘﻭﺠﺩ‬
‫ﻓﺎﺌﺩﺓ ﻤﻥ ﺘﻠﻘﻴﺢ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ‪.‬‬
‫ﻤﻼﺤﻅﺔ‪ :‬ﻴﺘﻡ ﺇﻋﻁﺎﺀ ﺍﻟﻠﻘﺎﺡ ﺭﻭﺘﻴﻨﻴﹰﺎ ﻟﻠﻔﺌﺎﺕ ﺍﻟﻤﺴﺘﻬﺩﻓﺔ ﺍﻟﺘﺎﻟﻴﺔ‪:‬‬
‫‪ o‬ﺍﻟﻤﺴﺎﻓﺭﻭﻥ ﺇﻟﻰ ﺍﻟﺩﻴﺎﺭ ﺍﻟﻤﻘﺩﺴﺔ ﻷﺩﺍﺀ ﻓﺭﻴﻀﺘﻲ ﺍﻟﺤﺞ ﻭﺍﻟﻌﻤﺭﺓ‪.‬‬
‫‪ o‬ﺍﻟﻤﺴﺎﻓﺭﻭﻥ ﺇﻟﻰ ﻤﻨﺎﻁﻕ ﻴﻨﺘﺸﺭ ﻓﻴﻬﺎ ﺍﻟﻤﺭﺽ‪.‬‬
‫‪ o‬ﻁﻼﺏ ﺍﻟﺼﻑ ﺍﻷﻭل ﻟﻠﺘﻌﻠﻴﻡ ﺍﻷﺴﺎﺴﻲ‪.‬‬
‫‪ o‬ﺍﻟﻤﺠﻨﺩﻭﻥ ﺍﻟﺠﺩﺩ‪.‬‬
‫‪ -‬ﻴﻭﺠﺩ ﺤﺎﻟﻴﹰﺎ ﻟﻘﺎﺡ ﺭﺒﺎﻋﻲ ﻤﺩﻤﺞ ﻴﺤﻭﻱ ﺍﻷﻨﻤﺎﻁ ‪ A,C,Y,W 135‬ﻴﺘﻤﻴﺯ ﺒﺈﻤﻜﺎﻨﻴﺔ ﺇﻋﻁﺎﺀﻩ ﻟﻸﻁﻔﺎل‬
‫ﻀﻤﻥ ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻭﻁﻨﻲ‪ ،‬ﻭﻤﺩﺓ ﺤﻤﺎﻴﺘﻪ ﺘﺯﻴﺩ ﻋﻥ ﺍﻟﺨﻤﺱ ﺴﻨﻭﺍﺕ‪ ،‬ﻜﻤﺎ ﺃﻨﻪ ﻴﻤﻨﻊ ﺤﺎﻟﺔ ﺍﻟﺤﻤل‬
‫ﺍﻟﺠﺭﺜﻭﻤﻲ ﻓﻲ ﺍﻟﺒﻠﻌﻭﻡ ‪....‬‬
‫• ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﻋﻥ ﺃﺴﺎﻟﻴﺏ ﺍﻟﺘﺼﺤﻴﺢ ﺍﻟﺸﺨﺼﻲ ﻭﻀﺭﻭﺭﺓ ﺘﺨﻔﻴﺽ ﺍﻟﺘﻤﺎﺱ ﺍﻟﻤﺒﺎﺸﺭ ﺃﻭ ﺍﻟﺨﻤﺞ ﺒﺎﻟﻘﻁﻴﺭﺍﺕ‬
‫ﻭﻤﻨﻊ ﺍﻻﺯﺩﺤﺎﻡ ﺍﻟﺯﺍﺌﺩ ﻓﻲ ﺃﻤﺎﻜﻥ ﺍﻟﻤﻌﻴﺸﺔ ﻭﺍﻟﻤﻭﺍﺼﻼﺕ ﺍﻟﻌﺎﻤﺔ ﻭﺃﻤﺎﻜﻥ ﺍﻟﻌﻤل )ﺍﻟﺜﻜﻨﺎﺕ‪ ،‬ﺍﻟﻤﻌﺴﻜﺭﺍﺕ‪،‬‬
‫ﺍﻟﻤﺩﺍﺭﺱ‪... ،‬ﺇﻟﺦ(‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﺤﺎﻻﺕ ﺍﻟﻤﺒﻠﻎ ﻋﻨﻬﺎ ﻭﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻤﺤﻠﻲ‪ ،‬ﻭﻓﺭﻴﻕ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻤﺤﻠﻲ ﻓﻲ ﺤﺎل‬
‫ﺤﺩﻭﺙ ﺍﻷﻭﺒﺌﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬

‫‪٤٨‬‬
‫• ﺭﻓﻊ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻷﺴﺒﻭﻋﻴﺔ ﻭﺍﻟﺸﻬﺭﻴﺔ ﻭﺍﺴﺘﻤﺎﺭﺍﺕ ﺍﻟﺘﻘﺼﻲ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﻭﺇﺒﻼﻍ ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﻋﻥ ﺤﺩﻭﺙ ﺍﻷﻭﺒﺌﺔ‪ ،‬ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(٦ ،٥ ،٤ ،٣‬‬
‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﻟﻠﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﻋﻤل ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﻭﺍﻟﻤﺴﺘﺸﻔﻴﺎﺕ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﻭﺘﻭﺯﻴﻊ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﻭﺍﺩ ﺍﻟﻤﺨﺩﺭﺓ‪.‬‬
‫• ﺘﻘﺩﻴﺭ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻟﻠﻘﺎﺡ ﻟﻴﺘﻡ ﺘﺄﻤﻴﻨﻪ ﻤﻥ ﻗﺒل ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪ ،‬ﺜﻡ ﺘﻭﺯﻴﻌﻪ ﻋﻠﻰ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ‪،‬‬
‫ﺍﻟﻤﺨﺼﺼﺔ ﻹﻋﻁﺎﺀ ﺍﻟﻠﻘﺎﺡ )ﻜﻤﺭﻜﺯ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﺩﻭﻟﻲ‪ ،‬ﻭﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﺨﻼل ﺤﻤﻠﺔ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻤﺩﺭﺴﻲ ‪.(....‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ )ﺨﺎﺼﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻤﺩﺭﺴﻴﺔ(‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻁﺎﺭﺌﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻘﻁﺭ‪.‬‬
‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﺇﻟﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻷﺸﺭﺍﻑ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﻭﺴﺎﺌل ﻭﻤﻭﺍﺩ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪.‬‬
‫• ﺘﻘﺩﻴﺭ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﻭﺍﺩ ﺍﻟﻤﺨﺒﺭﻴﺔ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﺍﻟﻠﻘﺎﺤﺎﺕ ﻭﺘﻭﺯﻴﻌﻬﺎ ﻋﻠﻰ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﺍﻟﺩﺭﺍﺴﺎﺕ ﻭﺍﻟﺒﺤﻭﺙ ﺃﻭ ﺍﻟﻤﺴﻭﺡ ﻟﻤﻌﺭﻓﺔ ﻤﻌﺩل ﺍﻻﻨﺘﺸﺎﺭ ﻭﻋﻭﺍﻤل ﺍﻟﺨﻁﺭ ﺍﻟﻤﺭﺘﺒﻁﺔ ﺒﺤﺩﻭﺙ ﺍﻟﻤﺭﺽ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ )ﺨﺎﺼﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻤﺩﺭﺴﻴﺔ(‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬

‫ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺒﺎﻟﻤﺴﺘﺩﻤﻴﺔ ﺍﻟﻨﺯﻟﻴﺔ‬

‫ﻤﺭﺽ ﺠﺭﺜﻭﻤﻲ ﻴﺘﻤﻴﺯ ﺒﺒﺩﺀ ﻓﺠﺎﺌﻲ ﺃﻭ ﺘﺩﺭﻴﺠﻲ ﻭﺍﻷﻋﺭﺍﺽ ﻋﺒﺎﺭﺓ ﻋﻥ ﺤﻤﻰ ﻭﺇﻗﻴﺎﺀ ﻭﻨﻭﺍﻡ ﻭﺘﻴﺒﺱ ﺍﻟﻌﻨﻕ‬
‫ﻭﺍﻟﻅﻬﺭ‪ ،‬ﻭﺘﻬﻴﺞ ﺴﺤﺎﺌﻲ ﻴﺘﺠﻠﻰ ﺒﺎﻨﺘﺒﺎﺝ ﺍﻟﻴﺎﻓﻭﺥ ﻓﻲ ﺍﻟﺭﻀﻊ‪.‬‬

‫ﻭﻤﻥ ﺍﻟﺸﺎﺌﻊ ﺤﺩﻭﺙ ﺍﻟﻐﻴﺒﻭﺒﺔ‪ ،‬ﻭﻫﻭ ﺩﺍﺌﻤﹰﺎ ﻴﺘﺭﺍﻓﻕ ﺒﺘﺠﺭﺜﻡ ﺍﻟﺩﻡ‪.‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﺍﻟﻤﺴﺘﺩﻤﻴﺔ ﺍﻟﻨﺯﻟﻴﺔ ‪) Hemophilus Influenza‬ﻋﺼﻴﺎﺕ ﺴﻠﺒﻴﺔ ﺍﻟﻐﺭﺍﻡ(‪ ،‬ﺘﻘﺴﻡ ﺇﻟﻰ ﺃﻨﻤﺎﻁ ﻤﺼﻠﻴﺔ ﻤﻥ )‪(a‬‬
‫ﺇﻟﻰ )‪ (f‬ﻋﻠﻰ ﺃﺴﺎﺱ ﺍﻟﻤﺴﺘﻀﺩﺍﺕ ﺍﻟﻤﺤﻔﻅﻴﺔ ﺍﻟﻨﻭﻋﻴﺔ )ﻋﺩﻴﺩﺓ ﺍﻟﺴﻜﺎﺭﻴﺩ(‪ ،‬ﻭﺍﻟﻤﺴﺘﺩﻤﻴﺔ ﺍﻟﻨﺯﻟﻴﺔ ﻤﻥ ﺍﻟﻨﻤﻁ )‪ (b‬ﻫﻲ‬
‫ﺃﻜﺜﺭ ﺇﻤﺭﺍﻀﺎﹰ‪.‬‬

‫‪٤٩‬‬
 ‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﺒﻭﺍﺴﻁﺔ ﺍﻟﻘﻁﻴﺭﺍﺕ ﻭﺍﻟﻤﻔﺭﺯﺍﺕ ﺍﻷﻨﻔﻴﺔ ﻭﺍﻟﺒﻠﻌﻭﻤﻴﺔ ﺃﺜﻨﺎﺀ ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻋﺎﻡ‪ .‬ﻭﺍﻟﻤﻨﺎﻋﺔ ﻤﻜﺘﺴﺒﺔ ﻤﻥ ﻋﺩﻭﻯ ﺴﺎﺒﻘﺔ ﺃﻭ ﺘﻤﻨﻴﻊ‪ .‬ﻭﻫﻨﺎﻙ ﻤﻨﺎﻋﺔ ﻤﻨﺘﻘﻠﺔ ﻋﺒﺭ ﺍﻟﻤﺸﻴﻤﺔ ﻟﻠﺭﻀﻴﻊ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫ﻤﺠﻬﻭل‪ .‬ﻴﺤﺘﻤل ﺃﻥ ﻴﻜﻭﻥ ﻤﻥ )‪ (٤-٢‬ﺃﻴﺎﻡ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻤﺎ ﺩﺍﻤﺕ ﺍﻟﺠﺭﺍﺜﻴﻡ ﻓﻲ ﺍﻟﻤﻔﺭﺯﺍﺕ ﺍﻷﻨﻔﻴﺔ ﻭﺍﻟﺒﻠﻌﻭﻤﻴﺔ‪ ،‬ﻭﻗﺩ ﺘﺒﻘﻰ ﻟﻤﺩﺓ ﻁﻭﻴﻠﺔ ﺒﺩﻭﻥ ﻤﻔﺭﺯﺍﺕ‪ .‬ﺘﺯﻭل ﺍﻟﻌﺩﻭﻯ‬
‫ﻓﻲ ﻏﻀﻭﻥ )‪ (٤٨-٢٤‬ﺴﺎﻋﺔ ﻤﻥ ﺍﻟﻌﻼﺝ ﺒﺎﻟﺼﺎﺩﺍﺕ‪.‬‬

‫ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺒﺎﻟﻌﻘﺩﻴﺔ ﺍﻟﺭﺌﻭﻴﺔ‬

‫ﻤﺭﺽ ﺠﺭﺜﻭﻤﻲ ﻴﺘﻤﻴﺯ ﺒﻤﻌﺩل ﺇﻤﺎﺘﺔ ﻤﺭﺘﻔﻊ‪ .‬ﻭﻫﻭ ﻋﺎﺩﺓ ﺨﺎﻁﻑ ﻴﺤﺩﺙ ﻤﻊ ﺘﺠﺭﺜﻡ ﺍﻟﺩﻡ‪ .‬ﻭﻗﺩ ﻴﺘﺭﺍﻓﻕ ﺘﺠﺭﺜﻡ‬
‫ﺍﻟﺩﻡ ﻤﻊ ﺍﻟﺘﻬﺎﺏ ﺍﻷﺫﻥ ﺍﻟﻭﺴﻁﻰ ﺃﻭ ﺍﻟﺨﺸﺎﺀ‪.‬‬

‫ﻴﺤﺩﺙ ﺍﻟﻤﺭﺽ ﺇﻓﺭﺍﺩﻴ ﹰﺎ ﻟﺩﻯ ﺍﻟﺭﻀﻊ ﻭﺍﻟﻤﺴﻨﻴﻥ‪ ،‬ﻭﻟﺩﻯ ﺒﻌﺽ ﺍﻟﻤﺠﻤﻭﻋﺎﺕ ﺍﻷﻜﺜﺭ ﺘﻌﺭﻀ ﹰﺎ ﻟﻠﺨﻁﺭ‬
‫)ﻜﺎﻟﻤﺭﻀﻰ ﺍﻟﻤﺴﺘﺄﺼل ﻟﻬﻡ ﺍﻟﻁﺤﺎل‪ ،‬ﺃﻭ ﺍﻟﺫﻴﻥ ﻟﺩﻴﻬﻡ ﻨﻘﺹ ﺍﻟﻐﺎﻤﺎﻏﻠﻭﺒﻭﻟﺒﻴﻥ‪.(...‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﺍﻟﻌﻘﺩﻴﺔ ﺍﻟﺭﺌﻭﻴﺔ ‪) Streptococeus Pneumonia‬ﻤﻜﻭﺭﺓ ﻤﺯﺩﻭﺠﺔ ﺇﻴﺠﺎﺒﻴﺔ ﺍﻟﻐﺭﺍﻡ(‪ ،‬ﻭﻫﻨﺎﻙ )‪ (٩٠‬ﻨﻤﻁ ﻤﺼﻠﻲ‬
‫ﻤﻌﺭﻭﻑ‪ ،‬ﻴﺨﺘﻠﻑ ﺘﻭﺯﻋﻬﺎ ﺤﺴﺏ ﺍﻷﻗﺎﻟﻴﻡ ﻭﺍﻟﺩﻭل‪.‬‬

‫ﻭﻫﻨﺎﻙ ﺤﺎﻟﻴﹰﺎ ﺩﺭﺍﺴﺔ ﻤﺨﺒﺭﻴﺔ ﻟﺘﺤﺩﻴﺩ ﺍﻷﻨﻤﺎﻁ ﺍﻟﻤﺼﻠﻴﺔ ﺍﻟﺴﺎﺌﺩﺓ‪.‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﺼﺎﺏ ﺃﻭ ﺍﻟﺤﺎﻤل‪ .‬ﻭﺤﻤل ﺍﻟﺠﺭﺜﻭﻡ ﺃﻜﺜﺭ ﺸﻴﻭﻋﹰﺎ ﻟﺩﻯ ﺍﻷﻁﻔﺎل ﻤﻨﻪ ﻟﺩﻯ ﺍﻟﺒﺎﻟﻐﻴﻥ‪.‬‬

‫‪٥٠‬‬
 ‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﺍﻨﺘﺸﺎﺭ ﺍﻟﻘﻁﻴﺭﺍﺕ ﻭﻤﻼﻤﺴﺔ ﺍﻹﻓﺭﺍﺯﺍﺕ ﺍﻟﺘﻨﻔﺴﻴﺔ‪ .‬ﻭﺇﻥ ﺍﻟﻤﻼﻤﺴﺔ ﺍﻟﻤﺒﺎﺸﺭﺓ ﻤﻊ ﺸﺨﺹ ﻤﺼﺎﺏ ﻴﻨﺘﺞ ﻋﻨﻪ‬
‫ﺍﻟﺠﺭﺜﻭﻡ ﻓﻲ ﺍﻟﺒﻠﻌﻭﻡ ﺍﻷﻨﻔﻲ ﺃﻜﺜﺭ ﻤﻥ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﻤﺭﺽ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻋﺎﻡ‪ .‬ﻭﺍﻟﻤﻨﺎﻋﺔ ﻤﻜﺘﺴﺒﺔ ﻤﻥ ﻋﺩﻭﻯ ﺴﺎﺒﻘﺔ ﺃﻭ ﺘﻤﻨﻴﻊ‪ .‬ﻭﻫﻨﺎﻙ ﻤﻨﺎﻋﺔ ﻤﻜﺘﺴﺒﺔ ﻋﺒﺭ ﺍﻟﻤﺸﻴﻤﺔ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‪ .‬ﺭﺒﻤﺎ ﻤﻥ )‪ (٤-١‬ﺃﻴﺎﻡ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻁﺎﻟﻤﺎ ﺒﻘﻲ ﺍﻟﺠﺭﺜﻭﻡ ﻓﻲ ﺍﻟﻤﻔﺭﺯﺍﺕ‪ .‬ﻭﻗﺩ ﺘﺴﺘﻤﺭ ﺍﻟﺴﺭﺍﻴﺔ ﻟﻔﺘﺭﺓ ﻁﻭﻴﻠﺔ ﻟﺩﻯ ﺍﻟﻤﺭﻀﻰ ﺍﻟﻤﻨﻘﻭﺼﻲ ﺍﻟﻤﻨﺎﻋﺔ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻤﺸﺎﺒﻬﺔ ﻟﻺﺠﺭﺍﺀﺍﺕ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﺤﻤﻰ ﺍﻟﻤﺨﻴﺔ ﺍﻟﺸﻭﻜﻴﺔ‪ .‬ﻭﺘﺨﺘﻠﻑ ﻋﻨﻬﺎ ﺒﻤﺎ ﻴﻠﻲ‪:‬‬
‫• ﻻ ﺘﻭﺠﺩ ﺇﺠﺭﺍﺀﺍﺕ ﺨﺎﺼﺔ ﻟﻼﺴﺘﺠﺎﺒﺔ ﻟﻸﻭﺒﺌﺔ‪ .‬ﻨﻅﺭﹰﺍ ﻷﻥ ﺍﻹﺼﺎﺒﺎﺕ ﺒﻜل ﻤﻥ ﺠﺭﺜﻭﻤﻲ ﺍﻟﻤﺴﺘﺩﻤﻴﺔ ﺍﻟﻨﺯﻟﻴﺔ‬
‫ﻭﺍﻟﻌﻘﺩﻴﺔ ﺍﻟﺭﺌﻭﻴﺔ ﺇﻓﺭﺍﺩﻴﺔ‪.‬‬
‫• ﺍﻟﻔﺌﺎﺕ ﺍﻟﻤﺴﺘﻬﺩﻓﺔ ﺒﻠﻘﺎﺡ ﺍﻟﻤﺴﺘﺩﻤﻴﺔ ﺍﻟﻨﺯﻟﻴﺔ )ﻟﻘﺎﺡ ﻤﺩﻤﺞ ﻴﺤﻭﻱ ﺍﻟﻨﻤﻁ ﺍﻟﻤﺼﻠﻲ ‪ ،( b‬ﻫﻲ ﺍﻷﻁﻔﺎل ﺒﻌﻤﺭ ﺩﻭﻥ‬
‫ﺍﻟﺴﻨﺔ ﻀﻤﻥ ﺍﻟﻠﻘﺎﺡ ﺍﻟﺨﺎﻤﺴﻲ ‪ DPT – HIB‬ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﻔﻴﺭﻭﺴﻲ ‪ B‬ﻭﺍﻟﺭﺒﺎﻋﻲ ‪ DPT – HIB‬ﻭﻴﺩﻋﻡ‬
‫ﺒﻌﻤﺭ ﺍﻟﺴﻨﺔ ﻭﺍﻟﻨﺼﻑ ﻀﻤﻥ ﺍﻟﻠﻘﺎﺡ ﺍﻟﺭﺒﺎﻋﻲ ‪ ،DPT – HIB‬ﺤﺴﺏ ﻤﺎ ﻫﻭ ﻭﺍﺭﺩ ﻓﻲ ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻭﻁﻨﻲ‬
‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(١٠‬‬
‫• ﺃﻤﺎ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻠﻘﺎﺡ ﺍﻟﻌﻘﺩﻴﺔ ﺍﻟﺭﺌﻭﻴﺔ ﻓﻴﻭﺠﺩ ﻟﻘﺎﺡ ﻤﺩﻤﺞ ﻴﺤﻭﻱ ﺍﻟﺴﺒﻊ ﺯﻤﺭ ﺍﻷﻜﺜﺭ ﺍﻨﺘﺸﺎﺭﹰﺍ ﻓﻲ ﺍﻟﻭﻻﻴﺎﺕ ﺍﻟﻤﺘﺤﺩﺓ‬
‫ﻭﺍﻟﺩﻭل ﺍﻷﻭﺭﺒﻴﺔ ‪ ..‬ﻤﺘﻭﻓﺭ ﻓﻘﻁ ﻟﺩﻯ ﺍﻟﻘﻁﺎﻉ ﺍﻟﺨﺎﺹ‪.‬‬

‫ﻭﻟﻡ ﻴﺩﺨل ﻀﻤﻥ ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻭﻁﻨﻲ‪ ،‬ﺤﻴﺙ ﺘﺠﺭﻯ ﺩﺭﺍﺴﺔ ﻤﺨﺒﺭﻴﺔ ﻓﻲ ﻤﺸﺎﻓﻲ ﺍﻷﻁﻔﺎل ﺍﻟﺠﺎﻤﻌﻲ‬
‫ﻭﺩﻤﺸﻕ ﻓﻲ ﻤﺤﺎﻓﻅﺔ ﺩﻤﺸﻕ ﻭﻤﺠﻤﻊ ﺍﻟﺒﺎﺴل ﻓﻲ ﻤﺤﺎﻓﻅﺔ ﺤﻤﺎﺓ ﻟﺩﺭﺍﺴﺔ ﺍﻷﻨﻤﺎﻁ ﺍﻟﻤﺼﻠﻴﺔ ﺍﻟﺴﺎﺌﺩﺓ ﻭﻤﺩﻯ ﺍﻨﺘﺸﺎﺭ‬
‫ﺍﻟﻤﺭﺽ‪ ،‬ﻭﺍﻷﻫﻤﻴﺔ ﺍﻟﺼﺤﻴﺔ ﻹﺩﺨﺎل ﺍﻟﻠﻘﺎﺡ ﻀﻤﻥ ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻭﻁﻨﻲ‪.‬‬

‫ﻴﻌﻁﻰ ﺍﻟﻠﻘﺎﺡ ﻟﺠﻤﻴﻊ ﺍﻷﻁﻔﺎل ﺒﻌﻤﺭ ﺃﻗل ﻤﻥ ﻋﺎﻤﻴﻥ ﻭﻟﻠﻔﺌﺎﺕ ﺍﻟﻌﺎﻟﻴﺔ ﺍﻟﺨﻁﻭﺭﺓ ﺒﻌﻤﺭ )‪ (٤-٢‬ﺴﻨﻭﺍﺕ‪.‬‬

‫‪٥١‬‬
 ‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ ﻟﺤﺎﻟﺔ ﺍﻟﺘﻬﺎﺏ ﺴﺤﺎﻴﺎ ﺠﺭﺜﻭﻤﻲ‬

‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻻﻟﺘﻬﺎﺒﺎﺕ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﺤﺎﺩ‪:‬‬

‫ﺒﺩﺀ ﻤﻔﺎﺠﺊ ﻟﺤﺭﺍﺭﺓ )< ‪ ٣٨.٥‬ﻡ ﺸﺭﺠﻴﺔ ﺃﻭ ‪ ٣٨‬ﻡ ﺇﺒﻁﻴﺔ( ﻤﻊ ﺼﻼﺒﺔ ﻨﻘﺭﺓ ﺃﻭ ﺘﻐﻴﺭ ﻓﻲ ﺩﺭﺠﺔ ﺍﻟﻭﻋﻲ ﺃﻭ‬
‫ﺃﻋﺭﺍﺽ ﺴﺤﺎﺌﻴﺔ ﺃﺨﺭﻯ )ﻜﻨﻭﺒﺔ ﻋﺼﺒﻴﺔ ﺃﻭ ﺤﺎﻟﺔ ﻫﻴﺎﺝ( ﻟﺩﻯ ﺸﺨﺹ ﺒﻌﻤﺭ ﺩﻭﻥ ﺍﻟﺴﻨﺔ‪ ،‬ﺘﺤﺩﺙ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ‬
‫ﻤﻥ ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﺤﺎﺩ ﻋﻨﺩﻤﺎ ﺘﺘﺭﺍﻓﻕ ﺍﻟﺤﺭﺍﺭﺓ ﻤﻊ ﺍﻨﺘﺒﺎﺝ ﺍﻟﻴﺎﻓﻭﺥ‪.‬‬

‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺤﺘﻤﻠﺔ ﻻﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﺠﺭﺜﻭﻤﻲ‪:‬‬

‫ﺤﺎﻟﺔ ﻤﺸﺘﺒﻬﺔ ﻤﻥ ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﺤﺎﺩ ﻜﻤﺎ ﻫﻭ ﻭﺍﺭﺩ ﺃﻋﻼﻩ ﻤﻊ ﻭﺍﺤﺩ ﻋﻠﻰ ﺍﻷﻗل ﻤﻤﺎ ﻴﻠﻲ‪:‬‬
‫‪ o‬ﺴﺎﺌل ﺩﻤﺎﻏﻲ ﺸﻭﻜﻲ ﻋﻜﺭ ﺃﻭ‬
‫‪ o‬ﻋﺩﺩ ﻜﺭﻴﺎﺕ ﺍﻟﺩﻡ ﺍﻟﺒﻴﻀﺎﺀ =< ‪ ١٠٠‬ﺨﻠﻴﺔ ‪ /‬ﻤل ﺃﻭ‬
‫‪ o‬ﻋﺩﺩ ﻜﺭﻴﺎﺕ ﺍﻟﺩﻡ ﺍﻟﺒﻴﻀﺎﺀ ﻤﻥ ‪ ١٠‬ﺇﻟﻰ ‪ ١٠٠‬ﺨﻠﻴﺔ ‪ /‬ﻤل‪.‬‬

‫ﻭﺯﻴﺎﺩﺓ ﻓﻲ ﺘﺭﻜﻴﺯ ﺍﻟﺒﺭﻭﺘﻴﻥ ﺃﻜﺜﺭ ﻤﻥ ‪ ١٠٠‬ﻤﻠﻎ ‪ /‬ﺩل ﺃﻭ ﻨﻘﺹ ﻓﻲ ﺘﺭﻜﻴﺯ ﺍﻟﻐﻠﻭﻜﻭﺯ ﺃﻗل ﻤﻥ‬
‫‪ ٤٠‬ﻤﻎ‪/‬ﺩل‪.‬‬
‫‪ o‬ﺼﺒﻐﺔ ﻏﺭﺍﻡ ﺘﻅﻬﺭ ﺃﺤﺩ ﻫﺫﻩ ﺍﻟﻨﺘﺎﺌﺞ ﺍﻟﺘﺎﻟﻴﺔ‪:‬‬

‫‪ -‬ﻋﺼﻴﺎﺕ ﺴﺎﻟﺒﺔ ﻟﺼﺒﻐﺔ ﺍﻟﻐﺭﺍﻡ )ﺍﻟﻤﺴﺘﺩﻤﻴﺔ ﺍﻟﻨﺯﻟﻴﺔ(‪.‬‬

‫‪ -‬ﻋﺼﻴﺎﺕ ﻤﻭﺠﺒﺔ ﻟﺼﺒﻐﺔ ﺍﻟﻐﺭﺍﻡ )ﺍﻟﻌﻘﺩﻴﺔ ﺍﻟﺭﺌﻭﻴﺔ(‪.‬‬

‫‪ -‬ﻜﺭﻴﺎﺕ ﻤﺯﺩﻭﺠﺔ ﺴﺎﻟﺒﺔ ﻟﺼﺒﻐﺔ ﺍﻟﻐﺭﺍﻡ )ﺍﻟﻨﻴﺴﺭﻴﺔ ﺍﻟﺴﺤﺎﺌﻴﺔ(‪.‬‬

‫‪ o‬ﺒﺎﻟﻨﺴﺒﺔ ﻟﻠﻨﻴﺴﺭﻴﺔ ﺍﻟﺴﺤﺎﺌﻴﺔ‪ :‬ﻭﻀﻊ ﻭﺒﺎﺌﻲ ﺃﻭ ﻭﺠﻭﺩ ﺍﻨﺩﻓﺎﻋﺎﺕ ﻨﻤﺸﻴﺔ ﺃﻭ ﻗﺭﻤﺯﻴﺔ‪.‬‬

‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺅﻜﺩﺓ ﻻﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﺠﺭﺜﻭﻤﻲ‪:‬‬

‫ﺤﺎﻟﺔ ﻤﺸﺘﺒﻪ ﺃﻭ ﻤﺤﺘﻤﻠﺔ‪ ،‬ﻜﻤﺎ ﻭﺭﺩ ﺃﻋﻼﻩ ﻤﻊ ﺇﻴﺠﺎﺒﻴﺔ ﻜﺸﻑ ﻤﺴﺘﻀﺩﺍﺕ ﺍﻟﺠﺭﺜﻭﻡ ﻓﻲ ﺍﻟﺴﺎﺌل ﺍﻟﺩﻤﺎﻏﻲ ﺍﻟﺸﻭﻜﻲ‬
‫ﺃﻭ ﺇﻴﺠﺎﺒﻴﺔ ﺯﺭﻉ ﺍﻟﺴﺎﺌل ﺍﻟﺩﻤﺎﻏﻲ ﺍﻟﺸﻭﻜﻲ ﺃﻭ ﺍﻟﺩﻡ‪.‬‬

‫ﺨﻁﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ‬
‫ﻴﺠﺏ ﺍﻟﺒﺩﺀ ﺒﺎﻟﻤﻌﺎﻟﺠﺔ ﺒﺸﻜل ﻤﺒﻜﺭ ﻋﻨﺩ ﺍﻻﺸﺘﺒﺎﻩ ﺍﻟﺴﺭﻴﺭﻱ ﻭﺒﻌﺩ ﺃﺨﺫ ﻋﻴﻨﺔ ﻤﻥ ﺍﻟﺴﺎﺌل ﺍﻟﺩﻤﺎﻏﻲ‪ ،‬ﻭﻗﺒل ﻅﻬﻭﺭ‬
‫ﻨﺘﻴﺠﺔ ﺍﻟﻔﺤﺹ ﺍﻟﺠﺭﺜﻭﻤﻲ‪ ،‬ﻭﻨﻅﺭﹰﺍ ﻟﻭﺠﻭﺩ ﺒﻌﺽ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺘﻲ ﻴﺼﻌﺏ ﻓﻴﻬﺎ ﺍﺴﺘﻔﺭﺍﺩ ﺍﻟﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ ﻓﺈﻨﻪ ﻴﻨﺼﺢ‬
‫ﺒﺎﺴﺘﻌﻤﺎل ﺍﻟﺼﺎﺩﺍﺕ ﻭﻓﻘﹰﺎ ﻟﺴﻥ ﺍﻟﻤﺭﻴﺽ ﻋﻠﻰ ﺍﻟﺸﻜل ﺍﻟﺘﺎﻟﻲ‪:‬‬

‫‪٥٢‬‬
 ‫ﻤﻌﺎﻟﺠﺔ ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﺠﺭﺜﻭﻤﻲ ﻋﻨﺩ ﺍﻷﻁﻔﺎل ﻭﺍﻟﺒﺎﻟﻐﻴﻥ‪:‬‬
‫ﻴﻌﺘﺒﺭ ﺍﻟﺒﻨﺴﻠﻴﻥ ﺍﻟﺩﻭﺍﺀ ﺍﻟﻤﺨﺘﺎﺭ ﺒﻴﻥ ﺍﻟﺼﺎﺩﺍﺕ‪ ،‬ﻴﻤﻜﻥ ﺇﻋﻁﺎﺀ ﺍﻷﻤﺒﻴﺴﻠﻠﻴﻥ‪ ،‬ﺍﻷﻤﻭﻜﺴﻴﺴﻠﻠﻴﻥ ﺃﻭ ﺍﻟﻜﻠﻭﺭﺍﻨﻔﻴﻨﻴﻜﻭل‬
‫ﻼ ﻭﺠﻭﺩ ﺒﻌﺽ ﺍﻟﺫﺭﺍﺭﻱ ﺍﻟﻤﻘﺎﻭﻤﺔ ﻤﻥ‬
‫ﺇﺫﺍ ﻟﻡ ﻴﺘﺤﺴﻥ ﺍﻟﻤﺭﻴﺽ ﺨﻼل ‪ ٤٨ - ٢٤‬ﺴﺎﻋﺔ ﻤﻥ ﺇﻋﻁﺎﺀ ﺍﻟﺒﻨﺴﻠﻴﻥ )ﻤﺜ ﹰ‬
‫ﺍﻟﻤﺴﺘﺩﻤﻴﺎﺕ ﺍﻟﻨﺯﻟﻴﺔ(‪.‬‬

‫ﻭﻴﺠﺏ ﺇﻋﻁﺎﺀ ﺍﻟﺩﻭﺍﺀ ﻤﺩﺓ ‪ ٤‬ﺃﻴﺎﻡ ﻓﻘﻁ ﻜﻤﺎ ﻫﻭ ﻭﺍﺭﺩ ﻓﻲ ﺍﻟﺠﺩﻭل‪:‬‬

‫ﻤﻌﺎﻟﺠﺔ ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﻋﻨﺩ ﺍﻟﻭﻟﺩﺍﻥ ﻭﺍﻷﻁﻔﺎل ﺩﻭﻥ ‪ ٣‬ﺃﺸﻬﺭ‪:‬‬

‫ﻨﻅﺭﹰﺍ ﻟﻜﻭﻥ ﺍﻟﻌﺼﻴﺎﺕ ﺍﻟﺴﻠﺒﻴﺔ ﺍﻟﻐﺭﺍﻡ ﻭﺨﺎﺼﺔ ﺍﻻﻴﺸﺭﻴﺸﻴﺎ ﻜﻭﻟﻲ ﺍﻟﻤﺴﺒﺏ ﺍﻷﻭل ﻻﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ‪ ،‬ﻟﺫﺍ ﻴﺠﺏ‬
‫ﺃﻥ ﺘﻜﻭﻥ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺒﺎﻟﺼﺎﺩﺍﺕ ﻤﻔﻴﺩﺓ ﻀﺩ ﻫﺫﺍ ﺍﻟﻌﺎﻤل ﻭﻫﺫﻩ ﺍﻷﺩﻭﻴﺔ ﻫﻲ ﺍﻷﻤﺒﻴﺴﻠﻴﻥ )‪ ٢٠٠‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ‬
‫ﻋﻠﻰ ﺃﺭﺒﻊ ﺠﺭﻋﺎﺕ( ﻭﺍﻟﺠﻨﺘﺎﻤﺎﻴﺴﻴﻥ )‪ ٦‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ(‪.‬‬

‫ﺘﻁﺒﻕ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﺩﺍﻋﻤﺔ ﻓﻲ ﺤﺎل ﺤﺩﻭﺙ ﺍﻻﺨﺘﻼﻁﺎﺕ ﺍﻟﺩﻭﺭﺍﻨﻴﺔ ﺃﻭ ﺍﻟﺘﻨﻔﺴﻴﺔ ﺃﻭ ﺍﻟﻌﺼﺒﻴﺔ‪.‬‬

‫ﺍﻟﺼﺎﺩﺍﺕ ﻟﻌﻼﺝ ﻤﺭﺽ ﺍﻟﺴﺤﺎﺌﻴﺎﺕ ﻭﺍﻷﺴﺒﺎﺏ ﺍﻟﺭﺌﻴﺴﻴﺔ ﺍﻷﺨﺭﻯ ﻻﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﺠﺭﺜﻭﻤﻲ‬
‫ﺍﻟﻤﺩﺓ )ﻴﻭﻡ(‬ ‫ﺠﺭﻋﺔ ﺍﻷﻁﻔﺎل‬ ‫ﺠﺭﻋﺔ ﺍﻟﻜﺒﺎﺭ‬ ‫ﻁﺭﻴﻕ ﺍﻹﻋﻁﺎﺀ‬ ‫ﺍﻟﺩﻭﺍﺀ‬

‫<‪٤‬‬ ‫‪ ٤٠٠‬ﺃﻟﻑ ﻭﺤﺩﺓ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ‬ ‫‪ ٤-٣‬ﻤﻠﻴﻭﻥ ﻭﺤﺩﺓ‬ ‫ﺤﻘﻥ ﻭﺭﻴﺩﻱ‬ ‫ﺍﻟﺒﻨﺴﻠﻴﻥ ﺝ‬

‫ﻤﻘﺴﻤﺔ ﻋﻠﻰ ‪ ٦-٤‬ﺠﺭﻋﺎﺕ‬ ‫‪ ٦-٤‬ﺴﺎﻋﺎﺕ‬

‫<‪٤‬‬ ‫‪ ٢٥٠‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ‬ ‫‪ ٣-٢‬ﻍ‪٦ /‬ﺴﺎﻋﺎﺕ‬ ‫ﺤﻘﻥ ﻭﺭﻴﺩﻱ‬ ‫ﺍﻷﻤﺒﻴﺴﻠﻴﻥ ﺃﻭ‬

‫ﻋﻠﻰ ‪ ٦-٤‬ﺠﺭﻋﺎﺕ‬ ‫ﺍﻷﻤﻭﻜﺴﻴﺴﻠﻠﻴﻥ‬

‫<‪٤‬‬ ‫‪ ٢٥٠‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ‬ ‫‪ ٣-٢‬ﻍ‪ ٦/‬ﺴﺎﻋﺎﺕ‬ ‫ﻓﻤﻭﻱ‬ ‫ﺍﻷﻤﻭﻜﺴﻴﺴﻠﻠﻴﻥ‬

‫ﻋﻠﻰ ‪ ٦-٤‬ﺠﺭﻋﺎﺕ‬

‫<‪٤‬‬ ‫‪ ١٠٠‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ‬ ‫‪١‬ﻍ‪ ١٢-٨/‬ﺴﺎﻋﺔ‬ ‫ﺤﻘﻥ ﻭﺭﻴﺩﻱ‬ ‫ﺍﻟﻜﻠﻭﺭﺍﻨﻔﻴﻨﻴﻜﻭل‬

‫ﻋﻠﻰ ‪ ٦-٤‬ﺠﺭﻋﺎﺕ‬

‫<‪٤‬‬ ‫‪ ٢٥٠‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ‬ ‫‪٢‬ﻍ‪ ٦/‬ﺴﺎﻋﺎﺕ‬ ‫ﺤﻘﻥ ﻭﺭﻴﺩﻱ‬ ‫ﺍﻟﺴﻴﻔﻭﺘﺎﻜﺴﻴﻡ‬

‫ﻋﻠﻰ ‪ ٦-٤‬ﺠﺭﻋﺎﺕ‬

‫<‪٤‬‬ ‫‪ ٨٠-٥٠‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ‬ ‫‪٢-١‬ﻍ‪ ٢٤-١٢/‬ﺴﺎﻋﺔ‬ ‫ﺤﻘﻥ ﻭﺭﻴﺩﻱ‬ ‫ﺍﻟﺴﻔﺘﺭﻴﺎﻜﺴﻭﻥ‬

‫ﺠﺭﻋﺔ ﻭﺍﺤﺩﺓ‬ ‫‪ ٨٠-٥٠‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ‬ ‫‪ ٢-١‬ﺠﺭﻋﺔ ﻭﺍﺤﺩﺓ‬ ‫ﺤﻘﻥ ﻋﻀﻠﻲ‬

‫‪‬‬

‫‪٥٣‬‬
 ‫‪‬‬
‫א‪F‬א‪ E‬‬
‫‪ Diphtheria‬‬
‫ﻤﺭﺽ ﺠﺭﺜﻭﻤﻲ ﺤﺎﺩ ﻴﺼﻴﺏ ﺍﻟﺠﻬﺎﺯ ﺍﻟﺘﻨﻔﺴﻲ ﺍﻟﻌﻠﻭﻱ )ﺍﻟﻠﻭﺯﺘﻴﻥ‪ ،‬ﺍﻟﺒﻠﻌﻭﻡ‪ ،‬ﺍﻟﺤﻨﺠﺭﺓ‪ ،‬ﺍﻷﻨﻑ( ﻭﻴﻤﻜﻥ ﺃﻥ‬
‫ﻴﺼﻴﺏ ﺃﻏﺸﻴﺔ ﻤﺨﺎﻁﻴﺔ ﺃﺨﺭﻯ )ﺍﻟﻤﻠﺘﺤﻤﺔ ﻭﺍﻷﻋﻀﺎﺀ ﺍﻟﺘﻨﺎﺴﻠﻴﺔ( ﺃﻭ ﺍﻟﺠﻠﺩ ﻭﺘﻔﻭﻕ ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﺴﺘﺘﺭﺓ ﺤﺎﻻﺕ‬
‫ﺍﻟﻤﺭﺽ ﺍﻟﻅﺎﻫﺭ‪.‬‬

‫ﻴﺴﺒﺏ ﺃﻋﺭﺍﺽ ﻤﻭﻀﻌﻴﺔ ﺤﺴﺏ ﻤﻜﺎﻥ ﺘﻭﻀﻌﻪ )ﺍﻟﺘﻬﺎﺏ ﻤﻭﻀﻌﻲ ﻤﻊ ﺘﺸﻜل ﻏﺸﺎﺀ ﺭﻤﺎﺩﻱ ﻤﻠﺘﺼﻕ(‪ ،‬ﺇﻀﺎﻓﺔ‬
‫ﺇﻟﻰ ﺘﻅﺎﻫﺭﺍﺕ ﻋﺎﻤﺔ ﺘﺘﺄﺨﺭ )‪ ٦-٢‬ﺃﺴﺎﺒﻴﻊ( ﻨﺎﺘﺠﺔ ﻋﻥ ﺇﻓﺭﺍﺯ ﺍﻟﺫﻴﻔﺎﻥ ﻭﻫﻲ ﺸﻠل ﺍﻷﻋﺼﺎﺏ ﺍﻟﻘﺤﻔﻴﺔ ﻭﺍﻟﺤﺭﻜﻴﺔ‬
‫ﻭﺍﻟﺤﺴﻴﺔ ﻭﺍﻟﺘﻬﺎﺏ ﻋﻀﻠﺔ ﺍﻟﻘﻠﺏ‪ ،‬ﻭﻏﺎﻟﺒﹰﺎ ﻤﺎ ﺘﻜﻭﻥ ﻫﻲ ﺍﻟﻤﺴﺅﻭﻟﺔ ﻋﻥ ﺍﻟﻭﻓﺎﺓ ﻭﻴﺼل ﻤﻌﺩل ﺍﻹﻤﺎﺘﺔ ﻓﻲ ﺍﻟﺤﺎﻻﺕ‬
‫ﻏﻴﺭ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺇﻟﻰ ‪ %١٠-٥‬ﻤﻥ ﺍﻟﺤﺎﻻﺕ‪.‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﺍﻟﻭﺘﺩﻴﺔ ﺍﻟﺨﻨﺎﻗﻴﺔ ‪ corynebacterium diphtheria‬ﻭﺍﻟﺠﺭﺜﻭﻡ ﻗﺎﺩﺭ ﻋﻠﻰ ﺇﻓﺭﺍﺯ ﺫﻴﻔﺎﻥ ﺨﺎﺭﺠﻲ‪.‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ ﻓﻘﻁ‪ ،‬ﺤﺎﻟﺔ ﺃﻭ ﺤﺎﻤل‪ ،‬ﻴﺸﻜل ﺍﻟﺤﻤل ﺍﻟﻘﺴﻡ ﺍﻷﻋﻅﻡ ﻤﻥ ﺍﻟﻤﺴﺘﻭﺩﻉ‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﺒﺎﻟﺘﻤﺎﺱ ﺍﻟﻤﺒﺎﺸﺭ ﻤﻊ ﺍﻟﻤﺭﻴﺽ ﺃﻭ ﺤﺎﻤل ﻟﻠﺠﺭﺜﻭﻡ‪ ،‬ﻭﺒﺸﻜل ﺃﻗل ﻋﻥ ﻁﺭﻴﻕ ﺍﻟﺘﻤﺎﺱ ﻤﻊ ﺃﺩﻭﺍﺕ ﻤﻠﻭﺜﺔ‬
‫ﺒﻤﻔﺭﺯﺍﺕ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﺨﻤﻭﺠﻴﻥ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﺨﻤﺞ ﻋﺎﻡ‪ ،‬ﻭﺘﻭﺠﺩ ﻤﻨﺎﻋﺔ ﻤﻨﻘﻭﻟﺔ ﻋﺒﺭ ﺍﻟﻤﺸﻴﻤﺔ ﻤﻥ ﺍﻷﻡ ﺇﻟﻰ ﻁﻔﻠﻬﺎ ﺨﻼل ﺴﺘﺔ ﺃﺸﻬﺭ ﺒﻌﺩ ﺍﻟﻭﻻﺩﺓ‪،‬‬
‫ﻭﻻ ﺘﻌﻁﻰ ﺍﻹﺼﺎﺒﺔ ﻤﻨﺎﻋﺔ ﻤﺅﻜﺩﺓ‪ ،‬ﻭﻴﻤﻜﻥ ﺇﺤﺩﺍﺙ ﻤﻨﺎﻋﺔ ﻓﺎﻋﻠﺔ ﻭﻤﺩﻴﺩﺓ ﺒﺎﻟﺘﻤﻨﻴﻊ ﺒﺎﻟﺫﻭﻓﺎﻥ ‪ Toxoid‬ﻀﻤﻥ ﺍﻟﻠﻘﺎﺡ‬
‫ﺍﻟﺜﻼﺜﻲ )‪ ،(DPT‬ﺃﻭ ﺍﻟﺜﻨﺎﺌﻲ )‪ (DT‬ﺃﻭ ﺍﻟﺭﺒﺎﻋﻲ )‪.(DPT- Hib‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫‪ ٥-٢‬ﺃﻴﺎﻡ‪ ،‬ﻭﺃﺤﻴﺎﻨﹰﺎ ﺃﻜﺜﺭ‪.‬‬

‫‪٥٤‬‬
 ‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻻ ﺘﺯﻴﺩ ﻋﻥ ﺃﺴﺒﻭﻋﻴﻥ‪ ،‬ﻟﻜﻥ ﺘﻁﻭل ﻓﻲ ﺍﻟﺤﻤﻠﺔ ﺍﻟﻨﺎﻗﻬﻴﻥ‪ ،‬ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﻔﻌﺎﻟﺔ ﺒﺎﻟﺼﺎﺩﺍﺕ ﺘﻨﻬﻲ ﺍﻟﺤﻤل ﺒﺴﺭﻋﺔ‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﺍﻋﺘﻤﺎﺩﹰﺍ ﻋﻠﻰ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‪ ،‬ﻭﻴﺜﺒﺕ ﺒﺎﻟﻔﺤﺹ ﺍﻟﺠﺭﺍﺜﻴﻤﻲ )ﻤﻥ ﺍﻷﻏﺸﻴﺔ ﺍﻟﻜﺎﺫﺒﺔ(‪.‬‬

‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ ﻟﺤﺎﻟﺔ ﺍﻟﺨﻨﺎﻕ‬

‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺭﺠﺤﺔ‪:‬‬
‫ﺍﻟﺘﻬﺎﺏ ﺒﻠﻌﻭﻡ ﺤﺎﺩ‪ ،‬ﺃﻭ ﺍﻟﺘﻬﺎﺏ ﺒﻠﻌﻭﻡ ﺃﻨﻔﻲ‪ ،‬ﺃﻭ ﺍﻟﺘﻬﺎﺏ ﺤﻨﺠﺭﺓ ﺤﺎﺩ ﻤﻊ ﻭﺠﻭﺩ ﺃﻏﺸﻴﺔ ﻜﺎﺫﺒﺔ )ﻭﻫﻲ ﻋﺒﺎﺭﺓ ﻋﻥ‬
‫ﻟﻁﺨﺔ ﺃﻭ ﻟﻁﺦ ﻤﻥ ﻏﺸﺎﺀ ﺭﻤﺎﺩﻱ ﻤﻠﺘﺼﻕ ﺃﻭ ﻤﺤﺎﻁ ﺒﺎﻟﺘﻬﺎﺏ(‪.‬‬

‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺅﻜﺩﺓ‪:‬‬
‫ﺤﺎﻟﺔ ﻤﺭﺠﺤﺔ ﻤﻊ ﺤﺎﻟﺔ ﻤﺜﺒﺘﺔ ﺒﺎﻟﻔﺤﺹ ﺍﻟﺠﺭﺜﻭﻤﻲ ﻟﻤﺴﺤﺔ ﻤﻥ ﺍﻷﻏﺸﻴﺔ ﺍﻟﻜﺎﺫﺒﺔ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬

‫• ﺍﻟﻜﺸﻑ ﺍﻟﻤﺒﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻻﺕ‪.‬‬
‫• ﺇﺒﻼﻍ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﻭﺩﺍﺌﺭﺓ ﺼﺤﺔ ﺍﻟﻁﻔل ﻭﺍﻟﺘﻠﻘﻴﺢ ﻓﻲ ﺍﻟﻤﺩﻴﺭﻴﺔ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺨﻼل ‪٢٤‬‬
‫ﺴﺎﻋﺔ ﺒﺎﻟﻬﺎﺘﻑ ﺃﻭ ﺍﻟﻔﺎﻜﺱ‪.‬‬
‫• ﺍﻟﻌﻼﺝ ﺍﻟﻨﻭﻋﻲ )ﺤﺴﺏ ﺍﻟﺨﻁﺔ ﺍﻟﻤﺭﻓﻘﺔ(‪ :‬ﺒﻌﺩ ﺃﺨﺫ ﻋﻴﻨﺔ ﻤﻥ ﺍﻷﻏﺸﻴﺔ ﺍﻟﻜﺎﺫﺒﺔ ﺃﻭ ﺍﻵﻓﺔ ﺍﻟﺠﻠﺩﻴﺔ ﻭﺇﺭﺴﺎﻟﻬﺎ‬
‫ﻟﻠﻤﺨﺒﺭ‪ ،‬ﻭﺍﻟﺒﺩﺀ ﺒﺎﻟﻌﻼﺝ ﻗﺒل ﻭﺼﻭل ﺍﻟﻨﺘﻴﺠﺔ ﺍﻟﻤﺨﺒﺭﻴﺔ‪.‬‬
‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ‪ :‬ﻤﻥ ﻗﺒل ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﻋﻨﺎﺼﺭ ﺼﺤﻴﺔ ﻤﻥ ﺍﻟﻤﺭﻜﺯ‬
‫ﺍﻟﺼﺤﻲ‪ ،‬ﺤﻴﺙ ﻴﺘﻡ ﺇﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﻤﺭﻴﺽ‪ ،‬ﻭﻴﺘﻡ ﺍﻟﺘﺭﻜﻴﺯ ﻓﻲ ﺍﻟﺴﺅﺍل ﻋﻠﻰ ﺍﻟﺤﺎﻟﺔ‬
‫ﺍﻟﺘﻤﻨﻴﻌﻴﺔ ﻟﻠﻤﺼﺎﺏ‪ ،‬ﻭﺍﻟﺒﺤﺙ ﻋﻥ ﺤﺎﻻﺕ ﺃﺨﺭﻯ‪ .‬ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(١٤‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻟﻤﻌﺭﻓﺔ ﺍﻟﺴﺒﺏ ﻭﻤﺼﺩﺭ ﺍﻟﻌﺩﻭﻯ‪.‬‬
‫• ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‪:‬‬
‫‪ -‬ﺍﻟﻌﺯل‪ :‬ﻴﻌﺯل ﺍﻟﻤﺭﻴﺽ ﺤﺘﻰ ﺜﺒﺎﺕ ﺴﻠﺒﻴﺔ ﺍﻟﺯﺭﻉ ﻤﺭﺘﻴﻥ )ﺍﻷﻭﻟﻰ ﺒﻌﺩ ﻭﻗﻑ ﺍﻟﻌﻼﺝ ﺒﺎﻟﺼﺎﺩﺍﺕ ﺒﻴﻭﻡ‪،‬‬
‫ﻭﺍﻟﺜﺎﻨﻴﺔ ﺒﻌﺩ ‪ ٢٤‬ﺴﺎﻋﺔ ﻋﻠﻰ ﺍﻷﻗل ﻤﻥ ﺍﻷﻭﻟﻰ(‪ ،‬ﺃﻭ ﺃﺴﺒﻭﻋﻴﻥ )ﻓﻲ ﺤﺎل ﻋﺩﻡ ﺘﻭﻓﺭ ﺍﻟﺯﺭﻉ(‪.‬‬
‫‪ -‬ﺍﻟﺘﻁﻬﻴﺭ‪ :‬ﻟﺠﻤﻴﻊ ﺍﻷﺩﻭﺍﺕ ﺍﻟﺘﻲ ﺘﻼﻤﺱ ﺍﻟﻤﺭﻴﺽ‪ ،‬ﻭﺠﻤﻴﻊ ﺍﻷﺩﻭﺍﺕ ﺍﻟﻤﻠﻭﺜﺔ ﺒﻤﻔﺭﺯﺍﺘﻪ‪.‬‬

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 ‫‪ -‬ﺍﻟﻤﺨﺎﻟﻁﻭﻥ‪:‬‬
‫‪ o‬ﺍﻟﻤﻤﻨﻌﻭﻥ ﺴﺎﺒﻘ ﹰﺎ‪ :‬ﻴﺠﺏ ﺇﻋﻁﺎﺅﻫﻡ ﺠﺭﻋﺔ ﻤﻌﺯﺯﺓ ﻤﻥ ﺍﻟﺫﻭﻓﺎﻥ )ﺍﻟﻠﻘﺎﺡ( ﻀﻤﻥ ‪ Dpt- Hib‬ﺃﻭ ‪.DT‬‬
‫‪ o‬ﻏﻴﺭ ﺍﻟﻤﻤﻨﻌﻴﻥ‪ :‬ﺍﻟﺒﺩﺀ ﺒﺎﻟﺘﻤﻨﻴﻊ ﺒﺎﻟﺠﺭﻋﺔ ﺍﻷﻭﻟﻰ ﻤﻥ ﺍﻟﻠﻘﺎﺡ ﻭﺇﻋﻁﺎﺀ ﺍﻴﺭﻴﺜﺭﻭﻤﻴﺴﻴﻥ ﺒﺎﻟﻔﻡ ‪ ١‬ﻍ ﺃﻭ‬
‫‪ ٣٠‬ﻤﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﻤﻘﺴﻤﺔ ﻋﻠﻰ ﺃﺭﺒﻊ ﺠﺭﻋﺎﺕ ﻟﻤﺩﺓ ﺃﺴﺒﻭﻉ‪.‬‬
‫ﻴﻘﻭﻡ ﺒﻌﻤﻠﻴﺎﺕ ﺍﻟﺘﻠﻘﻴﺢ ﻋﻨﺎﺼﺭ ﺍﻟﺘﻠﻘﻴﺢ ﻓﻲ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ‪.‬‬
‫‪ -‬ﻓﻲ ﺤﺎل ﺤﺩﻭﺙ ﺍﻷﻭﺒﺌﺔ ﺃﻭ ﺍﻟﻔﺎﺸﻴﺎﺕ ﻴﺠﺏ ﺇﺒﻼﻍ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪ ،‬ﺤﻴﺙ ﻴﻘﻭﻡ ﻓﺭﻴﻕ ﻤﻥ ﺍﻟﻤﺩﻴﺭﻴﺔ‬
‫ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﻋﻨﺎﺼﺭ ﺼﺤﻴﺔ ﻤﻥ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ ﺒﺯﻴﺎﺭﺓ ﺍﻟﻤﻨﻁﻘﺔ ﻟﻴﺘﻡ ﺘﻠﻘﻴﺢ ﺠﻤﻴﻊ ﺍﻟﻤﺴﺘﻌﺩﻴﻥ ﻭﺨﺎﺼﺔ‬
‫ﺍﻟﺭﻀﻊ ﻭﺍﻷﻁﻔﺎل ﻗﺒل ﺍﻟﺴﻥ ﺍﻟﻤﺩﺭﺴﻲ ﺒﺠﺭﻋﺘﻴﻥ ﺒﻔﺎﺼل ﺸﻬﺭ‪ ،‬ﺇﻀﺎﻓﺔ ﺇﻟﻰ ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﻟﺘﺤﺩﻴﺩ‬
‫ﻤﺼﺩﺭ ﺍﻟﻌﺩﻭﻯ ﻭﺍﻟﻤﺠﻤﻭﻋﺎﺕ ﺍﻷﻜﺜﺭ ﺘﻌﺭﻀﹰﺎ ﻟﻠﺨﻁﺭ‪.‬‬
‫‪ -‬ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪ :‬ﻟﺘﻌﺭﻴﻑ ﺍﻟﻨﺎﺱ ﻭﻻ ﺴﻴﻤﺎ ﺍﻵﺒﺎﺀ ﻭﺍﻷﻤﻬﺎﺕ ﺒﻤﺨﺎﻁﺭ ﺍﻟﺨﻨﺎﻕ ﻭﺃﻫﻤﻴﺔ ﺃﺨﺫ ﺍﻟﻠﻘﺎﺤﺎﺕ‬
‫ﺒﻤﻭﺍﻋﻴﺩﻫﺎ‪.‬‬
‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻟﺔ ﻓﻲ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪ ،‬ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪ ،(٣‬ﻭﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺼﻐﺭﻱ ﺍﻟﻤﻠﺤﻕ‬
‫ﺭﻗﻡ )‪.(٤‬‬
‫• ﺍﺘﺨﺎﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻭﻗﺎﺌﻴﺔ‪ :‬ﺘﻠﻘﻴﺢ ﺍﻷﻁﻔﺎل ﺒﺎﻟﻠﻘﺎﺡ ﺍﻟﺭﺒﺎﻋﻲ ﺤﺴﺏ ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻭﻁﻨﻲ‪ ،‬ﺍﻟﻤﻠﺤﻕ‬
‫ﺭﻗﻡ ) ‪.(١٠‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫• ﻤ ﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻤﺤﻠﻲ ﻓﻲ ﺍﺴﺘﻘﺼﺎﺀ ﺍﻟﺤﺎﻻﺕ‪.‬‬
‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻤﺤﻠﻲ ﻓﻲ ﻋﻤﻠﻴﺎﺕ ﺍﻟﺘﻠﻘﻴﺢ ﺨﻼل ﺍﻟﻔﺎﺸﻴﺎﺕ ﻭﺍﻷﻭﺒﺌﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ ‪.‬‬
‫• ﺭﻓﻊ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺸﻬﺭﻴﺔ ﻋﻥ ﺍﻹﺼﺎﺒﺎﺕ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﻭﺭﻓﻊ ﺘﻘﺎﺭﻴﺭ ﺍﻟﺘﺭﺼﺩ ﺍﻷﺴﺒﻭ ﻋﻴﺔ‬
‫ﻭﺍﻟﺼﻔﺭﻴﺔ ﻭﺍﺴﺘﻤﺎﺭﺍﺕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻭﺒﺎﺌﻲ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﺘﺨﺫﺓ ﻋﻨﺩ ﺤﺩﻭﺙ ﺍﻟﻔﺎﺸﻴﺎﺕ ﻭﺍﻷﻭﺒﺌﺔ‬
‫ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻟﻁﻔل ﻭﺍﻟﺘﻠﻘﻴﺢ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ‪.‬‬
‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﻟﻠﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﻋﻤل ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﻭﺘﻭﺯﻴﻊ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﻭﺍﺩ ﺍﻟﻤﺨﺒﺭﻴﺔ‪.‬‬
‫• ﺘﻘﺩﻴﺭ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻟﻠﻘﺎﺡ ﻟﻴﺘﻡ ﻤﻥ ﻗﺒل ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪ ،‬ﺜﻡ ﺘﻭﺯﻴﻌﻪ ﻋﻠﻰ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ )ﺨﺎﺼﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻤﺩﺭﺴﻴﺔ( ﻤﻥ ﺨﻼل ﺍﻟﻤﺠﻠﺱ ﺍﻟﺼﺤﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬

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 ‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬
‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻁﺎﺭﺌﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻘﻁﺭ‪.‬‬
‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﺇﻟﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﻭﺴﺎﺌل ﻭﻤﻭﺍﺩ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪.‬‬
‫• ﺘﻘﺩﻴﺭ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﻭﺍﺩ ﺍﻟﺨﺒﺭﻴﺔ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﺍﻟﻠﻘﺎﺤﺎﺕ ﻭﺘﻭﺯﻴﻌﻬﺎ ﻋﻠﻰ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﺍﻟﻤﺼل ﺍﻟﻤﻀﺎﺩ ﻟﻠﺫﻴﻔﺎﻥ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﺍﻟﺩﺭﺍﺴﺎﺕ ﻭﺍﻟﺒﺤﻭﺙ ﺃﻭ ﺍﻟﻤﺴﻭﺡ ﻟﻤﻌﺭﻓﺔ ﻤﻌﺩل ﺍﻻﻨﺘﺸﺎﺭ‪ ،‬ﻭﻋﻭﺍﻤل ﺍﻟﺨﻁﺭ ﺍﻟﻤﺭﺘﺒﻁﺔ ﺒﺤﺩﻭﺙ‬
‫ﺍﻟﻤﺭﺽ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻤﻥ ﺨﻼل ﺍﻟﻠﺠﺎﻥ ﺍﻟﻭﻁﻨﻴﺔ ﻟﻠﻤﻜﺎﻓﺤﺔ ﻭﺨﺎﺼﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻤﺩﺭﺴﻴﺔ ﻭﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ‬
‫ﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬

‫ﺨﻁﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ‬
‫ﻴﺠﺏ ﺍﻟﺒﺩﺀ ﺒﺎﻟﻤﻌﺎﻟﺠﺔ ﺒﺴﺭﻋﺔ ﻭﻋﻨﺩ ﺍﻻﺸﺘﺒﺎﻩ ﺍﻟﺴﺭﻴﺭﻱ )ﺒﻌﺩ ﺃﺨﺫ ﻨﻤﺎﺫﺝ ﻟﻠﺯﺭﻉ ﺍﻟﺠﺭﺜﻭﻤﻲ(‪.‬‬

‫ﻴﻌﻁﻰ ﺍﻟﻤﺼل ﺍﻟﻤﻀﺎﺩ ﻟﻠﺫﻴﻔﺎﻥ )ﺒﻌﺩ ﺍﺴﺘﺒﻌﺎﺩ ﻓﺭﻁ ﺍﻟﺘﺤﺴﺱ( ﺒﺠﺭﻋﺔ ﻭﺍﺤﺩﺓ ﻤﻘﺩﺍﺭﻫﺎ ‪ ١٠٠-٢٠‬ﺃﻟﻑ ﻭﺤﺩﺓ‬
‫ﺒﺎﻟﻁﺭﻴﻕ ﺍﻟﻌﻀﻠﻲ‪ ،‬ﻓﻲ ﺤﺎﻻﺕ ﺍﻟﺨﻤﺞ ﺍﻟﺸﺩﻴﺩ ﻴﺠﺏ ﺯﺭﻕ ﺍﻟﺘﺭﻴﺎﻕ ﺒﺎﻟﻌﻀل ﻭﺍﻟﻭﺭﻴﺩ ﻤﻌﹰﺎ‪.‬‬

‫ﻼ ﻋﻨﻪ( ﻭﻫﻲ‪:‬‬
‫ﻜﻤﺎ ﺘﻌﻁﻰ ﺍﻟﺼﺎﺩﺍﺕ ﺍﻟﻔﻌﺎﻟﺔ ﻀﺩ ﺍﻟﺠﺭﺜﻭﻡ )ﻭﺘﺴﺘﻌﻤل ﻤﻊ ﺍﻟﺘﺭﻴﺎﻕ ﻭﻟﻴﺱ ﺒﺩﻴ ﹰ‬

‫ﺍﺭﻴﺜﺭﻭﻤﺎﻴﺴﻴﻥ ‪١‬ﻍ‪ /‬ﻴﻭﻡ )ﺍﻷﻁﻔﺎل ‪٤٠‬ﻤﻎ‪ /‬ﻜﻎ( ﻟﻤﺩﺓ ﺴﺒﻌﺔ ﺃﻴﺎﻡ‪.‬‬

‫ﺒﺭﻭﻜﺎﺌﻴﻥ ﺒﻨﺴﻠﻴﻥ‪ ٦٠٠ :‬ﺃﻟﻑ‪ ٢-‬ﻤﻠﻴﻭﻥ ﻭﺤﺩﺓ ﺒﺎﻟﻌﻀل ﻴﻭﻤﻴﹰﺎ ﻟﻤﺩﺓ ‪ ١٠‬ﺃﻴﺎﻡ‪) ،‬ﺃﻭ ‪ ٣٠٠‬ﺃﻟﻑ ﻭﺤﺩﺓ ﻟﻸﻁﻔﺎل‬
‫ﺒﻭﺯﻥ ﺃﻗل ﻤﻥ ‪ ١٠‬ﻜﻎ‪ ٦٠٠ ،‬ﺃﻟﻑ ﻟﻸﻁﻔﺎل ﺒﻭﺯﻥ ﻴﺯﻴﺩ ﻋﻥ ‪١٠‬ﻜﻎ(‪.‬‬

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 ‫‪‬‬
‫א‪‬א‪ ‬‬
‫‪ Pertussis‬‬
‫ﻤﺭﺽ ﺠﺭﺜﻭﻤﻲ ﺤﺎﺩ ﻴﺼﻴﺏ ﺍﻟﺠﻬﺎﺯ ﺍﻟﺘﻨﻔﺴﻲ‪ ،‬ﻴﺒﺩﺃ ﺒﺄﻋﺭﺍﺽ ﻨﺯﻟﺔ ﺒﻠﻌﻭﻤﻴﺔ )ﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﻨﺯﻟﻴﺔ( ﺘﺩﻭﻡ ‪٢-١‬‬
‫ﺃﺴﺒﻭﻉ‪ ،‬ﻴﻠﻴﻬﺎ ﻤﺭﺤﻠﺔ ﺍﻟﺴﻌﺎل ﺍﻟﻨﻭﺒﻲ ﺍﻟﺫﻱ ﻴﺘﻤﻴﺯ ﺒﺴﻌﻼﺕ ﻋﻨﻴﻔﺔ ﻤﺘﻜﺭﺭﺓ‪ ،‬ﻭﻜل ﺴﻠﺴﻠﺔ ﻤﻥ ﺍﻻﻨﺘﻴﺎﺒﺎﺕ ﺒﻬﺎ ﺴﻌﻼﺕ‬
‫ﻜﺜﻴﺭﺓ ﻻ ﻴﻘﻁﻌﻬﺎ ﺸﻬﻴﻕ ﻭﻗﺩ ﻴﻌﻘﺒﻬﺎ ﺼﻴﺤﺔ ﺩﻴﻜﻴﺔ ﻤﻤﻴﺯﺓ ﺃﻭ ﺸﻬﻘﺔ ﺫﺍﺕ ﻨﻐﻤﺔ ﻋﺎﻟﻴﺔ‪ ،‬ﻭﻜﺜﻴﺭﹰﺍ ﻤﺎ ﺘﻨﺘﻬﻲ ﺍﻻﻨﺘﻴﺎﺒﺎﺕ‬
‫ﺒﺈﺨﺭﺍﺝ ﻤﺨﺎﻁ ﺭﺍﺌﻕ ﻭﻤﺘﻤﺎﺴﻙ‪ ،‬ﻭﺍﻟﻐﺎﻟﺏ ﺃﻻ ﺘﺤﺩﺙ ﺍﻟﺸﻬﻘﺔ ﺍﻟﻨﻤﻭﺫﺠﻴﺔ ﻓﻲ ﺼﻐﺎﺭ ﺍﻟﺭﻀﻊ ﻭﺍﻟﺒﺎﻟﻐﻴﻥ‪ ،‬ﻴﺩﻭﻡ ﺍﻟﺩﻭﺭ‬
‫ﺍﻟﻨﻭﺒﻲ ‪ ٢-١‬ﺸﻬﺭ‪ ،‬ﻤﻌﺩل ﺍﻹﻤﺎﺘﺔ ‪ ،%٤-٠.١‬ﻟﻜﻥ ﺘﺤﺩﺙ ﺍﻟﻭﻓﻴﺎﺕ ﻋﻨﺩ ﺍﻷﻁﻔﺎل ﺩﻭﻥ ﺍﻟﺴﻨﺔ‪.‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﻋﺼﻴﺔ ﺍﻟﺸﺎﻫﻭﻕ ‪.Bordetella pertussis‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﺭﻴﺽ ﻓﻘﻁ‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﻤﺒﺎﺸﺭ ﺒﺎﻟﻘﻁﻴﺭﺍﺕ ﺍﻟﺘﻨﻔﺴﻴﺔ ﺃﻭ ﺍﻟﺘﻤﺎﺱ ﺍﻟﻤﺒﺎﺸﺭ ﻤﻊ ﻤﻔﺭﺯﺍﺕ ﺍﻟﻤﺭﻴﺽ ﺍﻟﺘﻨﻔﺴﻴﺔ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﺨﻤﺞ ﻋﺎﻡ‪ ،‬ﻭﻻ ﻴﻭﺠﺩ ﻤﻨﺎﻋﺔ ﻤﻨﻘﻭﻟﺔ ﻋﺒﺭ ﺍﻟﻤﺸﻴﻤﺔ ﻤﻥ ﺍﻷﻡ ﺇﻟﻰ ﻁﻔﻠﻬﺎ‪ ،‬ﺘﻌﻁﻲ ﺍﻹﺼﺎﺒﺔ ﻤﻨﺎﻋﺔ‬
‫ﻤﺩﻴﺩﺓ ﻭﻤﺅﻜﺩﺓ‪ ،‬ﻜﻤﺎ ﻴﻤﻜﻥ ﺇﺤﺩﺍﺙ ﻤﻨﺎﻋﺔ ﻓﺎﻋﻠﺔ ﻭﻤﺩﻴﺩﺓ ﺒﺈﻋﻁﺎﺀ ﺍﻟﻠﻘﺎﺡ ﺍﻟﻤﻘﺘﻭل ﻀﻤﻥ ﺍﻟﻠﻘﺎﺡ ﺍﻟﺜﻼﺜﻲ )‪ (DPT‬ﺃﻭ‬
‫ﺍﻟﺭﺒﺎﻋﻲ )‪.(DPT-HIB‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫‪ ٣-١‬ﺃﺴﺎﺒﻴﻊ )ﻭﺴﻁﻴﹰﺎ ‪ ١٠‬ﺃﻴﺎﻡ(‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻤﻥ ﺒﺩﺀ ﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﻨﺯﻟﻴﺔ ﺤﺘﻰ ‪ ٣‬ﺃﺴﺎﺒﻴﻊ ﺒﻌﺩ ﺒﺩﺀ ﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﻨﻭﺒﻴﺔ )ﻓﻲ ﺤﺎل ﻋﺩﻡ ﺍﻟﻌﻼﺝ ﺒﺎﻟﺼﺎﺩﺍﺕ(‪،‬‬
‫ﺍﻟﺴﺭﺍﻴﺔ ﺃﻋﻠﻰ ﻓﻲ ﺍﻟﺩﻭﺭ ﺍﻟﻨﺯﻟﻲ‪ ،‬ﺍﻟﺼﺎﺩﺍﺕ ﺘﻨﻘﺹ ﺍﻟﺴﺭﺍﻴﺔ ﺤﺘﻰ ‪ ٧-٥‬ﺃﻴﺎﻡ ﻓﻘﻁ ﺒﻌﺩ ﺒﺩﺀ ﺍﻟﻌﻼﺝ ﺒﺎﻟﺼﺎﺩﺍﺕ‪.‬‬

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 ‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﺍﻋﺘﻤﺎﺩﹰﺍ ﻋﻠﻰ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‪ ،‬ﻭﻴﻤﻜﻥ ﺘﺄﻜﻴﺩ ﺍﻟﺘﺸﺨﻴﺹ ﺒﺎﺴﺘﻔﺭﺍﺩ ﺍﻟﺠﺭﺜﻭﻡ ﻤﻥ ﻤﺴﺤﺎﺕ‬
‫ﺒﻠﻌﻭﻤﻴﺔ )ﻤﻊ ﺍﻟﻌﻠﻡ ﺃﻨﻪ ﻤﻥ ﺍﻟﺼﻌﺏ ﺠﺩﹰﺍ ﺍﺴﺘﻔﺭﺍﺩ ﺍﻟﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ(‪.‬‬

‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ ﻟﺤﺎﻟﺔ ﺍﻟﺴﻌﺎل ﺍﻟﺩﻴﻜﻲ ﺍﻟﻤﺸﺘﺒﻬﺔ‬

‫ﻗﺼﺔ ﺴﻌﺎل ﺸﺩﻴﺩ‪ ،‬ﻤﻊ ﻭﺠﻭﺩ ﺃﺤﺩ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺘﺎﻟﻴﺔ‪ :‬ﺴﻌﺎل ﻤﺴﺘﻤﺭ ﻷﺴﺒﻭﻋﻴﻥ ﺃﻭ ﺃﻜﺜﺭ‪ ،‬ﻨﻭﺏ ﻤﻥ ﺍﻟﺴﻌﺎل‪،‬‬
‫ﺴﻌﺎل ﻤﺘﺒﻭﻉ ﺒﺈﻗﻴﺎﺀ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬
‫• ﺍﻟﻜﺸﻑ ﺍﻟﻤﺒﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻻﺕ‪.‬‬
‫• ﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻟﺤﺎﻻﺕ )ﻭﻓﻕ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ( ﻓﻲ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ )ﻓﻲ ﺍﻟﺤﺎﻻﺕ‬
‫ﺍﻟﻤﺘﻔﺭﻗﺔ( ﻭﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺼﻐﺭﻱ ﻤﻠﺤﻕ )‪ ،(٤ - ٣‬ﻭﺭﻓﻊ ﻫﺫﺍ ﺍﻟﺘﻘﺭﻴﺭ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫ﻭﺍﻟﻤﺯﻤﻨﺔ ﻓﻲ ﺍﻟﻤﺩﻴﺭﻴﺔ ﻭﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻟﻔﺎﺸﻴﺎﺕ ﺃﻭ ﺍﻷﻭﺒﺌﺔ ﺒﺸﻜل ﻓﻭﺭﻱ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫ﻭﺍﻟﻤﺯﻤﻨﺔ ﻓﻲ ﺍﻟﻤﺩﻴﺭﻴﺔ‪ ،‬ﻴﺭﻓﻊ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺼﻔﺭﻱ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ ﻓﻲ ﺍﻟﻤﺩﻴﺭﻴﺔ‪.‬‬
‫• ﺍﻟﻌﻼﺝ ﺍﻟﻨﻭﻋﻲ‪ :‬ﺇﻥ ﻤﻌﺎﻟﺠﺔ ﺍﻟﺤﺎﻟﺔ ﺘﻠﻌﺏ ﺩﻭﺭﹰﺍ ﻓﻲ ﺘﺨﻔﻴﻑ ﺤﺩﺓ ﺍﻟﻤﺭﺽ ﺇﺫﺍ ﺃﻋﻁﻴﺕ ﻓﻲ ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ ﺃﻭ‬
‫ﺒﺎﻜﺭﹰﺍ ﻓﻲ ﺍﻟﺩﻭﺭ ﺍﻟﻨﺯﻟﻲ‪ ،‬ﻭﻻ ﺘﺄﺜﻴﺭ ﻟﻬﺎ ﺇﺫﺍ ﺃﻋﻁﻴﺕ ﻓﻲ ﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﻨﻭﺒﻴﺔ‪ ،‬ﻭﻟﻜﻥ ﺍﻟﻌﻼﺝ ﻴﻘﺼﺭ ﺍﻟﺴﺭﺍﻴﺔ‪ ،‬ﻴﻌﻁﻰ‬
‫ﺍﻻﺭﻴﺜﺭﻭﻤﺎﻴﺴﻴﻥ ﻟﻤﺩﺓ ﺃﺴﺒﻭﻋﻴﻥ ﺃﻭ ﺍﻟﻜﻭﺘﺭﻴﻤﻭﻜﺴﺎﺯﻭل‪.‬‬
‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ‪ :‬ﻟﻠﻔﺎﺸﻴﺎﺕ ﻭﺍﻷﻭﺒﺌﺔ ﻓﻘﻁ‪ ،‬ﺤﻴﺙ ﻴﺘﻡ ﺇﺒﻼﻍ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﺒﺸﻜل ﻓﻭﺭﻱ‪،‬‬
‫ﻭﻴﺸﺎﺭﻙ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﻋﻨﺎﺼﺭ ﺼﺤﻴﺔ ﻤﻥ ﻤﺭﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ ﻭﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ ﻓﻲ ﻋﻤﻠﻴﺔ ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ‬
‫ﺍﻟﺘﻲ ﻴﺘﻡ ﻓﻴﻬﺎ ﺍﻟﺘﺭﻜﻴﺯ ﻓﻲ ﺍﻟﺴﺅﺍل ﻋﻥ ﺍﻟﺤﺎﻟﺔ ﺍﻟﺘﻤﻨﻴﻌﻴﺔ ﻟﻸﻁﻔﺎل‪ ،‬ﻭﺍﻟﺒﺤﺙ ﻋﻥ ﺤﺎﻻﺕ ﺃﺨﺭﻯ ﻏﻴﺭ ﻤﺸﺨﺼﺔ‬
‫ﺃﻭ ﻏﻴﺭ ﻤﺒﻠﻎ ﻋﻨﻬﺎ‪ ،‬ﻭﻴﺘﻡ ﺘﻠﻘﻴﺢ ﺍﻷﻁﻔﺎل ﻏﻴﺭ ﺍﻟﻤﻤﻨﻌﻴﻥ ﺃﻭ ﻏﻴﺭ ﺍﻟﻤﺴﺘﻜﻤﻠﻴﻥ ﻟﺠﺭﻋﺎﺘﻬﻡ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻤﻌﺭﻓﺔ ﺴﺒﺏ ﺍﻟﻔﺎﺸﻴﺎﺕ ﺃﻭ ﺍﻷﻭﺒﺌﺔ‪.‬‬
‫• ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‪:‬‬
‫‪ -‬ﻋﺯل ﺍﻟﻤﺭﻴﺽ ﻋﻥ ﺼﻐﺎﺭ ﺍﻷﻁﻔﺎل ﻭﺍﻟﺭﻀﻊ ﻤﺩﺓ ‪ ٥‬ﺃﻴﺎﻡ ﻋﻠﻰ ﺍﻷﻗل ﺒﻌﺩ ﺒﺩﺀ ﺍﻟﻌﻼﺝ ﺍﻟﺫﻱ ﻴﺠﺏ ﺃﻥ‬
‫ﻴﺴﺘﻤﺭ ﺃﺴﺒﻭﻋﻴﻥ ﻋﻠﻰ ﺍﻷﻗل‪.‬‬
‫‪ -‬ﺍﺴﺘﺒﻌﺎﺩ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﺃﻗل ﻤﻤﻥ ﺃﻋﻤﺎﺭﻫﻡ ﺃﻗل ﻤﻥ ‪ ٧‬ﺴﻨﻭﺍﺕ ﻭﻏﻴﺭ ﺍﻟﻤﻤﻨﻌﻴﻥ ﺒﺸﻜل ﻜﺎﻑ ﻋﻥ ﺍﻟﻤﺩﺍﺭﺱ‬
‫ﻭﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ ﻟﻤﺩﺓ ‪ ١٤‬ﻴﻭﻡ ﺒﻌﺩ ﺁﺨﺭ ﺘﻌﺭﺽ‪.‬‬
‫‪ -‬ﺘﻁﻬﻴﺭ ﻤﻔﺭﺯﺍﺕ ﺍﻟﻤﺭﻴﺽ )ﺍﻷﻨﻑ ﻭﺍﻟﺤﻠﻕ ﻭﺍﻷﺩﻭﺍﺕ ﺍﻟﻤﻠﻭﺜﺔ ﺒﻬﺎ(‪.‬‬

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 ‫‪ -‬ﺍﻟﻤﺨﺎﻟﻁﻭﻥ ﺃﻗل ﻤﻥ ‪ ٧‬ﺴﻨﻭﺍﺕ‪:‬‬
‫‪ o‬ﻤﻤﻨﻌﻭﻥ ﻤﺴﺘﻜﻤﻠﻭﻥ ﺠﺭﻋﺎﺘﻬﻡ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ‪ :‬ﻻ ﺩﺍﻋﻲ ﻹﻋﻁﺎﺀ ﺍﻟﻠﻘﺎﺡ ﺃﻭ ﺍﻟﻭﻗﺎﻴﺔ ﺍﻟﻜﻴﻤﻴﺎﺌﻴﺔ‪.‬‬
‫‪ o‬ﻏﻴﺭ ﻤﺴﺘﻜﻤﻠﻴﻥ ﺠﺭﻋﺎﺘﻬﻡ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ‪ :‬ﺍﺴﺘﻜﻤﺎل ﺍﻟﺠﺭﻋﺎﺕ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ )ﺍﻟﻠﻘﺎﺡ ﺍﻟﺭﺒﺎﻋﻲ ‪.(DPT-Hib‬‬
‫‪ o‬ﻏﻴﺭ ﻤﻤﻨﻌﻴﻥ‪ :‬ﺍﻟﺒﺩﺀ ﺒﺎﻟﺠﺭﻋﺔ ﺍﻷﻭﻟﻰ ﻤﻥ ﺍﻟﻠﻘﺎﺡ‪ ،‬ﻭﺇﻋﻁﺎﺀ ﺃﺭﻴﺜﺭﻭﻤﺎﻴﺴﻴﻥ ﺃﻭ ﻜﻭﺘﺭﻴﻤﻭﻜﺴﺎﺯﻭل ﻤﺩﺓ‬
‫‪ ١٤‬ﻴﻭﻡ ﺃﻭ ﻁﻭﺍل ﻓﺘﺭﺓ ﺇﻤﻜﺎﻥ ﺍﻨﺘﻘﺎل ﺍﻟﻌﺩﻭﻯ ﺇﺫﺍ ﺘﻌﺫﺭ ﻭﻗﻑ ﺍﻟﺘﻌﺭﺽ‪.‬‬
‫• ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﻟﻶﺒﺎﺀ ﻭﺍﻷﻤﻬﺎﺕ ﻋﻥ ﺃﺨﻁﺎﺭ ﺍﻟﺴﻌﺎل ﺍﻟﺩﻴﻜﻲ ﻭﻤﺯﺍﻴﺎ ﺍﻟﺒﺩﺀ ﺒﺎﻟﺘﻤﻨﻴﻊ ﻓﻲ ﺴﻥ ﻤﺒﻜﺭﺓ ﻭﻀﺭﻭﺭﺓ‬
‫ﺍﻟﻌﻨﺎﻴﺔ ﺒﺘﻐﺫﻴﺔ ﺍﻷﻁﻔﺎل ﻭﺨﺎﺼﺔ ﺼﻐﺎﺭ ﺍﻷﻁﻔﺎل‪.‬‬
‫• ﺍﺘﺨﺎﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻭﻗﺎﺌﻴﺔ‪ :‬ﺘﻠﻘﻴﺢ ﺍﻷﻁﻔﺎل ﺒﺎﻟﻠﻘﺎﺡ ﺍﻟﺭﺒﺎﻋﻲ ﺤﺴﺏ ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻭﻁﻨﻲ )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ ‪.(١٠‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻤﺤﻠﻲ ﻓﻲ ﺤﺎل ﺤﺩﻭﺙ ﺍﻟﻔﺎﺸﻴﺎﺕ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬
‫• ﺭﻓﻊ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺸﻬﺭﻴﺔ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪ ،‬ﻭﺇﺒﻼﻍ ﺩﺍﺌﺭﺓ ﺼﺤﺔ ﺍﻟﻁﻔل ﻭﺍﻟﺘﻠﻘﻴﺢ‬
‫ﻋﻨﺩ ﺤﺩﻭﺙ ﺍﻟﻔﺎﺸﻴﺎﺕ ﻭﺍﻷﻭﺒﺌﺔ‪ ،‬ﻭﺇﺭﺴﺎل ﺘﻘﺎﺭﻴﺭ ﺍﻟﺘﺭﺼﺩ ﺍﻷﺴﺒﻭﻋﻴﺔ ﻭﺍﻟﺼﻔﺭﻴﺔ‪.‬‬
‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﻟﻠﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﻋﻤل ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﺘﻭﺯﻴﻊ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﻭﺍﺩ ﺍﻟﻤﺨﺒﺭﻴﺔ‪.‬‬
‫• ﺘﻘﺩﻴﺭ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻟﻠﻘﺎﺡ ﻟﻴﺘﻡ ﺘﺄﻤﻴﻨﻪ ﻤﻥ ﻗﺒل ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪ ،‬ﺜﻡ ﺘﻭﺯﻴﻌﻪ ﻋﻠﻰ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﺨﺎﺼﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻤﺩﺭﺴﻴﺔ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻁﺎﺭﺌﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻘﻁﺭ‪.‬‬
‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﺇﻟﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﻭﺴﺎﺌل ﻭﻤﻭﺍﺩ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪.‬‬
‫• ﺘﻘﺩﻴﺭ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﻭﺍﺩ ﺍﻟﻤﺨﺒﺭﻴﺔ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﺍﻟﻠﻘﺎﺤﺎﺕ ﻭﺘﻭﺯﻴﻌﻬﺎ ﻋﻠﻰ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﺍﻟﺩﺭﺍﺴﺎﺕ ﻭﺍﻟﺒﺤﻭﺙ ﺃﻭ ﺍﻟﻤﺴﻭﺡ ﻟﻤﻌﺭﻓﺔ ﻤﻌﺩل ﺍﻻﻨﺘﺸﺎﺭ‪ ،‬ﻭﻋﻭﺍﻤل ﺍﻟﺨﻁﺭ ﺍﻟﻤﺭﺘﺒﻁﺔ ﺒﺤﺩﻭﺙ ﺍﻟﻤﺭﺽ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻤﻥ ﺨﻼل ﺍﻟﻠﺠﺎﻥ ﺍﻟﻭﻁﻨﻴﺔ‪ ،‬ﻭﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﻤﻨﻅﻤﺔ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬

‫‪٦٠‬‬
 ‫‪‬‬
‫א‪ ‬‬
‫‪ Measles‬‬
‫ﻤﻘﺩﻤﺔ‪:‬‬
‫ﺍﻟﺤﺼﺒﺔ ﻤﺭﺽ ﻓﻴﺭﻭﺴﻲ ﺤﺎﺩ‪ ،‬ﻴﺘﻅﺎﻫﺭ ﺒﺘﺭﻓﻊ ﺤﺭﺍﺭﻱ ﻤﻊ ﻁﻔﺢ ﺃﺤﻤﺭ ﻴﺒﺩﺃ ﻓﻲ ﺍﻟﻭﺠﻪ ﺜﻡ ﻴﻨﺘﺸﺭ ﻟﻴﺼﺒﺢ‬
‫ﻤﻌﻤﻤﹰﺎ ﻭﻴﺴﺘﻤﺭ ﻟﻤﺩﺓ ‪ ٣‬ﺃﻴﺎﻡ ﻋﻠﻰ ﺍﻷﻗل‪ ،‬ﻤﻊ ﺃﻫﻡ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺘﺎﻟﻴﺔ‪ :‬ﺴﻌﺎل ﺃﻭ ﺴﻴﻼﻥ ﺃﻨﻑ ﺃﻭ ﺍﻟﺘﻬﺎﺏ ﻤﻠﺘﺤﻤﺔ‪،‬‬
‫ﻭﻴﻜﻭﻥ ﺍﻟﻤﺭﺽ ﺃﺸﺩ ﻓﻲ ﺍﻟﺭﻀﻊ ﻭﻋﻨﺩ ﺍﻟﺒﺎﻟﻐﻴﻥ‪ ،‬ﻜﻤﺎ ﺃﻨﻪ ﺃﺨﻁﺭ ﻋﻨﺩ ﺍﻷﻁﻔﺎل ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﺴﻭﺀ ﺘﻐﺫﻴﺔ‪.‬‬

‫ﻭﻗﺩ ﺘﻨﺠﻡ ﻤﻀﺎﻋﻔﺎﺕ ﺍﻟﺤﺼﺒﺔ ﻋﻥ ﺘﻜﺎﺜﺭ ﻓﻴﺭﻭﺴﻲ ﺃﻭ ﻋﺩﻭﻯ ﺠﺭﺜﻭﻤﻴﺔ ﻭﺘﺸﻤل ﺍﻟﺘﻬﺎﺏ ﺍﻷﺫﻥ ﺍﻟﻭﺴﻁﻰ‪،‬‬
‫ﺍﻟﺘﻬﺎﺏ ﺍﻟﺭﺌﺔ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﺤﻨﺠﺭﺓ ﻭﺍﻟﺭﻏﺎﻤﻰ ﻭﺍﻟﻘﺼﺒﺎﺕ )ﺍﻟﺨﺎﻨﻭﻕ( ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﺩﻤﺎﻍ‪.‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﻓﻴﺭﻭﺱ ﺍﻟﺤﺼﺒﺔ ‪.Measles Virus‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﺭﻴﺽ‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫• ﺍﻟﺘﻤﺎﺱ ﺍﻟﻤﺒﺎﺸﺭ ﻤﻊ ﻤﻔﺭﺯﺍﺕ ﺍﻷﻨﻑ ﻭﺍﻟﺒﻠﻌﻭﻡ ﻟﻠﺸﺨﺹ ﺍﻟﻤﺼﺎﺏ‪.‬‬
‫• ﺍﻨﺘﺸﺎﺭ ﺍﻟﻘﻁﻴﺭﺍﺕ ﻋﻨﺩ ﺴﻌﺎل ﺍﻟﺸﺨﺹ ﺍﻟﻤﺼﺎﺏ ﺃﻭ ﻋﻁﺎﺴﻪ‪.‬‬
‫• ﺍﻷﺩﻭﺍﺕ ﺍﻟﻤﻠﻭﺜﺔ ﺤﺩﻴﺜﹰﺎ ﺒﻤﻔﺭﺯﺍﺕ ﺍﻷﻨﻑ ﻭﺍﻟﺤﻠﻕ ﻭﻫﻭ ﺃﻗل ﺸﻴﻭﻋﹰﺎ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫• ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻺﺼﺎﺒﺔ ﻋﺎﻡ )ﺠﻤﻴﻊ ﺍﻷﺸﺨﺎﺹ ﺍﻟﺫﻴﻥ ﻟﻡ ﻴﺼﺎﺒﻭﺍ ﺒﺎﻟﻤﺭﺽ ﺃﻭ ﻟﻡ ﻴﺘﻡ ﺘﻤﻨﻴﻌﻬﻡ ﻟﺩﻴﻬﻡ ﺍﺴﺘﻌﺩﺍﺩ‬
‫ﻟﻺﺼﺎﺒﺔ(‪.‬‬
‫• ﺍﻹﺼﺎﺒﺔ ﺘﺘﺭﻙ ﻤﻨﺎﻋﺔ ﺩﺍﺌﻤﺔ ﻭﺍﻟﻁﻔل ﺍﻟﺫﻱ ﻟﻡ ﻴﻭﻟﺩ ﻷﻡ ﺴﺒﻘﺕ ﺇﺼﺎﺒﺘﻬﺎ ﺒﺎﻟﻤﺭﺽ ﻴﺒﻘﻰ ﻤﻤﻨﻌﹰﺎ ﻟﻤﺩﺓ ‪ ٩-٦‬ﺃﺸﻬﺭ‬
‫ﺒﻌﺩ ﺍﻟﻭﻻﺩﺓ ﻭﺘﺘﺩﺨل ﺍﻷﻀﺩﺍﺩ ﺍﻟﺩﻤﻭﻴﺔ ﻓﻲ ﺍﻻﺴﺘﺠﺎﺒﺔ ﻟﻠﻘﺎﺡ‪ ،‬ﻭﺘﺒﻠﻎ ﻤﻨﺎﻋﺔ ﺍﻟﺘﻠﻘﻴﺢ ‪ % ٩٨-٩٥‬ﺒﻌﺩ )‪ (١٥‬ﺸﻬﺭ‬
‫ﻭﺘﺭﺘﻔﻊ ﺇﻟﻰ ‪ %٩٩‬ﺒﺈﻋﺎﺩﺓ ﺍﻟﺘﻠﻘﻴﺢ‪.‬‬

‫‪٦١‬‬
 ‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫)‪ (١٠‬ﺃﻴﺎﻡ‪ ،‬ﺇﺫ ﻴﺘﺭﺍﻭﺡ ﺒﻴﻥ )‪ (١٣-٨‬ﻴﻭﻤﹰﺎ ﻤﻥ ﺍﻟﺘﻌﺭﺽ ﺤﺘﻰ ﺒﺩﺀ ﺍﻟﺤﻤﻰ‪ ،‬ﻭﺤﻭﺍﻟﻲ )‪ (١٤‬ﻴﻭﻤﹰﺎ ﺤﺘﻰ ﻅﻬﻭﺭ ﺍﻟﻁﻔﺢ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﺘﻤﺘﺩ ﻗﺒل ﺒﺩﺀ ﺍﻟﺘﺭﻓﻊ ﺍﻟﺤﺭﻭﺭﻱ ﺒﻘﻠﻴل‪ ،‬ﻭﺘﺴﺘﻤﺭ ﻟﻤﺩﺓ )‪ (٤‬ﺃﻴﺎﻡ ﺒﻌﺩ ﻅﻬﻭﺭ ﺍﻟﻁﻔﺢ‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﻴﻌﺘﻤﺩ ﻋﻠﻰ ﺍﻷﺴﺱ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻭﺍﻟﻭﺒﺎﺌﻴﺔ‪ ،‬ﻭﻴﻤﻜﻥ ﺍﻟﺘﺜﺒﺕ ﻤﻨﻪ‪ :‬ﺒﺘﻤﻴﻴﺯ ﺍﻟﻤﺴﺘﻀﺩ ﺍﻟﻔﻴﺭﻭﺴﻲ ﻤﻥ ﺭﺸﺎﻓﺔ ﺒﻠﻌﻭﻤﻴﺔ‬
‫ﺒﻁﺭﻴﻘﺔ ﺍﻟﻀﺩ ﺍﻟﻤﺘﺄﻟﻘﺔ‪ ،‬ﺃﻭ ﺒﺎﺴﺘﻔﺭﺍﺩ ﺍﻟﻔﻴﺭﻭﺱ ﻤﻥ ﺍﻟﺩﻡ ﺃﻭ ﺍﻟﻤﻠﺘﺤﻤﺔ ﺃﻭ ﺍﻟﺒﻠﻌﻭﻡ ﺃﻭ ﺍﻟﺒﻭل ﻓﻲ ﻤﺯﺭﻋﺔ ﻨﺴﺠﻴﺔ‪.‬‬
‫ﻭﺍﻷﻜﺜﺭ ﺸﻴﻭﻋﹰﺎ ﻋﻴﺎﺭ ﺃﻀﺩﺍﺩ ﺍﻟـ ‪ IgM‬ﺍﻟﻭﻨﻌﻴﺔ ﻟﻠﺤﺼﺒﺔ ﺃﻭ ﺍﻻﺭﺘﻔﺎﻉ ﺍﻟﻤﻠﺤﻭﻅ ﻓﻲ ﺘﺭﻜﻴﺯ ﺍﻷﻀﺩﺍﺩ ﺒﻴﻥ ﺍﻟﻤﺼل‬
‫ﺍﻟﺤﺎﺩ ﻭﻤﺼل ﺍﻟﻨﻘﺎﻫﺔ‪.‬‬

‫ﺘﺅﺨﺫ ﻋﻴﻨﺔ ﺩﻤﻭﻴﺔ ﻤﻘﺩﺍﺭﻫﺎ )‪ (٥‬ﻤل ﻤﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻭﺘﺭﺴل ﻋﻥ ﻁﺭﻴﻕ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ ﺇﻟﻰ ﻤﺨﺒﺭ‬
‫ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ ﻓﻲ ﺍﻟﻭﺯﺍﺭﺓ ﻟﻌﻴﺎﺭ ﺍﻟـ ‪ . IgM‬ﻭﻴﻔﻀل ﺇﺠﺭﺍﺀ ﺍﻟﻔﺤﺹ ﺨﻼل )‪ (٧٢‬ﺴﺎﻋﺔ ﻤﻥ ﺒﺩﺀ ﺍﻟﻁﻔﺢ‪.‬‬

‫ﺇﻥ ﻭﺠﻭﺩ ﺍﻷﻀﺩﺍﺩ ﻤﺸﺨﺹ ﻟﻠﻤﺭﺽ‪ .‬ﻓﺈﺫﺍ ﻜﺎﻨﺕ ﺍﻟﻨﺘﻴﺠﺔ ﺴﻠﺒﻴﺔ ﺘﻔﺤﺹ ﺍﻟﻌﻴﻨﺔ ﻟﻠﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ ﻋﻨﺩ ﺍﻻﺸﺘﺒﺎﻩ ﺒﺎﻟﻤﺭﺽ‪.‬‬

‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ‬
‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ‪ :‬ﻗﺼﺔ ﺘﺭﻓﻊ ﺤﺭﻭﺭﻱ ﻤﻊ ﻁﻔﺢ ﺤﻁﺎﻁﻲ ﻏﻴﺭ ﺤﻭﻴﺼﻠﻲ‪ ،‬ﻤﻊ ﺃﺤﺩ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺘﺎﻟﻴﺔ‪ :‬ﺴﻌﺎل‬
‫ﺃﻭ ﺴﻴﻼﻥ ﺃﻨﻔﻲ ﺃﻭ ﺇﺤﻤﺭﺍﺭ ﻋﻴﻨﻲ )ﺍﻟﺘﻬﺎﺏ ﻤﻠﺘﺤﻤﺔ(‪ ،‬ﺃﻭ ﺃﻱ ﺤﺎﻟﺔ ﻴﺸﺘﺒﻪ ﺒﻬﺎ ﺍﻟﻁﺒﻴﺏ ﺃﻨﻬﺎ ﺤﺼﺒﺔ‪.‬‬
‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺜﺒﺘﺔ‪ :‬ﺤﺎﻟﺔ ﻤﺸﺘﺒﻬﺔ ﻤﻊ ﺘﺄﻜﻴﺩ ﻤﺨﺒﺭﻱ‪.‬‬
‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺜﺒﺘﺔ ﻭﺒﺎﺌﻴﹰﺎ‪ :‬ﺤﺎﻟﺔ ﻤﺸﺘﺒﻬﺔ ﻟﻡ ﺘﺴﺘﻁﻊ ﺃﺨﺫ ﻋﻴﻨﺔ ﺩﻡ ﻤﻨﻬﺎ ﻤﺭﺘﺒﻁﺔ ﻭﺒﺎﺌﻴﹰﺎ ﻤﻊ ﺤﺎﻟﺔ ﻤﺜﺒﺘﺔ ﻤﺨﺒﺭﻴ ﹰﺎ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻭﺍﺠﺏ ﺍﺘﺨﺎﺫﻫﺎ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬
‫• ﺍﻟﻜﺸﻑ ﺍﻟﻤﺒﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻟﺔ‪ ،‬ﺤﺴﺏ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ‪ ،‬ﻭﺃﺨﺫ ﻋﻴﻨﺔ ﺩﻤﻭﻴﺔ ﻟﻠﻔﺤﺹ ﺍﻟﻤﺨﺒﺭﻱ‪ ،‬ﻭﺘﺅﺨﺫ ﻋﻴﻨﺔ‬
‫ﻤﻘﺩﺍﺭﻫﺎ )‪ (٠.٥‬ﻤل ﻤﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ‪ ،‬ﻭﺘﺭﺴل ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ ﻓﻲ ﺍﻟﻤﺩﻴﺭﻴﺔ‪ ،‬ﻟﻴﺘﻡ ﺇﺭﺴﺎﻟﻬﺎ‬
‫ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﻤﺨﺎﺒﺭ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ ﻟﺘﺄﻜﻴﺩ ﺍﻟﺘﺸﺨﻴﺹ‪.‬‬
‫• ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻥ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ )ﺒﺎﻟﻬﺎﺘﻑ ﺃﻭ ﺒﺎﻟﻔﺎﻜﺱ( ﻭﻋﻥ ﺤﺩﻭﺙ ﻭﺒﺎﺀ‪ ،‬ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ – ﺃﺭﻗﺎﻡ‬
‫ﻭﻫﻭﺍﺘﻑ ﺍﻹﺒﻼﻍ )ﻤﻠﺤﻕ ‪.(٩‬‬
‫• ﺍﻟﻤﻌﺎﻟﺠﺔ‪ :‬ﺤﺴﺏ ﺨﻁﺔ ﺍﻟﻌﻼﺝ )ﺍﻟﻤﺭﻓﻘﺔ(‪.‬‬

‫‪٦٢‬‬
‫• ﺍﻟﻌﺯل‪ :‬ﻏﻴﺭ ﻋﻤﻠﻲ ﻓﻲ ﺍﻟﻤﺠﺘﻤﻊ ﺍﻟﻌﺎﻟﻡ‪ ،‬ﻭﺒﺎﻟﻨﺴﺒﺔ ﻟﻠﻤﺩﺍﺭﺱ ﻴﺠﺏ ﻋﺩﻡ ﺫﻫﺎﺏ ﺍﻷﻁﻔﺎل ﺍﻟﻤﺼﺎﺒﻴﻥ ﺇﻟﻰ ﺍﻟﻤﺩﺭﺴﺔ‬
‫ﻟﻤﺩﺓ )‪ (٤‬ﺃﻴﺎﻡ ﻋﻠﻰ ﺍﻷﻗل ﺒﻌﺩ ﻅﻬﻭﺭ ﺍﻟﻁﻔﺢ‪ ،‬ﺃﻤﺎ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻠﻤﺸﺎﻓﻲ‪ ،‬ﻓﺈﻥ ﺍﻟﻌﺯل ﺍﻟﺘﻨﻔﺴﻲ ﻤﻥ ﺒﺩﺀ ﺍﻟﻁﻭﺭ ﺍﻟﺘﺭﻟﻲ‬
‫ﻤﻥ ﺍﻟﻁﻭﺭ ﺍﻟﺒﺎﺩﺭﻱ ﺤﺘﻰ ﺍﻟﻴﻭﻡ ﺍﻟﺭﺍﺒﻊ ﺒﻌﺩ ﻅﻬﻭﺭ ﺍﻟﻁﻔﺢ‪ ،‬ﻴﻘﻠل ﻤﻥ ﺘﻌﺭﺽ ﺃﻁﻔﺎل ﺁﺨﺭﻴﻥ ﺃﻜﺜﺭ ﺨﻁﻭﺭﺓ‪.‬‬
‫• ﺍﻟﺘﻘﺼﻲ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻭﻋﻨﺩ ﺤﺩﻭﺙ ﻭﺒﺎﺀ ﻤﻥ ﻗﺒل ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﻓﻲ ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺼﺤﻴﺔ )ﻋﻥ‬
‫ﺍﻟﻌﺩﻭﻯ ﻭﻭﺠﻭﺩ ﺤﺎﻻﺕ ﺃﺨﺭﻯ ﺒﻴﻥ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﻭﺍﻟﺤﺎﻟﺔ ﺍﻟﺘﻤﻨﻌﻴﺔ ﻟﻬﻡ( ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﻓﺭﻴﻕ ﻟﺘﻘﺼﻲ ﻤﻥ ﺩﺍﺌﺭﺓ‬
‫ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ ﻭﺇﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ ﻭﺭﻓﻌﻬﺎ ﻟﻠﻤﺴﺘﻭﻯ ﺍﻷﻋﻠﻰ‪.‬‬
‫• ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﺫﻟﻙ ﺒﺈﻜﻤﺎل ﺍﻟﺠﺭﻋﺎﺕ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ ﻟﻠﻤﺨﺎﻟﻁﻴﻥ ﻟﻠﺤﺎﻟﺔ ﺍﻟﻤﺜﺒﺘﺔ‪ ،‬ﻭﺇﺭﺴﺎل ﺘﻘﺭﻴﺭ‬
‫ﺒﺎﻟﺘﻘﺼﻲ ﺍﻟﻭﺒﺎﺌﻲ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬
‫• ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﺤﻭل ﺍﻟﻤﺭﺽ ﻭﻷﻫﻤﻴﺔ ﺇﻋﻁﺎﺀ ﺍﻟﻠﻘﺎﺡ ﻟﻠﻭﻗﺎﻴﺔ ﻤﻥ ﺤﺩﻭﺙ ﺍﻟﻤﺭﺽ )ﻋﻨﺩ ﻅﻬﻭﺭ ﺤﺎﻟﺔ( ﻭﺫﻟﻙ‬
‫ﻟﻸﻫﺎﻟﻲ‪ .‬ﻭﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﻤﻥ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ ﻋﻨﺩ ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ )ﻋﻨﺩ ﺤﺩﻭﺙ ﻭﺒﺎﺀ(‪.‬‬
‫• ﺍﻟﻭﻗﺎﻴﺔ‪ :‬ﺇﻋﻁﺎﺀ ﺠﺭﻋﺘﻴﻥ ﻤﻥ ﻟﻘﺎﺡ ﺍﻟﺤﺼﺒﺔ ﻗﺒل ﺃﻥ ﻴﺘﻡ ﺍﻟﻁﻔل ﺍﻟﺴﻨﺔ ﺍﻟﺜﺎﻨﻴﺔ ﻤﻥ ﻋﻤﺭﻩ ﻀﻤﻥ ﻟﻘﺎﺡ ‪) MMR‬ﺍﻟﻤﻠﺤﻕ ‪.(١٠‬‬
‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻻﺕ ﻓﻲ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪ ،‬ﻭﺍﻷﺴﺒﻭﻋﻲ ﺍﻟﺼﻔﺭﻱ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(٦ - ٥ - ٤ - ٣‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫• ﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻠﺘﺭﺼﺩ ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻭﺍﻷﺴﺒﻭﻋﻲ ﺍﻟﺼﻔﺭﻱ )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ‬
‫‪ (٦‬ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ – ﺩﺍﺌﺭﺓ ﺼﺤﺔ ﺍﻟﻁﻔل‪ ،‬ﻭﻀﻤﻥ ﺘﻘﺭﻴﺭ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ‬
‫ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻓﻲ ﺍﻟﻭﺯﺍﺭﺓ )ﻤﻠﺤﻕ ﺭﻗﻡ ‪.(٣‬‬
‫‪ -‬ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻥ ﺍﻟﺤﺎﻻﺕ )ﻋﻨﺩ ﺤﺩﻭﺙ ﻭﺒﺎﺀ( ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ – ﺩﺍﺌﺭﺓ‬
‫ﺼﺤﺔ ﺍﻟﻁﻔل‪.‬‬
‫• ﺍﻟﺘﻘﺼﻲ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ )ﻋﻨﺩ ﺤﺩﻭﺙ ﻭﺒﺎﺀ(‪) ،‬ﻋﻥ ﺍﻹﺼﺎﺒﺔ ﻭﺘﺎﺭﻴﺨﻬﺎ ﻭﺍﻻﺴﻡ ﻭﺍﻟﻌﻤﺭ ﻭﺍﻟﺤﺎﻟﺔ‬
‫ﺍﻟﺘﻠﻘﻴﺤﻴﺔ ﻭﺍﻟﻌﻨﻭﺍﻥ(‪ ،‬ﻭﺍﻻﻫﺘﻤﺎﻡ ﺒﺸﻜل ﺨﺎﺹ ﺒﺎﻟﻤﺩﺍﺭﺱ‪ ،‬ﻭﺇﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(١٨‬‬
‫• ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﺨﻼل )‪ (٧٢‬ﺴﺎﻋﺔ ﻤﻥ ﺘﺎﺭﻴﺦ ﺍﻟﺘﻘﺼﻲ ﺤﻴﺙ ﻴﺘﻡ‪:‬‬
‫‪ -‬ﺘﻠﻘﻴﺢ ﺠﻤﻴﻊ ﺍﻷﻁﻔﺎل ﺩﻭﻥ ﺴﻥ ﺍﻹﺼﺎﺒﺔ ﻓﻲ ﻤﻨﻁﻘﺔ ﺍﻹﺼﺎﺒﺔ‪ ،‬ﺒﺠﺭﻋﺔ ﻤﻥ ﻟﻘﺎﺡ ﺍﻟﺤﺼﺒﺔ )ﺇﺫ ﺇﻥ ﺍﻟﻠﻘﺎﺡ ﻗﺩ‬
‫ﻴﻭﻓﺭ ﺍﻟﺤﻤﺎﻴﺔ ﺇﺫﺍ ﺃﻋﻁﻲ ﺨﻼل ‪ ٧٢‬ﺴﺎﻋﺔ ﻤﻥ ﺍﻟﺘﻌﺭﺽ(‪.‬‬
‫‪ -‬ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﺤﻭل ﺍﻟﻤﺭﺽ ﻭﻁﺭﻕ ﺍﻨﺘﻘﺎﻟﻪ ﻭﺍﻟﻭﻗﺎﻴﺔ ﻤﻨﻪ ﻭﺃﻫﻤﻴﺔ ﺍﻟﻠﻘﺎﺡ ﻓﻲ ﺫﻟﻙ‪ ،‬ﻭﺫﻟﻙ ﻟﻸﻤﻬﺎﺕ ﻭﺍﻷﻫﺎﻟﻲ‪.‬‬
‫ﻭﻴﺠﺏ ﺇﺭﺴﺎل ﺘﻘﺭﻴﺭ ﻋﻥ ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻫﺫﻩ ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ – ﻤﺩﻴﺭﻴﺔ‬
‫ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ – ﺩﺍﺌﺭﺓ ﺼﺤﺔ ﺍﻟﻁﻔل‪ ،‬ﺒﻌﺩ ﺍﻻﺤﺘﻔﺎﻅ ﺒﻨﺴﺨﺔ ﻤﻨﻬﺎ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻋﻠﻰ ﻭﺒﺎﺌﻴﺎﺕ ﺍﻟﻤﺭﺽ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ )ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ(‪.‬‬
‫• ﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪ ،‬ﻭﺇﻋﺩﺍﺩ ﺘﻐﺫﻴﺔ ﺭﺍﺠﻌﺔ ﺒﺫﻟﻙ‪ ،‬ﻭﺇﺭﺴﺎل ﺘﻘﺭﻴﺭ ﺤﻭل ﺫﻟﻙ ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ – ﺩﺍﺌﺭﺓ ﺼﺤﺔ ﺍﻟﻁﻔل‪.‬‬

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 ‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬
‫• ﺘﻠﻘﻲ ﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻭﺍﻷﺴﺒﻭﻋﻲ ﺍﻟﺼﻔﺭﻱ ﻟﻠﺘﺭﺼﺩ )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ ‪.(٦ ،٥ ،٤ ،٣‬‬
‫• ﺘﻠﻘﻲ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﺘﻘﺼﻲ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﺤﺎﻻﺕ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ )ﻋﻨﺩ ﺤﺩﻭﺙ ﻭﺒﺎﺀ( ﻭﺘﺤﻠﻴﻠﻬﺎ‬
‫ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻴﻬﺎ ﻭﺘﻘﻴﻴﻤﻬﺎ ﻭﺇﻋﺩﺍﺩ ﺘﻐﺫﻴﺔ ﺭﺍﺠﻌﺔ ﻭﺘﻘﺩﻴﻡ ﺍﻟﺩﻋﻡ ﻭﺍﻟﻤﺴﺎﻋﺩﺓ ﺤﻴﻥ ﺍﻟﻠﺯﻭﻡ‪.‬‬
‫• ﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻠﻘﻴﺢ ﻓﻲ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﻭﺘﻭﻓﻴﺭ ﻤﺴﺘﻠﺯﻤﺎﺘﻪ )ﻤﺤﺎﻗﻥ‪ ،‬ﺤﺎﻓﻅﺎﺕ ﺍﻟﻠﻘﺎﺡ ‪ ...‬ﺇﻟﺦ(‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻋﻠﻰ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ )ﻟﺠﻤﻴﻊ ﺍﻟﻤﺴﺘﻭﻴﺎﺕ ﻭﺠﻤﻴﻊ ﺍﻟﻘﻁﺎﻋﺎﺕ(‪.‬‬
‫• ﻭﻀﻊ ﺨﻁﺔ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﻤﺭﺽ‪.‬‬
‫• ﺍﻟﺘﻨﺴﻴﻕ ﻭﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ )ﺍﻟﻘﻁﺎﻋﺎﺕ ﺍﻟﺼﺤﻴﺔ‪ ،‬ﺍﻹﻋﻼﻡ‪ ،‬ﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺸﻌﺒﻴﺔ‪ ،‬ﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ(‪.‬‬
‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻻﺕ ﻓﻲ ﺍﻟﺴﺠل ﺍﻟﻭﻁﻨﻲ ﻟﺤﺎﻻﺕ ﺍﻟﺤﺼﺒﺔ ﻭﺍﻟﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ‪.‬‬

‫ﺨﻁﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ‬
‫• ﺍﻟﻤﻌﺎﻟﺠﺔ ﻋﺎﺩﺓ ﻋﺭﻀﻴﺔ‪ :‬ﻜﺈﻋﻁﺎﺀ ﺨﺎﻓﻀﺎﺕ ﺍﻟﺤﺭﺍﺭﺓ‪.‬‬
‫• ﺇﻥ ﻟﻠﻔﻴﺘﺎﻤﻴﻥ ‪ A‬ﺩﻭﺭﹰﺍ ﺃﺴﺎﺴﻴﹰﺎ ﻓﻲ ﺘﺨﻔﻴﺽ ﻤﻌﺩل ﺍﻹﻤﺎﺘﺔ‪ ،‬ﺨﺎﺼﺔ ﻋﻨﺩ ﻭﺠﻭﺩ ﺃﻋﺭﺍﺽ ﻨﻘﺹ ﺘﻐﺫﻴﺔ‪ ،‬ﻭﻴﻌﻁﻰ‬
‫ﺍﻟﻔﻴﺘﺎﻤﻴﻥ ‪ A‬ﻜﺎﻟﺘﺎﻟﻲ‪:‬‬
‫‪ ١٠٠‬ﺃﻟﻑ ﻭﺤﺩﺓ ﻤﺒﺎﺸﺭﺓ ﻋﻨﺩ ﺍﻟﺘﺸﺨﻴﺹ‪.‬‬ ‫‪ -‬ﺒﻌﻤﺭ ﺩﻭﻥ ﺍﻟﺴﻨﺔ‪:‬‬
‫ﻭ‪ ١٠٠‬ﺃﻟﻑ ﻭﺤﺩﺓ ﻓﻲ ﺍﻟﻴﻭﻡ ﺍﻟﺘﺎﻟﻲ‪.‬‬

‫‪ -‬ﺒﻌﻤﺭ ﺍﻟﺴﻨﺔ ﻓﻤﺎ ﻓﻭﻕ‪ ٢٠٠ :‬ﺃﻟﻑ ﻭﺤﺩﺓ ﻤﺒﺎﺸﺭﺓ ﻋﻨﺩ ﺍﻟﺘﺸﺨﻴﺹ‬
‫ﻭ‪ ٢٠٠‬ﺃﻟﻑ ﻭﺤﺩﺓ ﻓﻲ ﺍﻟﻴﻭﻡ ﺍﻟﺘﺎﻟﻲ‪.‬‬

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 ‫א‪ ‬א‪ RUBELLA‬‬
‫א‪ ‬א‪‬א‪  CONGENITAL RUBELLA‬‬
‫ﻤﻘﺩﻤﺔ‪:‬‬
‫ﻤﺭﺽ ﻓﻴﺭﻭﺴﻲ ﺤﻤﻭﻱ ﺨﻔﻴﻑ ﻤﻊ ﻁﻔﺢ ﻤﻨﹼﺸﺭ ﻤﻨﻘﻁ ﻭﺒﻘﻌﻲ ﺤﻁﺎﻁﻲ ﻴﺸﺒﻪ ﺃﺤﻴﺎﻨﹰﺎ ﻁﻔﺢ ﺍﻟﺤﺼﺒﺔ ﺃﻭ ﺍﻟﺤﻤﻰ‬
‫ﺍﻟﻘﺭﻤﺯﻴﺔ‪ ،‬ﻭﻓﻲ ﺍﻷﻁﻔﺎل ﻗﺩ ﺘﻭﺠﺩ ﺃﻋﺭﺍﺽ ﻋﺎﻤﺔ ﻗﻠﻴﻠﺔ ﺃﻭ ﻻ ﺘﻭﺠﺩ ﺃﻤﺎ ﺍﻟﺒﺎﻟﻐﻭﻥ ﻓﻘﺩ ﺘﺤﺩﺙ ﻟﺩﻴﻬﻡ ﺒﺎﺩﺭﺓ ﻟﻤﺩﺓ )‪-١‬‬
‫‪ (٥‬ﺃﻴﺎﻡ ﻤﻥ ﺤﻤﻰ ﺨﻔﻴﻔﺔ ﻭﺼﺩﺍﻉ ﻭﻓﺘﻭﺭ ﻭﺯﻜﺎﻡ ﺨﻔﻴﻑ ﻭﺍﻟﺘﻬﺎﺏ ﻤﻠﺘﺤﻤﺔ‪ ،‬ﻭﻴﺴﺒﻕ ﺍﻟﻁﻔﺢ ﺒـ)‪ (١٠-٦‬ﺃﻴﺎﻡ ﻀﺨﺎﻤﺔ‬
‫ﻋﻘﺩﻴﺔ ﻟﻤﻔﻴﺔ ﺨﻠﻑ ﺍﻷﺫﻥ ﺃﻭ ﺘﺤﺕ ﺍﻟﻘﺫﺍل ﺃﻭ ﺨﻠﻑ ﺍﻟﻌﻨﻕ‪ ،‬ﻭﻗﺩ ﻴﺤﺩﺙ ﻤﺎ ﻴﻘﺭﺏ ﻤﻥ ﻨﺼﻑ ﺍﻟﻌﺩﻭﻯ ﺒﺩﻭﻥ ﻁﻔﺢ‬
‫ﻭﺍﻀﺢ‪.‬‬

‫ﻗﺩ ﻴﺤﺩﺙ ﻗﻠﺔ ﺍﻟﺼﻔﻴﺤﺎﺕ ﻭﺍﻟﻜﺭﻴﺎﺕ ﺍﻟﺒﻴﺽ ﻭﺃﻟﻡ ﺍﻟﻤﻔﺼل ﻭﺍﻟﺘﻬﺎﺒﻪ ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﺩﻤﺎﻍ ﻜﻤﻀﺎﻋﻔﺔ ﻟﻠﻤﺭﺽ‪.‬‬

‫ﻭﺘﻜﻤﻥ ﺃﻫﻤﻴﺔ ﺍﻟﻤﺭﺽ ﺒﺴﺒﺏ ﻗﺩﺭﺘﻪ ﻋﻠﻰ ﺇﺤﺩﺍﺙ ﺍﻟﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ ﺍﻟﺨﻠﻘﻴﺔ ﻭﻫﻲ ﺘﺤﺩﺙ ﻟﺩﻯ ‪ %٩٠‬ﻤﻥ‬
‫ﺍﻟﺭﻀﻊ ﺍﻟﻤﻭﻟﻭﺩﻴﻥ ﻤﻥ ﻨﺴﺎﺀ ﻤﺼﺎﺒﺎﺕ ﺃﺜﻨﺎﺀ ﺍﻟﺜﻠﺙ ﺍﻷﻭل ﻤﻥ ﺍﻟﺤﻤل‪ ،‬ﻭﻴﻬﺒﻁ ﺨﻁﺭ ﺍﻟﺤﺩﻭﺙ ﺇﻟﻰ ‪%٢٠-١٠‬‬
‫ﺒﺤﻠﻭل ﺍﻷﺴﺒﻭﻉ ﺍﻟﺴﺎﺩﺱ ﻋﺸﺭ ﻭﻴﺼﺒﺢ ﻨﺎﺩﺭﹰﺍ ﺒﻌﺩ ﺍﻷﺴﺒﻭﻉ ﺍﻟﻌﺸﺭﻴﻥ‪.‬‬

‫ﻭﺍﻷﺠﻨﺔ ﺍﻟﻤﺼﺎﺒﺔ ﺒﺎﻟﻌﺩﻭﻯ ﻓﻲ ﻭﻗﺕ ﻤﺒﻜﺭ ﻫﻲ ﺍﻷﻜﺜﺭ ﺘﻌﺭﻀﹰﺎ ﻟﻠﻤﻭﺕ ﺩﺍﺨل ﺍﻟﺭﺤﻡ ﻭﺍﻹﺠﻬﺎﺽ ﻭﺍﻟﺘﺸﻭﻫﺎﺕ‬
‫ﺍﻟﺨﻠﻘﻴﺔ ﻷﺠﻬﺯﺓ ﻭﺃﻋﻀﺎﺀ ﺍﻟﺠﺴﻡ ﻭﺘﺸﻤل‪ :‬ﺍﻟﺼﻤﻡ‪ ،‬ﺍﻟﺴﺎﺩ‪ ،‬ﺍﻟﺯﺭﻕ ﺍﻟﺨﻠﻘﻲ‪ ،‬ﺼﻐﺭ ﺍﻟﺩﻤﺎﻍ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ‬
‫ﻭﺍﻟﺩﻤﺎﻍ‪ ،‬ﺘﺨﻠﻑ ﻋﻘﻠﻲ‪ ،‬ﻗﻨﺎﺓ ﺸﺭﻴﺎﻨﻴﺔ ﺴﺎﻟﻜﺔ‪ ،‬ﻋﻴﻭﺏ ﺍﻟﺤﻭﺍﺠﺯ ﺍﻷﺫﻴﻨﺔ ﺍﻟﺒﻁﻨﻴﺔ ﺃﻭ ﻀﺨﺎﻤﺔ ﻜﺒﺩ ﻭﻁﺤﺎل ﻭﻏﻴﺭﻫﺎ‪.‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﻓﻴﺭﻭﺱ ﺍﻟﺤﻤﻴﺭﺍﺀ ‪.RUBELLA Virus‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﺭﻴﺽ‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﺍﻟﺘﻤﺎﺱ ﻤﻊ ﻤﻔﺭﺯﺍﺕ ﺍﻟﺒﻠﻌﻭﻡ ﺍﻷﻨﻔﻲ ﻷﺸﺨﺎﺹ ﻤﺼﺎﺒﻴﻥ ﺒﺎﻟﻌﺩﻭﻯ ﻭﺫﻟﻙ ﺒﺎﻻﻨﺘﺸﺎﺭ ﺒﺎﻟﻘﻁﻴﺭﺍﺕ ﺃﻭ ﺒﺎﻟﺘﻤﺎﺱ ﺍﻟﻤﺒﺎﺸﺭ‬
‫ﻤﻊ ﺍﻟﻤﺭﻀﻰ‪.‬‬

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 ‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫• ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﻌﺩﻭﻯ ﻋﺎﻡ ﺒﻌﺩ ﻓﻘﺩﺍﻥ ﺍﻷﻀﺩﺍﺩ ﺍﻟﺩﻤﻭﻴﺔ ﺍﻟﻤﻜﺘﺴﺒﺔ ﻏﺒﺭ ﺍﻟﻤﺸﻴﻤﺔ‪.‬‬
‫• ﺍﻟﻤﻨﺎﻋﺔ ﺒﻌﺩ ﺍﻟﻌﺩﻭﻯ ﺍﻟﻁﺒﻴﻌﻴﺔ ﺩﺍﺌﻤﺔ ﻭﻁﻭﻴﻠﺔ ﺍﻷﺠل ﻭﺭﺒﻤﺎ ﻤﺴﺘﺩﻴﻤﺔ ﺒﻌﺩ ﺍﻟﺘﻠﻘﻴﺢ‪ .‬ﺃﻤﺎ ﺍﻟﺭﻀﻊ ﺍﻟﻤﻭﻟﻭﺩﻴﻥ ﻤﻥ‬
‫ﺃﻤﻬﺎﺕ ﻤﻨﻴﻌﺎﺕ ﻓﻬﻡ ﻤﺤﻤﻴﻴﻥ ﻟﻤﺩﺓ ‪ ٩-٦‬ﺃﺸﻬﺭ ﺒﻌﺩ ﺍﻟﻭﻻﺩﺓ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫)‪ (١٨-١٦‬ﻴﻭﻡ ﻀﻤﻥ ﻤﺠﺎل ﻴﺘﺭﺍﻭﺡ )‪ (٢٢-١٤‬ﻴﻭﻡ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻴﺒﺩﺃ ﻗﺒل ﺃﺴﺒﻭﻉ ﻤﻥ ﺒﺩﺀ ﺍﻟﻁﻔﺢ ﻭﺒﻌﺩ )‪ (٤‬ﺃﻴﺎﻡ ﻋﻠﻰ ﺍﻷﻗل ﻤﻥ ﻅﻬﻭﺭﻩ ﻭﺍﻟﻤﺭﺽ ﺸﺩﻴﺩ ﺍﻟﺴﺭﺍﻴﺔ ﺨﺎﺼﺔ ﻟﺩﻯ‬
‫ﺍﻟﺭﻀﻊ ﺍﻟﻤﺼﺎﺒﻭﻥ ﺒﺎﻟﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ ﺍﻟﺨﻠﻘﻴﺔ ﺍﻟﺫﻱ ﻴﺴﺘﻤﺭﻭﻥ ﺒﻁﺭﺡ ﺍﻟﻔﻴﺭﻭﺱ ﻟﻌﺩﺓ ﺸﻬﻭﺭ‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﻴﺘﻡ ﻋﻠﻰ ﺃﺴﺱ ﺴﺭﻴﺭﻴﺔ )ﻏﺎﻟﺒ ﹰﺎ ﻤﺎ ﻴﻜﻭﻥ ﻏﻴﺭ ﺩﻗﻴﻕ( ﻭﻭﺒﺎﺌﻴﺔ‪ ،‬ﻭﻴﺘﻡ ﺍﻟﺘﺜﺒﺕ ﻤﻨﻪ ﺒﺎﻟﻔﺤﺹ ﺍﻟﻤﺨﺒﺭﻱ ﺤﻴﺙ‬
‫ﻴﺭﺘﻔﻊ ﻋﻴﺎﺭ ﺍﻷﻀﺩﺍﺩ ﺍﻟﻨﻭﻋﻴﺔ )‪ (٤‬ﺃﻀﻌﺎﻑ ﻓﻲ ﻨﻤﺎﺫﺝ ﺍﻟﻤﺼل ﺍﻟﻤﺄﺨﻭﺫﺓ ﺨﻼل ﺍﻟﻁﻭﺭ ﺍﻟﺤﺎﺩ ﻭﻁﻭﺭ ﺍﻟﻨﻘﺎﻫﺔ‬
‫ﻭﻴﺘﻀﻤﻥ‪ :‬ﺘﺜﺒﻴﻁ ﺍﻟﺘﺭﺍﺹ ﺍﻟﺩﻤﻭﻱ ‪ HAI‬ﺃﻭ ﺘﺭﺍﺹ ﺍﻟﻼﺘﻜﺱ ﺃﻭ ﺍﻻﻴﻠﻴﺯﺍ ‪ ELISA‬ﺃﻭ ﺇﻅﻬﺎﺭ ﻭﺠﻭﺩ ﺍﻟـ‪IgM‬‬
‫ﺍﻟﻨﻭﻋﻲ ﺍﻟﺫﻱ ﻴﺩل ﻋﻠﻰ ﻋﺩﻭﻯ ﺤﺩﻴﺜﺔ ﻭﻫﻭ ﺍﻷﻜﺜﺭ ﺸﻴﻭﻋﹰﺎ‪.‬‬

‫ﻭﻴﻤﻜﻥ ﺍﺴﺘﻔﺭﺍﺩ ﺍﻟﻔﻴﺭﻭﺱ ﻤﻥ ﺍﻟﺒﻠﻌﻭﻡ ﺃﻭ ﺍﻟﺒﻭل ﻭﺍﻟﺒﺭﺍﺯ‪ ،‬ﻭﻜﻤﺎ ﻓﻲ ﻤﺭﺽ ﺍﻟﺤﺼﺒﺔ ﺘﺅﺨﺫ ﺍﻟﻌﻴﻨﺔ ﻤﻥ ﺍﻟﺤﺎﻻﺕ‬
‫ﺍﻟﻤﺸﺘﺒﻬﺔ ﻭﺘﻔﺤﺹ ﻓﻲ ﻤﺨﺒﺭ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ ﻟﻠﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ ﺒﻌﺩ ﻨﻔﻲ ﻭﺠﻭﺩ ﺍﻟﺤﺼﺒﺔ‪.‬‬

‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ ﻟﻠﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ‬

‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ‪ :‬ﺤﺭﺍﺭﺓ ﻭﻁﻔﺢ ﺤﻁﺎﻁﻲ ﻤﻊ ﻭﺍﺤﺩ ﻤﻥ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺘﺎﻟﻴﺔ‪ :‬ﻀﺨﺎﻤﺔ ﻋﻘﺩ ﻟﻤﻔﺎﻭﻴﺔ ﺭﻗﺒﻴﺔ ﺃﻭ‬
‫ﺘﺤﺕ ﺍﻟﻘﺫﺍل ﺃﻭ ﺨﻠﻑ ﺍﻷﺫﻥ ﺃﻭ ﺍﻟﺘﻬﺎﺏ ﻤﻔﺼل‪ /‬ﺃﻟﻡ ﻤﻔﺼل‪.‬‬
‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺜﺒﺘﺔ ﻤﺨﺒﺭﻴﹰﺎ‪ :‬ﺤﺎﻟﺔ ﻤﺸﺘﺒﻬﺔ ﻤﻊ ﺘﺄﻜﻴﺩ ﻤﺨﺒﺭﻱ‪.‬‬
‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺜﺒﺘﺔ ﻭﺒﺎﺌﻴﹰﺎ‪ :‬ﺤﺎﻟﺔ ﻁﻔﺢ ﻤﻊ ﺤﺭﺍﺭﺓ ﻟﺩﻯ ﻤﺭﻴﺽ ﻟﻡ ﻨﺴﺘﻁﻊ ﺃﺨﺫ ﻋﻴﻨﺔ ﺩﻤﻭﻴﺔ ﻤﻨﻪ ﻤﺭﺘﺒﻁﺔ ﻭﺒﺎﺌﻴﹰﺎ ﻤﻊ‬
‫ﺤﺎﻟﺔ ﻤﺜﺒﺘﺔ ﻤﺨﺒﺭﻴ ﹰﺎ‪.‬‬

‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ ﻟﻠﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ ﺍﻟﺨﻠﻘﻴﺔ‬

‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ‪ :‬ﻟﺩﻯ ﺭﻀﻴﻊ ﺒﻌﻤﺭ ﺃﻗل ﻤﻥ ﺴﻨﺔ ﻭﻴﺸﻙ ﺒﻬﺎ ﻋﻨﺩﻤﺎ ﻴﻜﻭﻥ ﻫﻨﺎﻙ ﻗﺼﺔ ﻹﺼﺎﺒﺔ ﺍﻷﻡ ﺃﺜﻨﺎﺀ ﺍﻟﺤﻤل‬
‫ﺒﺤﺼﺒﺔ ﺃﻟﻤﺎﻨﻴﺔ ﻤﺸﺘﺒﻬﺔ ﺃﻭ ﻤﺜﺒﺘﺔ‪.‬‬

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‫ﺃﻭ ﻋﻨﺩﻤﺎ ﻴﻜﻭﻥ ﺍﻟﻤﻭﻟﻭﺩ ﻤﺼﺎﺒﹰﺎ ﺒﺂﻓﺔ ﻗﻠﺒﻴﺔ ﺃﻭ ﺘﻭﻗﻊ ﻭﺠﻭﺩ ﺼﻤﻡ ﻤﻊ ﻭﺍﺤﺩ ﺃﻭ ﺃﻜﺜﺭ ﻤﻥ ﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﻌﻴﻨﻴﺔ‪ :‬ﺤﺩﻗﺔ‬
‫ﺒﻴﻀﺎﺀ )ﺴﺎﺩ( ﻨﻘﺹ ﻓﻲ ﺍﻟﺭﺅﻴﺔ‪ ،‬ﺼﻐﺭ ﺤﺠﻡ ﺍﻟﻌﻴﻥ‪ ،‬ﻜﺒﺭ ﺤﺠﻡ ﺍﻟﻌﻴﻥ ﻭﺯﺭﻕ ﺨﻠﻘﻲ ﻭﻫﻲ ﺘﻜﺸﻑ ﻤﻥ ﺍﻟﻌﺎﻤل‬
‫ﺍﻟﺼﺤﻲ ﻭﺘﺤﺎل ﺇﻟﻰ ﻁﺒﻴﺏ ﻤﺅﻫل‪.‬‬
‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺜﺒﺘﺔ ﺴﺭﻴﺭﻴﹰﺎ‪ :‬ﺍﻟﺤﺎﻟﺔ ﺍﻟﺘﻲ ﻴﻜﺸﻑ ﻓﻴﻬﺎ ﺍﺜﻨﻴﻥ ﻤﻥ ﺍﻟﻌﻼﻤﺎﺕ ﻓﻲ ﺍﻟﻤﺠﻤﻭﻋﺔ ‪ A‬ﺃﻭ ﻋﻼﻤﺔ ﻤﻥ‬
‫ﺍﻟﻤﺠﻤﻭﻋﺔ ‪ A‬ﻭﻋﻼﻤﺔ ﻤﻥ ﺍﻟﻤﺠﻤﻭﻋﺔ ‪.B‬‬
‫ﺍﻟﻤﺠﻤﻭﻋﺔ ‪ :A‬ﺴﺎﺩ ﻤﻊ ﺃﻭ ﺯﺭﻕ ﺨﻠﻘﻲ‪ ،‬ﺁﻓﺔ ﻗﻠﺒﻴﺔ ﺨﻠﻘﻴﺔ‪ ،‬ﻓﻘﺩ ﺴﻤﻊ ﺨﻠﻘﻲ ﺍﻟﻤﻨﺸﺄ‪ ،‬ﺍﻋﺘﻼل ﺸﺒﻜﻴﺔ ﺼﺒﺎﻏﻲ‪.‬‬
‫ﺍﻟﻤﺠﻤﻭﻋﺔ ‪ : B‬ﺍﻟﻔﺭﻓﺭﻴﺔ‪ ،‬ﺘﻀﺨﻡ ﻁﺤﺎل‪ ،‬ﺼﻐﺭ ﺤﺠﻡ ﺍﻟﺭﺃﺱ‪ ،‬ﺘﺨﻠﻑ ﻋﻘﻠﻲ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﺴﺤﺎﻴﺎ‪ ،‬ﺃﻤﺭﺍﺽ ﺘﺭﻗﻕ‬
‫ﺍﻟﻌﻅﺎﻡ‪ ،‬ﻴﺭﻗﺎﻥ ﻴﺒﺩﺃ ﺨﻼل ‪ ٢٤‬ﺴﺎﻋﺔ ﻤﻥ ﺍﻟﻭﻻﺩﺓ ﻭﻫﻲ ﺘﻜﺸﻑ ﻤﻥ ﻗﺒل ﻁﺒﻴﺏ ﻤﺅﻫل‪.‬‬
‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺜﺒﺘﺔ ﻤﺨﺒﺭﻴﹰﺎ‪ :‬ﺤﺎﻟﺔ ﻤﺜﺒﺘﺔ ﺴﺭﻴﺭﻴ ﹰﺎ ﻋﻨﺩ ﺭﻀﻴﻊ ﻤﻊ ﺇﻴﺠﺎﺒﻴﺔ ﻓﺤﺹ ﺍﻟﺩﻡ ﻟﻠـ ‪.IgM‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻭﺍﺠﺏ ﺍﺘﺨﺎﺫﻫﺎ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬
‫• ﺍﻟﻜﺸﻑ ﺍﻟﻤﺒﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺤﺴﺏ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ ﻭﺃﺨﺫ ﻋﻴﻨﺔ ﺩﻤﻭﻴﺔ )‪ (٠.٥‬ﻤل ﻟﻠﻔﺤﺹ ﺍﻟﻤﺨﺒﺭﻱ‪ ،‬ﺤﻴﺙ‬
‫ﺘﻔﺤﺹ ﻟﺘﺄﻜﻴﺩ ﺍﻟﺘﺸﺨﻴﺹ ﺒﺎﻟﺤﺼﺒﺔ ﻭﻓﻲ ﺤﺎل ﺍﻟﺴﻠﺒﻴﺔ ﺘﻔﺤﺹ ﻟﺘﺄﻜﻴﺩ ﺍﻟﺘﺸﺨﻴﺹ ﺒﺎﻟﺨﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ‪.‬‬
‫• ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻥ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ )ﺒﺎﻟﻔﺎﻜﺱ ﺃﻭ ﺍﻟﻬﺎﺘﻑ( ﻭﻋﻥ ﺤﺩﻭﺙ ﻭﺒﺎﺀ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬
‫• ﺍﻟﻤﻌﺎﻟﺠﺔ‪ :‬ﻻ ﻴﻭﺠﺩ ﻋﻼﺝ ﻨﻭﻋﻲ‪.‬‬
‫• ﺍﻟﻌﺯل‪ :‬ﻓﻲ ﺍﻟﻤﺴﺘﺸﻔﻴﺎﺕ ﻭﺍﻟﻤﺅﺴﺴﺎﺕ ﻴﻨﺒﻐﻲ ﺘﺩﺒﻴﺭ ﺍﻟﻤﺭﻀﻰ ﺍﻟﻤﺸﺘﺒﻪ ﺒﺈﺼﺎﺒﺘﻬﻡ ﺒﺎﻟﻤﺭﺽ ﻓﻲ ﻏﺭﻑ ﺨﺎﺼﺔ‬
‫ﻭﺘﺤﺕ ﺇﺠﺭﺍﺀﺍﺕ ﻋﺯل ﺍﻟﺘﻤﺎﺱ‪ .‬ﻭﻴﺴﺘﺒﻌﺩ ﺍﻷﻁﻔﺎل ﻤﻥ ﺍﻟﻤﺩﺍﺭﺱ ﻭﺍﻟﺒﺎﻟﻐﻭﻥ ﻤﻥ ﺍﻟﻌﻤل ﻟﻤﺩ )‪ (٧‬ﺃﻴﺎﻡ ﺒﻌﺩ ﺒﺩﺀ‬
‫ﺍﻟﻁﻔﺢ ﻭﻴﻨﺒﻐﻲ ﻤﺤﺎﻭﻟﺔ ﻤﻨﻊ ﺘﻌﺭﺽ ﺍﻟﻨﺴﺎﺀ ﺍﻟﺤﻭﺍﻤل ﻏﻴﺭ ﺍﻟﻤﻨﻴﻌﺎﺕ‪ .‬ﺃﻤﺎ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻠﺭﻀﻊ ﺍﻟﻤﺼﺎﺒﻭﻥ ﺒﺎﻟﺤﺼﺒﺔ‬
‫ﺍﻷﻟﻤﺎﻨﻴﺔ ﺍﻟﺨﻠﻘﻴﺔ ﻨﻅﺭﹰﺍ ﻷﻨﻬﻡ ﻗﺩ ﻴﻨﺸﺭﻭﻥ ﺍﻟﻔﻴﺭﻭﺱ ﻟﻔﺘﺭﺓ ﻁﻭﻴﻠﺔ ﻟﺫﺍ ﻴﺠﺏ ﻋﺯﻟﻬﻡ ﻭﺘﻤﻨﻴﻊ ﻜل ﻤﺨﺎﻟﻁﻴﻬﻡ‪.‬‬
‫• ﺍﻟﺘﻘﺼﻲ ﺍﻟﻭﺒﺎﺌﻲ ﻭﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻜﻤﺎ ﻫﻭ ﻭﺍﺭﺩ ﻓﻲ ﺒﺤﺙ ﺍﻟﺤﺼﺒﺔ‪.‬‬
‫• ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﻟﻸﻫﺎﻟﻲ‪.‬‬
‫• ﺍﻟﻭﻗﺎﻴﺔ ﺒﺈﻋﻁﺎﺀ ﺍﻟﻠﻘﺎﺡ ﺍﻟﺜﻼﺜﻲ )‪ (MMR‬ﺒﺠﺭﻋﺘﻴﻥ ﻗﺒل ﺃﻥ ﻴﻜﻤل ﺍﻟﻁﻔل ﺍﻟﺴﻨﺔ ﺍﻟﺜﺎﻨﻴﺔ ﻤﻥ ﻋﻤﺭﻩ‪ ،‬ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(١٠‬‬
‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻻﺕ ﻓﻲ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻷﺴﺒﻭﻋﻲ ﺍﻟﺼﻔﺭﻱ )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ ‪.(٦ ،٥ ،٤ ،٣‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫• ﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻠﺘﺭﺼﺩ ﻭﺍﻷﺴﺒﻭﻋﻲ ﺍﻟﺼﻔﺭﻱ ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ‬
‫ﺍﻟﺼﺤﻴﺔ ﻭﻀﻤﻥ ﺘﻘﺭﻴﺭ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ ‪.(٣‬‬
‫• ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻥ ﺍﻟﺤﺎﻻﺕ )ﻋﻨﺩ ﺤﺩﻭﺙ ﻭﺒﺎﺀ( ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ – ﺩﺍﺌﺭﺓ ﺼﺤﺔ‬
‫ﺍﻟﻁﻔل‪.‬‬

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‫• ﺍﻟﺘﻘﺼﻲ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﺤﺎﻻﺕ ﺍﻟﻤﺜﺒﺘﺔ ﻭﻋﻨﺩ ﺤﺩﻭﺙ ﻭﺒﺎﺀ ﻜﻤﺎ ﻓﻲ ﻤﺭﺽ ﺍﻟﺤﺼﺒﺔ ﻭﺘﻘﺼﻲ ﺤﺎﻻﺕ ﺍﻟﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ‬
‫ﺍﻟﺨﻠﻘﻴﺔ ﻭﺇﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺍﺕ ﺍﻟﺘﻘﺼﻲ‪ ،‬ﻤﻠﺤﻕ ﺭﻗﻡ )‪.(١٩ - ١٨‬‬
‫• ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺨﻼل ‪ ٧٢‬ﺴﺎﻋﺔ ﻤﻥ ﺘﺎﺭﻴﺦ ﺍﻟﺘﻘﺼﻲ ﻭﺘﺘﻀﻤﻥ‪:‬‬
‫‪ -‬ﺍﻟﺒﺤﺙ ﻋﻥ ﺍﻷﻁﻔﺎل ﺍﻟﻐﻴﺭ ﻤﻤﻨﻌﻴﻥ ﻓﻲ ﻤﻨﻁﻘﺔ ﺍﻹﺼﺎﺒﺔ ﻭﺘﻠﻘﻴﺢ ﻏﻴﺭ ﺍﻟﻤﻠﻘﺤﻴﻥ ﻤﻨﻬﻡ‪.‬‬
‫‪ -‬ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﻟﻸﻤﻬﺎﺕ ﻭﺍﻷﻫﺎﻟﻲ‪.‬‬
‫ﻭﻴﺠﺏ ﺇﺭﺴﺎل ﺘﻘﺭﻴﺭ ﻋﻥ ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ – ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ‬
‫ﺍﻟﺼﺤﻴﺔ – ﺩﺍﺌﺭﺓ ﺼﺤﺔ ﺍﻟﻁﻔل ﺒﻌﺩ ﺍﻻﺤﺘﻔﺎﻅ ﺒﻨﺴﺨﺔ ﻤﻨﻬﺎ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻜﻤﺎ ﻓﻲ ﻤﺭﺽ ﺍﻟﺤﺼﺒﺔ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬

‫‪‬‬ ‫ﻨﻔﺱ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﺨﺎﺼﺔ ﺒﻤﺭﺽ ﺍﻟﺤﺼﺒﺔ‪.‬‬

‫‪٦٨‬‬
 ‫‪‬‬
‫א‪‬א‪F‬א‪‬א‪‬א‪‬א‪ E‬‬
‫ﺍﻟﺘﻌﺭﻴﻑ‪:‬‬
‫ﺍﻟﻜﺭﻴﺏ ﻤﺭﺽ ﺘﻨﻔﺴﻲ ﺸﺩﻴﺩ ﺍﻟﺴﺭﺍﻴﺔ ﻴﻨﺠﻡ ﻋﻥ ﺯﻤﺭﺓ ﻤﻥ ﻓﻴﺭﻭﺴﺎﺕ ﺍﻷﻨﻔﻠﻭﻨﺯﺍ ‪) A‬ﻟﻠﻔﻴﺭﻭﺱ ﺜﻼﺜﺔ ﺃﻨﻤﺎﻁ‬
‫ﺭﺌﻴﺴﻴﺔ ‪.(A, B, C‬‬
‫ﻴﺘﻅﺎﻫﺭ ﺍﻟﻤﺭﺽ ﺒﻤﺠﻤﻭﻋﺔ ﻤﻥ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ ﺍﻟﺘﺎﻟﻴﺔ‪:‬‬
‫ﺘﺭﻓﻊ ﺤﺭﻭﺭﻱ ﻓﻭﻕ ﺍﻟـ ‪ ،٣٨‬ﺍﻟﺴﻌﺎل‪ ،‬ﺃﻟﻡ ﺒﻠﻌﻭﻡ‪ ،‬ﺍﻟﺴﻴﻼﻥ ﺍﻷﻨﻔﻲ‪ ،‬ﺍﻵﻻﻡ ﺍﻟﻌﻀﻠﻴﺔ ﻭﺍﻟﻤﻔﺼﻠﻴﺔ‪ ،‬ﺍﻟﻀﻌﻑ‬
‫ﻭﺍﻟﺘﻌﺏ‪ ،‬ﺍﻟﻌﺭﻭﺍﺀﺍﺕ‪ ،‬ﻭﻗﺩ ﻴﺤﺩﺙ ﻓﻲ ﺒﻌﺽ ﺃﻨﻤﺎﻁ ﺍﻟﻤﺭﺽ )ﻜﺎﻷﻨﻔﻠﻭﻨﺯﺍ ﺍﻟﺠﺎﺌﺤﻴﺔ ‪ (A/H1N1‬ﺍﻹﺴﻬﺎل ﻭﺍﻹﻗﻴﺎﺀ‬
‫ﺘﺘﺭﺍﻭﺡ ﺸﺩﺓ ﺍﻟﻤﺭﺽ ﺒﻴﻥ ﺨﻤﺞ ﻻ ﻋﺭﻀﻲ ﺇﻟﻰ ﻤﺭﺽ ﺸﺩﻴﺩ ﻴﺨﺘﻠﻁ ﺒﺫﺍﺕ ﺍﻟﺭﺌﺔ ﻭﺍﻟﻘﺼﻭﺭ ﺍﻟﺘﻨﻔﺴﻲ ﻭﺍﻟﻭﻓﺎﺓ‬
‫ﻭﺨﺎﺼﺔ ﻤﻊ ﻭﺠﻭﺩ ﻋﻭﺍﻤل ﺍﻟﺨﻁﻭﺭﺓ‪ :‬ﻜﺎﻟﺤﻤل ﻭﺍﻟﺒﺩﺍﻨﺔ ﻭﺍﻟﺴﻥ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﺯﻤﻨﺔ ﻭﺍﻟﻤﻨﻘﺼﺔ ﻟﻠﻤﻨﺎﻋﺔ‪.‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﻤﻥ ﻋﺎﺌﻠﺔ ‪.Orthomixo Virus‬‬
‫ﻭﻟﻪ ﺜﻼﺜﺔ ﺃﻨﻤﺎﻁ‪.A, B, C :‬‬
‫ﻴﺘﻤﻴﺯ ﺍﻟﻨﻤﻁ ‪ A‬ﺒﺄﻨﻪ ﻴﺼﻴﺏ ﺍﻟﺒﺸﺭ ﻭﺍﻟﺤﻴﻭﺍﻨﺎﺕ )ﺍﻟﻁﻴﻭﺭ‪ ،‬ﺍﻟﺨﻨﺎﺯﻴﺭ‪ ...‬ﺇﻟﺦ(‪.‬‬
‫ﻜﺫﻟﻙ ﺒﺘﻐﻴﻴﺭ ﺼﻔﺎﺘﻪ ﺍﻟﺠﻴﻨﻴﺔ ﻤﻤﺎ ﻴﺅﺩﻱ ﻟﻅﻬﻭﺭ ﺯﻤﺭ ﺠﺩﻴﺩﺓ ﻻ ﻴﺘﻌﺭﻑ ﻋﻠﻴﻬﺎ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻤﻨﺎﻋﻲ ﻤﻤﺎ ﻴﺅﺩﻱ‬
‫ﻟﺤﺩﻭﺙ ﺃﻭﺒﺌﺔ ﻭﺠﺎﺌﺤﺎﺕ ﺒﺸﺭﻴﺔ‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﻴﻨﺘﻘل ﻋﻥ ﻁﺭﻴﻕ ﺍﻟﺭﺫﺍﺫ ﺍﻟﻨﺎﺠﻡ ﻋﻥ ﺴﻌﺎل ﻭﻋﻁﺎﺱ ﺍﻟﺸﺨﺹ ﺍﻟﻤﺭﻴﺽ ﺃﻭ ﺍﻟﺤﺎﻤل ﻟﻠﻤﺭﺽ ﻜﻤﺎ ﻴﻨﺘﻘل ﻋﻥ‬
‫ﻁﺭﻴﻕ ﻟﻤﺱ ﺃﺸﻴﺎﺀ ﻤﻠﻭﺜﺔ ﺒﺎﻟﻔﻴﺭﻭﺱ ﺜﻡ ﻭﻀﻊ ﺍﻷﻴﺩﻱ ﻋﻠﻰ ﺃﻷﻨﻑ ﺃﻭ ﺍﻟﻔﻡ ﺃﻭ ﺍﻟﻌﻴﻥ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫ﻋﺎﺩﺓ )‪ (٣ - ١‬ﺃﻴﺎﻡ ﻭﻗﺩ ﻴﻤﺘﺩ ﺤﺘﻰ ﺴﺒﻌﺔ ﺃﻴﺎﻡ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻴﺼﺒﺢ ﺍﻟﺸﺨﺹ ﺍﻟﻤﺨﻤﻭﺝ ﻤﻌﺩﻴﹰﺎ ﻗﺒل ﻴﻭﻡ ﻭﺍﺤﺩ ﻤﻥ ﻅﻬﻭﺭ ﺍﻷﻋﺭﺍﺽ ﻭﻴﺴﺘﻤﺭ ﻟﺩﻯ ﺍﻟﺒﺎﻟﻐﻴﻥ ﻟﻤﺩﺓ ﻻ ﺘﺯﻴﺩ‬
‫ﻋﻥ ﺍﻟﺴﺒﻌﺔ ﺃﻴﺎﻡ ﻤﻥ ﻅﻬﻭﺭ ﺍﻷﻋﺭﺍﺽ ﺃﻤﺎ ﻟﺩﻯ ﺍﻷﻁﻔﺎل ﻓﻴﺘﺠﺎﻭﺯ ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ ﺍﻟﺴﺒﻌﺔ ﺃﻴﺎﻡ‪.‬‬

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 ‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﻋﻨﺩﻤﺎ ﺘﻅﻬﺭ ﺯﻤﺭ ﺠﺩﻴﺩﺓ ﺘﺘﺴﺎﻭﻯ ﻨﺴﺏ ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻺﺼﺎﺒﺔ ﺒﻴﻥ ﺍﻷﻁﻔﺎل ﻭﺍﻟﺒﺎﻟﻐﻴﻥ‪ ،‬ﻭﺘﺴﺒﺏ ﺍﻟﻌﺩﻭﻯ ﻤﻨﺎﻋﺔ‬
‫ﻨﻭﻋﻴﺔ ﻀﺩ ﺍﻟﻔﻴﺭﻭﺱ ﺍﻟﺴﺎﺒﻕ ﻭﻟﻜﻥ ﻤﺩﺓ ﺍﻟﻤﻨﺎﻋﺔ ﻭﺸﺩﺘﻬﺎ ﺘﺘﻭﻗﻔﺎﻥ ﻋﻠﻰ ﺩﺭﺠﺔ ﺍﻟﺘﻐﻴﺭ ﺍﻟﻤﺴﺘﻀﺩﻱ ﻭﻋﺩﺩ ﻤﺭﺍﺕ‬
‫ﺍﻟﻌﺩﻭﻯ ﺍﻟﺴﺎﺒﻘﺔ‪.‬‬

‫ﻭﺘﻌﻁﻲ ﺍﻟﻠﻘﺎﺤﺎﺕ ﻤﻨﺎﻋﺔ ﻨﻭﻋﻴﺔ ﻟﻠﻔﻴﺭﻭﺴﺎﺕ ﺍﻟﻤﺴﺘﺨﺩﻤﺔ ﻀﻤﻥ ﺍﻟﻠﻘﺎﺡ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‬
‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬
‫• ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﺒﺎﻜﺭ ﻭﺍﻟﻌﻼﺝ ﻭﻴﺘﻡ ﺒﺎﻟﻤﻨﺯل ﻟﻠﺤﺎﻻﺕ ﺍﻟﺒﺴﻴﻁﺔ ﻭﻴﺘﻀﻤﻥ‪:‬‬
‫‪ -‬ﺍﻟﺭﺍﺤﺔ ﻓﻲ ﺍﻟﺴﺭﻴﺭ‪.‬‬

‫‪ -‬ﺘﻨﺎﻭل ﺨﺎﻓﻀﺎﺕ ﺍﻟﺤﺭﺍﺭﺓ‪.‬‬

‫‪ -‬ﺘﻨﺎﻭل ﺍﻟﺴﻭﺍﺌل ﺒﻜﺜﺭﺓ‪.‬‬

‫‪ -‬ﺍﻻﺒﺘﻌﺎﺩ ﻋﻥ ﺍﻟﺘﺩﺨﻴﻥ ﻭﺘﻨﺎﻭل ﺍﻟﻤﺸﺭﻭﺒﺎﺕ ﺍﻟﻜﺤﻭﻟﻴﺔ‪.‬‬

‫‪ -‬ﺘﻨﺎﻭل ﺍﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﻔﻴﺭﻭﺴﻴﺔ ﻋﻨﺩ ﻭﺠﻭﺩ ﻋﻭﺍﻤل ﺍﻟﺨﻁﻭﺭﺓ‪.‬‬

‫‪ -‬ﻤﻌﺎﻟﺠﺔ ﺍﻻﺨﺘﻼﻁﺎﺕ ﺍﻟﺘﻨﻔﺴﻴﺔ ﻜﺫﺍﺕ ﺍﻟﺭﺌﺔ ﺒﺎﻟﺼﺎﺩﺍﺕ ﺍﻟﻤﻨﺎﺴﺒﺔ‪.‬‬

‫‪ -‬ﺍﻹﺤﺎﻟﺔ ﺇﻟﻰ ﺍﻟﻤﺸﻔﻰ ﻋﻨﺩ ﺴﻭﺀ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻌﺎﻤﺔ ﻭﻅﻬﻭﺭ ﺍﻻﺨﺘﻼﻁﺎﺕ ﺍﻟﺘﻨﻔﺴﻴﺔ ﻟﺘﻘﺩﻴﻡ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻨﺎﺴﺏ‪.‬‬

‫‪ -‬ﻴﺠﺏ ﺃﻥ ﺘﺘﻡ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺒﺈﺸﺭﺍﻑ ﺍﻟﻜﺎﺩﺭ ﺍﻟﻁﺒﻲ ﺃﻤﺎ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺸﺩﻴﺩﺓ ﻭﺍﻟﻤﺨﺘﻠﻁﺔ ﻓﺘﻌﺎﻟﺞ ﺒﺎﻷﺩﻭﻴﺔ ﺍﻟﻤﻨﺎﺴﺒﺔ‬
‫)ﺼﺎﺩﺍﺕ‪ ،‬ﻤﻀﺎﺩﺍﺕ ﻓﻴﺭﻭﺴﻴﺔ‪ ،‬ﺃﻜﺴﺠﺔ‪ ...‬ﺇﻟﺦ(‪.‬‬
‫• ﺍﻟﺘﺭﺼﺩ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﺤﺎﻻﺕ‪:‬‬

‫‪ -‬ﺍﻹﺒﻼﻍ‪ :‬ﻤﻥ ﻗﺒل ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﻭﺍﻟﻌﻴﺎﺩﺍﺕ ﺤﻴﺙ ﻴﺘﻡ ﺇﺭﺴﺎل ﺘﻘﺭﻴﺭ ﺸﻬﺭﻱ ﻋﻥ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺸﺒﻴﻬﺔ‬
‫ﺒﺎﻹﻨﻔﻠﻭﻨﺯﺍ ‪ ILI‬ﺍﻟﻤﻠﺤﻕ )‪ (٣ - ٢‬ﺃﻤﺎ ﻓﻲ ﺍﻟﻤﺸﺎﻓﻲ ﻓﻴﺭﺴل ﺘﻘﺭﻴﺭ ﺸﻬﺭﻱ ﻋﻥ ﺍﻹﻨﺘﺎﻨﺎﺕ ﺍﻟﺘﻨﻔﺴﻴﺔ ﺍﻟﻤﻘﺒﻭﻟﺔ‬
‫ﻓﻲ ﺍﻟﻤﺸﺎﻓﻲ‪.‬‬

‫‪ -‬ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻨﺩ ﺤﺩﻭﺙ ﺍﻷﻭﺒﺌﺔ ﻭﺍﻟﻔﺎﺸﻴﺎﺕ ﺒﺎﻟﻬﺎﺘﻑ ﺃﻭ ﺒﺎﻟﻔﺎﻜﺱ‪.‬‬

‫‪ -‬ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ‪ :‬ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻟﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ ﺤﻴﺙ ﻴﻘﻭﻡ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺒﺯﻴﺎﺭﺓ ﺍﻟﺤﺎﻟﺔ ﻭﺇﻤﻼﺀ‬
‫ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ ‪ (٣٦‬ﻭﺃﺨﺫ ﻋﻴﻨﺔ ﺒﻠﻌﻭﻤﻴﺔ ﻭﺒﻠﻌﻭﻤﻴﺔ ﺃﻨﻔﻴﺔ ﻤﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﻘﺒﻭﻟﺔ ﻓﻲ ﺍﻟﻌﻨﺎﻴﺔ‬
‫ﺍﻟﻤﺸﺩﺩﺓ‪ ،‬ﺘﺭﺴل ﻤﻊ ﺍﻻﺴﺘﻤﺎﺭﺓ ﺇﻟﻰ ﻤﺨﺎﺒﺭ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ ﻟﻠﺘﺸﺨﻴﺹ )ﺘﺭﺴل ﻨﺴﺨﺔ ﻤﻥ ﺍﻻﺴﺘﻤﺎﺭﺓ ﺇﻟﻰ‬
‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻓﻲ ﺍﻟﻭﺯﺍﺭﺓ(‪.‬‬

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‫• ﺍﻟﺘﻭﻋﻴﺔ ﺍﻟﺼﺤﻴﺔ ﺒﺄﻫﻤﻴﺔ ﺘﻁﺒﻴﻕ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻭﻗﺎﺌﻴﺔ ﻭﺘﺘﻀﻤﻥ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﺼﺤﺔ ﺍﻟﺸﺨﺼﻴﺔ‬
‫ﻭﺼﺤﺔ ﺍﻟﺠﻬﺎﺯ ﺍﻟﺘﻨﻔﺴﻲ‪:‬‬

‫‪ -‬ﺍﺴﺘﻌﻤﺎل ﺍﻟﻤﻨﺩﻴل ﺃﺜﻨﺎﺀ ﺍﻟﺴﻌﺎل ﻭﺍﻟﻌﻁﺎﺱ‪.‬‬

‫‪ -‬ﻏﺴل ﺍﻷﻴﺩﻱ ﺒﺎﻟﻤﺎﺀ ﻭﺍﻟﺼﺎﺒﻭﻥ ﻻ ﺴﻴﻤﺎ ﺒﻌﺩ ﺍﻟﺴﻌﺎل ﻭﺍﻟﻌﻁﺎﺱ ﺃﻭ ﻟﻤﺱ ﺃﺸﻴﺎﺀ ﻤﻠﻭﺜﺔ ﺒﺎﻟﻔﻴﺭﻭﺱ‪.‬‬

‫‪ -‬ﺘﺠﻨﺏ ﻟﻤﺱ ﺍﻷﻨﻑ ﺃﻭ ﺍﻟﻔﻡ ﺃﻭ ﺍﻟﻌﻴﻥ‪.‬‬

‫‪ -‬ﺍﻻﺒﺘﻌﺎﺩ ﻋﻥ ﻤﺨﺎﻟﻁﺔ ﺍﻟﻤﺭﻀﻰ ﻭﺘﺠﻨﺏ ﺘﻘﺒﻴﻠﻬﻡ‪.‬‬

‫‪ -‬ﺍﻟﺘﻬﻭﻴﺔ ﺍﻟﺠﻴﺩﺓ ﻟﻠﻤﺴﻜﻥ ﻭﺒﺸﻜل ﻤﺴﺘﻤﺭ‪.‬‬

‫‪ -‬ﻭﻀﻊ ﺍﻟﻜﻤﺎﻤﺔ ﻋﻠﻰ ﺍﻷﻨﻑ ﻭﺍﻟﻔﻡ ﻓﻲ ﺤﺎل ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﻤﺭﺽ‪.‬‬

‫‪ -‬ﺒﻘﺎﺀ ﺍﻟﻤﺭﻀﻰ ﻓﻲ ﺍﻟﻤﻨﺯل ﻭﻋﺩﻡ ﺫﻫﺎﺒﻬﻡ ﺇﻟﻰ ﺍﻟﻌﻤل ﺃﻭ ﺍﻟﻤﺩﺭﺴﺔ‪.‬‬

‫‪ -‬ﺘﻨﺎﻭل ﺍﻟﻠﻘﺎﺡ ﻤﻥ ﻗﺒل ﺍﻟﻔﺌﺎﺕ ﺍﻟﻌﺎﻟﻴﺔ ﺍﻟﺨﻁﻭﺭﺓ‪.‬‬

‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻓﻲ ﺘﻁﺒﻴﻕ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻹﺼﺤﺎﺡ ﺍﻟﺒﻴﺌﻲ ﻓﻲ ﺃﻤﺎﻜﻥ ﺍﻟﺘﺠﻤﻌﺎﺕ ﻜﺎﻟﻤﺩﺍﺭﺱ ﻭﺍﻟﺘﻲ‬
‫ﺘﺘﻀﻤﻥ ﺘﺨﻔﻴﺽ ﺍﻻﺯﺩﺤﺎﻡ ﻭﺘﻭﻓﻴﺭ ﺍﻟﻤﻴﺎﻩ ﺍﻟﺼﺎﻟﺤﺔ ﻟﻠﺸﺭﺏ ﻭﺍﻟﺼﺎﺒﻭﻥ ﻭﺍﻟﺘﻬﻭﻴﺔ ﺍﻟﻤﺘﻜﺭﺭﺓ‪ ...‬ﺇﻟﺦ‪.‬‬

‫ﻭﻻ ﻴﻭﺼﻰ ﺒﺈﻏﻼﻕ ﺃﻤﺎﻜﻥ ﺍﻟﺘﺠﻤﻌﺎﺕ ﺍﻻﻨﺘﺸﺎﺭ ﺍﻟﻭﺍﺴﻊ ﻟﻠﻤﺭﻀﻰ ﻓﻲ ﺃﻤﺎﻜﻥ ﺍﻟﺘﺠﻤﻌﺎﺕ‪.‬‬
‫• ﺍﻟﺘﻠﻘﻴﺢ‪:‬‬

‫‪ -‬ﻴﻌﻁﻰ ﺍﻟﻠﻘﺎﺡ ﺍﻟﻤﻭﺴﻤﻲ ﻟﻠﺫﺍﻫﺒﻴﻥ ﻷﺩﺍﺀ ﻓﺭﻴﻀﺔ ﺍﻟﺤﺞ ﻭﻟﻠﻤﺴﻨﻴﻥ ﺒﻌﻤﺭ )‪ (٦٥‬ﺴﻨﺔ ﻓﻤﺎ ﻓﻭﻕ‪ ،‬ﺤﺴﺏ ﺨﻁﺔ‬
‫ﺍﻟﻭﺯﺍﺭﺓ ﻓﻲ ﺍﻟﺘﻠﻘﻴﺢ ﻀﻤﻥ ﻤﺅﺴﺴﺎﺘﻬﺎ ﺍﻟﺼﺤﻴﺔ )ﻤﺭﺍﻜﺯ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﺩﻭﻟﻴﺔ ﻭﻋﻴﺎﺩﺍﺕ ﺍﻟﻤﺴﻨﻴﻥ(‪.‬‬

‫ﻜﻤﺎ ﻴﻌﻁﻰ ﻟﻠﻤﺼﺎﺒﻴﻥ ﺒﺎﻷﻤﺭﺍﺽ ﺍﻟﻤﺯﻤﻨﺔ ﻤﻥ ﻜﺎﻓﺔ ﺍﻷﻋﻤﺎﺭ ﻓﻲ ﻋﻴﺎﺩﺍﺕ ﺍﻟﻘﻁﺎﻉ ﺍﻟﺨﺎﺹ‪.‬‬

‫‪ -‬ﺃﺜﻨﺎﺀ ﺠﺎﺌﺤﺔ ‪ A\H1N1‬ﺃﻋﻁﻲ ﺍﻟﻠﻘﺎﺡ ﺇﻀﺎﻓﺔ ﻟﻠﻔﺌﺎﺕ ﺍﻟﺴﺎﺒﻘﺔ ﺇﻟﻰ ﺍﻟﺤﻭﺍﻤل ﻭﺍﻷﻁﻔﺎل ﺩﻭﻥ ﺍﻟﺨﻤﺱ ﺴﻨﻭﺍﺕ‬
‫ﻭﺍﻟﻌﺎﻤﻠﻴﻥ ﺍﻟﺼﺤﻴﻴﻥ ﻓﻲ ﺘﺩﺒﻴﺭ ﺍﻹﻨﺘﺎﻨﺎﺕ ﺍﻟﺘﻨﻔﺴﻴﺔ ﻓﻲ ﺍﻟﻤﺸﺎﻓﻲ‪.‬‬
‫• ﺍﻟﻌﻼﺝ ﺍﻟﻭﻗﺎﺌﻲ ﻏﻴﺭ ﻤﻨﺼﻭﺡ ﺒﻪ ﺒﺸﻜل ﺭﻭﺘﻴﻨﻲ ﻭﻴﻌﻁﻰ ﻟﻠﻌﺎﻤﻠﻴﻥ ﺍﻟﺼﺤﻴﻴﻥ ﻓﻲ ﺘﺩﺒﻴﺭ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ‪ ،‬ﻋﻨﺩ‬
‫ﻭﺠﻭﺩ ﺨﻁﺭ ﺸﺩﻴﺩ ﻟﻠﺘﻌﺭﺽ ﻟﻠﻌﺩﻭﻯ )ﻋﺩﻡ ﺘﻁﺒﻴﻕ ﺇﺠﺭﺍﺀﺍﺕ ﻤﻜﺎﻓﺤﺔ ﺍﻟﻌﺩﻭﻯ‪.(...‬‬

‫‪ -‬ﻴﻌﻁﻰ ﺍﻷﻭﺴﻠﺘﺎﻤﻴﻔﻴﺭ ﺒﻤﻘﺩﺍﺭ ‪ ٧٥‬ﻤﻠﻎ ﻴﻭﻤﻴﹰﺎ ﻟﻤﺩﺓ ﻋﺸﺭﺓ ﺃﻴﺎﻡ‪.‬‬

‫‪ -‬ﻭﻴﻌﻁﻰ ﺍﻟﺯﺍﻨﺎﻤﻴﻔﻴﺭ ﺒﻤﻘﺩﺍﺭ ﺒﺨﺘﺎﻥ )‪ (٥ × ٢‬ﻤﻠﻎ ﻴﻭﻤﻴ ﹰﺎ ﻟﻤﺩﺓ ﻋﺸﺭﺓ ﺃﻴﺎﻡ‪.‬‬

‫• ﺘﻘﻭﻡ ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﻤﺩﻴﺭﻴﺔ ﻤﺨﺎﺒﺭ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ ﺒﺈﺠﺭﺍﺀ ﺘﻨﻤﻴﻁ ﻟﺤﺎﻻﺕ ﺍﻷﻤﺭﺍﺽ‬
‫ﺍﻟﺸﺒﻴﻬﺔ ﺒﺎﻷﻨﻔﻠﻭﻨﺯﺍ ﺍﻟﻤﺭﺍﺠﻌﺔ ﻷﻗﺴﺎﻡ ﺍﻹﺴﻌﺎﻑ ﻓﻲ ﻤﺸﻔﻴﻲ ﺩﻭﻤﺎ )ﺭﻴﻑ ﺩﻤﺸﻕ( ﻭﺍﻟﻬﻼل )ﺩﻤﺸﻕ(‪ ،‬ﻟﻤﻌﺭﻓﺔ‬
‫ﺍﻟﺯﻤﺭﺓ ﺍﻟﻤﺴﺒﺒﺔ ﻟﻠﻤﺭﺽ‪.‬‬

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 ‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬
‫• ﺘﻠﻌﺏ ﺍﻹﺒﻼﻏﺎﺕ ﺍﻟﻔﻭﺭﻴﺔ ﻭﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺸﻬﺭﻴﺔ ﻤﻥ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ ﻭﺇﺭﺴﺎﻟﻬﺎ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ‬
‫ﺍﻟﺴﺎﺭﻴﺔ ﻓﻲ ﺍﻟﻭﺯﺍﺭﺓ‪.‬‬
‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻤﻥ ﺍﻷﻨﻔﻠﻭﻨﺯﺍ ‪ A\H1N1‬ﺍﻟﻤﻘﺒﻭﻟﺔ ﻓﻲ ﺍﻟﻌﻨﺎﻴﺔ ﺍﻟﻤﺸﺩﺩﺓ ﻭﺇﺭﺴﺎل ﺍﺴﺘﻤﺎﺭﺓ‬
‫ﺍﻟﺘﻘﺼﻲ ﻤﻊ ﺍﻟﻌﻴﻨﺔ ﺍﻟﺒﻠﻌﻭﻤﻴﺔ ﻭﺍﻟﺒﻠﻌﻭﻤﻴﺔ ﺍﻷﻨﻔﻴﺔ ﺇﻟﻰ ﻤﺨﺎﺒﺭ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ ﻓﻲ ﺍﻟﻭﺯﺍﺭﺓ ﻭﺘﺭﺴل ﻨﺴﺨﺔ ﻤﻥ‬
‫ﺍﻻﺴﺘﻤﺎﺭﺓ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪.‬‬
‫• ﺇﺭﺴﺎل ﺘﻘﺭﻴﺭ ﺃﺴﺒﻭﻋﻲ ﺼﻔﺭﻱ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻤﻥ ﺃﻨﻔﻠﻭﻨﺯﺍ ‪) A\H1N1‬ﻴﺭﺴل ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺼﻔﺭﻱ ﻴﻭﻤﻴ ﹰﺎ‬
‫ﻋﻨﺩ ﺤﺩﻭﺙ ﺍﻷﻭﺒﺌﺔ(‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺘﺩﺒﻴﺭ ﺍﻟﺤﺎﻻﺕ ﻭﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﺭﺽ‪.‬‬
‫• ﺍﻟﺘﻭﻋﻴﺔ ﻋﻥ ﺍﻟﻤﺭﺽ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻭﻗﺎﻴﺔ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﺨﻁﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﻨﺸﺭﺍﺕ ﺍﻟﺘﻭﻋﻴﺔ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻤﻥ ﺨﻼل ﺍﻟﻤﺠﻠﺱ ﺍﻟﺼﺤﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬
‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻻﺕ ﻀﻤﻥ ﺴﺠل ﺨﺎﺹ ﺒﺎﻟﻤﺭﻀﻰ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬

‫• ﺘﻠﻘﻲ ﺍﻹﺒﻼﻏﺎﺕ ﺍﻟﻔﻭﺭﻴﺔ ﻭﺍﺴﺘﻤﺎﺭﺍﺕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻭﻗﺎﺌﻲ ﻭﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺸﻬﺭﻴﺔ ﻭﺍﻷﺴﺒﻭﻋﻴﺔ ﻤﻥ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‬
‫ﻭﺇﺠﺭﺍﺀ ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻬﺎ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﺍﻟﺨﻁﺔ ﺍﻟﻭﻁﻨﻴﺔ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﺭﺽ ﻭﻤﺘﺎﺒﻌﺔ ﺘﻨﻔﻴﺫﻫﺎ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﺍﻟﺩﻻﺌل ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﺘﺭﺼﺩ ﺍﻟﻭﺒﺎﺌﻲ ﻭﺍﻟﺘﺩﺍﺒﻴﺭ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻭﺍﻟﻭﻗﺎﺌﻴﺔ ﻭﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻤﺨﺒﺭﻱ‪ ...‬ﺇﻟﺦ ﻭﺘﻭﺯﻴﻌﻬﺎ‬
‫ﻟﻠﻤﺴﺘﻭﻴﺎﺕ ﺍﻷﺩﻨﻰ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﻨﺸﺭﺍﺕ ﺍﻟﺘﻭﻋﻴﺔ ﻋﻥ ﺍﻟﻤﺭﺽ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻭﻗﺎﻴﺔ ﻭﺘﻭﺯﻴﻌﻬﺎ ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻷﺩﻨﻰ‪.‬‬
‫• ﺍﻟﺘﻭﻋﻴﺔ ﻋﻥ ﺍﻟﻤﺭﺽ ﻋﺒﺭ ﻭﺴﺎﺌل ﺍﻹﻋﻼﻡ ﺍﻟﻤﺨﺘﻠﻔﺔ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﻋﻤل ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻭﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬

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 ‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ ﻟﺤﺎﻟﺔ ‪٢٠٠٩ A/H1N1‬‬

‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻟﻺﺼﺎﺒﺔ ﺒﻔﻴﺭﻭﺱ ﺍﻹﻨﻔﻠﻭﻨﺯﺍ ﺍﻟﺠﺎﺌﺤﻴﺔ )‪:(ILI) A (H1N1‬‬

‫ﺸﺨﺹ ﻤﺼﺎﺏ ﺒﺤﻤﻰ ﻤﻔﺎﺠﺌﺔ ﺃﻋﻠﻰ ﻤﻥ ‪ ٣٨‬ﻡ ﻤﺘﺭﺍﻓﻘﺔ ﺒﺴﻌﺎل ﺠﺎﻑ ﻭﺃﻟﻡ ﺒﻠﻌﻭﻤﻲ ﻤﻊ ﻭﺍﺤﺩ ﺃﻭ ﺃﻜﺜﺭ ﻤﻥ‬
‫ﺍﻷﻋﺭﺍﺽ ﺍﻟﺘﺎﻟﻴﺔ‪:‬‬

‫ﺍﻟﺴﻴﻼﻥ ﺍﻷﻨﻔﻲ‪ ،‬ﺍﻟﺼﺩﺍﻉ‪ ،‬ﺍﻟﻌﺭﻭﺍﺀﺍﺕ‪ ،‬ﺍﻷﻟﻡ ﺍﻟﻤﻔﺼﻠﻲ ﻭﺃﺤﻴﺎﻨﹰﺎ ﺍﻹﺴﻬﺎل ﻭ‪/‬ﺃﻭ ﺍﻹﻗﻴﺎﺀ‪.‬‬

‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻤﻊ ﻋﻭﺍﻤل ﺍﻟﺨﻁﻭﺭﺓ‪:‬‬

‫ﺸﺨﺹ ﻤﺼﺎﺏ ﺒﺈﻨﻔﻠﻭﻨﺯﺍ ﻤﺸﺘﺒﻬﺔ )‪ (ILI‬ﻤﻊ ﻭﺍﺤﺩ ﺃﻭ ﺃﻜﺜﺭ ﻤﻥ ﻋﻭﺍﻤل ﺍﻟﺨﻁﻭﺭﺓ ﺍﻟﺘﺎﻟﻴﺔ‪:‬‬
‫• ﺍﻟﺤﻤل‪.‬‬
‫• ﺍﻟﻌﻤﺭ )ﺩﻭﻥ ﺍﻟﺨﻤﺱ ﺴﻨﻭﺍﺕ‪ ،‬ﻓﻭﻕ ﺍﻟﺨﻤﺱ ﻭﺴﺘﻭﻥ ﺴﻨﺔ(‪.‬‬
‫• ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﺯﻤﻨﺔ )ﺃﻤﺭﺍﺽ ﺍﻟﻘﻠﺏ ﺍﻟﻤﺯﻤﻨﺔ‪ ،‬ﺃﻤﺭﺍﺽ ﺍﻟﻘﺼﺒﺎﺕ ﻭﺍﻟﺭﺌﺔ ﺍﻟﻤﺯﻤﻨﺔ‪ ،‬ﺍﻷﻤﺭﺍﺽ ﺍﻻﺴﺘﻘﻼﺒﻴﺔ‬
‫ﻜﺎﻟﺴﻜﺭﻱ‪ ،‬ﺍﻷﻤﺭﺍﺽ ﺍﻟﺩﻤﻭﻴﺔ‪ ،‬ﺃﻤﺭﺍﺽ ﻨﻘﺹ ﺍﻟﻤﻨﺎﻋﺔ‪ ،‬ﺍﻟﻘﺼﻭﺭ ﺍﻟﻜﻠﻭﻱ ﺃﻭ ﺍﻟﻜﺒﺩﻱ ﺍﻟﻤﺯﻤﻥ‪ ...‬ﺇﻟﺦ(‪.‬‬
‫• ﺍﻟﺴﻤﻨﺔ‪.‬‬
‫• ﺍﻷﻭﺭﺍﻡ ﻭﺍﻟﺴﺭﻁﺎﻨﺎﺕ‪.‬‬
‫• ﺍﻷﺩﻭﻴﺔ ﺍﻟﻤﻨﻘﺼﺔ ﻟﻠﻤﻨﺎﻋﺔ )ﻜﺎﻟﻜﻭﺭﺘﻴﺯﻭﻥ(‪.‬‬

‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺨﺘﻠﻁﺔ‪:‬‬
‫ﺸﺨﺹ ﻤﺼﺎﺏ ﺒﺈﻨﻔﻠﻭﻨﺯﺍ ﻤﺸﺘﺒﻬﺔ )‪) (ILI‬ﻤﻊ ﺃﻭ ﺒﺩﻭﻥ ﻭﺠﻭﺩ ﻋﻭﺍﻤل ﺨﻁﻭﺭﺓ(‪ ،‬ﺘﻁﻭﺭ ﻟﺩﻴﻪ ﻭﺍﺤﺩ ﺃﻭ ﺃﻜﺜﺭ‬
‫ﻤﻥ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺘﺎﻟﻴﺔ‪:‬‬
‫• ﺼﻌﻭﺒﺔ ﺃﻭ ﻀﻴﻕ ﺃﻭ ﺴﺭﻋﺔ ﺍﻟﺘﻨﻔﺱ‪.‬‬
‫• ﺯﺭﻗﺔ‪.‬‬
‫• ﺘﻐﻴﻡ ﻭﻋﻲ ﺃﻭ ﺩﻭﺍﺭ‪.‬‬
‫• ﺍﺴﺘﻤﺭﺍﺭ ﺍﻟﺤﺭﺍﺭﺓ ﻷﻜﺜﺭ ﻤﻥ ﻴﻭﻤﻴﻥ‪.‬‬
‫• ﺇﻗﻴﺎﺀ ﻤﺴﺘﻤﺭ ﻤﻊ ﺃﻭ ﺒﺩﻭﻥ ﺇﺴﻬﺎل‪.‬‬
‫• ﺘﺠﻔﺎﻑ ﻨﻘﺹ ﻜﻤﻴﺔ ﺍﻟﺒﻭل‪.‬‬
‫• ﻫﻴﺎﺝ ﺃﻭ ﻋﺩﻡ ﺘﺠﺎﻭﺏ ﻟﺩﻯ ﺍﻷﻁﻔﺎل‪.‬‬
‫• ﺃﻟﻡ ﻓﻲ ﺍﻟﺼﺩﺭ‪.‬‬
‫• ﻗﺸﻊ ﻤﻠﻭﻥ ﺃﻭ ﻤﺩﻤﻰ‪.‬‬

‫‪٧٣‬‬
 ‫ﺤﺎﻟﺔ ﺘﻨﻔﺴﻴﺔ ﺤﺎﺩﺓ ﻭﺨﻴﻤﺔ )‪:(SARI‬‬
‫ﺸﺨﺹ ﻤﺼﺎﺏ ﺒﺈﻨﻔﻠﻭﻨﺯﺍ ﻅﻬﺭﺕ ﻋﻠﻴﻪ ﻤﻨﺫ ﺍﻟﺒﺩﺀ ﻭﺍﺤﺩ ﺃﻭ ﺃﻜﺜﺭ ﻤﻥ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺘﺎﻟﻴﺔ‪:‬‬
‫• ﻋﺴﺭ ﺘﻨﻔﺱ ﺤﺎﺩ‪ ،‬ﺯﻴﺎﺩﺓ ﺴﺭﻋﺔ ﺍﻟﺘﻨﻔﺱ )< ‪ ٣٠‬ﻨﻔﺱ‪/‬ﺩ ﻟﻠﺒﺎﻟﻐﻴﻥ‪ ٤٠ < ،‬ﻨﻔﺱ‪/‬ﺩ ﻟﻸﻁﻔﺎل ﺒﻌﻤﺭ ﻓﻭﻕ ﺍﻟﺴﻨﺔ‪،‬‬
‫< ‪ ٥٠‬ﻨﻔﺱ‪/‬ﺩ ﻟﻸﻁﻔﺎل ﺒﻌﻤﺭ ﺴﻨﺔ ﻓﻤﺎ ﺩﻭﻥ(‪.‬‬
‫• ﻋﻼﻤﺎﺕ ﺘﺠﻔﺎﻑ ﺸﺩﻴﺩ‪.‬‬
‫• ﻋﻼﻤﺎﺕ ﺼﺩﻤﺔ ﺴﺭﻴﺭﻴﺔ‪.‬‬
‫• ﺘﻐﻴﻴﻡ ﻭﻋﻲ ﺃﻭ ﺘﺨﻠﻴﻁ ﺫﻫﻨﻲ ﺃﻭ ﻫﻴﺎﺝ ﻟﺩﻯ ﺍﻟﺒﺎﻟﻐﻴﻥ‪.‬‬
‫• ﻫﻴﺎﺝ ﺃﻭ ﻨﻌﺎﺱ ﻭﺼﻌﻭﺒﺔ ﻓﻲ ﺍﻹﻴﻘﺎﻅ ﻟﺩﻯ ﺍﻷﻁﻔﺎل‪.‬‬
‫• ﺘﻁﻭﺭ ﺴﺭﻴﻊ ﻟﻠﻤﺭﻀﻰ ﺃﻭ ﺍﺴﺘﻤﺭﺍﺭﻩ ﻟﻔﺘﺭﺓ ﻁﻭﻴﻠﺔ )ﺍﺴﺘﻤﺭﺍﺭ ﺍﻟﺤﻤﻰ ﺒﻌﺩ ﻴﻭﻤﻴﻥ ﻤﻥ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺒﺨﺎﻓﻀﺎﺕ‬
‫ﺍﻟﺤﺭﺍﺭﺓ( ـ ﺼﻭﺭﺓ ﺍﻟﺼﺩﺭ ﺘﺒﻴﻥ ﻭﺠﻭﺩ ﻤﻅﺎﻫﺭ ﻏﻴﺭ ﻋﺎﺩﻴﺔ ﻜﺎﺭﺘﺸﺎﺡ ﺜﻨﺎﺌﻲ ﺍﻟﺠﺎﻨﺏ )ﺫﺍﺕ ﺭﺌﺔ(‪.‬‬

‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺅﻜﺩﺓ‪:‬‬
‫ﺤﺎﻟﺔ ﻤﺸﺘﺒﻬﺔ ﻟﻺﺼﺎﺒﺔ ﺒﺎﻹﻨﻔﻠﻭﻨﺯﺍ ﻤﻊ ﺘﺄﻜﻴﺩ ﻤﺨﺒﺭﻱ ﺒﺎﻟـ ‪ Real time RT-PCR‬ﺃﻭ ﺒﻌﺯل ﺍﻟﻔﻴﺭﻭﺱ‪.‬‬

‫‪٧٤‬‬
 ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ‬

‫ﻤﺨﻁﻁ ﺘﺩﺒﻴﺭ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻤﻥ ﺍﻹﻨﻔﻠﻭﻨﺯﺍ ‪٢٠٠٩ - A/H1N1‬‬

‫)‪Influenza like Illness (ILI‬‬
‫ﺘﻌﺭﻴﻑ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ‪ :‬ﺤﺭﺍﺭﺓ ﻓﻭﻕ ْ‪ ٣٨‬ﻡ ‪ +‬ﺴﻌﺎل ﺠﺎﻑ ‪ +‬ﺃﻟﻡ ﺒﻠﻌﻭﻤﻲ ﻭﻗﺩ ﻴﺘﺭﺍﻓﻕ ﻤﻊ ﺁﻻﻡ ﻋﻀﻠﻴﺔ‪ ،‬ﺼﺩﺍﻉ‪،‬‬
‫ﻗﺸﻌﺭﻴﺭﺓ‪ ،‬ﺯﻜﺎﻡ‪ ،‬ﺇﻗﻴﺎﺀ‪ ،‬ﺇﺴﻬﺎل‪.‬‬

‫ﻓﺤﺹ ﺴﺭﻴﺭﻱ‬

‫ﻤﺭﺽ ﺸﺩﻴﺩ )‪(SARI‬‬ ‫ﻤﺭﺽ ﺨﻔﻴﻑ )ﺤﺎﻟﺔ ﺒﺴﻴﻁﺔ(‬ ‫ﻤﺭﺽ ﺨﻔﻴﻑ‬

‫)ﺤﺎﻟﺔ ﺘﻨﻔﺴﻴﺔ ﺤﺎﺩﺓ ﻭﺨﻴﻤﺔ(‬ ‫‪ +‬ﻋﻭﺍﻤل ﺨﻁﻭﺭﺓ‬ ‫)ﺤﺎﻟﺔ ﺒﺴﻴﻁﺔ(‬

‫ﻋﻭﺍﻤل ﺍﻟﺨﻁﻭﺭﺓ‪:‬‬ ‫ـ ﻻ ﺘﻭﺠﺩ ﻋﻼﻤﺎﺕ ﺍﻟﻤﺭﺽ‬

‫ﺤﺩﻭﺙ ﺃﺤﺩ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺘﺎﻟﻴﺔ‪:‬‬
‫ـ ﺍﻤﺭﺃﺓ ﺤﺎﻤل‪.‬‬ ‫ﺍﻟﺸﺩﻴﺩ‪.‬‬
‫ـ ﺸﺩﺓ ﺘﻨﻔﺴﻴﺔ‪.‬‬
‫ـ ﺃﻁﻔﺎل ﺩﻭﻥ ‪ ٥‬ﺴﻨﻭﺍﺕ‪.‬‬ ‫ـ ﻟﻴﺱ ﻀﻤﻥ ﻤﺠﻤﻭﻋﺔ ﺍﻟﺨﻁﻭﺭﺓ‬
‫ـ ﺯﻴﺎﺩﺓ ﺴﺭﻋﺔ ﺍﻟﺘﻨﻔﺱ‪.‬‬
‫ـ ﺍﻟﻜﻬﻭل ﻓﻭﻕ ‪ ٦٥‬ﺴﻨﺔ‪.‬‬
‫ـ ﻋﻼﻤﺎﺕ ﺘﺠﻔﺎﻑ ﺸﺩﻴﺩ‪.‬‬
‫ﺍﻷﺸﺨﺎﺹ ﺍﻟﺫﻴﻥ ﻴﻌﺎﻨﻭﻥ ﻤﻥ‪:‬‬ ‫ﻴﺘﻡ ﺒﺈﺸﺭﺍﻑ ﺍﻟﻁﺒﻴﺏ‪.‬‬ ‫ـ‬
‫ـ ﻋﻼﻤﺎﺕ ﺼﺩﻤﺔ ﻤﺘﻭﻗﻌﺔ‪.‬‬
‫ـ ﺃﻤﺭﺍﺽ ﻗﺼﺒﻴﺔ ﺭﺌﻭﻴﺔ ﻤﺯﻤﻨﺔ‪.‬‬ ‫ﻋﺯل ﻭﻋﻨﺎﻴﺔ ﻤﻨﺯﻟﻴﺔ ‪+‬‬ ‫ـ‬
‫ـ ﺘﻐﻴﻡ ﻭﻋﻲ‪.‬‬
‫ـ ﺃﻤﺭﺍﺽ ﻗﻠﺒﻴﺔ ﻭﻋﺎﺌﻴﺔ ﻤﺯﻤﻨﺔ ﻤﺎ ﻋﺩﺍ ﻓﺭﻁ‬ ‫ﻤﻌﺎﻟﺠﺔ ﻋﺭﻀﻴﺔ‪.‬‬ ‫ـ‬
‫ـ ﺘﻁﻭﺭ ﺴﺭﻴﻊ ﻟﻠﻤﺭﺽ ﺃﻭ‬
‫ﺍﻟﺘﻭﺘﺭ ﺍﻟﺸﺭﻴﺎﻨﻲ‪.‬‬ ‫ﺘﺜﻘﻴﻑ ﺼﺤﻲ‪.‬‬ ‫ـ‬
‫ﺍﺴﺘﻤﺭﺍﺭﻩ ﻟﻔﺘﺭﺓ ﻁﻭﻴﻠﺔ‪.‬‬
‫ـ ﺍﻀﻁﺭﺍﺒﺎﺕ ﻋﺼﺒﻴﺔ ﻤﺯﻤﻨﺔ‪.‬‬
‫ـ ﻤﻊ ﺃﻭ ﺒﺩﻭﻥ ﻋﻭﺍﻤل ﺍﻟﺨﻁﻭﺭﺓ‪.‬‬
‫ـ ﺃﻤﺭﺍﺽ ﻨﻘﺹ ﺍﻟﻤﻨﺎﻋﺔ‪.‬‬ ‫ﻴﺘﻡ ﺒﺈﺸﺭﺍﻑ ﺍﻟﻁﺒﻴﺏ‪.‬‬ ‫ـ‬
‫ـ ﺍﻀﻁﺭﺍﺒﺎﺕ ﺩﻤﻭﻴﺔ‪.‬‬ ‫ﻋﺯل ﻭﻋﻨﺎﻴﺔ ﻤﻨﺯﻟﻴﺔ ‪+‬‬ ‫ـ‬
‫ﻗﺒﻭل ﺒﺎﻟﻤﺸﻔﻰ‬ ‫ـ ﻗﺼﻭﺭ ﻜﻠﻭﻱ ﺃﻭ ﻜﺒﺩﻱ ﻤﺯﻤﻥ‪.‬‬ ‫ﻤﻌﺎﻟﺠﺔ ﻋﺭﻀﻴﺔ‪.‬‬ ‫ـ‬
‫ﺍﻟﺒﺩﺀ ﺒﺎﻟﻌﻼﺝ ﺍﻟﻤﻀﺎﺩ ﻟﻠﻔﻴﺭﻭﺴﺎﺕ‬ ‫ـ ﺍﻀﻁﺭﺍﺒﺎﺕ ﺍﺴﺘﻘﻼﺒﻴﺔ ﻤﺜل ﺍﻟﺴﻜﺭﻱ‪.‬‬ ‫ﺘﺜﻘﻴﻑ ﺼﺤﻲ‪.‬‬ ‫ـ‬
‫ـ ﺍﻟﺒﺩﺍﻨﺔ ‪.٣٠ ≤ BMI‬‬
‫ﺃﻁﺒﺎﺀ ﺍﻟﻌﻨﺎﻴﺔ ﺍﻟﻤﺸﺩﺩﺓ ﻴﻘﺭﺭﻭﻥ‬ ‫ـ ﺃﻭﺭﺍﻡ )ﺴﺭﻁﺎﻨﺎﺕ(‪.‬‬
‫‪ +‬ﺇﺫﺍ ﺤﺼل ﺃﺤﺩ ﺃﻷﻋﺭﺍﺽ ﺍﻟﺘﺎﻟﻴﺔ‬
‫ﺍﻟﻘﺒﻭل ﺒﺎﻟﻌﻨﺎﻴﺔ ﺃﻭ ﻭﻀﻌﻪ ﻋﻠﻰ‬ ‫ـ ﺘﻨﺎﻭل ﺃﺩﻭﻴﺔ ﻤﻨﻘﺼﺔ ﻟﻠﻤﻨﺎﻋﺔ‬ ‫ﻴﺤﻭل ﺇﻟﻰ ﺍﻟﻤﺅﺴﺴﺔ ﺍﻟﺼﺤﻴﺔ‪:‬‬
‫ﺍﻟﻤﻨﻔﺴﺔ ﺤﺴﺏ ﺍﻟﺤﺎﻟﺔ ﺍﻟﺴﺭﻴﺭﻴﺔ‬ ‫)ﻜﺎﻟﻜﻭﺭﺘﻴﺯﻭﻥ(‪.‬‬ ‫ـ ﺼﻌﻭﺒﺔ ﺃﻭ ﻀﻴﻕ ﺃﻭ ﺴﺭﻋﺔ ﺘﻨﻔﺱ‪.‬‬
‫ـ ﺯﺭﻋﺔ‪.‬‬
‫ـ ﺘﻐﻴﻡ ﻭﻋﻲ ﺃﻭ ﺩﻭﺍﺭ‪.‬‬
‫ﺇﺠﺭﺍﺀ ‪PCR‬‬ ‫ـ ﺩﻭﺍﺀ ﻤﻀﺎﺩ ﻟﻠﻔﻴﺭﻭﺴﺎﺕ‪.‬‬ ‫ـ ﺍﺴﺘﻤﺭﺍﺭ ﺍﻟﺤﺭﺍﺭﺓ ﻷﻜﺜﺭ ﻤﻥ ﻴﻭﻤﻴﻥ‪.‬‬

‫ﻤﻼﺤﻅﺔ‪:‬‬
‫ـ ﻋﺯل ﻓﻲ ﺍﻟﻤﻨﺯل ‪+‬‬ ‫ـ ﺇﻗﻴﺎﺀ ﻤﺴﺘﻤﺭ ﻤﻊ ﺃﻭ ﺒﺩﻭﻥ ﺇﺴﻬﺎل‪.‬‬
‫ـ ﺘﺠﻔﺎﻑ‪.‬‬
‫ـ ﻟﻠﺤﻭﺍﻤل ﺍﺴﺘﺸﺎﺭﺓ ﻨﺴﺎﺌﻴﺔ ﻭﺇﺠﺭﺍﺀ‬ ‫ـ ﻤﺭﺍﺠﻌﺔ ﻓﻭﺭﻴﺔ ﻟﻠﻤﺸﻔﻰ ﺇﺫﺍ ﺘﺤﻭل ﺇﻟﻰ‬
‫ـ ﻨﻘﺹ ﻜﻤﻴﺔ ﺍﻟﺒﻭل‪.‬‬
‫‪.PCR‬‬ ‫ﻤﺭﺽ ﺸﺩﻴﺩ )‪.(SARI‬‬ ‫ـ ﺘﻬﻴﺞ ﺃﻭ ﻋﺩﻡ ﺘﺠﺎﻭﺏ ﻟﺩﻯ ﺍﻷﻁﻔﺎل‪.‬‬
‫ـ ﻓﻲ ﺤﺎل ﺩﺨﻭل ﺍﻟﻤﺭﻴﺽ ﺒﺎﻟﻌﻨﺎﻴﺔ ﺃﻭ‬
‫ﺍﻟﻤﻨﻔﺴﺔ ﺘﻤﺩﺩ ﻓﺘﺭﺓ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻟﻤﺩﺓ ‪١٠‬‬
‫ﺃ‬

‫‪٧٥‬‬
 ‫ﻤﺨﻁﻁ ﺍﻟﻌﻼﺝ ﻟﻸﻨﻔﻠﻭﻨﺯﺍ )‪٢٠٠٩ - A (H1N1‬‬
‫ﻴﻔﻴﺩ ﺍﻟﻌﻼﺝ ﺒﺎﻷﻭﺴﻠﺘﺎﻤﻴﻔﻴﺭ )ﺍﻟﺘﺎﻤﻴﻔﻠﻭ( ﺒﺘﺤﺴﻴﻥ ﺍﻟﺤﺎﻟﺔ ﺍﻟﺼﺤﻴﺔ ﻟﻠﻤﺭﻴﺽ ﻭﺘﻘﺼﻴﺭ ﻓﺘﺭﺓ ﺍﻟﻤﺭﺽ‪ ،‬ﻜﻤﺎ ﻴﻔﻴﺩ‬
‫ﻓﻲ ﻤﻨﻊ ﺍﻻﺨﺘﻼﻁﺎﺕ‪.‬‬
‫ﻤﺩﺓ ﺍﻟﻌﻼﺝ‬ ‫ﻜﻤﻴﺔ ﺍﻟﺩﻭﺍﺀ )ﺍﻟﺠﺭﻋﺔ(‬ ‫ﺍﻟﺸﻠل ﺍﻟﺴﺭﻴﺭﻱ‬
‫)‪ (٥‬ﺃﻴﺎﻡ‬ ‫)‪ (٧٥‬ﻤﻠﻎ ﻤﺭﺘﻴﻥ ﺒﺎﻟﻴﻭﻡ )‪(٢ × ١‬‬ ‫ﺍﻟﺤﺎﻻﺕ ﺨﻔﻴﻔﺔ ﺍﻟﺸﺩﺓ‬
‫)‪ (١٠‬ﺃﻴﺎﻡ‬ ‫)‪ (٧٥‬ﻤﻠﻎ ﻤﺭﺘﻴﻥ ﺒﺎﻟﻴﻭﻡ )‪(٢ × ١‬‬ ‫ﻋﺩﻡ ﺤﺩﻭﺙ ﺘﺤﺴﻥ ﺴﺭﻴﺭﻱ‬
‫)‪ (١٠‬ﺃﻴﺎﻡ‬ ‫)‪ (١٥٠‬ﻤﻠﻎ ﻤﺭﺘﻴﻥ ﺒﺎﻟﻴﻭﻡ )‪(٢ × ٢‬‬ ‫ﺍﻟﺤﺎﻻﺕ ﺍﻟﺸﺩﻴﺩﺓ‬

‫ﺍﻟﻤﻘﺎﺩﻴﺭ ﺍﻟﻌﻼﺠﻴﺔ ﻟﻸﻁﻔﺎل ﺒﻌﻤﺭ ﻓﻭﻕ ﺍﻟﺴﻨﺔ ﻭﺍﻷﻁﻔﺎل ﺒﻌﻤﺭ )‪ ٢‬ـ ‪ ١٢‬ﺴﻨﺔ( ﺍﻟﺠﺭﻋﺎﺕ ﺍﻟﻤﻭﺼﻰ ﺒﻬﺎ ﻜﻤﺎ ﻴﻠﻲ‪:‬‬
‫ﺍﻟﺠﺭﻋﺔ ﺍﻟﻌﻼﺠﻴﺔ ﺍﻟﻤﻭﺼﻰ ﺒﻬﺎ ﻟﻤﺩﺓ ﺨﻤﺴﺔ ﺃﻴﺎﻡ‬ ‫ﺍﻟﻭﺯﻥ‬
‫)‪ (٣٠‬ﻤﻠﻎ ﻤﺭﺘﻴﻥ ﻴﻭﻤﻴﹰﺎ‬ ‫)‪ (١٥‬ﻜﻎ ﺃﻭ ﺃﻗل‬
‫)‪ (٤٥‬ﻤﻠﻎ ﻤﺭﺘﻴﻥ ﻴﻭﻤﻴﹰﺎ‬ ‫)‪ (٢٣ - ١٥‬ﻜﻎ‬
‫)‪ (٦٠‬ﻤﻠﻎ ﻤﺭﺘﻴﻥ ﻴﻭﻤﻴﹰﺎ‬ ‫)‪ (٤٠ - ٢٤‬ﻜﻎ‬
‫)‪ (٧٥‬ﻤﻠﻎ ﻤﺭﺘﻴﻥ ﻴﻭﻤﻴﹰﺎ‬ ‫)‪ (٤١‬ﻜﻎ ﻓﻤﺎ ﻓﻭﻕ‬
‫ﻓﻲ ﺤﺎل ﻋﺩﻡ ﺤﺩﻭﺙ ﺘﺤﺴﻥ ﺴﺭﻴﺭﻱ ﺘﻤﺩﺩ ﻓﺘﺭﺓ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻟﻤﺩﺓ ﻋﺸﺭﺓ ﺃﻴﺎﻡ ﻭﺘﻀﺎﻋﻑ ﺍﻟﺠﺭﻋﺔ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺸﺩﻴﺩﺓ‪.‬‬

‫ﺃﻤﺎ ﺍﻟﺠﺭﻋﺎﺕ ﺍﻟﻤﻭﺼﻰ ﺒﻬﺎ ﻤﻥ ﺩﻭﺍﺀ ﺍﻷﻭﺴﻠﺘﺎﻤﻴﻔﻴﺭ ﻟﻌﻼﺝ ﺍﻷﻁﻔﺎل ﺒﻌﻤﺭ ﺩﻭﻥ ﺍﻟﺴﻨﺔ ﻓﻬﻲ ﻜﻤﺎ ﻴﻠﻲ‪:‬‬
‫ﺍﻟﺠﺭﻋﺔ ﺍﻟﻌﻼﺠﻴﺔ ﺍﻟﻤﻭﺼﻰ ﺒﻬﺎ ﻟﻤﺩﺓ ﺨﻤﺴﺔ ﺃﻴﺎﻡ‬ ‫ﺍﻟﻌﻤﺭ‬
‫‪ ١٢‬ﻤﻠﻎ ﻤﺭﺘﺎﻥ‪/‬ﺒﺎﻟﻴﻭﻡ‬ ‫ﺃﻗل ﻤﻥ ‪ ٣‬ﺃﺸﻬﺭ‬
‫‪ ٢٠‬ﻤﻠﻎ ﻤﺭﺘﺎﻥ‪/‬ﺒﺎﻟﻴﻭﻡ‬ ‫ﻤﻥ ‪ ٥ - ٣‬ﺃﺸﻬﺭ‬
‫‪ ٢٥‬ﻤﻠﻎ ﻤﺭﺘﺎﻥ‪/‬ﺒﺎﻟﻴﻭﻡ‬ ‫ﻤﻥ ‪ ١١ - ٦‬ﺃﺸﻬﺭ‬
‫ﻓﻲ ﺤﺎل ﻋﺩﻡ ﺤﺩﻭﺙ ﺘﺤﺴﻥ ﺴﺭﻴﺭﻱ ﺘﻤﺩﺩ ﻓﺘﺭﺓ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻟﻤﺩﺓ ﻋﺸﺭﺓ ﺃﻴﺎﻡ ﻭﺘﻀﺎﻋﻑ ﺍﻟﺠﺭﻋﺔ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺸﺩﻴﺩﺓ‪.‬‬
‫• ﻴﻌﻁﻰ ﻟﻠﺤﻭﺍﻤل ﻭﺍﻟﻤﺭﻀﻌﺎﺕ‪.‬‬
‫• ﻤﻀﺎﺩﺍﺕ ﺍﻻﺴﺘﻁﺒﺎﺏ‪ :‬ﺍﻟﺘﺤﺴﺱ ﻷﻱ ﻤﻥ ﻤﻜﻭﻨﺎﺕ ﺍﻟﺩﻭﺍﺀ‪.‬‬
‫• ﺍﻻﺤﺘﻴﺎﻁﺎﺕ ﺍﻟﺨﺎﺼﺔ ﻋﻨﺩ ﺍﺴﺘﻌﻤﺎل ﺍﻟﺩﻭﺍﺀ‪ :‬ﺍﻟﺩﻭﺍﺀ ﻓﻌﺎل ﻓﻘﻁ ﻟﻺﺼﺎﺒﺔ ﺒﻔﻴﺭﻭﺴﺎﺕ ﺍﻷﻨﻔﻠﻭﻨﺯﺍ ﺍﻟﺠﺎﺌﺤﻴﺔ‪.‬‬
‫• ﺍﻟﺘﺄﺜﻴﺭﺍﺕ ﺍﻟﺠﺎﻨﺒﻴﺔ‪ :‬ﻤﻨﻬﺎ ﻫﻀﻤﻴﺔ ﺨﻔﻴﻔﺔ ﻤﺜل‪ :‬ﻏﺜﻴﺎﻥ ﻭﺇﻗﻴﺎﺀ ﻭﺃﻟﻡ ﺒﻁﻨﻲ ﻭﻋﺴﺭ ﻫﻀﻡ ﻭﺇﺴﻬﺎل‪ .‬ﻭﺍﻷﻗل‬
‫ﺸﻴﻭﻋﹰﺎ‪ :‬ﺼﺩﺍﻉ‪ ،‬ﺩﻭﺨﺔ‪ ،‬ﺘﻌﺏ‪ ،‬ﺃﺭﻕ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﻤﻠﺘﺤﻤﺔ ﻭﺸﺭﻱ‪ .‬ﻭﻨﺎﺩﺭﹰﺍ ﻤﺎ ﺘﺤﺩﺙ ﺘﻅﺎﻫﺭﺍﺕ ﺘﺤﺴﺴﻴﺔ‪.‬‬
‫ﺃﻤﺎ ﺍﻟﻌﻼﺝ ﺒﺎﻟﺯﺍﻨﺎﻤﻴﻔﺭ ﻓﻴﺴﺎﻋﺩ ﻓﻲ ﺇﺯﺍﻟﺔ ﺃﻋﺭﺍﺽ ﺍﻟﻤﺭﺽ ﻭﺘﻘﺼﻴﺭ ﻤﺩﺘﻪ ﻤﻥ ﺨﻼل ﻤﻨﻊ ﺘﻜﺎﺜﺭ ﺍﻟﻔﻴﺭﻭﺱ ﺒﺎﻟﺭﺌﺔ‪.‬‬
‫ﻻ ﻴﺴﺘﺨﺩﻡ ﺍﻟﺩﻭﺍﺀ ﻓﻲ ﺤﺎل ﻭﺠﻭﺩ ﺘﺤﺴﺱ ﻹﺤﺩﻯ ﻤﻜﻭﻨﺎﺘﻪ ﻜﺫﻟﻙ ﺒﻌﻤﺭ ﺩﻭﻥ ﺍﻟﺨﻤﺱ ﺴﻨﻭﺍﺕ‪.‬‬
‫ﻴﺴﺘﺨﺩﻡ ﺘﺤﺕ ﺍﻹﺸﺭﺍﻑ ﺍﻟﻁﺒﻲ ﺍﻟﻤﺒﺎﺸﺭ ﻋﻨﺩ ﻭﺠﻭﺩ ﻀﻌﻑ ﻤﻨﺎﻋﺔ‪ ،‬ﻭﻋﻨﺩ ﻭﺠﻭﺩ ﺭﺒﻭ ﻤﺴﺘﻤﺭ ﺃﻭ ﺁﻓﺔ ﺭﺌﻭﻴﺔ‬
‫ﺸﺩﻴﺩﺓ ﻭﻤﺴﺘﻤﺭﺓ )ﻜﺎﻨﺘﻔﺎﺥ ﺍﻟﺭﺌﺔ‪ ،‬ﺍﻵﻓﺔ ﺍﻟﺭﺌﻭﻴﺔ ﺍﻟﺴﺎﺩﺓ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﻘﺼﺒﺎﺕ ﺍﻟﻤﺯﻤﻥ( ﺤﻴﺙ ﻴﻤﻜﻥ ﺃﻥ ﻴﻌﻴﻕ ﺍﺴﺘﺨﺩﺍﻡ‬
‫ﺍﻷﺩﻭﻴﺔ ﺍﻟﻌﻼﺠﻴﺔ ﻟﻬﺫﻩ ﺍﻷﻤﺭﺍﺽ ﻋﻥ ﻁﺭﻴﻕ ﺍﻻﺴﺘﻨﺸﺎﻕ‪ ،‬ﻭﻜﺫﻟﻙ ﺃﺜﻨﺎﺀ ﺍﻟﺤﻤل‪.‬‬
‫ﺍﻟﺠﺭﻋﺔ ﺍﻟﻌﻼﺠﻴﺔ‪ :‬ﺒﺨﺘﺎﻥ )‪ (٥ × ٢‬ﻤﻠﻎ ﺼﺒﺎﺤﹰﺎ ﻭﻤﺴﺎ ‪‬ﺀ ﻟﻤﺩﺓ ﺨﻤﺴﺔ ﺃﻴﺎﻡ ﻭﻻ ﻴﻌﻁﻰ ﻟﻌﻤﺭ ﺩﻭﻥ ﺍﻟﺨﻤﺱ ﺴﻨﻭﺍﺕ‪.‬‬

‫‪٧٦‬‬
 ‫‪‬‬
‫א‪F‬א‪ E‬‬
‫‪ Tuberculosis‬‬
‫ﺍﻟﺘﻌﺭﻴﻑ‪:‬‬
‫ﻫﻭ ﻤﺭﺽ ﺠﺭﺜﻭﻤﻲ ﺴﺎﺭ ﻤﻥ ﺃﻤﺭﺍﺽ ﺍﻟﻤﺘﻔﻁﺭﺍﺕ‪ ،‬ﻴﻤﺭ ﺍﻟﺨﻤﺞ ﺍﻷﻭﻟﻲ ﻋﺎﺩﺓ ﺩﻭﻥ ﺃﻥ ﻴﻼﺤﻅ ﻭﺘﻅﻬﺭ‬
‫ﺍﻟﺤﺴﺎﺴﻴﺔ ﻟﻠﺴﻠﻴﻥ ﺨﻼل ﺃﺴﺎﺒﻴﻊ ﻗﻠﻴﻠﺔ‪ ،‬ﻭﻜﺜﻴﺭﹰﺍ ﻤﺎ ﺘﻠﺘﺌﻡ ﺍﻵﻓﺎﺕ ﺩﻭﻥ ﺃﻱ ﺘﻐﻴﺭﺍﺕ ﻤﺘﺒﻘﻴﺔ ﻤﺎ ﻋﺩﺍ ﺘﻜﻠﺴﺎﺕ ﺭﺌﻭﻴﺔ ﺃﻭ‬
‫ﺒﻌﺽ ﺍﻟﻌﻘﺩ ﺍﻟﻠﻤﻔﻴﺔ ﺍﻟﺭﻏﺎﻤﻴﺔ ﺍﻟﻘﺼﺒﻴﺔ‪ ،‬ﻭﻗﺩ ﻴﺘﺭﻗﻰ ﻤﺒﺎﺸﺭﺓ ﺇﻟﻰ ﺘﺩﺭﻥ ﺭﺌﻭﻱ ﺃﻭ ﻴﺴﺒﺏ ﻋﻥ ﻁﺭﻴﻕ ﺍﻻﻨﺘﺸﺎﺭ‬
‫ﺍﻟﻠﻤﻔﻲ ﺍﻟﺩﻤﻭﻱ ﻟﻠﻌﺼﻴﺎﺕ ﺇﺼﺎﺒﺎﺕ ﺭﺌﻭﻴﺔ ﺃﻭ ﺩﺨﻨﻴﺔ ﺃﻭ ﺇﺼﺎﺒﺎﺕ ﺨﺎﺭﺝ ﺍﻟﺭﺌﺔ )ﺍﻟﺴﺤﺎﻴﺎ‪ ،‬ﺍﻟﻌﻅﺎﻡ‪ ،‬ﺍﻟﺠﻬﺎﺯ ﺍﻟﺒﻭﻟﻲ‬
‫ﺍﻟﺘﻨﺎﺴﻠﻲ‪...‬ﺍﻟﺦ( ﻭﻴﻨﺸﺄ ﺍﻟﺘﺩﺭﻥ ﺍﻟﺭﺌﻭﻱ ﻋﻤﻭﻤﹰﺎ ﻤﻥ ﺒﺅﺭﺓ ﻜﺎﻤﻨﺔ ﺒﺎﻗﻴﺔ ﻤﻥ ﺍﻟﺨﻤﺞ ﺍﻷﻭﻟﻲ ﻭﻴﺘﻅﺎﻫﺭ ﺴﺭﻴﺭﻴﹰﺎ ﺒﺘﻌﺏ‬
‫ﻭﺤﻤﻰ ﻭﻓﻘﺩﺍﻥ ﺍﻟﻭﺯﻥ ﻓﻲ ﻭﻗﺕ ﻤﺒﻜﺭ‪ ،‬ﺒﻴﻨﻤﺎ ﺘﺼﺒﺢ ﺍﻷﻋﺭﺍﺽ ﺍﻟﻤﻭﻀﻌﻴﺔ ﻤﻥ ﺴﻌﺎل ﻭﺃﻟﻡ ﺼﺩﺭﻱ ﻭﻨﻔﺙ ﺩﻤﻭﻱ‬
‫ﻭﺍﻀﺤﺔ ﻓﻲ ﺍﻟﻤﺭﺍﺤل ﺍﻟﻤﺘﻘﺩﻤﺔ‪.‬‬

‫ﺇﻥ ﺍﻟﺸﻜل ﺍﻟﺴﺭﻴﺭﻱ ﺍﻟﺴﺎﺌﺩ ﻟﺩﻯ ﺍﻟﺭﻀﻊ ﻭﺍﻷﻁﻔﺎل ﻫﻭ ﺍﻟﺨﻤﺞ ﺍﻷﻭﻟﻲ ﻭﻴﻜﺜﺭ ﺤﺩﻭﺙ ﺍﻟﺩﺍﺀ ﺍﻟﺩﺨﻨﻲ ﻭﺍﻟﺘﺩﺭﻥ‬
‫ﺨﺎﺭﺝ ﺍﻟﺭﺌﻭﻱ‪ ،‬ﺃﻤﺎ ﻟﺩﻯ ﺍﻟﻜﺒﺎﺭ ﻓﺎﻟﺸﻜل ﺍﻟﺴﺭﻴﺭﻱ ﺍﻟﺴﺎﺌﺩ ﻫﻭ ﺍﻟﺘﺩﺭﻥ ﺍﻟﺭﺌﻭﻱ ﻭﻴﻤﻜﻥ ﻤﺸﺎﻫﺩﺓ ﺍﻟﺘﺩﺭﻥ ﺨﺎﺭﺝ‬
‫ﺍﻟﺭﺌﻭﻱ ﻭﺍﻟﺩﺍﺀ ﺍﻟﺫﺨﻨﻲ‪.‬‬

‫ﺴﻠﺴﻠﺔ ﺍﻟﻌﺩﻭﻯ‪:‬‬
‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﺍﻟﻤﺘﻔﻁﺭﺓ ﺍﻟﺴﻠﻴﺔ ‪.Mucobacterium Tuberculosis‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﺨﻤﻭﺝ ﻭﺍﻟﻤﺼﺎﺏ ﺒﺎﻟﻤﺭﺽ‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﺒﺎﻟﺘﻌﺭﺽ ﻟﻠﻌﺼﻴﺎﺕ ﻓﻲ ﻨﻭﻯ ﺍﻟﻘﻁﻴﺭﺍﺕ ﺍﻟﻤﺤﻤﻭﻟﺔ ﻓﻲ ﺍﻟﻬﻭﺍﺀ ﻓﻲ ﻗﺸﻊ ﺃﺸﺨﺎﺹ ﻟﺩﻴﻬﻡ ﺘﺩﺭﻥ ﺨﺎﻤﺞ‪ ،‬ﻭﻗﺩ‬
‫ﻴﺤﺩﺙ ﻏﺯﻭ ﻤﺒﺎﺸﺭ ﻤﻥ ﺨﻼل ﺃﻏﺸﻴﺔ ﻤﺨﺎﻁﻴﺔ ﺃﻭ ﺸﻘﻭﻕ ﻓﻲ ﺍﻟﺠﻠﺩ ﻭﻟﻜﻥ ﻫﺫﺍ ﻨﺎﺩﺭ ﺠﺩﹰﺍ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﻤﺭﺽ ﻋﺎﻡ‪ ،‬ﺨﺎﺼﺔ ﻟﺩﻯ ﺍﻷﻁﻔﺎل ﺒﻌﻤﺭ ﺩﻭﻥ ﺜﻼﺙ ﺴﻨﻭﺍﺕ ﺤﻴﺙ ﻴﻜﻭﻥ ﻟﺩﻴﻬﻡ ﺍﻻﺴﺘﻌﺩﺍﺩ ﺃﻜﺒﺭ‬

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‫ﻟﻼﻨﺘﻘﺎل ﻤﻥ ﺍﻟﺨﻤﺞ ﺍﻟﺒﺩﺌﻲ ﺇﻟﻰ ﺍﻹﺼﺎﺒﺔ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻜﺫﻟﻙ ﻴﻜﻭﻥ ﺍﻻﺴﺘﻌﺩﺍﺩ ﺃﻜﺒﺭ ﻟﺩﻯ ﺍﻟﻤﺭﺍﻫﻘﻴﻥ ﻭﺍﻟﻤﺴﻨﻴﻥ ﻭﻜل ﻤﻥ‬
‫ﻟﺩﻴﻬﻡ ﺘﺜﺒﻁ ﻤﻨﺎﻋﻲ ﺃﻭ ﻟﺩﻯ ﺍﻟﻜﺤﻭﻟﻴﻴﻥ ﺃﻭ ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﺎﻟﺩﺍﺀ ﺍﻟﺴﻜﺭﻱ ﺃﻭ ﺍﻟﺫﻴﻥ ﺃﺠﺭﻱ ﻟﻬﻡ ﺍﺴﺘﺌﺼﺎل ﻤﻌﺩﺓ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫ﺤﻭﺍﻟﻲ ‪ ١٤-١٢‬ﺃﺴﺒﻭﻉ ﻤﻥ ﺒﺩﺍﻴﺔ ﺍﻟﺨﻤﺞ ﺤﺘﻰ ﻅﻬﻭﺭ ﺍﻵﻓﺔ ﺍﻟﺒﺩﺌﻴﺔ ﺍﻟﻔﻌﺎﻟﺔ‪ ،‬ﺃﻭ ﺘﻔﺎﻋل ﻤﻠﺤﻭﻅ ﻻﺨﺘﺒﺎﺭ‬
‫ﺍﻟﺴﻠﻴﻥ‪.‬‬

‫ﺃﻤﺎ ﺍﻹﺼﺎﺒﺎﺕ ﺍﻟﻤﺘﺭﻗﻴﺔ ﻭﺍﻹﺼﺎﺒﺎﺕ ﺨﺎﺭﺝ ﺍﻟﺭﺌﺔ ﻗﺩ ﺘﺤﺘﺎﺝ ﺇﻟﻰ ﺴﻨﺘﻴﻥ ﺤﺘﻰ ﺘﻅﻬﺭ‪ ،‬ﻭﻴﻤﻜﻥ ﺃﻥ ﺘﻅل ﻫﺎﺠﻌﺔ‬
‫ﻓﺘﺭﺓ ﻁﻭﻴﻠﺔ ﺠﺩﹰﺍ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﺘﺴﺘﻤﺭ ﺍﻟﺴﺭﺍﻴﺔ ﻁﺎﻟﻤﺎ ﻜﺎﻥ ﻫﻨﺎﻙ ﻨﺸﺭ ﻟﻠﻌﺼﻴﺎﺕ ﺍﻟﺴﻠﻴﺔ ﻋﻥ ﻁﺭﻴﻕ ﺍﻟﻘﺸﻊ ﻟﺩﻯ ﺇﻨﺴﺎﻥ ﻤﺼﺎﺏ ﺒﺂﻓﺔ ﺴﻠﻴﺔ‬
‫ﻤﻔﺘﻭﺤﺔ‪ ،‬ﻭﺘﺨﻔﺽ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﺼﺤﻴﺤﺔ ﺒﺎﻟﺼﺎﺩﺍﺕ ﺴﺭﺍﻴﺔ ﺍﻟﻤﺭﺽ ﺒﺴﺭﻋﺔ ﺒﻴﻨﻤﺎ ﺘﺴﺎﻋﺩ ﺍﻟﺒﻴﺌﺔ ﺍﻟﻤﻐﻠﻘﺔ ﻭﻏﻴﺭ‬
‫ﺍﻟﻤﻬﻭﺍﺓ ﻭﻏﻴﺭ ﺍﻟﻤﻌﺭﻀﺔ ﻷﺸﻌﺔ ﺍﻟﺸﻤﺱ ﻋﻠﻰ ﺤﺩﻭﺙ ﻭﺴﺭﺍﻴﺔ ﺍﻟﻤﺭﺽ‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﻴﻌﺘﻤﺩ ﻋﻠﻰ ﺍﺴﺘﻔﺭﺍﺩ ﻋﺼﻴﺎﺕ ﻤﻘﺎﻭﻤﺔ ﻟﻠﺤﻤﺽ ﻓﻲ ﻟﻁﺎﺨﺎﺕ ﻤﻠﻭﻨﺔ ﻤﻥ ﺍﻟﻘﺸﻊ ﺃﻭ ﺴﻭﺍﺌل ﺍﻟﺠﺴﻡ ﺍﻷﺨﺭﻯ‪.‬‬
‫ﺒﺎﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ ﺍﻟﻤﺒﺎﺸﺭ ﺃﻭ ﺍﺴﺘﻔﺭﺍﺩ ﺍﻟﻌﺼﻴﺎﺕ ﺒﺎﻟﺯﺭﻉ ﻋﻠﻰ ﺃﻭﺴﺎﻁ ﺨﺎﺼﺔ‪.‬‬

‫ﻭﻋﻨﺩ ﺴﻠﺒﻴﺔ ﺍﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ )ﺒﻌﺩ ﻓﺤﺼﻴﻥ ﻴﻭﻤﻴﻴﻥ ﻋﻠﻰ ﺍﻷﻗل( ﻴﻤﻜﻥ ﺍﻻﻋﺘﻤﺎﺩ ﻋﻠﻰ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ‬
‫ﺍﻟﺴﺭﻴﺭﻴﺔ ﻭﺍﻟﺼﻭﺭﺓ ﺍﻟﺸﻌﺎﻋﻴﺔ‪.‬‬

‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ‬

‫ﺍﻟﻤﺸﺘﺒﻪ ﺇﺼﺎﺒﺘﻪ ﺒﺎﻟﺘﺩﺭﻥ‪:‬‬

‫ﺍﻟﺘﺩﺭﻥ ﺍﻟﺭﺌﻭﻱ‪:‬‬
‫• ﺴﻌﺎل ﻤﺴﺘﻤﺭ ﻟﻤﺩﺓ )‪ (٣‬ﺃﺴﺎﺒﻴﻊ ﺃﻭ ﺃﻜﺜﺭ ﺩﻭﻥ ﺘﺤﺴﻥ ﺒﺎﻟﻤﻌﺎﻟﺠﺔ ﻏﻴﺭ ﺍﻟﻨﻭﻋﻴﺔ‪.‬‬
‫• ﺃﻭ ﻗﺸﻊ ﻤﺸﻭﺏ ﺒﺎﻟﺩﻡ ﺃﺤﻴﺎﻨﹰﺎ‪.‬‬
‫• ﺃﻭ ﻭﺠﻭﺩ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺘﺎﻟﻴﺔ‪ :‬ﺘﻌﺏ‪ ،‬ﻓﻘﺩﺍﻥ ﺸﻬﻴﺔ‪ ،‬ﻨﻘﺹ ﻭﺯﻥ‪ ،‬ﺘﻌﺭﻕ ﻟﻴﻠﻲ‪ ،‬ﺤﻤﻰ‪ ،‬ﻀﻴﻕ ﻨﻔﺱ ﻭﺃﻟﻡ ﺼﺩﺭ‪.‬‬

‫ﺍﻟﺘﺩﺭﻥ ﺨﺎﺭﺝ ﺍﻟﺭﺌﺔ‪:‬‬

‫ﺤﺴﺏ ﺍﻟﻌﻀﻭ ﺍﻟﻤﺼﺎﺏ‪.‬‬

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 ‫ﺍﻟﺘﺩﺭﻥ ﺍﻟﺭﺌﻭﻱ )‪ (+‬ﺍﻟﻘﺸﻊ‪:‬‬
‫ﺍﻟﺘﺩﺭﻥ ﻟﺩﻯ ﻤﺭﻴﺽ ﻤﻊ ﻤﺎ ﻴﻠﻲ‪:‬‬
‫• ﺇﻴﺠﺎﺒﻴﺔ ﻓﺤﺼﻴﻥ ﻤﺨﺒﺭﻴﻥ ﻋﻠﻰ ﺍﻷﻗل ﻟﻠﻘﺸﻊ )ﺒﺎﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ ﺍﻟﻤﺒﺎﺸﺭ( ﺃﻭ‪.‬‬
‫• ﺇﻴﺠﺎﺒﻴﺔ ﻓﺤﺹ ﻤﺨﺒﺭﻱ ﻭﺍﺤﺩ ﻟﻠﻘﺸﻊ ﻤﻊ ﻋﻼﻤﺎﺕ ﺸﻌﺎﻋﻴﺔ ﺘﺘﻤﺎﺸﻰ ﻤﻊ ﺘﺩﺭﻥ ﺭﺌﻭﻱ ﻓﻌﺎل ﺃﻭ‪.‬‬
‫• ﺇﻴﺠﺎﺒﻴﺔ ﻓﺤﺹ ﻤﺨﺒﺭﻱ ﻭﺍﺤﺩ ﻟﻠﻘﺸﻊ ﻤﻊ ﺇﻴﺠﺎﺒﻲ ﺯﺭﻉ ﻋﻴﻨﺔ ﻗﺸﻊ ﻭﺍﺤﺩﺓ ﻋﻠﻰ ﺍﻷﻗل‪.‬‬

‫ﺍﻟﺘﺩﺭﻥ ﺍﻟﺭﺌﻭﻱ ﺴﻠﺒﻲ ﺍﻟﻘﺸﻊ‪:‬‬

‫ﺍﻟﺘﺩﺭﻥ ﻟﺩﻯ ﻤﺭﻴﺽ ﻴﺸﻜﻭ ﻤﻥ ﺃﻋﺭﺍﺽ ﻤﻭﺤﻴﺔ ﺒﺎﻹﺼﺎﺒﺔ ﺒﺎﻟﻤﺭﺽ ﻤﻊ ﻭﺍﺤﺩ ﻤﻤﺎ ﻴﻠﻲ‪:‬‬
‫• ﻤﺠﻤﻭﻋﺘﻴﻥ ﻤﻥ ﺍﻟﻔﺤﻭﺹ ﻟﻌﻴﻨﺘﻲ ﻗﺸﻊ ﻋﻠﻰ ﺍﻷﻗل ﺴﻠﺒﻴﺘﻴﻥ ﺒﺎﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ ﺍﻟﻤﺒﺎﺸﺭ ﺃﺠﺭﻴﹰﺎ ﺒﻔﺎﺼل‬
‫ﺃﺴﺒﻭﻋﻴﻥ‪ ،‬ﻋﻼﻤﺎﺕ ﺸﻌﺎﻋﻴﺔ ﺘﺘﻤﺎﺸﻰ ﻤﻊ ﺘﺩﺭﻥ ﺭﺌﻭﻱ ﻓﻌﺎل ﻭﻋﺩﻡ ﺘﺤﺴﻥ ﺍﻟﻤﺭﻴﺽ ﺒﻌﺩ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻷﻜﺜﺭ ﻤﻥ‬
‫ﺃﺴﺒﻭﻉ ﺒﺎﻟﺼﺎﺩﺍﺕ ﺍﻟﻭﺍﺴﻌﺔ ﺍﻟﻁﻴﻑ‪ ،‬ﻗﺭﺍﺭ ﺍﻟﻁﺒﻴﺏ ﺒﺎﻟﻤﻌﺎﻟﺠﺔ ﺒﺎﻷﺩﻭﻴﺔ ﺍﻟﻨﻭﻋﻴﺔ ﺃﻭ‪،‬‬
‫• ﻤﺭﻴﺽ ﻤﺭﻀﹰﺎ ﺸﺩﻴﺩﺍﹰ‪ ،‬ﺴﻠﺒﻴﺔ ﻋﻴﻨﺘﻲ ﻗﺸﻊ ﻋﻠﻰ ﺍﻷﻗل ﺒﺎﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ ﺍﻟﻤﺒﺎﺸﺭ‪ ،‬ﻋﻼﻤﺎﺕ ﺸﻌﺎﻋﻴﺔ ﺘﺘﻤﺎﺸﻰ‬
‫ﻤﻊ ﺘﺩﺭﻥ ﺭﺌﻭﻱ ﻤﻨﺘﺸﺭ )ﺨﻼﻟﻲ‪ -‬ﺩﺨﻨﻲ(‪ ،‬ﻗﺭﺍﺭ ﺍﻟﻁﺒﻴﺏ ﺒﺎﻟﻤﻌﺎﻟﺠﺔ ﺒﺎﻷﺩﻭﻴﺔ ﺍﻟﻨﻭﻋﻴﺔ ﺃﻭ‪،‬‬
‫• ﻤﺭﻴﺽ ﻓﺤﺹ ﻗﺸﻌﻪ ﺍﻟﻤﺠﻬﺭﻱ ﺍﻟﻤﺒﺎﺸﺭ ﺍﻟﺒﺩﺌﻲ ﺴﺒﻴﺎﹰ‪ ،‬ﻭﺯﺭﻉ ﻗﺸﻌﺔ ﺍﻟﺘﺎﻟﻲ ﺇﻴﺠﺎﺒﻴﹰﺎ‪.‬‬

‫ﺍﻟﺘﺩﺭﻥ ﺨﺎﺭﺝ ﺍﻟﺭﺌﺔ‪:‬‬

‫• ﺇﺼﺎﺒﺔ ﺨﺎﺭﺝ ﺍﻟﺭﺌﺔ‪.‬‬
‫• ﻴﺒﻴﻥ ﺍﻟﺘﺸﺨﻴﺹ ﻋﻠﻰ ﻨﺘﻴﺠﺔ ﻋﻴﻨﺔ ﻭﺍﺤﺩﺓ ﺒﺎﻟﻔﺤﺹ ﺒﺎﻟﺯﺭﻉ ﺃﻭ ﺍﻟﻔﺤﺹ ﺍﻟﻨﺴﻴﺠﻲ ﻟﻶﻓﺔ‪ ،‬ﺃﻭ ﻋﻠﻰ ﺃﻋﺭﺍﺽ‬
‫ﻭﻋﻼﻤﺎﺕ ﺴﺭﻴﺭﻴﺔ ﻭﺍﻀﺤﺔ ﻟﻠﺘﺩﺭﻥ ﺨﺎﺭﺝ ﺍﻟﺭﺌﻭﻱ ﻤﺘﺒﻭﻋﺔ ﺒﻘﺭﺍﺭ ﺍﻟﻁﺒﻴﺏ ﺒﺎﻟﻌﻼﺝ ﺒﺎﻷﺩﻭﻴﺔ ﺍﻟﻨﻭﻋﻴﺔ‪.‬‬
‫• ﻴﺼﻨﻑ ﺍﻟﻤﺭﻴﺽ ﺍﻟﻤﺼﺎﺏ ﺒﺘﺩﺭﻥ ﺭﺌﻭﻱ ﻭﺨﺎﺭﺝ ﺍﻟﺭﺌﺔ ﻋﻠﻰ ﺃﻨﻪ ﻤﺭﻴﺽ ﺘﺩﺭﻥ ﺭﺌﻭﻱ‪.‬‬

‫ﺇﺠﺭﺍﺀ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‬

‫ﻴﺘﻀﻤﻥ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﻭﻤﺭﺍﻜﺯ ﺍﻟﻤﻨﺎﻁﻕ ﻭﺍﻟﻤﺸﺎﻓﻲ ﺍﻟﺘﻲ ﺃﺩﺨﻠﺕ ﺇﻟﻴﻬﺎ ﺨﺩﻤﺎﺕ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺘﺩﺭﻥ‪.‬‬
‫• ﺃﺨﺫ ﻟﻁﺎﺨﺎﺕ ﺍﻟﻘﺸﻊ ﻭﻓﺤﺼﻬﺎ ﻭﺇﺭﺴﺎﻟﻬﺎ ﻷﻗﺭﺏ ﻤﺭﻜﺯ ﺼﺤﻲ ﺘﻘﺩﻡ ﻓﻴﻪ ﺨﺩﻤﺎﺕ ﻓﺤﺹ ﺍﻟﻘﺸﻊ‪ ،‬ﻭﺫﻟﻙ ﻟﻠﻤﺭﻀﻰ‬
‫ﺒﻌﻤﺭ ﻓﻭﻕ )‪ (١٥‬ﺴﻨﺔ ﺍﻟﻤﺭﺍﺠﻌﻴﻥ ﺒﺸﻜﻭﻯ ﺴﻌﺎل ﻭﺃﻟﻡ ﺼﺩﺭﻱ ﻟﻤﺩﺓ ﺃﻜﺜﺭ ﻤﻥ ﺃﺴﺒﻭﻋﻴﻥ‪ ،‬ﻟﻡ ﺘﺘﺤﺴﻥ ﺒﺎﻟﻤﻌﺎﻟﺠﺔ‬
‫ﺍﻟﻤﻀﺎﺩﺓ ﻟﻼﻟﺘﻬﺎﺏ ﻭﻴﺭﺍﺠﻊ ﻟﻁﻠﺏ ﺍﻟﺨﺩﻤﺔ‪.‬‬
‫• ﺇﻋﻁﺎﺀ ﺍﻟﻌﻼﺝ ﻭﻓﻕ ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻌﻼﺠﻲ ﺍﻟﻤﺤﺩﺩ ﻤﻥ ﻗﺒل ﺍﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ‪.‬‬

‫‪٧٩‬‬
‫• ﺍﻟﺘﻘﺼﻲ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻤﺨﺎﻟﻁﻲ ﺍﻟﺤﺎﻟﺔ ﻓﻲ ﻤﻨﻁﻘﺔ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ ﻭﺇﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺓ‬
‫ﺍﻟﺘﻘﺼﻲ ﺍﻟﺨﺎﺼﺔ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪ ،(٣٥‬ﻭﺍﻟﺒﺤﺙ ﻋﻥ ﺤﺎﻻﺕ ﺃﺨﺭﻯ ﻓﻲ ﻤﻨﻁﻘﺔ ﺍﻹﺼﺎﺒﺔ ﻭﺇﺤﺎﻟﺔ ﺍﻟﺤﺎﻻﺕ‬
‫ﺍﻟﻤﺸﺘﺒﻬﺔ ﺇﻟﻰ ﺃﻗﺭﺏ ﻤﺭﻜﺯ ﺼﺤﻲ ﺘﻘﺩﻡ ﻓﻴﻪ ﺨﺩﻤﺎﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻟﻠﺘﺸﺨﻴﺹ ﻭﺍﻟﻌﻼﺝ‪.‬‬
‫• ﺍﺴﺘﺩﻋﺎﺀ ﺍﻟﻤﺘﺴﺭﺒﻴﻥ ﻤﻥ ﺍﻟﻌﻼﺝ ﻟﻠﺘﺄﻜﺩ ﻤﻥ ﺘﻨﺎﻭﻟﻬﻡ ﺍﻟﻌﻼﺝ ﺒﺸﻜل ﻤﻨﺘﻅﻡ‪.‬‬
‫• ﺍﻟﺘﻭﻋﻴﺔ ﺍﻟﺼﺤﻴﺔ ﻋﻥ ﺍﻟﻤﺭﺽ ﻭﺨﻁﻭﺭﺘﻪ ﻭﻀﺭﻭﺭﺓ ﻁﻠﺏ ﺍﻟﺨﺩﻤﺔ ﺍﻟﺼﺤﻴﺔ ﻭﺍﻟﻌﻼﺝ ﻭﻤﺘﺎﺒﻌﺘﻪ‪.‬‬
‫• ﺭﻓﻊ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺸﻬﺭﻴﺔ ﺇﻟﻰ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ ﻭﻓﻕ ﺍﻟﻨﻤﺎﺫﺝ ﺍﻟﻤﻌﺘﻤﺩﺓ‪.‬‬
‫• ﺘﻘﻭﻡ ﻜﺎﻓﺔ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ ﺒﺎﻟﺘﻠﻘﻴﺢ ﺒﻠﻘﺎﺡ ﺍﻟـ ‪ BCG‬ﻓﻲ ﺍﻷﺴﺒﻭﻉ ﺍﻷﻭل ﻤﻥ ﺍﻟﻭﻻﺩﺓ ﻀﻤﻥ ﺒﺭﻨﺎﻤﺞ‬
‫ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻭﻁﻨﻲ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫ﻭﻴﺘﻀﻤﻥ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﺘﺩﺭﻥ‪:‬‬
‫• ﺍﻟﻜﺸﻑ ﺍﻟﺒﺎﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻟﺔ ﺒﺤﺴﺏ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ‪.‬‬
‫• ﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺅﻜﺩﺓ ﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﺍﻟﺨﺎﺹ ﺒﺎﻟﺘﺭﺩﻥ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻟﺘﺩﺭﻥ ﻓﻲ ﺍﻟﻭﺯﺍﺭﺓ ﻋﺒﺭ‬
‫ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻟﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪ ،‬ﻤﻠﺤﻕ ﺭﻗﻡ )‪.(٣٢) (٣١‬‬
‫• ﻴﺘﻡ ﺍﻹﺒﻼﻍ ﻤﻥ ﻗﺒل ﺍﻷﻁﺒﺎﺀ ﻓﻲ ﻋﻴﺎﺩﺍﺘﻬﻡ ﺒﺎﺴﺘﻤﺎﺭﺓ ﺨﺎﺼﺔ ﻟﻺﺒﻼﻍ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪ (٣٤‬ﻭﺍﻟﺘﻲ ﺘﺭﺴل ﻟﺩﺍﺌﺭﺓ‬
‫ﻤﻜﺎﻓﺤﺔ ﺍﻟﺘﺩﺭﻥ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪.‬‬
‫• ﺍﻟﻌﻼﺝ ﺍﻟﻨﻭﻋﻲ ﺤﺴﺏ ﺍﻟﺒﺭﺍﻤﺞ ﺍﻟﻌﻼﺠﻴﺔ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﻤﺭﺽ ﻭﺒﻌﺩ ﻁﻠﺏ ﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺨﺒﺭﻴﺔ ﺍﻟﻤﺸﺨﺼﺔ‪ ،‬ﻭﻴﺘﻡ‬
‫ﺒﺈﺸﺭﺍﻑ ﻋﻨﺎﺼﺭ ﻤﺩﺭﺒﺔ‪.‬‬
‫• ﺍﻟﻌﺯل‪ :‬ﺍﻟﻌﻼﺝ ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﻏﻴﺭ ﻀﺭﻭﺭﻱ ﺇﻻ ﻟﻠﻤﺭﻀﻰ ﻤﺭﻀﹰﺎ ﺸﺩﻴﺩﹰﺍ ﻭﻴﻤﻜﻥ ﻋﻼﺝ ﺍﻟﻤﺭﻀﻰ ﻓﻲ ﺍﻟﻤﻨﺯل ﻤﻊ‬
‫ﻭﻀﻊ ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﺘﺩﺭﻥ ﺭﺌﻭﻱ ﺇﻴﺠﺎﺒﻲ ﺍﻟﻘﺸﻊ ﻓﻲ ﻏﺭﻓﺔ ﺨﺎﺼﺔ ﻤﻬﻭﺍﺓ ﻭﺃﻥ ﻴﻌﻠﻤﻭﺍ ﺘﻐﻁﻴﺔ ﺍﻷﻨﻑ ﻭﺍﻟﻔﻡ ﻋﻨﺩ‬
‫ﺍﻟﺴﻌﺎل ﺃﻭ ﺍﻟﻌﻁﺎﺱ‪ ،‬ﻭﻜﻴﻔﻴﺔ ﺍﻟﺘﺨﻠﺹ ﻤﻥ ﺍﻟﻘﺸﻊ ﻭﺍﻟﻤﻨﺎﺩﻴل ﺍﻟﻭﺭﻗﻴﺔ ﺍﻟﻤﻠﻭﻨﺔ ﻭﻴﻘﻭﻡ ﺍﻟﻤﺸﻔﻰ ﺒﺈﺒﻼﻍ ﺍﻟﻤﺭﻜﺯ‬
‫ﺍﻟﺘﺨﺼﺼﻲ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﻘﺒﻭﻟﺔ ﻓﻴﻪ ﻟﻺﺸﺭﺍﻑ ﻋﻠﻰ ﺘﺩﺒﻴﺭﻫﺎ ﻭﺘﻭﻓﻴﺭ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻼﺌﻡ‪.‬‬
‫• ﺍﻟﺘﻁﻬﻴﺭ ﺍﻟﻤﺭﺍﻓﻕ‪ :‬ﻴﺠﺏ ﺍﻟﻤﻭﺍﻅﺒﺔ ﻋﻠﻰ ﻏﺴل ﺍﻷﻴﺩﻱ ﻭﻤﻤﺎﺭﺴﺎﺕ ﺍﻟﺘﻨﻅﻴﻑ ﺍﻟﻤﻨﺯﻟﻲ ﺍﻟﺭﻭﺘﻴﻨﻴﺔ ﻭﻻ ﺘﻭﺠﺩ‬
‫ﺍﺤﺘﻴﺎﻁﺎﺕ ﺨﺎﺼﺔ ﻟﺘﺩﺍﻭل ﺍﻷﻁﺒﺎﻕ ﻭﺍﻟﻐﺴﻴل ﻭﻤﻔﺎﺭﺵ ﺍﻷﺴﺭ‪‬ﺓ ﻭﺍﻟﻤﻼﺒﺱ ﻭﺍﻷﺩﻭﺍﺕ ﺍﻟﺸﺨﺼﻴﺔ ﻭﻴﺘﻡ ﺇﺯﺍﻟﺔ ﺘﻠﻭﺙ‬
‫ﺍﻟﻬﻭﺍﺀ ﺒﺎﻟﺘﻬﻭﻴﺔ‪.‬‬
‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﻤﺭﻀﻰ ﻓﻲ ﺍﻟﻤﻨﺯل ﺃﻭ ﺍﻟﻤﺸﻔﻰ ﻭﻟﻤﺨﺎﻟﻁﻴﻬﻡ ﻭﺇﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ ﻭﺇﺭﺴﺎﻟﻬﺎ ﺇﻟﻰ‬
‫ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺘﺩﺭﻥ ﻭﺍﻟﺘﺄﻜﺩ ﻤﻥ ﻤﺘﺎﺒﻌﺔ ﺍﻟﻤﺭﻀﻰ ﻟﻠﻌﻼﺝ ﻭﺍﺴﺘﺩﻋﺎﺀ ﺍﻟﻤﺘﺴﺭﺒﻴﻥ ﻤﻨﻬﻡ ﻭﺍﻟﺒﺤﺙ ﻋﻥ ﺤﺎﻻﺕ‬
‫ﺃﺨﺭﻯ ﻏﻴﺭ ﻤﺸﺨﺼﺔ ﻭﻋﻥ ﺍﻷﻁﻔﺎل ﺍﻟﻐﻴﺭ ﻤﻠﻘﺤﻴﻥ ﻭﺍﺘﺨﺎﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﻤﺨﺎﻟﻁﻴﻥ ﻭﻴﺘﻡ ﻤﻥ ﻗﺒل‬
‫ﻓﺭﻴﻕ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ ﻟﻠﺘﺩﺭﻥ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﺍﻟﺘﻲ ﺃﺩﺨﻠﺕ ﺇﻟﻴﻬﺎ ﺨﺩﻤﺎﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﻠﺤﻕ‬
‫ﺭﻗﻡ )‪.(٣٥‬‬
‫• ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﻋﻥ ﺍﻟﻤﺭﺽ ﻭﺨﻁﻭﺭﺘﻪ ﻭﻁﺭﻕ ﺍﻟﻭﻗﺎﻴﺔ ﻤﻨﻪ ﻭﺃﻫﻤﻴﺔ ﺍﻟﻌﻼﺝ ﻭﻤﺘﺎﺒﻌﺘﻪ‪.‬‬

‫‪٨٠‬‬
‫• ﺩﺭﺍﺴﺔ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﺒﺈﺠﺭﺍﺀ ﺘﻔﺎﻋل ﺍﻟﺴﻠﻴﻥ‪ ،‬ﻴﺭﺍﻗﺏ ﺍﻟﺴﻠﺒﻴﻭﻥ ﺃﻭ ﺒﻨﺘﻴﺠﺔ ﺍﺨﺘﺒﺎﺭ ﻻ ﻨﻭﻋﻲ )‪ ٥ - ٠‬ﻤﻠﻡ( ﻤﺩﺓ‬
‫ﺴﺘﺔ ﺃﺴﺎﺒﻴﻊ ﺤﻴﺙ ﻴﻌﺎﺩ ﺍﻻﺨﺘﺒﺎﺭ ﻓﺈﺫﺍ ﺒﻘﻲ ﺴﻠﺒﻴﺎﹰ ﻴﻠﻘﺢ ﺍﻷﻁﻔﺎل ﺍﻟﻐﻴﺭ ﻤﻠﻘﺤﻴﻥ‪ ،‬ﺃﻤﺎ ﺇﺫﺍ ﺍﻨﻘﻠﺏ ﺇﻟﻰ ﺇﻴﺠﺎﺒﻲ‬
‫)< ‪ ١٠‬ﻤﻠﻡ( ﻴﻌﻁﻰ ﺍﻟﻤﺨﺎﻟﻁﻭﻥ ﺍﻟﻜﺒﺎﺭ ﻭﺍﻷﻁﻔﺎل ﺒﻐﺽ ﺍﻟﻨﻅﺭ ﻋﻥ ﺤﺎﻟﺘﻬﻡ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻭﻗﺎﺌﻲ‬
‫ﺒﺎﻻﻴﺯﻭﻨﻴﺎﺯﻴﺩ ﻤﺩﺓ ﺴﺘﺔ ﺃﺸﻬﺭ ﺃﻤﺎ ﺍﻹﻴﺠﺎﺒﻴﻭﻥ ﻤﻊ ﺃﻋﺭﺍﺽ ﻤﻭﺤﻴﺔ ﺒﺎﻟﻤﺭﺽ ﻓﻴﺤﺎﻟﻭﻥ ﻹﺠﺭﺍﺀ ﺍﻟﻔﺤﻭﺹ‬
‫ﺍﻟﻤﺸﺨﺼﺔ ﻭﻴﻌﺎﻟﺞ ﺍﻟﻤﺼﺎﺒﻭﻥ ﻤﻨﻬﻡ‪ .‬ﻴﻌﺎﻟﺞ ﺍﻟﻁﻔل ﺒﺎﻟﺘﺩﺭﻥ ﺍﻷﻭﻟﻲ ﺍﻟﺜﺎﺒﺕ ﺴﺭﻴﺭﻴﺎﹰ ﻭﺸﻌﺎﻋﻴﺎﹰ ﻤﻊ ﺍﺨﺘﺒﺎﺭ ﺴﻠﻴﻥ‬
‫ﺇﻴﺠﺎﺒﻲ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﺤﻭل ﻭﺒﺎﺌﻴﺎﺕ ﺍﻟﻤﺭﺽ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﻴﺘﻡ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺸﻌﺒﺔ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ‬
‫ﺍﻟﺴﺎﺭﻴﺔ ﻭﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺘﺩﺭﻥ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ‪.‬‬
‫• ﻭﻀﻊ ﺨﻁﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﺤﻠﻴﺔ ﻭﺘﺘﻀﻤﻥ ﺘﻘﺩﻴﺭ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﻭﺍﺩ ﺍﻟﻤﺨﺒﺭﻴﺔ‪ ...‬ﺇﻟﺦ ﻭﺍﻟﻌﻤل ﻋﻠﻰ‬
‫ﺘﻭﻓﻴﺭ ﻤﺴﺘﻠﺯﻤﺎﺘﻬﺎ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻭﺍﻟﺘﻨﺴﻴﻕ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺫﺍﺕ ﺍﻟﻌﻼﻗﺔ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬

‫• ﺘﻠﻘﻲ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺸﻬﺭﻴﺔ ﻭﺇﺠﺭﺍﺀ ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻭﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ‪.‬‬
‫• ﻭﻀﻊ ﺨﻁﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻋﻠﻰ ﻤﺴﺘﻭﻯ ﺍﻟﻘﻁﺭ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﺍﺤﺘﻴﺎﺠﺎﺕ ﻋﻤﻠﻴﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻤﻥ ﺃﺩﻭﻴﺔ ﻭﻤﻭﺍﺩ ﻤﺨﺒﺭﻴﺔ ﻭﺘﺠﻬﻴﺯﺍﺕ‪ ...‬ﺇﻟﺦ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺘﻨﻔﻴﺫ ﺒﻨﻭﺩ ﺍﻟﺨﻁﺔ‪.‬‬
‫• ﻤﺘﺎﺒﻌﺔ ﻨﺘﺎﺌﺞ ﺍﻟﻌﻼﺝ ﻟﻠﻤﺭﻀﻰ ﺍﻟﻤﺴﺠﻠﻴﻥ ﻓﻲ ﻤﺭﻜﺯ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﺘﺴﺠﻴﻠﻬﺎ ﺒﺘﻘﺭﻴﺭ ﺸﻬﺭﻱ ﻴﺭﺴل ﺇﻟﻰ ﺩﺍﺌﺭﺓ‬
‫ﻤﻜﺎﻓﺤﺔ ﺍﻟﺴل ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﺘﻨﻔﺴﻴﺔ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(٣٣‬‬
‫• ﺇﻋﺩﺍﺩ ﻭﺴﺎﺌل ﻭﻤﻭﺍﺩ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪.‬‬
‫• ﺘﻘﻭﻴﻡ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﻋﻤﻠﻴﺔ ﺘﻨﻔﻴﺫ ﺍﻟﺨﻁﺔ ﻭﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻭﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬
‫• ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺩﺭﺍﺴﺎﺕ ﻭﺍﻟﺒﺤﻭﺙ )ﺍﻨﺘﺸﺎﺭ ﺍﻟﻤﺭﺽ‪ ،‬ﺍﻟﺘﺴﺭﻱ ﺍﻟﺩﻭﺍﺌﻲ‪ ،‬ﺍﻟﻤﺭﻀﻰ ﺍﻟﻤﻘﺎﻭﻤﻴﻥ ﻟﻠﻌﻼﺝ‪ ...‬ﺇﻟﺦ(‪.‬‬

‫‪٨١‬‬
 ‫ﺨﻁﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ‬
‫ﺍﻟﺘﺩﺭﻥ ﻤﺭﺽ ﻤﻤﻴﺕ ﻭﻟﻜﻥ ﻗﺎﺒل ﻟﻠﺸﻔﺎﺀ ﺍﻟﺘﺎﻡ ﺒﺎﻟﻤﻌﺎﻟﺠﺔ ﺒﺎﻷﺩﻭﻴﺔ ﺍﻟﺩﺭﻨﻴﺔ ﻭﺍﻟﺘﻲ ﺘﺯﻴﺩ ﻓﻌﺎﻟﻴﺘﻬﺎ ﻋﻥ‪%٩٥‬‬
‫ﺤﺴﺏ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻌﺎﻟﻤﻴﺔ‪:‬‬

‫ﺃﻫﺩﺍﻑ ﺍﻟﻤﻌﺎﻟﺠﺔ‪:‬‬
‫• ﺇﺤﺩﺍﺙ ﺍﻨﻘﻼﺏ ﺠﺭﺜﻭﻤﻲ ﺒﺎﻜﺭ‪.‬‬
‫• ﻤﻨﻊ ﺤﺩﻭﺙ ﺍﻟﻤﻘﺎﻭﻤﺔ ﺍﻟﺩﻭﺍﺌﻴﺔ‪.‬‬
‫• ﻤﻨﻊ ﺍﻟﻨﻜﺱ‪ ،‬ﺘﻌﻘﻴﻴﻡ ﺍﻵﻓﺎﺕ‪.‬‬
‫• ﺘﺨﻔﻴﻑ ﻤﻌﺎﻨﺎﺓ ﺍﻟﻤﺭﻴﺽ‪.‬‬

‫ﻤﺒﺎﺩﺉ ﺍﻟﻤﻌﺎﻟﺠﺔ‪:‬‬
‫• ﺘﻨﺎﻭل ﺍﻟﻭﺠﺒﺔ ﺍﻟﻌﻼﺠﻴﺔ ﺩﻓﻌﺔ ﻭﺍﺤﺩﺓ ﺼﺒﺎﺤﹰﺎ ﻗﺒل ﺍﻟﻔﻁﻭﺭ ﺒﻨﺼﻑ ﺴﺎﻋﺔ‪.‬‬
‫• ﺘﻨﺎﻭل ﺍﻟﺩﻭﺍﺀ ﺒﺸﻜل ﻴﻭﻤﻲ ﻭﻤﻨﺘﻅﻡ‪.‬‬
‫• ﺘﻨﺎﻭل ﺍﻟﺩﻭﺍﺀ ﻭﻓﻕ ﺍﻟﻤﻘﺎﺩﻴﺭ ﺍﻟﻌﻼﺠﻴﺔ ﺍﻟﻤﻘﺭﺭﺓ‪.‬‬
‫• ﺇﺠﺭﺍﺀ ﻓﺤﺹ ﺍﻟﻤﺘﺎﺒﻌﺔ ﻓﻲ ﻤﻭﺍﻋﻴﺩﻫﺎ ﺍﻟﻤﻘﺭﺭﺓ ﻤﻥ ﻗﺒل ﺍﻟﻤﺭﻜﺯ ﺍﻟﻤﻌﺎﻟﺞ‪.‬‬
‫• ﻤﺭﺍﺠﻌﺔ ﺍﻟﻁﺒﻴﺏ ﻟﺩﻯ ﺤﺩﻭﺙ ﺃﻋﺭﺍﺽ ﺠﺎﻨﺒﻴﺔ ﻟﻸﺩﻭﻴﺔ ﺍﻟﻤﺴﺘﻌﻤﻠﺔ‪.‬‬

‫ﻤﺭﺍﺤل ﺍﻟﻤﻌﺎﻟﺠﺔ‪:‬‬
‫• ﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﻤﻜﺜﻔﺔ‪ :‬ﻤﺩﺘﻬﺎ )‪ (٣ - ١‬ﺃﺸﻬﺭ ﺤﺴﺏ ﺍﻷﺩﻭﻴﺔ ﺍﻟﻤﺴﺘﻌﻤﻠﺔ‪ ،‬ﺘﻬﺩﻑ ﻟﻺﻴﻘﺎﻑ ﺍﻟﺴﺭﻴﻊ ﻟﻠﺘﻜﺎﺜﺭ ﺍﻟﺠﺭﺜﻭﻤﻲ‬
‫ﻭﺇﺒﺎﺩﺓ ﺃﻜﺒﺭ ﻋﺩﺩ ﻤﻤﻜﻥ ﻤﻥ ﺍﻟﺠﺭﺍﺜﻴﻡ ﺒﺴﺭﻋﺔ ﻭﻤﻨﻊ ﺍﻟﻤﻘﺎﻭﻤﺔ ﺍﻟﻤﻜﺘﺴﺒﺔ‪.‬‬
‫• ﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﻤﺴﺘﻤﺭﺓ‪ :‬ﻤﺩﺘﻬﺎ )‪ (٥ - ٤‬ﺸﻬﻭﺭ ﺤﺴﺏ ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻌﻼﺠﻲ ﺍﻟﻤﻁﺒﻕ ﻭﺘﺒﺩﺃ ﺒﻌﺩ ﺤﺩﻭﺙ ﺍﻻﻨﻘﻼﺏ ﺍﻟﺠﺭﺜﻭﻤﻲ‪.‬‬

‫ﺍﻟﺒﺭﺍﻤﺞ ﺍﻟﻌﻼﺠﻴﺔ ﺍﻟﻤﺴﺘﻌﻤﻠﺔ ﻓﻲ ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻭﻁﻨﻲ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﺘﺩﺭﻥ‬

‫ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻌﻼﺠﻲ ﺍﻷﻭل )‪ (2HRSZ/4HR‬ﺃﻭ )‪:(2HREZ/4HR‬‬
‫ﺍﻟﻔﺌﺔ ﺍﻟﻤﺴﺘﻬﺩﻓﺔ‪:‬‬
‫• ﺍﻟﺤﺎﻻﺕ ﺍﻟﺠﺩﻴﺩﺓ ﻟﻠﺘﺩﺭﻥ ﺍﻟﺭﺌﻭﻱ ﺍﻹﻴﺠﺎﺒﻲ ﺍﻟﻠﻁﺎﺨﺔ‪.‬‬
‫• ﺍﻟﺤﺎﻻﺕ ﺍﻟﺨﻁﺭﺓ ﺍﻟﻤﺸﺨﺼﺔ ﺤﺩﻴﺜﹰﺎ ﺒﺄﺸﻜﺎل ﺍﻟﺘﺩﺭﻥ ﺍﻟﺸﺩﻴﺩﺓ ﻭﺘﺸﻤل ﻫﺫﻩ ﺍﻟﻔﺌﺔ‪ :‬ﻤﺭﻀﻰ ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﺩﺭﻨﻲ‬
‫ﻭﺩﺍﺀ ﺍﻟﺩﺨﻥ ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﺘﺎﻤﻭﺭ ﻭﺍﻟﺒﺭﻴﺘﻭﺍﻥ ﻭﺍﻟﺠﻨﺏ ﺍﻟﺩﺭﻨﻲ ﺜﻨﺎﺌﻲ ﺍﻟﺠﺎﻨﺏ ﻭﺍﻟﻤﺭﺽ ﺍﻟﻨﺨﺎﻋﻲ ﺍﻟﻤﺼﺤﻭﺏ‬
‫ﺒﻤﻀﺎﻋﻔﺎﺕ ﻋﺼﺒﻴﺔ ﻭﺍﻟﺘﺩﺭﻥ ﺍﻟﻤﻌﻭﻱ‪ ،‬ﻭﺍﻟﺒﻭﻟﻲ ﺍﻟﺘﻨﺎﺴﻠﻲ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻥ ﺍﻟﺭﺌﻭﻱ ﺴﻠﺒﻲ ﺍﻟﻠﻁﺎﺨﺔ ﺍﻟﻤﺼﺤﻭﺏ ﺒﺈﺼﺎﺒﺎﺕ ﻤﺘﻨﻴﺔ ﺸﺎﻤﻠﺔ‪.‬‬

‫‪٨٢‬‬
 ‫ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻌﻼﺠﻲ ﺍﻟﺜﺎﻨﻲ )‪:(2HREZS/1HREZ/5HRE‬‬
‫ﺍﻟﻔﺌﺔ ﺍﻟﻤﺴﺘﻬﺩﻓﺔ‪:‬‬
‫ﺤﺎﻻﺕ ﺍﻟﻨﻜﺱ ﻭﻓﺸل ﺍﻟﻤﻌﺎﻟﺠﺔ )ﺇﻴﺠﺎﺒﻴﺔ ﺍﻟﻠﻁﺎﺨﺔ(‪.‬‬

‫ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻌﻼﺠﻲ ﺍﻟﺜﺎﻟﺙ )‪:(2HRZ/4HR‬‬

‫ﺍﻟﻔﺌﺔ ﺍﻟﻤﺴﺘﻬﺩﻓﺔ‪:‬‬
‫• ﺍﻟﺘﺩﺭﻥ ﺍﻟﺭﺌﻭﻱ ﺴﻠﺒﻲ ﺍﻟﻠﻁﺎﺨﺔ ﺍﻟﻤﺼﺤﻭﺏ ﺒﺈﺼﺎﺒﺎﺕ ﻤﺘﻴﻨﺔ ﻤﺤﺩﻭﺩﺓ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻥ ﺨﺎﺭﺝ ﺍﻟﺭﺌﺔ )ﻋﺩﺍ ﺍﻷﺸﻜﺎل ﺍﻟﺴﺭﻴﺭﻴﺔ ﺍﻟﺩﺍﺨﻠﺔ ﻓﻲ ﺍﻟﻔﺌﺔ ﺍﻷﻭﻟﻰ(‪.‬‬

‫ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻌﻼﺠﻲ ﺍﻟﺭﺍﺒﻊ )‪:(6H‬‬

‫ﺍﻟﻔﺌﺔ ﺍﻟﻤﺴﺘﻬﺩﻓﺔ‪:‬‬
‫ﻤﺨﺎﻟﻁﻲ ﺍﻟﻤﺭﻴﺽ ﺇﻴﺠﺎﺒﻲ ﺍﻟﻘﺸﻊ ﺘﺤﺕ ﻋﻤﺭ ‪ ٢٥‬ﺴﻨﺔ‪ ،‬ﻭﺍﻟﺫﻴﻥ ﻟﺩﻴﻬﻡ ﺘﻔﺎﻋل ﺍﻟﺴﻠﻴﻥ ﻓﻭﻕ ‪ ١٠‬ﻤﻠﻡ ﻭﺍﻟﻌﺎﻤﻠﻴﻥ‬
‫ﻓﻲ ﺍﻟﺤﻘل ﺍﻟﻁﺒﻲ ﻟﺩﻯ ﺍﻟﺘﺤﺎﻗﻬﻡ ﺒﺎﻟﻌﻤل ﺤﺩﻴﺜﹰﺎ ﺒﻌﻤﺭ ﺃﻗل ﻤﻥ ‪ ٢٥‬ﻋﺎﻤﹰﺎ ﻤﻊ ﺇﻴﺠﺎﺒﻴﺔ ﺍﺨﺘﺒﺎﺭ ﺍﻟﺴﻠﻴﻥ ﻓﻭﻕ ‪ ١٠‬ﻤﻡ‪.‬‬

‫ﺍﻟﺒﺭﺍﻤﺞ ﺍﻟﻌﻼﺠﻴﺔ ﻓﻲ ﺍﻷﻭﻀﺎﻉ ﺍﻟﺨﺎﺼﺔ‬

‫ﺍﻟﺤﻭﺍﻤل‪:‬‬
‫ﺇﻥ ﻤﻌﻅﻡ ﺍﻷﺩﻭﻴﺔ ﺍﻟﺴﻠﻴﺔ ﻤﺄﻤﻭﻨﺔ ﺍﻻﺴﺘﻌﻤﺎل ﺃﺜﻨﺎﺀ ﺍﻟﺤﻤل ﺒﺎﺴﺘﺜﻨﺎﺀ ﺍﻟﺴﺘﺭﺒﺘﻭﻤﻴﺴﻴﻥ ﻟﻜﻭﻨﻪ ﻤﺘﻠﻔﹰﺎ ﻷﺫﻥ ﺍﻟﺠﻨﻴﻥ‪،‬‬
‫ﻟﺫﺍ ﻴﺤﻅﺭ ﺍﺴﺘﻌﻤﺎﻟﻪ ﺃﺜﻨﺎﺀ ﺍﻟﺤﻤل‪ ،‬ﻭﻴﺴﺘﻌﺎﺽ ﻋﻨﻪ ﺒﺎﻹﻴﺘﺎﻤﺒﻭﺘﻭل‪.‬‬

‫ﺍﻟﻤﺭﻀﻌﺎﺕ‪:‬‬
‫ﻴﺠﺏ ﺃﻥ ﺘﺘﻠﻘﻰ ﺍﻷﻡ ﺍﻟﻤﺭﻀﻌﺔ ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻌﻼﺠﻲ ﺍﻟﻜﺎﻤل‪ ،‬ﻭﻫﺫﻩ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻫﻲ ﺍﻟﻁﺭﻴﻘﺔ ﺍﻟﻤﺜﻠﻰ ﻟﻠﻭﻗﺎﻴﺔ ﻤﻥ‬
‫ﺇﺼﺎﺒﺔ ﺍﻟﺭﻀﻴﻊ ﺒﺎﻟﺘﺩﺭﻥ‪.‬‬

‫ﺍﻟﻨﺴﺎﺀ ﺍﻟﻠﻭﺍﺘﻲ ﻴﺘﻨﺎﻭﻟﻥ ﺃﻗﺭﺍﺹ ﻤﻨﻊ ﺍﻟﺤﻤل ﺍﻟﻔﻤﻭﻴﺔ‪:‬‬

‫ﻴﺘﻔﺎﻋل ﺍﻟﺭﻴﻔﺎﻤﺒﻴﺴﻴﻥ ﻤﻊ ﺃﻗﺭﺍﺹ ﻤﻨﻊ ﺍﻟﺤﻤل ﺍﻟﻔﻤﻭﻴﺔ ﻤﻤﺎ ﻴﺤﺘﻤل ﺍﻨﺨﻔﺎﺽ ﻓﻌﺎﻟﻴﺘﻬﺎ ﻜﻤﺎﻨﻊ ﻟﻠﺤﻤل‪ .‬ﻟﺫﺍ ﻴﺠﺏ‬
‫ﻋﻠﻰ ﺍﻟﻤﺭﺃﺓ ﺃﻥ ﺘﺨﺘﺎﺭ ﺒﻴﻥ ﺃﻗﺭﺍﺹ ﻤﻨﻊ ﺍﻟﺤﻤل ﺍﻟﻤﺤﺘﻭﻴﺔ ﻋﻠﻰ ﺠﺭﻋﺔ ﺃﻋﻠﻰ ﻤﻥ ﺍﻷﺴﺘﺭﻭﺠﻴﻥ ﺃﻭ ﺍﻻﺴﺘﻌﺎﻀﺔ ﻋﻨﻬﺎ‬
‫ﺒﻭﺴﻴﻠﺔ ﺃﺨﺭﻯ ﻟﻤﻨﻊ ﺍﻟﺤﻤل‪.‬‬

‫‪٨٣‬‬
 ‫ﻤﻌﺎﻟﺠﺔ ﺍﻟﻤﺭﻀﻰ ﺍﻟﻤﺼﺎﺒﻭﻥ ﺒﺎﻟﺘﻬﺎﺏ ﻜﺒﺩ ﻓﻴﺭﻭﺴﻲ ﺤﺎﺩ‪:‬‬
‫ﻓﻲ ﺒﻌﺽ ﺍﻟﺤﺎﻻﺕ ﻴﻤﻜﻥ ﺇﺭﺠﺎﺀ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺇﻟﻰ ﺤﻴﻥ ﺘﺤﺴﻥ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺤﺎﺩ‪ ،‬ﻭﻓﻲ ﺒﻌﺽ ﺤﺎﻻﺕ‬
‫ﺍﻟﻀﺭﻭﺭﺓ ﻴﻌﻁﻰ ﺍﻟﺴﺘﺭﺒﺘﻭﻤﻴﺴﻴﻥ ﻭﺍﻹﻴﺘﺎﻤﺒﻭﺘﻭل ﻟﻔﺘﺭﺓ ﺃﻗﺼﺎﻫﺎ ﺜﻼﺜﺔ ﺃﺸﻬﺭ ﺤﺘﻰ ﺘﺤﺴﻥ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺘﻌﻘﺒﻬﺎ‬
‫ﻤﺭﺤﻠﺔ ﻤﺴﺘﻤﺭﺓ ﻤﺩﺘﻬﺎ ﺴﺘﺔ ﺃﺸﻬﺭ ﻴﻌﻁﻰ ﺨﻼﻟﻬﺎ ﺍﻷﻴﺯﻭﻨﻴﺎﺯﻴﺩ‪ ،‬ﻭﺍﻟﺭﻴﻔﺎﻤﺒﻴﺴﻴﻥ )‪.(3SE/6RH‬‬

‫ﻤﻌﺎﻟﺠﺔ ﺍﻟﻤﺭﻀﻰ ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﻤﺭﺽ ﻜﺒﺩﻱ ﻤﺯﻤﻥ‪:‬‬

‫ﻴﻤﻜﻥ ﺇﻋﻁﺎﺀ ﺍﻷﺩﻭﻴﺔ ﺍﻟﺴﻠﺒﻴﺔ ﺒﺎﺴﺘﺜﻨﺎﺀ ﺍﻟﺒﻴﺭﺍﺯﻴﻥ ﺃﻤﻴﺩ ﺍﻟﺴﺎﻡ ﻟﻠﺨﻠﻴﺔ ﺍﻟﻜﺒﺩﻴﺔ‪ ،‬ﻭﻋﻠﻴﻪ ﺘﻜﻭﻥ ﺍﻟﻨﻅﻡ ﺍﻟﻌﻼﺠﻴﺔ‬
‫ﺍﻟﻤﻔﻀﻠﺔ‪:‬‬
‫‪.2RHES/6RH -‬‬
‫‪.2HSE/10HE -‬‬

‫ﻤﺭﺽ ﻗﺼﻭﺭ ﺍﻟﻜﻠﻴﺔ‪:‬‬

‫ﺍﻟﻨﻅﺎﻡ ﺍﻟﻌﻼﺠﻲ ﻫﻭ ‪ 2RHZ/6RH‬ﻭﻴﺠﺏ ﺇﻋﻁﺎﺀ ﺍﻟﺒﻴﺭﻴﺩﻭﻜﺴﻴﻥ ﻤﻊ ﺍﻹﻴﺯﻭﻨﻴﺎﺯﻴﺩ ﻟﻠﻭﻗﺎﻴﺔ ﻤﻥ ﺍﻻﻋﺘﻼل‬
‫ﺍﻟﻌﺼﺒﻲ ﺍﻟﻤﺤﻴﻁﻲ‪.‬‬
‫ﻭﻻ ﻴﻌﻁﻰ ﺍﻟﺴﺘﺭﺒﺘﻭﻤﻴﺴﻴﻥ ﻭﺍﻹﻴﺘﺎﻤﺒﻭﺘﻭل ﻨﻅﺭﹰﺍ ﻷﻥ ﺇﻁﺭﺍﺤﻬﻤﺎ ﻴﺘﻡ ﻋﻥ ﻁﺭﻴﻕ ﺍﻟﻜﻠﻴﺔ‪.‬‬

‫ﺍﻟﻌﻼﺝ ﺘﺤﺕ ﺍﻹﺸﺭﺍﻑ ﺍﻟﻤﺒﺎﺸﺭ‬

‫ﺇﻥ ﺍﻟﻬﺩﻑ ﻤﻥ ﺍﻟﻌﻼﺝ ﺘﺤﺕ ﺍﻹﺸﺭﺍﻑ ﻫﻭ ﻀﻤﺎﻥ ﺍﻟﺘﺯﺍﻡ ﺍﻟﻤﺭﻴﺽ ﺒﺈﺘﻤﺎﻡ ﻓﺘﺭﺓ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺒﺎﻷﺩﻭﻴﺔ ﺍﻟﻤﻀﺎﺩﺓ‬
‫ﻟﻠﺘﺩﺭﻥ ﻭﺍﻟﺒﺎﻟﻐﺔ ‪ ٩ - ٦‬ﺃﺸﻬﺭ‪.‬‬

‫ﻴﺘﻡ ﺍﻟﻌﻼﺝ ﻓﻲ ﺃﻗﺭﺏ ﻤﺭﻜﺯ ﺼﺤﻲ ﻤﻥ ﺴﻜﻥ ﺍﻟﻤﺭﻴﺽ‪ ،‬ﻭﺫﻟﻙ ﻋﻥ ﻁﺭﻴﻕ ﺃﺤﺩ ﺍﻟﻌﺎﻤﻠﻴﻥ ﺍﻟﺼﺤﻴﻴﻥ ﺍﻟﻤﺩﺭﺒﻴﻥ‪.‬‬
‫ﺃﻤﺎ ﺍﻟﻤﺭﻀﻰ ﺍﻟﺒﻌﻴﺩﻴﻥ ﻋﻥ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ ﻓﻴﺘﻡ ﻋﻼﺠﻬﻡ ﻋﻥ ﻁﺭﻴﻕ ﺃﺤﺩ ﺃﻓﺭﺍﺩ ﺍﻟﻤﺠﺘﻤﻊ ﺍﻟﻤﺤﻠﻲ ﺍﻟﻤﺩﺭﺒﻴﻥ ﺃﻭ‬
‫ﺃﺤﺩ ﺍﻟﻌﺎﻤﻠﻴﻥ ﺍﻟﺼﺤﻴﻴﻥ ﺍﻟﻤﻜﻠﻔﻴﻥ ﺒﺎﻟﻤﻬﺎﻡ ﺍﻟﺨﺎﺭﺠﻴﺔ‪.‬‬

‫ﻭﻴﻔﻴﺩ ﺍﻟﻌﻼﺝ ﻓﻲ ﺍﻟﻤﻨﺯل ﻤﻥ ﺍﻟﻨﻭﺍﺤﻲ ﺍﻟﺘﺎﻟﻴﺔ‪:‬‬

‫• ﻓﺎﺌﺩﺓ ﻋﻼﺠﻴﺔ ﺘﻌﺎﺩل ﻓﺎﺌﺩﺓ ﺍﻟﻌﻼﺝ ﻓﻲ ﺍﻟﻤﺸﻔﻰ‪.‬‬
‫• ﻋﺩﻡ ﺘﻌﻁﻴل ﺍﻟﻤﺭﻴﺽ ﻋﻥ ﻋﻤﻠﻪ‪.‬‬
‫• ﻋﺩﻡ ﻓﺼل ﺍﻟﻤﺭﻴﺽ ﻋﻥ ﻋﺎﺌﻠﺘﻪ‪.‬‬
‫• ﺘﻭﻓﻴﺭ ﻤﺎﺩﻱ ﺤﻴﺙ ﺃﻥ ﻜﻠﻔﺔ ﺍﻟﻌﻼﺝ ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﺴﺘﺔ ﺃﻀﻌﺎﻑ ﻜﻠﻔﺔ ﺍﻟﻌﻼﺝ ﻓﻲ ﺍﻟﻤﻨﺯل‪.‬‬
‫• ﺇﻥ ﺨﻁﺭ ﺍﻟﻌﺩﻭﻯ ﺒﻌﺩ ﻜﺸﻑ ﺍﻟﻤﺭﺽ ﻭﺍﺤﺩ ﻓﻲ ﺍﻟﻤﻨﺯل ﻭﺍﻟﻤﺸﻔﻰ‪.‬‬

‫‪٨٤‬‬
 ‫ﻋﻼﺝ ﺍﻟﻤﺭﻀﻰ ﺍﻟﻤﻘﺎﻭﻤﻴﻥ ﻋﻠﻰ ﺍﻷﺩﻭﻴﺔ ﺍﻟﺴﻠﻴﺔ‬
‫ﺍﻟﻤﻘﺎﻭﻤﺔ ﻋﻠﻰ ﺍﻷﺩﻭﻴﺔ ﺍﻟﺴﻠﻴﺔ ﻤﻘﺎﻭﻤﺔ ﻁﺒﻴﻌﻴﺔ )ﻋﺩﻭﻯ‪ ،‬ﻤﻘﺎﻭﻤﺔ ﻟﻠﻌﻼﺝ ﺍﻟﺩﻭﺍﺌﻲ ﺒﺩﻭﻥ ﺘﻨﺎﻭل ﺩﻭﺍﺀ ﻤﻀﺎﺩ‬
‫ﻟﻠﺴل ﺃﻭ ﻤﺨﺎﻟﻁﺔ ﻟﻤﺭﻴﺽ ﻤﺨﻤﻭﺝ ﺒﻌﺼﻴﺔ ﻤﻘﺎﻭﻤﺔ‪ (...‬ﺃﻭ ﺃﻭﻟﻴﺔ )ﻨﺎﺠﻤﺔ ﻋﻥ ﻋﺩﻭﻯ ﺒﻌﺼﻴﺔ ﻤﻘﺎﻭﻤﺔ ﻤﻥ ﺸﺨﺹ‬
‫ﻤﺨﻤﻭﺝ ﺒﻬﺫﻩ ﺍﻟﻌﺼﻴﺔ‪ (...‬ﺃﻭ ﺜﺎﻨﻭﻴﺔ ـ ﻤﻜﺘﺴﺒﺔ )ﺘﺎﻟﻴﺔ ﻟﺒﺭﻨﺎﻤﺞ ﻋﻼﺠﻲ ﺨﺎﻁﻰﺀ‪ :‬ﻤﻥ ﺤﻴﺙ ﺍﻟﻤﺩﺓ ﻭﺍﻟﻜﻤﻴﺔ ﺃﻭ‬
‫ﻨﺘﻴﺠﺔ ﺘﺴﺭﺏ ﺍﻟﻤﺭﻀﻰ‪ ...‬ﺇﻟﺦ(‪.‬‬

‫ﻜﺫﻟﻙ ﺘﻭﺠﺩ ﻤﻘﺎﻭﻤﺔ ﻋﻠﻰ ﺍﻷﺩﻭﻴﺔ ﻋﺩﻴﺩﺓ )ﻤﻘﺎﻭﻤﺔ ﻟﺩﻭﺍﺌﻴﻥ ﺃﻭ ﺃﻜﺜﺭ ﺒﻐﺽ ﺍﻟﻨﻅﺭ ﻋﻥ ﺍﻟﺩﻭﺍﺀ ﺍﻟﻤﺴﺘﺨﺩﻡ(‬
‫ﻭﻤﻘﺎﻭﻤﺔ ﻤﺘﻌﺩﺩﺓ ‪) MDR‬ﻤﻘﺎﻭﻤﺔ ﻋﻠﻰ ﺍﻷﻗل ﻟﺩﻭﺍﺀ ﺍﻹﻴﺯﻭﻨﻴﺎﺯﻴﺩ ﻭﺍﻟﺭﻴﻔﺎﻤﺒﻴﺴﻴﻥ( ﻭﻫﻲ ﺨﻁﺭﺓ ﻭﺼﻌﺒﺔ ﺍﻟﺸﻔﺎﺀ‪.‬‬

‫ﻴﻬﺩﻑ ﺒﺭﻨﺎﻤﺞ ﻋﻼﺝ ﺍﻟﻤﺭﻀﻰ ﺍﻟﻤﻘﺎﻭﻤﻴﻥ )‪ (MDR‬ﺇﻟﻰ ﺘﺤﻘﻴﻕ ﺍﻟﺸﻔﺎﺀ ﺍﻟﺘﺎﻡ ﻟﻬﺅﻻﺀ ﺍﻟﻤﺭﻀﻰ ﺒﺤﻴﺙ ﻻ‬
‫ﻴﻌﻭﺩﻭﻥ ﻤﺼﺩﺭﹰﺍ ﻟﻠﻌﺩﻭﻯ ﺒﺎﻟﻌﺼﻴﺎﺕ ﺍﻟﻤﻘﺎﻭﻤﺔ‪.‬‬

‫ﻜﻤﺎ ﻴﻬﺩﻑ ﺇﻟﻰ ﻤﻨﻊ ﻅﻬﻭﺭ ﺍﻟﻤﻘﺎﻭﻤﺔ‪ ،‬ﻤﻥ ﺨﻼل ﺘﻁﺒﻴﻕ ﺍﻟﻨﻅﺎﻡ ﺍﻟﻌﻼﺠﻲ ﺍﻟﻤﻌﻴﺎﺭﻱ‪ ،‬ﻓﻲ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ‬
‫ﻟﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﺘﺤﺕ ﺍﻹﺸﺭﺍﻑ‪ ،‬ﻤﻊ ﺇﺸﺭﺍﻙ ﺍﻟﻘﻁﺎﻉ ﺍﻟﺨﺎﺹ‪.‬‬

‫ﺇﻥ ﺃﻜﺜﺭ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﻌﺭﻀﻴﻥ ﻟﻠﻤﻘﺎﻭﻤﺔ ﺍﻟﺩﻭﺍﺌﻴﺔ ﻫﻡ ﺍﻟﻜﺤﻭﻟﻴﻴﻥ ﻭﻤﺘﻌﺎﻁﻲ ﺍﻟﻤﺨﺩﺭﺍﺕ ﻭﺍﻟﺴﺠﻨﺎﺀ ﻭﺍﻟﻤﺭﻀﻰ‬
‫ﺍﻟﻨﻔﺴﻴﻴﻥ ﻭﺍﻟﻼﺠﺌﻴﻥ ﻭﺍﻟﻤﺸﺭﺩﻴﻥ ﻭﺍﻷﺸﺨﺎﺹ ﺍﻟﺫﻴﻥ ﻻ ﻴﻁﺒﻕ ﻋﻠﻴﻬﻡ ﺍﻟـ ‪ DOTS‬ﻷﺴﺒﺎﺏ ﺍﺠﺘﻤﺎﻋﻴﺔ ﻭﺍﻗﺘﺼﺎﺩﻴﺔ ﻭﺜﻘﺎﻓﻴﺔ‪.‬‬

‫ﺘﻡ ﺘﺨﺼﻴﺹ ﻤﺸﻔﻰ ﺍﻟﺤﺎﺭﺙ )ﻤﺤﺎﻓﻅﺔ ﺤﻤﺹ( ﻭﺍﻟﺒﺎﺏ )ﻤﺤﺎﻓﻅﺔ ﺤﻠﺏ( ﻟﻌﻼﺝ ﺍﻟﻤﺭﻀﻰ‪.‬‬

‫‪٨٥‬‬
 ‫ﺠﺩﻭل ﺍﻷﺩﻭﻴﺔ ﻭﻤﻘﺎﺩﻴﺭﻫﺎ ﻭﺠﺭﻋﺎﺘﻬﺎ ﻭﺁﺜﺎﺭﻫﺎ ﺍﻟﺠﺎﻨﺒﻴﺔ‬

‫ﺍﻷﺩﻭﻴﺔ ﺍﻟﺩﺭﻨﻴﺔ‬
‫ﺍﻵﺜﺎﺭ ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﻋﺩﺩ ﺍﻟﺤﺒﺎﺕ‬ ‫ﻋﻴﺎﺭ ﺍﻟﺤﺒﺔ‬ ‫ﺍﻟﺠﺭﻋﺔ ﺍﻟﺩﻭﺍﺌﻴﺔ‬ ‫ﺍﺴﻡ ﺍﻟﺩﻭﺍﺀ‬ ‫ﺭﻤﺯ‬
‫ﺃﻭ ﺍﻟﺯﺠﺎﺠﺔ‬ ‫ﺍﻟﺩﻭﺍﺀ‬
‫ﻓﻭﻕ ‪ ٥٠‬ﻜﻎ‬ ‫ﺘﺤﺕ ‪ ٥٠‬ﻜﻎ‬

‫ﺍﻟﺘﻬﺎﺏ ﺃﻋﺼﺎﺏ‬ ‫‪ ٣‬ﺤﺒﺎﺕ ﻴﻭﻤﻴﹰﺎ‬ ‫ﺤﺒﺔ ‪ ١٠٠‬ﻤﻎ‬ ‫‪ ٥‬ﻤﻠﻎ‪/‬ﻜﻎ‬ ‫ﺇﻴﺯﻭﻨﻴﺎﺯﻴﺩ‬ ‫‪H‬‬

‫ﻭﺍﻟﺘﻬﺎﺏ ﻜﺒﺩ‬ ‫‪٣‬‬ ‫‪٢‬‬

‫ﺍﻟﺘﻬﺎﺏ ﻜﺒﺩ‬ ‫ﺤﺒﺘﺎﻥ ﻴﻭﻤﻴﹰﺎ‬ ‫ﺤﺒﺔ ‪ ٣٠٠‬ﻤﻎ‬ ‫‪ ١٠‬ﻤﻊ‪/‬ﻜﻎ‬ ‫ﺭﻴﻔﺎﻤﻴﺴﻴﻥ‬ ‫‪R‬‬

‫ﺃﻭ ‪ ١٥٠‬ﻤﻎ‬

‫‪٢‬‬ ‫‪١.٥‬‬

‫ﺍﻟﺘﻬﺎﺏ ﻋﺼﺏ‬ ‫‪ ٣‬ﺤﺒﺎﺕ ﻴﻭﻤﻴﹰﺎ‬ ‫ﺤﺒﺔ ‪ ٤٠٠‬ﻤﻎ‬ ‫‪ ١٥‬ـ ‪٢٥‬‬ ‫ﺇﻴﺘﺎﻡ ﺒﻭﺘﻭل‬ ‫‪E‬‬

‫ﺒﺼﺭﻱ‬ ‫ﻤﻠﻎ‪/‬ﻜﻎ‬

‫‪٣‬‬ ‫‪٢‬‬

‫ﺍﻟﺘﻬﺎﺏ ﻜﺒﺩ‬ ‫‪ ٤‬ﺤﺒﺎﺕ ﻴﻭﻤﻴﹰﺎ‬ ‫ﺤﺒﺔ ‪ ٥٠٠‬ﻤﻎ‬ ‫‪ ٣٥‬ﻤﻠﻎ‪/‬ﻜﻎ‬ ‫ﺒﻴﺭﺍﺯﻴﻨﺎﻤﻴﺩ‬ ‫‪Z‬‬

‫‪٤‬‬ ‫‪٣‬‬

‫ﺍﻟﺘﻬﺎﺏ ﻋﺼﺏ‬ ‫ﺇﺒﺭﺓ ﺃﻭ ﺜﻠﺜﻲ ﺍﻹﺒﺭﺓ ﻴﻭﻤﻴﹰﺎ‬ ‫ﺃﻤﺒﻭﻟﺔ ‪ ١‬ﻍ‬ ‫‪ ٢٠‬ﻤﻠﻎ‪/‬ﻜﻎ‬ ‫ﺴﺘﺭﺒﺘﻭﻤﺎﻴﺴﻴﻥ‬ ‫‪SM‬‬

‫ﺴﻤﻌﻲ‬

‫ﺤﺒﺘﺎﻥ ﻴﻭﻤﻴﹰﺎ‬ ‫ﺤﺒﺔ ‪١٥٠/٣٠٠‬‬ ‫ﻤﺸﺘﺭﻙ‬ ‫ﺭﻴﻔﺎﺯﻴﺩ‬ ‫‪RH‬‬

‫‪٢‬‬ ‫‪١.٥‬‬

‫‪٨٦‬‬
 ‫ﺍﻷﺩﻭﻴﺔ ﺍﻟﻤﺭﻜﺒﺔ‬
‫ﺘﺸﻤل ﺍﻷﺩﻭﻴﺔ ﺍﻟﻤﺭﻜﺒﺔ ﻋﻠﻰ ﺩﻭﺍﺀﻴﻥ ﺃﻭ ﺃﻜﺜﺭ ﺩﺍﺨل ﺍﻟﻘﺭﺹ ﺍﻟﻭﺍﺤﺩ‪.‬‬

‫ﻤﺯﺍﻴﺎ ﺍﻷﺩﻭﻴﺔ ﺍﻟﻤﺭﻜﺒﺔ‪:‬‬

‫• ﺘﻘﻠل ﺍﺤﺘﻤﺎﻻﺕ ﺍﻟﻭﻗﻭﻉ ﻓﻲ ﺃﺨﻁﺎﺀ ﻋﻼﺠﻴﺔ ﻏﻴﺭ ﻤﻘﺼﻭﺩﺓ‪.‬‬
‫• ﺘﺯﻴﺩ ﺍﺤﺘﻤﺎﻻﺕ ﻭﺼﻑ ﺍﻷﻁﺒﺎﺀ ﻟﻨﻅﺎﻡ ﻋﻼﺠﻲ ﻓﻌﺎل‪.‬‬
‫• ﻗﻠﺔ ﻋﺩﺩ ﺍﻟﺤﺒﺎﺕ ﺍﻟﺘﻲ ﺴﻴﺘﻨﺎﻭﻟﻬﺎ ﺍﻟﻤﺭﻴﺽ ﻟﻠﻤﻌﺎﻟﺠﺔ‪.‬‬
‫• ﻓﻲ ﺤﺎل ﺘﻨﺎﻭل ﺍﻟﻤﺭﻴﺽ ﻋﻼﺠﻪ ﺩﻭﻥ ﺇﺸﺭﺍﻑ ﺍﻟﻌﺎﻤل ﺍﻟﺼﺤﻲ ﻻ ﻴﻤﻜﻨﻪ ﺘﻨﺎﻭل ﺍﻟﻌﻼﺝ ﺒﺸﻜل ﺍﻨﺘﻘﺎﺌﻲ‪.‬‬
‫• ﺘﺒﺴﻴﻁ ﻋﻤﻠﻴﺔ ﺸﺭﺍﺀ ﺍﻷﺩﻭﻴﺔ ﻭﺇﺩﺍﺭﺘﻬﺎ ﻭﺘﺩﺍﻭﻟﻬﺎ‪.‬‬
‫• ﻴﺤﺩ ﻤﻥ ﻅﻬﻭﺭ ﺠﺭﺍﺜﻴﻡ ﻤﻘﺎﻭﻤﺔ ﻟﻸﺩﻭﻴﺔ‪.‬‬

‫ﻤﺴﺎﻭﻯﺀ ﺍﻷﺩﻭﻴﺔ ﺍﻟﻤﺭﻜﺒﺔ‪:‬‬

‫• ﻴﻤﻜﻥ ﺃﻥ ﻴﻨﺨﻔﺽ ﺍﻟﺘﻭﺍﺘﺭ ﺍﻟﺤﻴﻭﻱ ﻟﻸﺩﻭﻴﺔ ﻻ ﺴﻴﻤﺎ ﺍﻟﺭﻴﻔﺎﻤﺒﻴﺴﻴﻥ‪.‬‬
‫• ﻓﻲ ﺤﺎل ﺍﻟﺨﻁﺄ ﻓﻲ ﺘﻘﺩﻴﺭ ﺍﻟﺠﺭﻋﺔ ﺍﻟﻴﻭﻤﻴﺔ ﻟﻠﻤﺭﻴﺽ ﺃﻜﺜﺭ ﻤﻥ ﺍﻟﺠﺭﻋﺔ ﺍﻟﻤﻘﺭﺭﺓ ﻫﻨﺎﻙ ﺨﻁﺭ ﺤﺩﻭﺙ ﺍﻟﺘﺴﻤﻡ‬
‫ﻭﻓﻲ ﺤﺎل ﺘﻘﺩﻴﺭ ﺍﻟﺠﺭﻋﺔ ﺃﻗل ﻤﻥ ﺍﻟﻤﻘﺭﺭ ﺴﺘﺅﺩﻱ ﺇﻟﻰ ﺤﺩﻭﺙ ﺍﻟﻤﻘﺎﻭﻤﺔ ﺍﻟﺩﻭﺍﺌﻴﺔ‪.‬‬

‫ﻭﻗﺩ ﺃﻭﺼﺕ ﻤﻨﻅﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ ﻤﻌﺎﻟﺠﺔ ﻤﺭﻀﻰ ﺍﻟﺴل ﺒﺎﻷﺩﻭﻴﺔ ﺍﻟﻤﺭﻜﺒﺔ ﻭﺍﻟﺠﺩﻭل ﺍﻟﺘﺎﻟﻲ ﻴﺒﻴﻥ ﺍﻷﺩﻭﻴﺔ‬
‫ﺍﻟﻤﺭﻜﺒﺔ ﻭﻋﻴﺎﺭﻫﺎ‪.‬‬

‫ﺠﺩﻭل ﺍﻷﺩﻭﻴﺔ ﺍﻟﻤﺭﻜﺒﺔ ﻭﺠﺭﻋﺎﺘﻬﺎ ﻭﻤﻘﺎﺩﻴﺭﻫﺎ ﻋﻨﺩ ﺍﻟﺒﺎﻟﻐﻴﻥ‬

‫ﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﻤﺴﺘﻤﺭﺓ‬ ‫ﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﻤﻜﺜﻔﺔ‬ ‫ﻭﺯﻥ ﺍﻟﻤﺭﻴﺽ )ﻜﻎ(‬

‫‪ ٤‬ﺃﺸﻬﺭ‬ ‫ﺸﻬﺭﻴﻥ‬
‫ﻴﻭﻤﻲ‬ ‫ﻴﻭﻤﻲ‬
‫‪RH‬‬ ‫‪RHZE‬‬
‫‪(150+75) mg‬‬ ‫‪(150+75+499+275) mg‬‬

‫‪٢‬‬ ‫‪٢‬‬ ‫‪٣٧ - ٣٠‬‬

‫‪٣‬‬ ‫‪٣‬‬ ‫‪٥٤ - ٣٨‬‬
‫‪٤‬‬ ‫‪٤‬‬ ‫‪٧٠ - ٥٥‬‬
‫‪٥‬‬ ‫‪٥‬‬ ‫‪ ٧١‬ﺃﻭ ﺃﻜﺜﺭ‬

‫‪٨٧‬‬
‫ﺠﺩﻭل ﺍﻷﺩﻭﻴﺔ ﺍﻟﻤﺭﻜﺒﺔ ﻤﻘﺎﺩﻴﺭﻫﺎ ﻭﺠﺭﻋﺎﺘﻬﺎ ﻟﺤﺎﻻﺕ ﺍﻟﺴل ﺴﻠﺒﻲ ﺍﻟﻘﺸﻊ ﻋﻨﺩ ﺍﻷﻁﻔﺎل‬
‫ﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﻤﺴﺘﻤﺭﺓ‬ ‫ﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﻤﻜﺜﻔﺔ‬ ‫ﻭﺯﻥ ﺍﻟﻤﺭﻴﺽ )ﻜﻎ(‬

‫‪ ٤‬ﺃﺸﻬﺭ‬ ‫ﺸﻬﺭﻴﻥ‬
‫ﺃﻭ ﻴﻭﻤﻲ‬ ‫ﻴﻭﻤﻲ‬
‫‪RH‬‬ ‫‪RHZ‬‬

‫)‪(60 mg +30 mg‬‬ ‫)‪(60 mg +30 mg + 150 mg‬‬

‫‪١‬‬ ‫‪١‬‬ ‫>‪٧‬‬

‫‪١.٥‬‬ ‫‪١.٥‬‬ ‫‪٩-٨‬‬
‫‪٢‬‬ ‫‪٢‬‬ ‫‪١٤ - ١٠‬‬

‫‪٣‬‬ ‫‪٣‬‬ ‫‪١٩ - ١٥‬‬

‫‪٤‬‬ ‫‪٤‬‬ ‫‪٢٤ - ٢٠‬‬
‫‪٥‬‬ ‫‪٥‬‬ ‫‪٢٩ - ٢٥‬‬

‫‪٨٨‬‬
 ‫ﺍﻟﺒﺭﺍﻤﺞ ﺍﻟﻌﻼﺠﻴﺔ ﻟﻠﻤﺭﻀﻰ ﺍﻟﻤﻘﺎﻭﻤﻴﻥ ﻟﻸﺩﻭﻴﺔ ﺍﻟﺴﻠﻴﺔ )‪(MDR‬‬
‫ﻴﺠﺏ ﺃﻥ ﻴﻜﻭﻥ ﻫﻨﺎﻙ ﻨﺘﺎﺌﺞ ﺤﺴﺎﺴﻴﺔ ﻤﺜﺒﺘﺔ ﻷﺩﻭﻴﺔ ﺍﻟﺨﻁ ﺍﻷﻭل ﻗﺒل ﺍﻟﺒﺩﺀ ﺒﺎﻟﻌﻼﺝ‪.‬‬

‫ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻌﻼﺠﻲ‬ ‫ﻤﻘﺎﻭﻡ ﻟﻠﺭﻴﻔﺎ ﻭﺍﻹﻴﺯﻭﻨﻴﺎﺯﻴﺩ ﻋﻠﻰ ﺍﻷﻗل ‪) MDR‬ﻤﺘﻌﺩﺩ ﺍﻟﻤﻘﺎﻭﻤﺔ(‬

‫*‪6 km, Z, Of, Et, E* / 15 Of, Et, E‬‬ ‫ﻤﺭﻴﺽ ﺠﺩﻴﺩ‬
‫‪6 KN, Z, Of, Et, Cs / 18 Of, Et, Cs‬‬ ‫ﻤﺭﻴﺽ ﺒﻌﺩ ﻓﺸل ﻟﻠﺒﺭﻨﺎﻤﺞ ﺍﻷﻭل ﻭﺍﻟﺜﺎﻨﻲ ﺃﻭ ﺒﻌﺩ ﺘﺴﺭﺏ ﺃﻭ ﻨﻜﺱ‬
‫‪6Cm, PAS, Et, Cs, / 18 PAS, Et, Cs‬‬ ‫ﺍﻟﻤﺭﻴﺽ ﺘﻨﺎﻭل ﺃﺩﻭﻴﺔ ﺍﻟﺨﻁ ﺍﻟﺜﺎﻨﻲ‬

‫* ﻴﻤﻜﻥ ﺍﺴﺘﺨﺩﺍﻤﻪ ﺇﺫﺍ ﻜﺎﻨﺕ ﺍﻟﻌﺼﻴﺔ ﻤﺘﺤﺴﺱ ﻟﻠـ ‪.E‬‬

‫‪Kn‬‬ ‫ﻜﻨﺎﻤﻴﺴﻴﻥ‪:‬‬
‫‪Z‬‬ ‫ﺒﻴﺭﺍﺯﻴﻥ ﺃﻤﻴﺩ‪:‬‬
‫‪Of‬‬ ‫ﺃﻭﻨﻠﻭﻜﺴﺎﺴﻴﻥ‪:‬‬
‫‪Et‬‬ ‫ﺇﻴﺘﻴﻭﻨﺎﻤﻴﺩ‪:‬‬
‫‪E‬‬ ‫ﺇﻴﺘﺎﻤﺒﻭﺘﻭل‪:‬‬
‫‪Cs‬‬ ‫ﺴﻴﻜﻠﻭﺴﻴﺭﻴﻥ‬
‫‪PAS‬‬ ‫ﺒﺎﺭﺍ ﺃﻤﻴﻨﻭﺴﺎﻟﻴﺴﻴﻠﻴﻙ ﺃﺴﻴﺩ‪:‬‬
‫‪Cm‬‬ ‫ﻜﺎﺒﺭﻭﻤﻴﺴﻴﻥ‬

‫‪‬‬
‫‪‬‬

‫‪٨٩‬‬


٩٠
 

٩٢
 ‫‪ ‬‬
‫א‪‬א‪‬א‪ ‬‬
‫‪ Viral Hepatitis‬‬

‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ ﻟﺤﺎﻟﺔ ﺍﻟﺘﻬﺎﺏ ﻜﺒﺩ ﻓﻴﺭﻭﺴﻲ‬

‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ‪ :‬ﺤﺎﻟﺔ ﺸﺨﺹ ﻤﺼﺎﺏ ﺒﻴﺭﻗﺎﻥ ﻤﺴﺒﻭﻕ ﺒﺄﻋﺭﺍﺽ ﻋﺎﻤﺔ )ﺘﻭﻋﻙ‪ ،‬ﻗﻬﻡ‪ ،‬ﻏﺜﻴﺎﻥ‪ ،‬ﺍﻨﺯﻋﺎﺝ‬
‫ﺒﻁﻨﻲ( ﻤﻊ ﺃﻭ ﺒﺩﻭﻥ ﺤﻤﻰ‪.‬‬

‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺭﺠﺤﺔ‪ :‬ﺤﺎﻟﺔ ﻤﺸﺘﺒﻬﺔ ﻤﻊ ﻓﺤﻭﺹ ﺇﻴﺠﺎﺒﻴﺔ ﻟﻭﻅﺎﺌﻑ ﺍﻟﻜﺒﺩ ﻭﺍﺭﺘﻔﺎﻉ ﺨﻤﺎﺌﺭ )ﺍﻷﻤﻴﻨﻭﺘﺭﺍﻨﺴﻔﻴﺭﺍﺯ(‪.‬‬

‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺅﻜﺩﺓ‪ :‬ﺤﺎﻟﺔ ﻤﺭﺠﺤﺔ ﻤﻊ ﻓﺤﻭﺹ ﻤﺨﺒﺭﻴﺔ ﻨﻭﻋﻴﺔ ﺇﻴﺠﺎﺒﻴﺔ )ﻜﺸﻑ ﺍﻟﻤﺴﺘﻀﺩ ﺍﻟﻔﻴﺭﻭﺴﻲ ﺃﻭ ﺍﺭﺘﻔﺎﻉ‬
‫ﺃﻀﺩﺍﺩ ﺍﻟﻔﻴﺭﻭﺱ(‪.‬‬

‫ﺘﻀﻡ ﺍﻟﺘﻬﺎﺒﺎﺕ ﺍﻟﻜﺒﺩ ﺍﻟﻔﻴﺭﻭﺴﻴﺔ ﻋﺩﺓ ﺃﻨﻤﺎﻁ‪:‬‬

‫• ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻷﻟﻔﻲ ‪.A‬‬

‫• ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ ‪.B‬‬

‫• ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺴﻲ ‪.C‬‬

‫• ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺩﻟﺘﺎﻭﻱ ‪.D‬‬

‫• ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﻴﺎﺌﻲ ‪.E‬‬

‫• ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ‪.G‬‬

‫‪‬‬

‫‪٩٣‬‬
 ‫‪‬‬
‫א‪‬א‪‬א‪ A‬‬
‫ﻤﺭﺽ ﻓﻴﺭﻭﺴﻲ‪ ،‬ﻴﺒﺩﺃ ﻋﺎﺩﺓ ﺒﺸﻜل ﻤﻔﺎﺠﺊ‪ ،‬ﻭﻴﺘﻅﺎﻫﺭ ﺒﺤﻤﻰ ﻭﺘﻭﻋﻙ ﻭﻗﻬﻡ ﻭﻏﺜﻴﺎﻥ ﻭﺍﻨﺯﻋﺎﺝ ﺒﻁﻨﻲ‪ ،‬ﻭﻴﻌﻘﺏ‬
‫ﺫﻟﻙ ﻴﺭﻗﺎﻥ ﺨﻼل ﺒﻀﻌﺔ ﺃﻴﺎﻡ‪ ،‬ﻭﻜﺜﻴﺭﹰﺍ ﻤﺎ ﻴﻜﻭﻥ ﺍﻟﺨﻤﺞ ﺒﺩﻭﻥ ﺃﻋﺭﺽ ﺃﻭ ﺨﻔﻴﻔ ﹰﺎ ﺒﺩﻭﻥ ﻴﺭﻗﺎﻥ‪ .‬ﻏﺎﻟﺒﹰﺎ ﻤﺎ ﻴﺼﻴﺏ‬
‫ﺍﻷﻁﻔﺎل‪ ،‬ﻭﺘﺯﺩﺍﺩ ﺸﺩﺓ ﺍﻟﻤﺭﺽ ﻤﻊ ﺘﻘﺩﻡ ﺍﻟﻌﻤﺭ‪ ،‬ﻭﻟﻜﻥ ﺍﻟﺸﻔﺎﺀ ﺍﻟﺘﺎﻡ ﺒﺩﻭﻥ ﻋﻘﺎﺒﻴل ﺃﻭ ﻨﻜﺴﺎﺕ ﻫﻭ ﺍﻟﻘﺎﻋﺩﺓ‪ ،‬ﺇﺫ ﺃﻥ‬
‫ﻤﻌﺩل ﺍﻹﻤﺎﺘﺔ ﺒﻴﻥ ﺍﻟﺤﺎﻻﺕ ﺃﻗل ﻤﻥ ‪.%٠.١‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﻓﻴﺭﻭﺱ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻷﻟﻔﻲ ‪  Hepatitis A virus‬ﻭﻫﻭ ﻓﻴﺭﻭﺱ ﺭﻨﺎﻭﻱ )‪ (RNA‬ﻤﻥ ﺯﻤﺭﺓ ﺍﻟﻔﻴﺭﻭﺴﺎﺕ‬
‫ﺍﻟﺒﻴﻜﻭﺭﻨﺎﻭﻴﺔ ‪.Picorna Virus‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﺭﻴﺽ ﻭﺍﻟﺤﺎﻤل‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫• ﻤﻥ ﺇﻨﺴﺎﻥ ﺇﻟﻰ ﺇﻨﺴﺎﻥ ﻋﻥ ﺍﻟﻁﺭﻴﻕ ﺍﻟﺒﺭﺍﺯﻱ ﺍﻟﻔﻤﻭﻱ‪.‬‬
‫• ﻋﻥ ﻁﺭﻴﻕ ﺘﻨﺎﻭل ﻤﺎﺀ ﺃﻭ ﻁﻌﺎﻡ ﻤﻠﻭﺙ‪.‬‬
‫• ﻨﺎﺩﺭﹰﺍ ﻋﻥ ﻁﺭﻴﻕ ﻨﻘل ﺍﻟﺩﻡ ﻤﻥ ﻤﺘﺒﺭﻉ ﻓﻲ ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﺨﻤﺞ ﻋﺎﻡ‪ ،‬ﻭﺍﻷﺨﻤﺎﺝ ﺍﻟﺨﻔﻴﻔﺔ ﻭﺍﻟﻼﻴﺭﻗﺎﻨﻴﺔ ﺸﺎﺌﻌﺔ ﻓﻲ ﺍﻟﺭﻀﻊ ﻭﺍﻷﻁﻔﺎل‪ ،‬ﻭﻴﺤﺘﻤل ﺃﻥ ﺘﺒﻘﻰ‬
‫ﺍﻟﻤﻨﺎﻋﺔ ﺍﻟﺘﺎﻟﻴﺔ ﻟﻺﺼﺎﺒﺔ ﻤﺩﻯ ﺍﻟﺤﻴﺎﺓ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫‪ ١٥‬ـ ‪ ٥٠‬ﻴﻭﻡ )ﻭﺴﻁﻴﹰﺎ ﺸﻬﺭ(‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻤﻥ ﺍﻟﻨﺼﻑ ﺍﻟﺜﺎﻨﻲ ﻟﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ ﻭﻴﺴﺘﻤﺭ ﺒﻀﻌﺔ ﺃﻴﺎﻡ ﺒﻌﺩ ﻅﻬﻭﺭ ﺍﻟﻴﺭﻗﺎﻥ )ﺃﻭ ﺍﺭﺘﻔﺎﻉ ﺨﻤﺎﺌﺭ‬
‫ﻼ ﻟﻠﻔﻴﺭﻭﺱ ﻟﻔﺘﺭﺍﺕ ﻁﻭﻴﻠﺔ‪.‬‬
‫ﺍﻷﻤﻴﻨﻭﺘﺭﺍﺘﺴﻔﻴﺭﺍﺯ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻼﻴﺭﻗﺎﻨﻴﺔ(‪ ،‬ﻭﻓﻲ ﺤﺎﻻﺕ ﻨﺎﺩﺭﺓ ﻴﺒﻘﻰ ﺍﻟﻤﺭﻴﺽ ﺤﺎﻤ ﹰ‬

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 ‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﺍﻋﺘﻤﺎﺩ ﻋﻠﻰ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‪ ،‬ﻭﺍﺭﺘﻔﺎﻉ ﺨﻤﺎﺌﺭ ﺍﻷﻤﻴﻨﻭﺘﺭﺍﻨﻤﺴﻔﻴﺭﺍﺯ‪ ،‬ﻭﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺼﻠﻴﺔ‪:‬‬
‫ﻋﻴﺎﺭ ﺍﻷﻀﺩﺍﺩ ﺍﻟﻔﻴﺭﻭﺴﻴﺔ ﻤﻥ ﻨﻤﻁ ‪ Igm‬ﻭﺍﻟـ ‪ Elisa‬ﻻﻜﺘﺸﺎﻑ ﺍﻟﻔﻴﺭﻭﺴﺎﺕ ﻭﺃﻀﺩﺍﺩﻫﺎ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬

‫• ﺍﻟﻜﺸﻑ ﺍﻟﻤﺒﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻻﺕ‪.‬‬
‫• ﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻟﺤﺎﻻﺕ )ﻭﻓﻕ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ( ﻓﻲ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ )ﻓﻲ ﺍﻟﺤﺎﻻﺕ‬
‫ﺍﻟﻤﺘﻔﺭﻗﺔ(‪ ،‬ﻭﺭﻓﻊ ﻫﺫﺍ ﺍﻟﺘﻘﺭﻴﺭ ﺇﻟﻰ ﺸﻌﺒﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻓﻲ ﺍﻟﻤﺩﻴﺭﻴﺔ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪ .(٣-٢‬ﻭﺍﻹﺒﻼﻍ ﻋﻥ‬
‫ﺍﻟﻔﺎﺸﻴﺎﺕ ﺃﻭ ﺍﻷﻭﺒﺌﺔ ﺒﺸﻜل ﻓﻭﺭﻱ ﺇﻟﻰ ﺸﻌﺒﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻓﻲ ﺍﻟﻤﺩﻴﺭﻴﺔ‪.‬‬
‫• ﺍﻟﻌﻼﺝ‪ :‬ﻻ ﻴﻭﺠﺩ ﻋﻼﺝ ﻨﻭﻋﻲ ﻟﻠﻤﺭﺽ‪.‬‬
‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ‪ :‬ﻟﻠﻔﺎﺸﻴﺎﺕ ﻭﺍﻷﻭﺒﺌﺔ ﻓﻘﻁ‪ ،‬ﻤﻥ ﻗﺒل ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻤﺘﻭﺴﻁ ﻭﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﻋﻨﺎﺼﺭ ﺼﺤﻴﺔ‬
‫ﻤﻥ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ ﻭﻤﺭﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ‪ ،‬ﻭﺇﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﻤﺭﺽ ﺍﻟﻤﻠﺤﻕ )ﺭﻗﻡ ‪(٢٠‬‬
‫ﻭﺩﺭﺍﺴﺔ ﺍﻟﻅﺭﻭﻑ ﺍﻟﺒﻴﺌﻴﺔ )ﻭﺨﺎﺼﺔ ﻤﺼﺎﺩﺭ ﻤﻴﺎﻩ ﺍﻟﺸﺭﺏ ﻭﻁﺭﻕ ﺍﻟﺼﺭﻑ ﺍﻟﺼﺤﻲ( ﻭﺍﻟﺒﺤﺙ ﻋﻥ ﺤﺎﻻﺕ‬
‫ﺃﺨﺭﻯ ﻓﻲ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ‪ ،‬ﻟﺘﺤﺩﻴﺩ ﻁﺭﺯ ﺍﻻﻨﺘﻘﺎل ﻫل ﻫﻲ ﻤﻥ ﺸﺨﺹ ﻟﺸﺨﺹ ﺃﻭ ﻋﻥ ﻁﺭﻴﻕ ﺍﻟﻁﻌﺎﻡ ﺃﻭ ﺍﻟﻤﺎﺀ‬
‫ﺍﻟﻤﻠﻭﺙ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻤﻌﺭﻓﺔ ﺴﺒﺏ ﺍﻟﻔﺎﺸﻴﺎﺕ ﺃﻭ ﺍﻷﻭﺒﺌﺔ‪.‬‬
‫• ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‪:‬‬
‫‪ -‬ﺍﻟﻌﺯل‪ :‬ﺘﻁﺒﻴﻕ ﺍﻻﺤﺘﻴﺎﻁﺎﺕ ﺍﻟﻤﻌﻭﻴﺔ ﺨﻼل ﺍﻷﺴﺒﻭﻋﻴﻥ ﺍﻷﻭﻟﻴﻥ ﻤﻥ ﺍﻟﻤﺭﺽ‪.‬‬
‫‪ -‬ﺍﻟﺘﻁﻬﻴﺭ ﻭﺍﻟﺘﺨﻠﺹ ﺍﻟﺼﺤﻲ ﻤﻥ ﺍﻟﺒﺭﺍﺯ ﻭﺍﻟﺒﻭل ﻭﺍﻟﺩﻡ‪.‬‬
‫‪ -‬ﺇﻋﻁﺎﺀ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ﺒﻤﻘﺩﺍﺭ ‪ ٠.٠٤ - ٠.٠٢‬ﻤل‪/‬ﻜﻎ ﻤﻥ ﻭﺯﻥ ﺍﻟﺠﺴﻡ ﺒﺎﻟﻌﻀل‪.‬‬
‫‪ -‬ﺘﺤﺴﻴﻥ ﺍﻹﺼﺤﺎﺡ ﺍﻟﺒﻴﺌﻲ ﻭﺍﻹﻤﺩﺍﺩ ﺒﻤﺎﺀ ﻤﺄﻤﻭﻥ‪ ،‬ﻭﺇﺯﺍﻟﺔ ﺍﻟﺘﻠﻭﺙ ﺍﻟﺒﺭﺍﺯﻱ ﻟﻸﻁﻌﻤﺔ ﻭﺍﻟﻤﺎﺀ‪.‬‬
‫‪ -‬ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪ :‬ﺒﺨﺼﻭﺹ ﺍﻹﺼﺤﺎﺡ ﺍﻟﺠﻴﺩ ﻭﺍﻟﺘﺼﺤﺢ ﺍﻟﺸﺨﺼﻲ ﻤﻊ ﺘﺭﻜﻴﺯ ﺨﺎﺹ ﻋﻠﻰ ﺍﻟﺘﺨﻠﺹ‬
‫ﺍﻟﺼﺤﻲ ﻤﻥ ﺍﻟﺒﺭﺍﺯ ﻭﻏﺴل ﺍﻟﻴﺩﻴﻥ ﺠﻴﺩﹰﺍ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻤﺤﻠﻲ ﻓﻲ ﺤﺎل ﺤﺩﻭﺙ ﺍﻟﻔﺎﺸﻴﺎﺕ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬

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‫• ﺭﻓﻊ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺸﻬﺭﻴﺔ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻭﺇﺒﻼﻍ ﺍﻟﺩﺍﺌﺭﺓ ﻋﻥ ﺤﺩﻭﺙ ﺍﻟﻔﺎﺸﻴﺎﺕ‬
‫ﻭﺍﻷﻭﺒﺌﺔ‪.‬‬
‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﻟﻠﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﻋﻤل ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﻭﺘﻭﺯﻴﻊ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﻭﺍﺩ ﺍﻟﻤﺨﺒﺭﻴﺔ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻤﻥ ﺨﻼل ﺍﻟﻤﺠﻠﺱ ﺍﻟﺼﺤﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻁﺎﺭﺌﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻘﻁﺭ‪.‬‬
‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﺇﻟﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﻭﺴﺎﺌل ﻭﻤﻭﺍﺩ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪.‬‬
‫• ﺘﻘﺩﻴﺭ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﻭﺍﺩ ﺍﻟﻤﺨﺒﺭﻴﺔ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﺍﻟﺩﺭﺍﺴﺎﺕ ﻭﺍﻟﺒﺤﻭﺙ ﺃﻭ ﺍﻟﻤﺴﻭﺡ ﻟﻤﻌﺭﻓﺔ ﻤﻌﺩل ﺍﻻﻨﺘﺸﺎﺭ‪ ،‬ﻭﻋﻭﺍﻤل ﺍﻟﺨﻁﺭ ﺍﻟﻤﺭﺘﺒﻁﺔ ﺒﺤﺩﻭﺙ ﺍﻟﻤﺭﺽ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻭﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬

‫ﻤﻼﺤﻅﺔ‪ :‬ﻴﺘﻭﻓﺭ ﺤﺎﻟﻴﺎﹰ ﻟﻘﺎﺡ ﺤﻲ ﻤﻀﻌﻑ ﻤﺨﺼﺹ ﻟﻠﻘﻁﺎﻉ ﺍﻟﺨﺎﺹ‪ ،‬ﻟﻴﻌﻁﻰ ﺒﺠﺭﻋﺘﻴﻥ ﺒﻔﺎﺼل )‪ (٦‬ﺃﺸﻬﺭ‬
‫ﻭﺒﻌﻤﺭ ﻓﻭﻕ ﺍﻟﺴﻨﺘﻴﻥ‪ ،‬ﻭﻫﻭ ﻏﻴﺭ ﻤﻌﺘﻤﺩ ﻀﻤﻥ ﺨﻁﺔ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻓﻲ ﺍﻟﻭﻗﺎﻴﺔ ﻤﻥ ﺍﻟﻤﺭﺽ‬
‫)ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻭﻁﻨﻲ(‪.‬‬

‫ﻭﻟﻘﺩ ﻭﻀﻌﺕ ﻤﻨﻅﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ ﺒﻌﺽ ﺍﻟﺘﻭﺼﻴﺎﺕ ﻻﺴﺘﺨﺩﺍﻡ ﺍﻟﻠﻘﺎﺡ‪ ،‬ﺤﻴﺙ ﻴﺴﺘﻌﻤل ﻟﺩﻯ ﺍﻟﻔﺌﺎﺕ‬
‫ﺍﻟﻤﻌﺭﻀﺔ ﻟﺨﻁﺭ ﻤﺭﺘﻔﻊ ﻟﻠﻌﺩﻭﻯ ﻓﻲ ﺒﻠﺩﺍﻥ ﺘﺭﺘﻔﻊ ﻓﻴﻬﺎ ﻤﻌﺩﻻﺕ ﻭﻗﻭﻉ ﺍﻟﻤﺭﺽ‪ ،‬ﻜﻤﺭﺽ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ‬
‫ﺍﻟﻤﺯﻤﻥ ﺃﻭ ﺍﻀﻁﺭﺍﺒﺎﺕ ﻋﻭﺍﻤل ﺍﻟﺘﺠﻠﻁ‪ ،‬ﻭﻤﺩﻤﻨﻲ ﺍﻟﻤﺨﺩﺭﺍﺕ ﺒﺎﻟﺤﻘﻥ‪ ،‬ﻭﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﺴﺘﻌﺩﻴﻥ ﻟﻺﺼﺎﺒﺔ‬
‫ﺍﻟﻤﺴﺎﻓﺭﻴﻥ ﻟﻬﺫﻩ ﺍﻟﺒﻠﺩﺍﻥ‪ ،‬ﻭﺍﻷﻁﻔﺎل‪ ،‬ﻜﻤﺎ ﻴﻤﻜﻥ ﺇﻋﻁﺎﺀﻩ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻔﺎﺸﻴﺎﺕ ﻋﻠﻰ ﻤﺴﺘﻭﻯ ﺍﻟﻤﺠﺘﻤﻌﺎﺕ ﺍﻟﻤﺤﻠﻴﺔ‬
‫ﺍﻟﺼﻐﻴﺭﺓ ﺇﺫﺍ ﺃﻋﻁﻲ ﺒﺎﻜﺭﺍﹰ‪.‬‬

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 ‫‪‬‬
‫א‪‬א‪‬א‪ B‬‬
‫ﻤﺭﺽ ﻓﻴﺭﻭﺴﻲ‪ ،‬ﻴﺒﺩﺃ ﻋﺎﺩﺓ ﺒﺸﻜل ﻤﺨﺎﺘل‪ ،‬ﻭﻴﺘﻅﺎﻫﺭ ﺒﻘﻬﻡ ﻭﺃﻟﻡ ﺒﻁﻨﻲ ﻤﺒﻬﻡ‪ ،‬ﻏﺜﻴﺎﻥ‪ ،‬ﺇﻗﻴﺎﺀ‪ ،‬ﺜﻡ ﻴﻅﻬﺭ ﺍﻟﻴﺭﻗﺎﻥ‪،‬‬
‫ﻭﺍﻟﺤﺭﺍﺭﺓ ﻴﻤﻜﻥ ﺃﻥ ﺘﻜﻭﻥ ﻏﺎﺌﺒﺔ ﺃﻭ ﺨﻔﻴﻔﺔ‪ ،‬ﻴﻤﻜﻥ ﺃﻥ ﻴﺤﺩﺙ ﺃﻟﻡ ﻤﻔﺼﻠﻲ ﻭﻁﻔﺢ‪ .‬ﺘﺘﺭﺍﻭﺡ ﺸﺩﺓ ﺍﻟﻤﺭﺽ ﻤﻥ ﺤﺎﻻﺕ‬
‫ﻏﻴﺭ ﻤﺘﻅﺎﻫﺭﺓ ﺴﺭﻴﺭﻴﹰﺎ ﺇﻟﻰ ﺤﺎﻻﺕ ﺸﺩﻴﺩﺓ ﻭﻤﻤﻴﺘﺔ ﻤﻥ ﺍﻟﻨﺨﺭ ﺍﻟﻜﺒﺩﻱ ﺍﻟﺤﺎﺩ‪ ،‬ﻤﻌﺩل ﺍﻹﻤﺎﺘﺔ ﺤﻭﺍﻟﻲ ‪.%١‬‬

‫ﺘﺤﺩﺙ ﺤﺎﻟﺔ ﺍﻟﺤﻤل ﻋﻨﺩ ‪ %٢٠ - ٠.١/‬ﻤﻥ ﺍﻟﺒﺎﻟﻐﻴﻥ‪ ،‬ﻭﻋﻨﺩ ‪ %/٩٠ - ٧٠/‬ﻤﻥ ﺍﻷﻁﻔﺎل‪.‬‬

‫ﻭﺇﻥ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ ﻤﺴﺅﻭل ﻋﻥ ﺤﻭﺍﻟﻲ ‪ %٨٠‬ﻤﻥ ﺤﺎﻻﺕ ﺴﺭﻁﺎﻥ ﺍﻟﻜﺒﺩ‪.‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﻓﻴﺭﻭﺱ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ ‪ Hepatitis B virus‬ﻭﻫﻭ ﻴﺘﻜﻭﻥ ﻤﻥ ﺜﻼﺜﺔ ﻤﺴﺘﻀﺩﺍﺕ ﻫﻲ‪HbsAg- HbcAg- :‬‬
‫‪ HbeAg-‬ﻭﻫﻭ ﻓﻴﺭﻭﺱ ﺩﻨﺎﻭﻱ )‪ (DNA‬ﻤﻥ ﺯﻤﺭﺓ ‪ Hepadena virus‬ﻭﻟﻪ ﺃﺭﺒﻌﺔ ﺃﻨﻤﺎﻁ ﺠﻴﻨﻴﺔ ﺤﺴﺏ ﺘﺭﻜﻴﺏ‬
‫ﺍﻟﻤﺴﺘﻀﺩ ﺍﻟﺴﻁﺤﻲ ‪.HBsAg‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﺭﻴﺽ ﻭﺍﻟﺤﺎﻤل‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﻴﻭﺠﺩ ﺍﻟﻤﺴﺘﻀﺩ ﺍﻟﺴﻁﺤﻲ ﻓﻲ ﺠﻤﻴﻊ ﻤﻔﺭﺯﺍﺕ ﺍﻟﺠﺴﻡ ﻭﻤﻔﺭﻏﺎﺘﻪ ﺘﻘﺭﻴﺒﺎﹰ‪ ،‬ﻭﻟﻜﻥ ﺘﺒﻴﻥ ﺃﻥ ﺍﻟﻤﻭﺍﺩ ﺍﻟﺨﺎﻤﺠﺔ‬
‫ﺘﻘﺘﺼﺭ ﻋﻠﻰ ﺍﻟﺩﻡ ﻭﺍﻟﻠﻌﺎﺏ ﻭﺍﻟﻤﻨﻲ ﻭﺍﻟﺴﻭﺍﺌل ﺍﻟﻤﻬﺒﻠﻴﺔ‪.‬‬

‫• ﺒﺎﻟﺘﻌﺭﺽ ﺇﻟﻰ ﺴﻭﺍﺌل ﺍﻟﺠﺴﻡ ﺍﻟﺨﺎﻤﺠﺔ ﻤﻥ ﺨﻼل ﺍﻟﺠﻠﺩ )ﺒﺎﻟﺤﻘﻥ(‪ ،‬ﻭﻤﻥ ﺨﻼل ﺍﻟﺠﺭﻭﺡ ﺃﻭ ﺍﻟﺘﻬﺘﻜﺎﺕ ﺍﻟﻤﻠﻭﺜﺔ‪،‬‬
‫ﻭﺍﻻﺴﺘﻌﻤﺎل ﺍﻟﻤﺸﺘﺭﻙ ﻷﻤﻭﺍﺱ ﺍﻟﺤﻼﻗﺔ ﺃﻭ ﻓﺭﺍﺸﻲ ﺍﻷﺴﻨﺎﻥ‪ ،‬ﻭﻤﻥ ﺨﻼل ﺍﻷﻏﺸﻴﺔ ﺍﻟﻤﺨﺎﻁﻴﺔ ﻭﺍﻟﺘﻌﺭﺽ ﻓﻲ‬
‫ﺤﻭﺍﺩﺙ ﻭﺨﺯ ﺍﻹﺒﺭﺓ ﻭﺍﻟﻭﺸﻡ‪.‬‬

‫• ﻨﻘل ﺍﻟﺩﻡ ﻤﻥ ﺸﺨﺹ ﻤﺨﻤﻭﺝ‪.‬‬

‫• ﺍﻻﻨﺘﻘﺎل ﻓﻲ ﻓﺘﺭﺓ ﻤﺎ ﺤﻭل ﺍﻟﻭﻻﺩﺓ ﻤﻥ ﺍﻷﻡ ﺇﻟﻰ ﺍﻟﻭﻟﻴﺩ‪.‬‬

‫• ﺍﻻﺘﺼﺎل ﺍﻟﺠﻨﺴﻲ ﺍﻟﻁﺒﻴﻌﻲ ﻭﺍﻟﺸﺎﺫ‪.‬‬

‫• ﺍﻻﺘﺼﺎل ﺍﻟﺼﻤﻴﻤﻲ ﺒﻴﻥ ﺼﻐﺎﺭ ﺍﻷﻁﻔﺎل )ﻭﻫﻭ ﺍﻟﻁﺭﻴﻕ ﺍﻷﻫﻡ ﻻﻨﺘﻘﺎل ﺍﻟﻤﺭﺽ ﻓﻲ ﺍﻟﺒﻠﺩﺍﻥ ﺫﺍﺕ ﻤﻌﺩل ﺍﻻﻨﺘﺸﺎﺭ‬
‫ﺍﻟﻤﺭﺘﻔﻊ(‪.‬‬

‫‪٩٧‬‬
 ‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﺨﻤﺞ ﻋﺎﻡ‪ ،‬ﻭﻴﻜﻭﻥ ﺍﻟﺨﻤﺞ ﻓﻲ ﺍﻷﻁﻔﺎل ﻋﺎﺩﺓ ﺃﺨﻑ ﻭﻏﺎﻟﺒ ﹰﺎ ﻻ ﻴﺭﻗﺎﻨﻲ‪ ،‬ﻭﺘﺤﺩﺙ ﻤﻨﺎﻋﺔ ﻗﻭﻴﺔ ﻋﻘﺏ‬
‫ﺍﻟﺨﻤﺞ ﻋﻨﺩﻤﺎ ﺘﺘﻭﻟﺩ ﺃﻀﺩﺍﺩ ﺍﻟﻤﺴﺘﻀﺩ ﺍﻟﺴﻁﺤﻲ ﻭﻴﻜﻭﻥ ﺍﻟﻤﺴﺘﻀﺩ ﺍﻟﺴﻁﺤﻲ ﻏﺎﺌﺒ ﹰﺎ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫‪ ١٨٠ - ٤٥‬ﻴﻭﻡ )ﻭﺴﻁﻴﹰﺎ ‪ ٣ - ٢‬ﺃﺸﻬﺭ(‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻴﻤﺘﺩ ﻓﺘﺭﺓ ﺃﺴﺎﺒﻴﻊ ﻜﺜﻴﺭﺓ ﻗﺒل ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ‪ ،‬ﻭﻴﺴﺘﻤﺭ ﻁﻭﺍل ﻓﺘﺭﺓ ﺍﻟﻤﺭﺽ ﺍﻟﺤﺎﺩ‪ ،‬ﻭﺃﺜﻨﺎﺀ ﺤﺎﻟﺔ ﺤﻤل ﺍﻟﻔﻴﺭﻭﺱ‬
‫ﺍﻟﻤﺯﻤﻨﺔ ﺍﻟﺘﻲ ﻗﺩ ﺘﻤﺘﺩ ﻋﺩﺓ ﺴﻨﻭﺍﺕ‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﺍﻋﺘﻤﺎﺩﹰﺍ ﻋﻠﻰ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‪ ،‬ﻭﺍﺭﺘﻔﺎﻉ ﺨﻤﺎﺌﺭ ﺍﻷﻤﻴﻨﻭﺘﺭﺍﻨﺴﻔﻴﺭﺍﺯ‪ ،‬ﻭﻴﻤﻜﻥ ﺘﺄﻜﻴﺩ ﺍﻟﺘﺸﺨﻴﺹ‬
‫ﺒﺈﻅﻬﺎﺭ ﺍﻟﻤﺴﺘﻀﺩ ﺍﻟﺴﻁﺤﻲ ‪ ،HBsAg‬ﺃﻭ ﻅﻬﻭﺭ ﺤﺩﻴﺙ ﻷﻀﺩﺍﺩ ﺍﻟﻤﺴﺘﻀﺩﺍﺕ ﺍﻟﻠﺒﻴﺔ ‪ Anti-HBc‬ﺃﻭ ﺍﻟﺴﻁﺤﻴﺔ‬
‫‪.Anti-HBs‬‬

‫ﺇﻥ ﻅﻬﻭﺭ ﺍﻟﻤﺴﺘﻀﺩﺍﺕ ﺍﻟﺴﻁﺤﻴﺔ ‪ ،HBsAg‬ﻴﺩل ﻋﻠﻰ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﻤﺭﺽ ﻭﺍﺴﺘﻤﺭﺍﺭﻫﺎ ﺇﻟﻰ ﺍﻷﺯﻤﺎﻥ‪.‬‬

‫ﺃﻤﺎ ﻅﻬﻭﺭ ﺃﻀﺩﺍﺩ ﺍﻟﻤﺴﺘﻀﺩﺍﺕ ﺍﻟﺴﻁﺤﻴﺔ ‪ anti-HBs‬ﻴﺩل ﻋﻠﻰ ﺤﺩﻭﺙ ﺍﻟﻤﻨﺎﻋﺔ ﻨﺘﻴﺠﺔ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﻤﺭﺽ ﺃﻭ‬
‫ﺇﻋﻁﺎﺀ ﺍﻟﻠﻘﺎﺡ‪.‬‬

‫ﺇﻥ ﻅﻬﻭﺭ ﺃﻀﺩﺍﺩ ﺍﻟﻤﺴﺘﻀﺩﺍﺕ ﺍﻟﻠﺒﻴﺔ ‪ anti-HBc‬ﻴﺩل ﻋﻠﻰ ﺍﻟﻤﻨﺎﻋﺔ ﻨﺘﻴﺠﺔ ﺍﻹﺼﺎﺒﺔ ﺍﻟﺴﺎﺒﻘﺔ ﺃﻭ ﺍﻟﺤﺎﻟﻴﺔ‬
‫ﺒﺎﻟﻤﺭﺽ ﻭﻴﺭﺘﻔﻊ ﻀﺩ ﺍﻟﻤﺴﺘﻀﺩ ﺍﻟﻠﺒﻲ ‪ Igm‬ﻓﻲ ﺍﻹﺼﺎﺒﺔ ﺍﻟﺤﺎﺩﺓ ﻭﻴﺨﺘﻔﻲ ﺒﻌﺩ ﺴﺘﺔ ﺃﺸﻬﺭ‪.‬‬

‫ﺒﺎﻟﻨﺴﺒﺔ ﻟـ ‪ HBeAg‬ﻴﺩل ﻭﺠﻭﺩﻩ ﻋﻠﻰ ﺸﺩﺓ ﺍﻹﻤﺭﺍﻀﻴﺔ ﻭﺴﻭﺀ ﺍﻹﻨﺫﺍﺭ ﺒﻌﻜﺱ ﺍﻟـ ‪ anti-Hbe‬ﺍﻟﺫﻱ ﻴﺩل‬
‫ﻭﺠﻭﺩﻩ ﻋﻠﻰ ﺤﺴﻥ ﺇﻨﺫﺍﺭ ﺍﻟﻤﺭﺽ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬

‫• ﺍﻟﻜﺸﻑ ﺍﻟﻤﺒﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻪ ﺇﺼﺎﺒﺘﻬﺎ ﻭﺇﺤﺎﻟﺘﻬﺎ ﺇﻟﻰ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﺘﺸﺨﻴﺹ ﻭﺍﻟﻌﻼﺝ ﻤﺸﻔﻰ ﺍﺒﻥ‬
‫ﺍﻟﻨﻔﻴﺱ ﻭﻤﺸﻔﻰ ﺩﻤﺸﻕ ﻓﻲ ﻤﺤﺎﻓﻅﺔ ﺩﻤﺸﻕ ﻤﺸﻔﻰ ﺯﺍﻫﻲ ﺃﺯﺭﻕ ﻓﻲ ﻤﺤﺎﻓﻅﺔ ﺤﻠﺏ ﺍﻟﻤﺸﻔﻰ ﺍﻟﻭﻁﻨﻲ ﻓﻲ ﻤﺤﺎﻓﻅﺔ‬
‫ﺤﻤﺹ ﺍﻟﻤﺸﻔﻰ ﺍﻟﻭﻁﻨﻲ ﻗﺴﻡ ﺍﻟﻬﻀﻤﻴﺔ ﻓﻲ ﻤﺤﺎﻓﻅﺔ ﺍﻟﻼﺫﻗﻴﺔ ﺒﻨﺎﺀ ﻋﻴﺎﺩﺍﺕ ﺍﻟﺴﻜﺭﻱ ﻓﻲ ﻤﺤﺎﻓﻅﺔ ﺩﻴﺭ ﺍﻟﺯﻭﺭ‪.‬‬

‫‪٩٨‬‬
‫• ﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ ‪ (٣ - ٢‬ﻭﻴﺭﻓﻊ ﻫﺫﺍ‬
‫ﺍﻟﺘﻘﺭﻴﺭ ﻋﻥ ﻁﺭﻴﻕ ﻤﺭﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬
‫• ﺍﻟﻌﻼﺝ‪ :‬ﻻ ﺘﻭﺠﺩ ﻤﻌﺎﻟﺠﺔ ﻨﻭﻋﻴﺔ ﻟﻼﻟﺘﻬﺎﺏ ﺍﻟﺤﺎﺩ ﻭﺘﺘﻭﻓﺭ ﺍﻟﻌﺩﻴﺩ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻟﻌﻼﺝ ﺍﻻﻟﺘﻬﺎﺏ ﺍﻟﻤﺯﻤﻥ ﻴﺴﺘﺨﺩﻡ‬
‫ﻓﻲ ﺍﻟﺨﻁﺔ ﺍﻟﻭﻁﻨﻴﺔ ﺍﻟﺒﻴﻎ‪-‬ﺍﻨﺘﺭﻓﻴﺭﻭﻥ ﻭﺍﻻﻨﺘﺭﻓﻴﺭﻭﻥ ﺃﻟﻔﺎ ﻭﺍﻟﻼﻤﻴﻔﻭﺩﻴﻥ ﻭﺍﻷﺩﻴﻔﻭﻓﻴﺭ ﺩﻴﺒﻔﻭﻜﺴﻴل‪.‬‬
‫• ﺍﻟﻌﻼﺝ ﺒﺎﻟﺒﻴﻎ‪-‬ﺍﻨﺘﺭﻓﻴﺭﻭﻥ ﺫﻭ ﻓﺎﺌﻘﺔ ﻜﺒﻴﺭﺓ ﻟﺩﻯ ﺍﻟﻤﺭﻀﻰ ﺍﻹﻴﺠﺎﺒﻴﻴﻥ ﻟﻠﻤﺴﺘﻀﺩ ﺍﻟﻴﺎﺌﻲ ‪ ،HBeAg‬ﺤﻴﺙ ﻴﺤﺩﺙ‬
‫ﺘﻭﻗﻑ ﻓﻲ ﺍﻟﺘﻨﺴﺦ ﺍﻟﻔﻴﺭﻭﺴﻲ ﻟﺩﻯ ‪ %٣٠‬ﻤﻥ ﺍﻟﻤﻌﺎﻟﺠﻴﻥ ﻭﻴﺨﺘﻔﻲ ﺍﻟﻤﺴﺘﻀﺩ ﺍﻟﻠﺒﻲ ‪ HBv-DNA‬ﻟﺩﻯ ‪%٢٥‬‬
‫ﻤﻨﻬﻡ ﺒﻌﺩ ﺴﻨﺔ ﻤﻥ ﺍﻟﻤﻌﺎﻟﺠﺔ‪ ،‬ﻜﻤﺎ ﻴﺨﺘﻔﻲ ﻟﺩﻯ ‪ %٦٣‬ﻤﻥ ﺍﻟﺴﻠﺒﻴﻴﻥ ﻟﻠﻤﺴﺘﻀﺩ ﺍﻟﻴﺎﺌﻲ ‪ HBeAg‬ﻭﺍﻻﺴﺘﺠﺎﺒﺔ‬
‫ﻤﺸﺎﺒﻬﺔ ﻓﻲ ﺍﻷﺩﻭﻴﺔ ﺍﻷﺨﺭﻯ ﻭﻟﻜﻥ ﺘﻭﺠﺩ ﺘﺄﺜﻴﺭﺍﺕ ﺠﺎﻨﺒﻴﺔ ﺸﺩﻴﺩﺓ ﻟﻼﻨﺘﺭﻓﻴﺭﻭﻥ ﻭﺍﻟﺒﻴﻎ‪-‬ﺍﻨﺘﺭﻓﻴﺭﻭﻥ ﺘﺘﻁﻠﺏ‬
‫ﻤﺭﺍﻗﺒﺔ ﻟﺼﻴﻐﺔ‪ ،‬ﻭﻫﻲ ﺃﺨﻑ ﻟﻠﺩﻭﺍﺌﻴﻥ ﺍﻵﺨﺭﻴﻥ‪.‬‬
‫• ﺘﻌﺘﻤﺩ ﺍﻟﺨﻁﺔ ﺍﻟﻭﻁﻨﻴﺔ ﺍﻟﺼﺎﺩﺭﺓ ﻋﻥ ﺍﻟﻠﺠﻨﺔ ﺍﻟﻭﻁﻨﻴﺔ ﻻﻟﺘﻬﺎﺒﺎﺕ ﺍﻟﻜﺒﺩ ﺍﻟﻔﻴﺭﻭﺴﻴﺔ‪.‬‬
‫• ﺍﻟﺘﻘﺼﻲ ﺍﻟﻭﺒﺎﺌﻲ‪ :‬ﻟﻠﻔﺎﺸﻴﺎﺕ ﻓﻘﻁ‪ ،‬ﺤﻴﺙ ﻴﻘﻭﻡ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺒﺎﻟﻤﺩﻴﺭﻴﺔ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﻓﺭﻴﻕ ﻤﺭﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ‬
‫ﻭﻋﻨﺎﺼﺭ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ ﺒﺯﻴﺎﺭﺓ ﺍﻟﻤﻨﻁﻘﺔ ﻭﺇﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺍﺕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﻤﺭﺽ ﻭﺍﻟﺘﺄﻜﻴﺩ ﺒﺎﻟﺴﺅﺍل‬
‫ﻋﻠﻰ ﻗﺼﺔ ﺘﻌﺭﺽ ﻟﺤﻕ ﻤﻠﻭﺜﺔ ﺃﻭ ﻨﻘل ﺩﻡ ﺃﻭ ﺍﺘﺼﺎل ﺠﻨﺴﻲ ﻤﻊ ﺸﺨﺹ ﻤﺨﻤﻭﺝ ﻭﻤﻌﺭﻓﺔ ﺍﻟﺤﺎﻟﺔ ﺍﻟﺘﻤﻨﻴﻌﻴﺔ‬
‫ﻟﻸﻁﻔﺎل )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ ‪.(٢١‬‬
‫• ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‪:‬‬
‫‪ -‬ﺍﻟﻌﺯل‪ :‬ﺘﻁﺒﻕ ﺍﺤﺘﻴﺎﻁﺎﺕ ﺍﻟﺩﻡ ﻭﺴﻭﺍﺌل ﺍﻟﺠﺴﻡ ﺤﺘﻰ ﻴﺨﺘﻔﻲ ﺍﻟﻤﺴﺘﻀﺩ ﺍﻟﺴﻁﺤﻲ ﻭﺘﻅﻬﺭ ﺃﻀﺩﺍﺩﻩ‪.‬‬
‫‪ -‬ﺍﻟﺘﻁﻬﻴﺭ ﺍﻟﻤﺭﺍﻓﻕ‪ :‬ﻴﻁﺒﻕ ﻋﻠﻰ ﺍﻷﺠﻬﺯﺓ ﻭﺍﻷﺩﻭﺍﺕ ﺍﻟﻤﻠﻭﺜﺔ ﺒﺎﻟﺩﻡ ﺃﻭ ﺍﻟﻠﻌﺎﺏ ﺃﻭ ﺍﻟﻤﻨﻲ‪.‬‬
‫‪ -‬ﺤﻤﺎﻴﺔ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﺍﻟﻤﻼﺼﻘﻴﻥ ﻟﻠﻤﺭﻴﺽ ﺃﻭ ﺍﻟﺫﻴﻥ ﺘﻌﺭﻀﻭﺍ ﻟﻭﺨﺯﺍﺕ ﺃﺒﺭ ﺃﻭ ﻷﺩﻭﺍﺕ ﺠﺎﺭﺤﺔ ﻤﺸﻜﻭﻙ ﻓﻲ‬
‫ﺴﻼﻤﺘﻬﺎ ﺒﺈﻋﻁﺎﺌﻬﻡ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ﺍﻟﻨﻭﻋﻲ ﺍﻟﻤﻀﺎﺩ ﻻﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ ﻤﻊ ﺍﻟﺒﺩﺀ ﺒﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻤﻨﻴﻊ‬
‫ﺍﻟﻤﻜﻭﻥ ﻤﻥ ‪ ٣‬ﺯﺭﻗﺎﺕ )‪ ٠.٥‬ﻤل ﻟﻸﻁﻔﺎل ﺩﻭﻥ ﺍﻟﻌﺎﺸﺭﺓ ﻤﻥ ﺍﻟﻌﻤﺭ‪ ١ ،‬ﻤل ﻟﻸﺸﺨﺎﺹ ﺒﻌﻤﺭ ﻋﺸﺭ ﺴﻨﻭﺍﺕ‬
‫ﻓﻤﺎ ﻓﻭﻕ‪ ،‬ﺍﻟﻔﺎﺼل ﺒﻴﻥ ﺍﻟﺠﺭﻋﺔ ﺍﻷﻭﻟﻰ ﻭﺍﻟﺜﺎﻨﻴﺔ ﺸﻬﺭ‪ ،‬ﻭﺒﻴﻥ ﺍﻟﺜﺎﻨﻴﺔ ﻭﺍﻟﺜﺎﻟﺜﺔ ﺨﻤﺴﺔ ﺃﺸﻬﺭ( ﻭﻴﻤﻜﻥ ﺘﻁﺒﻴﻕ‬
‫ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻤﻨﻴﻊ ﺍﻟﺴﺭﻴﻊ )ﺍﻟﻔﺎﺼل ﺒﻴﻥ ﺍﻟﺠﺭﻋﺔ ﺍﻷﻭﻟﻰ ﻭﺍﻟﺜﺎﻨﻴﺔ ﺸﻬﺭ ﻭﺒﻴﻥ ﺍﻟﺜﺎﻨﻴﺔ ﻭﺍﻟﺜﺎﻟﺜﺔ ﺸﻬﺭ ﻭﺒﻴﻥ ﺍﻟﺜﺎﻟﺜﺔ‬
‫ﻭﺍﻟﺭﺍﺒﻌﺔ ﻋﺸﺭﺓ ﺃﺸﻬﺭ( ﺃﻭ ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻤﻨﻴﻊ ﺍﻟﺴﺭﻴﻊ ﺠﺩﹰﺍ )ﺍﻟﻔﺎﺼل ﺒﻴﻥ ﺍﻟﺠﺭﻋﺔ ﺍﻷﻭﻟﻰ ﻭﺍﻟﺜﺎﻨﻴﺔ ﺃﺴﺒﻭﻉ ﻭﺒﻴﻥ‬
‫ﺍﻟﺜﺎﻨﻴﺔ ﻭﺍﻟﺜﺎﻟﺜﺔ ﺃﺴﺒﻭﻋﺎﻥ ﻭﺍﻟﺜﺎﻟﺜﺔ ﻭﺍﻟﺭﺍﺒﻌﺔ ‪ ١٢‬ﺸﻬﺭ( ﻋﻨﺩ ﺍﻟﻀﺭﻭﺭﺓ‪.‬‬
‫ﻴﻌﻁﻰ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ﺍﻟﻨﻭﻋﻲ ﺒﻤﻘﺩﺍﺭ )‪ (٠,٠٦‬ﻤﻠﻎ‪/‬ﻜﻎ ﺃﻱ )‪ (٥‬ﻤل ﻟﻠﺒﺎﻟﻐﻴﻥ‪.‬‬
‫‪ -‬ﺤﻤﺎﻴﺔ ﺍﻟﻭﻟﺩﺍﻥ ﻤﻥ ﺃﻤﻬﺎﺕ ﺇﻴﺠﺎﺒﻴﺎﺕ ﺍﻟﻌﺎﻤل ﺍﻷﺴﺘﺭﺍﻟﻲ ﺒﺈﻋﻁﺎﺌﻬﻡ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ﺍﻟﻨﻭﻋﻲ ﺨﻼل ﺒﻀﻌﺔ‬
‫ﺴﺎﻋﺎﺕ ﺒﻌﺩ ﺍﻟﻭﻻﺩﺓ ﻭﺍﻟﺠﺭﻋﺔ ﺍﻷﻭﻟﻰ ﻤﻥ ﺍﻟﻠﻘﺎﺡ ﺨﻼل ﺍﻷﺴﺒﻭﻉ ﺍﻷﻭل ﻤﻊ ﺘﻁﺒﻴﻕ ﺃﺤﺩ ﺒﺭﺍﻤﺞ ﺍﻟﺘﻤﻨﻴﻊ‬
‫ﺍﻟﻤﺫﻜﻭﺭﺓ ﺴﺎﺒﻘﹰﺎ‪) ،‬ﺍﻟﻤﻘﺩﺍﺭ ‪ ٠,٥‬ﻤل ﻤﻥ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ﺍﻟﻨﻭﻋﻲ(‪.‬‬
‫‪ -‬ﺘﻤﻨﻴﻊ ﺍﻷﻁﻔﺘﺎل ﺩﻭﻥ ﺍﻟﺴﻨﺔ ﺒﺎﻟﻠﻘﺎﺡ ﺍﻟﻤﻀﺎﺩ ﻻﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ )ﻭﻫﻡ ﺍﻷﻜﺜﺭ ﻋﺭﻀﺔ ﻟﺘﻁﻭﺭ ﺤﺎﻟﺔ ﺍﻟﺤﻤل‬
‫ﻭﺍﻻﺨﺘﻼﻁﺎﺕ ﻓﻲ ﺍﻟﻤﺴﺘﻘﺒل( ﻭﺫﻟﻙ ﺤﺴﺏ ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻭﻁﻨﻲ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(١٠‬‬
‫‪ -‬ﺘﻤﻨﻴﻊ ﺍﻟﻔﺌﺎﺕ ﺍﻟﻤﻌﺭﻀﺔ ﻟﺨﻁﺭ ﺍﻹﺼﺎﺒﺔ ﻜﺎﻟﻌﺎﻤﻠﻴﻥ ﺍﻟﺼﺤﻴﻴﻥ )ﺃﻁﺒﺎﺀ‪ ،‬ﻤﻤﺭﻀﺎﺕ‪ ،‬ﻗﺎﺒﻼﺕ‪ ،...‬ﺇﻟﺦ( ﻓﻲ‬

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‫ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ‪ ،‬ﻭﻤﺭﻀﻰ ﻏﺴﻴل ﺍﻟﻜﻠﻴﺔ ﻭﺍﻟﺫﻴﻥ ﻴﻌﺎﻨﻭﻥ ﻤﻥ ﺍﻀﻁﺭﺍﺒﺎﺕ ﻨﺯﻓﻴﺔ ﻭﻴﺘﻠﻘﻭﻥ ﻤﻨﺘﺠﺎﺕ ﺍﻟﺩﻡ‬
‫ﺒﺎﺴﺘﻤﺭﺍﺭ ﻜﺫﻟﻙ ﻋﺎﺌﻠﺔ ﺍﻟﻤﺭﻴﺽ ﺍﻹﻴﺠﺎﺒﻲ ﺒﺎﻟﻔﺤﻭﺹ ﺍﻟﻤﺼﻠﻴﺔ )ﺍﻟﺴﻠﺒﻴﻴﻥ ﺍﻟﻌﺎﻤل ﺍﻷﺴﺘﺭﺍﻟﻲ ﻤﻨﻬﻡ( ﻭﻤﺘﻌﺎﻁﻲ‬
‫ﺍﻟﻤﺨﺩﺭﺍﺕ ﻋﻥ ﻁﺭﻴﻕ ﺍﻟﺤﻘﻥ ﻭﺍﻟﺸﺭﻜﺎﺀ ﺍﻟﺠﻨﺴﻴﻴﻥ ﻟﺸﺨﺹ ﻤﺸﺘﺒﻪ ﺃﻨﻪ ﺤﺎﻤل ﻟﻠﻔﻴﺭﻭﺱ ﻴﻌﻁﻰ ﻟﻘﺎﺡ ﺍﻟﺘﻬﺎﺏ‬
‫ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ ﺍﻟﻜﻬﻠﻲ ﺒﺜﻼﺙ ﺯﺭﻗﺎﺕ )ﺍﻟﻔﺎﺼل ﺒﻴﻥ ﺍﻷﻭﻟﻰ ﻭﺍﻟﺜﺎﻨﻴﺔ ﺸﻬﺭ ﻭﺒﻴﻥ ﺍﻟﺜﺎﻨﻴﺔ ﻭﺍﻟﺜﺎﻟﺜﺔ ﺨﻤﺴﺔ ﺃﺸﻬﺭ(‪.‬‬
‫ﻴﻌﻁﻰ ﻤﺭﻀﻰ ﻏﺴﻴل ﺍﻟﻜﻠﻴﺔ ﻀﻌﻑ ﺠﺭﻋﺔ ﺍﻟﻠﻘﺎﺡ ﺃﻱ )‪ (٢‬ﻤل ﻟﻠﻜﺒﺎﺭ‪.‬‬
‫‪ -‬ﻓﺤﺹ ﺍﻟﻤﺴﺘﻀﺩ ﺍﻟﺴﻁﺤﻲ ﻋﻨﺩ ﺠﻤﻴﻊ ﺍﻟﻤﺘﺒﺭﻋﻴﻥ ﺒﺎﻟﺩﻡ )ﻓﻲ ﺒﻨﻭﻙ ﺍﻟﺩﻡ ﺃﻭ ﺍﻟﻤﺴﺘﺸﻔﻴﺎﺕ ﺍﻟﺘﻲ ﻓﻴﻬﺎ ﺒﻨﻙ ﺩﻡ(‬
‫ﻭﺭﻓﺽ ﻭﺤﺩﺍﺕ ﺍﻟﺩﻡ ﻤﻥ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﺨﻤﻭﺠﻴﻥ‪.‬‬
‫‪ -‬ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﻟﻠﺠﻤﻬﻭﺭ ﺤﻭل ﺃﻫﻤﻴﺔ ﺍﻟﺘﻌﻘﻴﻡ ﺍﻟﺠﻴﺩ ﻟﻸﺩﻭﺍﺕ ﺍﻟﺠﺎﺭﺤﺔ ﻭﺍﺴﺘﻌﻤﺎل ﺍﻟﺤﻘﻥ ﻟﻤﺭﺓ ﻭﺍﺤﺩﺓ‬
‫ﻭﺘﺜﻘﻴﻑ ﺍﻵﺒﺎﺀ ﻭﺍﻷﻤﻬﺎﺕ ﻋﻥ ﺃﺨﻁﺎﺭ ﺍﻟﻤﺭﺽ ﻭﻤﺯﺍﻴﺎ ﺘﻤﻨﻴﻊ ﺃﻁﻔﺎﻟﻬﻡ ﺒﺴﻥ ﻤﺒﻜﺭﺓ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻤﺤﻠﻲ ﻓﻲ ﺤﺎل ﺤﺩﻭﺙ ﺍﻟﻔﺎﺸﻴﺎﺕ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬
‫• ﺭﻓﻊ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺸﻬﺭﻴﺔ ﺇﻟﻰ ﻤﺩﻴﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ ‪ (٣‬ﺒﻤﺎ ﻓﻴﻬﺎ ﺍﻟﺘﻘﺎﺭﻴﺭ‬
‫ﺍﻟﺼﺎﺩﺭﺓ ﻤﻥ ﺒﻨﻭﻙ ﺍﻟﺩﻡ ﻭﻤﺭﺍﻜﺯ ﻏﺴﻴل ﺍﻟﻜﻠﻴﺔ ﻭﻤﺭﺍﻜﺯ ﺍﻟﺘﺸﺨﻴﺹ ﻭﺍﻟﻤﻌﺎﻟﺠﺔ ﻭﺍﻹﺒﻼﻍ ﻋﻥ ﺤﺩﻭﺙ ﺍﻟﻔﺎﺸﻴﺎﺕ‬
‫ﻭﺍﻷﻭﺒﺌﺔ‪.‬‬
‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﻟﻠﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﻋﻤل ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺨﺎﺼﺔ ﺒﺘﺩﺒﻴﺭ ﺍﻟﺤﺎﻻﺕ ﻭﻤﺘﺎﺒﻌﺔ ﺘﻨﻔﻴﺫ ﺍﻟﺨﻁﺔ ﺍﻟﻭﻁﻨﻴﺔ ﻟﻠﺘﺩﺒﻴﺭ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﻭﺘﻭﺯﻴﻊ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﻭﺍﺩ ﺍﻟﻤﺨﺒﺭﻴﺔ‪.‬‬
‫• ﺘﻘﺩﻴﺭ ﺍﻻﺤﺘﻴﺎﺝ ﻤﻥ ﺍﻟﻠﻘﺎﺡ ﻟﻴﺘﻡ ﺘﺄﻤﻴﻨﻪ ﻤﻥ ﻗﺒل ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪.‬‬
‫• ﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺘﻨﻔﻴﺫ ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻭﻁﻨﻲ ﻭﺘﻠﻘﻴﺢ ﺍﻟﻔﺌﺎﺕ ﺍﻟﻌﺎﻟﻴﺔ ﺍﻟﺨﻁﻭﺭﺓ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﻤﺩﻴﺭﻴﺘﻲ ﺍﻷﻤﺭﺍﺽ‬
‫ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﺨﻁﺔ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﻭﺍﻟﻌﻤل ﻋﻠﻰ ﺘﻨﻔﻴﺫﻫﺎ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻤﻥ ﺨﻼل ﺍﻟﻤﺠﻠﺱ ﺍﻟﺼﺤﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻁﺎﺭﺌﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻘﻁﺭ‪.‬‬
‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﻟﻠﻤﺴﺘﻭﻴﺎﺕ ﺍﻷﺩﻨﻰ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﺍﻟﺨﻁﺔ ﺍﻟﻭﻁﻨﻴﺔ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﺭﺽ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﻠﺠﻨﺔ ﺍﻟﻭﻁﻨﻴﺔ ﻻﻟﺘﻬﺎﺒﺎﺕ ﺍﻟﻜﺒﺩ ﻭﻤﺘﺎﺒﻌﺔ ﺘﻨﻔﻴﺫﻫﺎ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺘﻨﻔﻴﺫ ﺍﻟﺨﻁﺔ ﺍﻟﻭﻁﻨﻴﺔ‪.‬‬

‫‪١٠٠‬‬
 ‫• ﺇﻋﺩﺍﺩ ﻤﻭﺍﺩ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪.‬‬
‫• ﺘﻘﺩﻴﺭ ﺍﻻﺤﺘﻴﺎﺝ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﺍﻟﻤﻭﺍﺩ ﺍﻟﻤﺨﺒﺭﻴﺔ ﻭﻤﺘﺎﺒﻌﺔ ﺘﺄﻤﻴﻨﻬﺎ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﺍﻟﻠﻘﺎﺡ ﻭﺘﻭﺯﻴﻌﻪ ﻋﻠﻰ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺘﻨﻔﻴﺫ ﺘﻠﻘﻴﺢ ﺍﻷﻁﻔﺎل ﻭﺍﻟﻔﺌﺎﺕ ﺍﻟﻌﺎﻟﻴﺔ ﺍﻟﺨﻁﻭﺭﺓ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﺍﻟﺩﺭﺍﺴﺎﺕ ﻭﺍﻟﺒﺤﻭﺙ ﻭﺍﻟﻤﺴﻭﺡ ﻟﻤﻌﺭﻓﺔ ﻤﻌﺩل ﺍﻨﺘﺸﺎﺭ ﺍﻟﻤﺭﺽ ﻭﻋﻭﺍﻤل ﺍﻟﺨﻁﺭ ﺍﻟﻤﺭﺘﺒﻁﺔ ﺒﺤﺩﻭﺜﻪ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻭﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬

‫ﺨﻁﺔ ﺍﻟﻌﻼﺝ‬
‫ﺴﻴﺘﻡ ﻓﻴﻤﺎ ﻴﻠﻲ ﻋﺭﺽ ﺍﻟﻨﻘﺎﻁ ﺍﻷﺴﺎﺴﻴﺔ ﻟﻠﺨﻁﺔ ﺍﻟﺼﺎﺩﺭﺓ ﻋﻥ ﺍﻟﻠﺠﻨﺔ ﺍﻟﻭﻁﻨﻴﺔ ﻻﻟﺘﻬﺎﺒﺎﺕ ﺍﻟﻜﺒﺩ ﺍﻟﻔﻴﺭﻭﺴﻴﺔ‪.‬‬

‫ﻴﻌﻁﻰ ﺍﻟﻌﻼﺝ ﻟﻠﻤﺼﺎﺒﻴﻥ ﺒﺎﻟﺘﻬﺎﺏ ﻜﺒﺩ ﻤﺯﻤﻥ ﻤﺘﻭﺴﻁ ﺇﻟﻰ ﺸﺩﻴﺩ ﻤﻥ ﻨﻤﻭﺫﺝ )‪ HBeAg (+‬ﻭﺍﻟﺘﻬﺎﺏ ﻜﺒﺩ ﻤﺯﻤﻥ‬
‫ﻤﻥ ﻨﻤﻭﺫﺝ )‪ ،HBeAg (-‬ﻜﺫﻟﻙ ﻟﻠﻤﺼﺎﺒﻴﻥ ﺒﺎﻟﺘﺸﻤﻊ ﺍﻟﻜﺒﺩﻱ ﺍﻟﻤﻌﺎﻭﺽ ﻭﺍﻟﻼﻤﻌﺎﻭﺽ‪.‬‬

‫ﺒﻴﻨﻤﺎ ﻻ ﻴﻌﻁﻰ ﻟﻠﺤﺎﻻﺕ ﺍﻷﺨﺭﻯ‪ :‬ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﺎﻟﺘﻬﺎﺏ ﻜﺒﺩ ﺤﺎﺩ ﺃﻭ ﺼﺎﻋﻕ‪ ،‬ﺍﻟﺤﻤﻠﺔ ﺍﻟﻤﺯﻤﻨﻭﻥ ﺒﺩﻭﻥ ﻓﻌﺎﻟﻴﺔ‬
‫ﻟﻠﻤﺭﺽ‪ ،‬ﺍﻟﻤﺼﺎﺒﻭﻥ ﺒﺎﻟﺘﻬﺎﺏ ﻜﺒﺩ ﻤﺯﻤﻥ ﺨﻔﻴﻑ ﺍﻟﺸﺩﺓ‪.‬‬

‫ﺸﺭﻭﻁ ﺍﻟﻤﻌﺎﻟﺠﺔ‪:‬‬
‫ﻴﺸﺘﺭﻁ ﻟﻠﻤﻌﺎﻟﺠﺔ ﻭﺠﻭﺩ ﺘﻨﺎﺴﺦ ﻓﻴﺭﻭﺴﻲ ﻓﻌﺎل )‪ (HBVDNA‬ﺃﻜﺜﺭ ﻤﻥ )‪ (١٠‬ﺁﻻﻑ ﻭﺤﺩﺓ ﺩﻭﻟﻴﺔ ﻓﻲ ﺍﻟﻨﻤﻭﺫﺝ‬
‫)‪ ،HBeAg (+‬ﻭ)‪ (٢‬ﺃﻟﻑ ﻭﺤﺩﺓ ﺩﻭﻟﻴﺔ ﻓﻲ ﺍﻟﻨﻤﻭﺫﺝ )‪ HBeAg (-‬ﻭﻭﺠﻭﺩ ﺩﻻﺌل ﻋﻠﻰ ﺍﻟﻨﺨﺭ ﺍﻟﻨﺴﻴﺠﻲ )ﺍﺭﺘﻔﺎﻉ‬
‫ﺨﻤﺎﺌﺭ ﺍﻟﻜﺒﺩ ﻷﻜﺜﺭ ﻤﻥ ﻀﻌﻔﻲ ﺍﻟﻁﺒﻴﻌﻲ( ﺃﻭ ﻭﺠﻭﺩ ﺇﺼﺎﺒﺔ ﻨﺨﺭﻴﺔ ﺃﻭ ﺘﻠﻴﻔﻴﺔ ﻓﻲ ﺨﺯﻋﺔ ﺍﻟﻜﺒﺩ‪.‬‬

‫ﺍﻷﺩﻭﻴﺔ ﺍﻟﻌﻼﺠﻴﺔ‪:‬‬
‫ﺍﻷﺩﻭﻴﺔ ﺍﻟﻤﻌﺘﻤﺩﺓ ﻓﻲ ﺍﻟﺨﻁﺔ ﺍﻟﻭﻁﻨﻴﺔ ﻫﻲ‪ :‬ﺍﻟﺒﻴﻎ‪-‬ﺍﻨﺘﺭﻓﻴﺭﻭﻥ )‪ (PGE – IFN"2a‬ﺍﻷﺩﻴﻔﻭﻤﻴﺯﺩﻴﺒﻴﻔﻭﻜﺴﻴل‬
‫)‪ ،(Adefovir Dipivoxil) (ADV‬ﺍﻟﻼﻤﻴﻔﻭﺩﻴﻥ )‪ (LAM‬ﻭﺍﻻﻨﺘﺭﻓﻴﺭﻭﻥ ﺍﻟﻔﺎ )& ‪.(IFN‬‬

‫ﺍﻟﻤﻘﺎﺩﻴﺭ ﺍﻟﻌﻼﺠﻴﺔ ﻭﻁﺭﻕ ﺍﻹﻋﻁﺎﺀ ﻭﺍﻟﻔﺌﺎﺕ ﺍﻟﻤﺴﺘﻬﺩﻓﺔ‪:‬‬

‫• ﻴﻌﻁﻰ ﺍﻟـ )‪ (PEG-IFN‬ﺘﺤﺕ ﺍﻟﺠﻠﺩ ﺒﺠﺭﻋﺔ )‪ (١٨٠‬ﻤﻜﻎ ﻤﺭﺓ ﺒﺎﻷﺴﺒﻭﻉ ﻟﻠﺒﺎﻟﻐﻴﻥ‪.‬‬
‫• ﻴﻌﻁﻰ ﺍﻟـ )&‪ (IFN‬ﺘﺤﺕ ﺍﻟﺠﻠﺩ ﺒﺠﺭﻋﺔ )‪ (١٠-٩‬ﻤﻠﻴﻭﻥ ﻭﺤﺩﺓ ‪/‬ﺴﻡ‪ ٢‬ﺜﻼﺙ ﻤﺭﺍﺕ ﺒﺎﻷﺴﺒﻭﻉ ﻟﻠﺒﺎﻟﻐﻴﻥ )ﻏﻴﺭ‬
‫ﻤﺴﺘﺨﺩﻡ ﻓﻲ ﺍﻟﺨﻁﺔ ﺍﻟﻭﻁﻨﻴﺔ(‪ ،‬ﻭﺒﺠﺭﻋﺔ )‪ (٨‬ﻤﻠﻴﻭﻥ ﻭﺤﺩﺓ‪/‬ﻡ‪ ٣‬ﺜﻼﺙ ﻤﺭﺍﺕ ﺒﺎﻷﺴﺒﻭﻉ ﻟﻸﻁﻔﺎل ﻋﻠﻰ ﺃﻥ ﻻ‬
‫ﺘﺘﻌﺩﻯ ﺍﻟﺠﺭﻋﺔ )‪ (١٠‬ﻤﻼﻴﻴﻥ ﻭﺤﺩﺓ‪.‬‬
‫• ﻴﻌﻁﻰ ﺍﻟـ )‪ (ADV‬ﺒﻤﻘﺩﺍﺭ )‪ (١٠‬ﻤﻠﻎ ﻴﻭﻤﻴﹰﺎ ﻋﻥ ﻁﺭﻴﻕ ﺍﻟﻔﻡ‪ ،‬ﻟﺩﻯ ﺍﻟﺒﺎﻟﻐﻴﻥ ﺒﻌﻤﺭ ﻓﻭﻕ ﺍﻟـ )‪ (١٢‬ﺴﻨﺔ‪.‬‬

‫‪١٠١‬‬
‫• ﻴﻌﻁﻰ ﺍﻟـ )‪ (LAM‬ﺒﻤﻘﺩﺍﺭ )‪ (١٠٠‬ﻤﻠﻎ ﻤﺭﺓ ﻭﺍﺤﺩﺓ ﻴﻭﻤﻴﹰﺎ ﻋﻥ ﻁﺭﻴﻕ ﺍﻟﻔﻡ ﻟﻠﻜﺒﺎﺭ )ﻏﻴﺭ ﻤﺴﺘﺨﺩﻡ ﻓﻲ ﺍﻟﺨﻁﺔ‬
‫ﺍﻟﻭﻁﻨﻴﺔ( ﻭ)‪ (٣‬ﻤﻠﻎ‪/‬ﻜﻎ ﻟﻸﻁﻔﺎل ﻋﻠﻰ ﺃﻥ ﻻ ﺘﺘﻌﺩﻯ )‪ (١٠٠‬ﻤﻠﻎ‪.‬‬
‫ﻜﻤﺎ ﻴﺴﺘﺨﺩﻡ ﻟﺩﻯ ﺍﻟﺤﻭﺍﻤل ﺒﻨﻔﺱ ﺠﺭﻋﺔ ﺍﻟﻜﺒﺎﺭ‪ ،‬ﻭﻴﻔﻴﺩ ﻓﻲ ﻭﻗﺎﻴﺔ ﺍﻟﺠﻨﻴﻥ ﻤﻥ ﺍﻹﺼﺎﺒﺔ‪.‬‬
‫• ﻤﺭﻀﻰ ﺍﻟﻘﺼﻭﺭ ﺍﻟﻜﻠﻭﻱ‪ :‬ﻴﺴﺘﺨﺩﻡ ﺍﻟـ )‪ (ADV‬ﻭﺍﻟـ )‪ (LAM‬ﻭﺘﻌﺩل ﺍﻟﺠﺭﻋﺔ ﺤﺴﺏ ﺩﺭﺠﺔ ﺍﻟﻘﺼﻭﺭ‬
‫ﺍﻟﻜﻠﻭﻱ‪.‬‬

‫ﻤﺩﺓ ﺍﻟﻤﻌﺎﻟﺠﺔ‪:‬‬
‫ﺘﺨﺘﻠﻑ ﺤﺴﺏ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺭﻀﻴﺔ ﻭﻜﻤﺎ ﻫﻭ ﻤﺒﻴﻥ ﻓﻲ ﺍﻟﺠﺩﻭل‪:‬‬

‫ﻤﺩﺓ ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻟﺩﻭﺍﺀ‬ ‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺭﻀﻴﺔ‬

‫ﺴﻨﺔ‬ ‫‪PEG-IFN&2a‬‬ ‫ﺍﻟﺘﻬﺎﺏ ﻜﺒﺩ ﻤﺯﻤﻥ )‪  HBE Ag (+‬‬

‫ﺴﻨﺔ‬ ‫&‪IFN‬‬
‫ﺴﻨﺔ ﻋﻠﻰ ﺍﻷﻗل‬ ‫‪LAM‬‬
‫ﺴﻨﺔ ﺒﻌﺩ ﺤﺩﻭﺙ ﺍﻻﻨﻘﻼﺏ ﺍﻟﻤﺼﻠﻲ ﻟـ ‪HBeAg‬‬ ‫‪ADV‬‬

‫ﺴﻨﺔ‬ ‫‪PEG-IFN&2a‬‬ ‫ﺍﻟﺘﻬﺎﺏ ﻜﺒﺩ ﻤﺯﻤﻥ )­(‪  HBe Ag‬‬

‫ﺴﻨﺔ‬ ‫&‪IFN‬‬
‫ﻋﺩﺓ ﺴﻨﻭﺍﺕ‬ ‫‪LAM‬‬
‫ﻋﺩﺓ ﺴﻨﻭﺍﺕ ﻭﺤﺘﻰ ﺤﺩﻭﺙ ﺍﻻﻨﻘﻼﺏ ﺍﻟﻤﺼﻠﻲ‬ ‫‪ADV‬‬
‫ﻟﻠـ ‪HBsAg‬‬

‫ﻜﻤﺎ ﻓﻲ ﺍﻟﺴﺎﺒﻕ‬ ‫ﻴﺴﺘﻁﺏ ﺇﻋﻁﺎﺀ ﺍﻟـ )‪(PEGIFN‬‬ ‫ﺍﻟﺘﺸﻤﻊ ﺍﻟﻤﻌﺎﻭﺽ‬

‫ﻜﻤﺎ ﻓﻲ ﺍﻟﺴﺎﺒﻕ‬ ‫ﻴﺴﺘﻁﺏ ﺇﻋﻁﺎﺀ ﺍﻟـ )‪(ADV‬‬ ‫ﺍﻟﺘﺸﻤﻊ ﻏﻴﺭ ﺍﻟﻤﻌﺎﻭﺽ‬

‫ﺴﻨﺔ‬ ‫ﻴﺴﺘﻁﺏ ﺇﻋﻁﺎﺀ ﺍﻟـ )‪(IFN‬‬ ‫ﺍﻷﻁﻔﺎل‬

‫ﻭﺍﻟـ )‪(LAM‬‬ ‫)‪  HBs Ag (+‬‬
‫ﻟﻔﺘﺭﺓ ﺘﺯﻴﺩ ﻋﻥ ﺴﺘﺔ ﺃﺸﻬﺭ‬

‫‪١٠٢‬‬
 ‫‪‬‬
‫א‪‬א‪ C‬‬
‫ﻤﺭﺽ ﻓﻴﺭﻭﺴﻲ‪ ،‬ﻴﺒﺩﺃ ﻋﺎﺩﺓ ﺒﺸﻜل ﻤﺨﺎﺘل‪ ،‬ﻭﻴﺘﻅﺎﻫﺭ ﺒﻘﻬﻡ‪ ،‬ﺍﻨﺯﻋﺎﺝ ﺒﻁﻨﻲ‪ ،‬ﻏﺜﻴﺎﻥ‪ ،‬ﺇﻗﻴﺎﺀ‪ ،‬ﺜﻡ ﻴﺘﻁﻭﺭ ﺍﻟﻴﺭﻗﺎﻥ‬
‫)ﻭﻫﻭ ﺃﻗل ﺸﻴﻭﻋﹶًﺎ ﻤﻨﻪ ﻓﻲ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ(‪ ،‬ﺘﺘﺭﺍﻭﺡ ﺸﺩﺓ ﺍﻟﻤﺭﺽ ﻤﻥ ﺨﻤﺞ ﻏﻴﺭ ﻤﺘﻅﺎﻫﺭ ﺴﺭﻴﺭﻴﹰﺎ ﺇﻟﻰ ﺨﻤﺞ‬
‫ﺼﺎﻋﻕ ﻭﻤﻤﻴﺕ‪ ،‬ﻭﺇﻥ ﺍﻹﺯﻤﺎﻥ ﺸﺎﺌﻊ‪.‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﻓﻴﺭﻭﺱ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ‪ Hepatitis C Virus‬ﻭﻫﻭ ﻓﻴﺭﻭﺱ ﺭﻨﺎﻭﻱ )‪ (RNA‬ﻤﻥ ﺯﻤﺭﺓ ﺍﻟﻔﻴﺭﻭﺴﺎﺕ ﺍﻟﻤﺼﻐﺭﺓ‬
‫ﻭﻟﻪ )‪ (٦‬ﺃﻨﻤﺎﻁ ﺠﻴﻨﻴﺔ ﻭﺃﻜﺜﺭ ﻤﻥ )‪ (٩٠‬ﻨﻤﻁًﹰﺎ ﻓﺭﻋﻴﺎﹰ‪ ،‬ﻭﺍﻷﻨﻤﺎﻁ )‪ (٣ - ٢ - ١‬ﻫﻲ ﺍﻷﻜﺜﺭ ﺍﻨﺘﺸﺎﺭﹰﺍ ﻓﻲ ﺍﻟﻌﺎﻟﻡ‬
‫ﺒﻴﻨﻤﺎ ﻴﻨﺘﺸﺭ ﺍﻟﻨﻤﻁﺎﻥ )‪ (٥ - ٤‬ﻓﻲ ﺃﻓﺭﻴﻘﻴﺎ ﻭﺍﻟﻨﻤﻁ )‪ (٦‬ﻓﻲ ﺁﺴﻴﺎ‪.‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﺭﻴﺽ ﺃﻭ ﺍﻟﺤﺎﻤل‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﻜﻤﺎ ﻓﻲ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ‪ ،‬ﻭﻟﻜﻨﻪ ﺸﺎﺌﻊ ﺍﻻﻨﺘﻘﺎل ﺒﻨﻘل ﺍﻟﺩﻡ ﻟﺫﻟﻙ ﻴﺴﻤﻰ ﺍﻟﻤﺭﺽ ﺍﻟﻤﺭﺍﻓﻕ ﻟﻨﻘل ﺍﻟﺩﻡ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﺨﻤﺞ ﻋﺎﻡ‪ ،‬ﻭﻻ ﺘﻌﺭﻑ ﺩﺭﺠﺔ ﺍﻟﻤﻨﺎﻋﺔ ﺍﻟﺘﻲ ﻴﻤﻜﻥ ﺃﻥ ﺘﻌﻘﺏ ﺍﻟﺨﻤﺞ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫‪ ١٨٠ - ١٥‬ﻴﻭﻡ ﻭﺴﻁﻴﹰﺎ )‪ ٩ - ٦‬ﺃﺴﺎﺒﻴﻊ(‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻴﻤﺘﺩ ﻤﻥ ﺍﻷﺴﺒﻭﻉ ﺍﻷﻭل ﺍﻟﺫﻱ ﻴﺴﺒﻕ ﻅﻬﻭﺭ ﺍﻷﻋﺭﺍﺽ ﺍﻷﻭﻟﻴﺔ ﻟﻠﻤﺭﺽ‪ ،‬ﻭﻴﺴﺘﻤﺭ ﺨﻼل ﻓﺘﺭﺓ ﺍﻟﻤﺭﺽ ﺍﻟﺤﺎﺩ‪،‬‬
‫ﻭﻗﺩ ﻴﻤﺘﺩ ﻟﻔﺘﺭﺍﺕ ﻁﻭﻴﻠﺔ ﻓﻲ ﺤﺎﻟﺔ ﺍﻟﺤﻤل ﺍﻟﻤﺯﻤﻥ ﻟﻠﻤﺭﺽ‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﺍﻋﺘﻤﺎﺩﹰﺍ ﻋﻠﻰ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‪ ،‬ﻭﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺼﻠﻴﺔ‪ :‬ﺍﻟـ ‪ PCR‬ﻟﻜﺸﻑ ﺍﻟﻤﺴﺘﻀﺩ ﺍﻟﻔﻴﺭﻭﺴﻲ‬
‫‪ HCV-RNA‬ﻭﺍﻟـ ‪ EIA‬ﻟﻜﺸﻑ ﺃﻀﺩﺍﺩ ﺍﻟﻔﻴﺭﻭﺱ ‪ anti HCV‬ﻜﺫﻟﻙ ﺍﻟـ ‪.ELISA‬‬

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 ‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬
‫ﺍﻹﺠﺭﺍﺀﺍﺕ ﻤﻤﺎﺜﻠﺔ ﻟﺘﻠﻙ ﺍﻟﻭﺍﺠﺏ ﺇﺘﺒﺎﻋﻬﺎ ﺒﺎﻟﻨﺴﺒﺔ ﻻﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﻔﻴﺭﻭﺴﻲ ﺍﻟﺒﺎﺌﻲ ﻭﺘﺨﺘﻠﻑ ﻋﻨﻬﺎ ﺒﻌﺩ ﻭﺠﻭﺩ‬
‫ﻟﻘﺎﺡ ﻓﻌﺎل‪ ،‬ﻭﻓﺎﺌﺩﺓ ﻏﻴﺭ ﻭﺍﻀﺤﺔ ﻟﻠﻭﻗﺎﻴﺔ ﺒﺎﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ‪.‬‬

‫ﺒﺎﻟﻨﺴﺒﺔ ﻟﻠﻌﻼﺝ ﺘﻌﺘﻤﺩ ﺍﻟﺨﻁﺔ ﺍﻟﺼﺎﺩﺭﺓ ﻋﻥ ﺍﻟﻠﺠﻨﺔ ﺍﻟﻭﻁﻨﻴﺔ ﻻﻟﺘﻬﺎﺒﺎﺕ ﺍﻟﻜﺒﺩ ﺍﻟﻔﻴﺭﻭﺴﻴﺔ‪.‬‬

‫ﺒﻴﻨﺕ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﺭﺘﻔﺎﻉ ﻨﺴﺒﺔ ﺍﻻﺴﺘﺠﺎﺒﺔ ﺒﺎﻟﻌﻼﺝ ﺍﻟﻤﺸﺘﺭﻙ ﺒﺎﻟﺒﻴﻎ ﺃﻨﺘﺭﻓﻴﺭﻭﻥ ﻭﺍﻟﺭﻴﺒﺎﻓﻴﺭﻴﻥ ﺇﻟﻰ ‪%٤٩-٤٢‬‬
‫ﻤﻘﺎﺭﻨﺔ ﺒـ ‪ %٣٩-٣٣‬ﺒﺎﻟﻌﻼﺝ ﺒﺎﻟﺒﻴﻎ ﺍﻨﺘﺭﻓﻴﺭﻭﻥ ﻓﻲ ﺍﻟﻨﻤﻁ ﺍﻟﺠﻴﻨﻲ ‪ ١‬ﻭﺘﺭﺘﻔﻊ ﺇﻟﻰ ‪ %٨٢‬ﻤﻘﺎﺭﻨﺔ ﺒـ ‪%٧٩-٦١‬‬
‫ﻓﻲ ﺍﻟﻨﻤﻁﻴﻥ ‪ ٢‬ﻭ‪.٤‬‬

‫ﻜﻤﺎ ﺘﺭﺘﻔﻊ ﺒﺎﻟﻌﻼﺝ ﺍﻟﻤﺸﺘﺭﻙ ﺒﻴﻥ ﺍﻻﻨﺘﺭﻓﻴﺭﻭﻥ ﻭﺍﻟﺭﻴﺒﺎﻓﻴﺭﻴﻥ ﻤﻥ ‪ %١٦‬ﺇﻟﻰ ‪ %٤١‬ﺒﻌﺩ )‪ (٤٨‬ﺃﺴﺒﻭﻉ‪ .‬ﻭﺘﺒﻠﻎ‬
‫ﻭﺴﻁﻴﹰﺎ ‪ %٢٩‬ﻓﻲ ﺍﻟﻨﻤﻁﻴﻥ ﺍﻟﺠﻴﻨﻴﻴﻥ ‪١‬ﻭ‪ ٤‬ﻭ ‪ %٦٥‬ﻓﻲ ﺍﻟﻨﻤﻁﻴﻥ ﺍﻟﺠﻴﻨﻴﻴﻥ ‪ ٢‬ﻭ‪٣‬‬

‫ﺍﻟﻤﺩﺓ ﺍﻟﻌﻼﺠﻴﺔ ﻟﻠﻨﻤﻁﻴﻥ ﺍﻟﺠﻴﻨﻴﻴﻥ ‪٢‬ﻭ‪ ٣‬ﻤﺨﺘﻠﻔﺔ ﺤﺴﺏ ﺴﺭﻋﺔ ﺍﻻﺴﺘﺠﺎﺒﺔ‪:‬‬

‫• ﺴﺭﻴﻌﺔ )‪ HCV-RNA :(RVR‬ﺴﻠﺒﻲ ﺒﻌﺩ )‪ (٤‬ﺃﺴﺎﺒﻴﻊ ﻭﺍﻟﺤﻤل ﺍﻟﻔﻴﺭﻭﺴﻲ ﺃﻗل ﻤﻥ )‪ (٦٠٠‬ﺃﻟﻑ ﻭﺤﺩﺓ‪/‬ﻤل‪:‬‬
‫ﺍﻟﻤﺩﺓ )‪ (١٦‬ﺃﺴﺒﻭﻉ‪.‬‬
‫• ﺒﺎﻜﺭﺓ ﺘﺎﻤﺔ )‪ HCV-RNA :(CEVR‬ﺴﻠﺒﻲ ﺒﻌﺩ )‪ (١٢‬ﺃﺴﺒﻭﻉ‪ :‬ﺍﻟﻤﺩﺓ )‪ (٢٤‬ﺃﺴﺒﻭﻉ‪.‬‬
‫• ﺒﺎﻜﺭﺓ ﻏﻴﺭ ﺘﺎﻤﺔ )‪ HCV-RNA :(PEVR‬ﺴﻠﺒﻲ ﺒﻌﺩ )‪ (٢٤‬ﺃﺴﺒﻭﻉ ﻭﺍﻨﺨﻔﺎﻀﻪ ﺃﻜﺜﺭ ﻤﻥ )‪ (٢‬ﻟﻐﺎﺭﻴﺘﻡ ﻋﻨﺩ ﻗﺒل‬
‫ﺍﻟﻤﻌﺎﻟﺠﺔ ﺒﻌﺩ )‪ (١٢‬ﺃﺴﺒﻭﻉ‪ :‬ﺍﻟﻤﺩﺓ )‪ (٤٨‬ﺃﺴﺒﻭﻉ‪.‬‬

‫ﺍﻟﻤﺩﺓ ﺍﻟﻌﻼﺠﻴﺔ ﻟﻸﻨﻤﺎﻁ ﺍﻷﺨﺭﻯ‪١ :‬ﻭ‪٤‬ﻭ‪:٥‬‬

‫• ﺤﻤل ﻓﻴﺭﻭﺴﻲ ﺃﻗل ﻤﻥ )‪ (٦٠٠‬ﺃﻟﻑ ﻭﺤﺩﺓ ﻤل ﻓﻲ ﺍﻟﻨﻤﻁ )‪ (١‬ﻭﺘﻠﻴﻑ ﺃﻗل ﻤﻥ ﺩﺭﺠﺔ )‪ (٣‬ﻓﻲ ﺍﻟﻨﻤﻁ )‪ (٤‬ﻤﻊ‬
‫)‪ :(RVR‬ﺍﻟﻤﺩﺓ )‪ (٢٤‬ﺃﺴﺒﻭﻉ‪.‬‬
‫• ﺒﺎﻗﻲ ﺍﻟﺤﺎﻻﺕ ﻤﻊ )‪ :(CEVR‬ﺍﻟﻤﺩﺓ )‪ (٤٨‬ﺃﺴﺒﻭﻉ ﺃﻭ ﻤﻊ )‪ :(PEVE‬ﺍﻟﻤﺩﺓ )‪ (٧٢‬ﺃﺴﺒﻭﻉ ﻭﺘﻭﻗﻑ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺇﺫﺍ‬
‫ﺒﻘﻲ ﺍﻟـ ‪ HCV-RNA‬ﺇﻴﺠﺎﺒﻲ‪.‬‬

‫ﺍﻟﻤﻘﺎﺩﻴﺭ ﺍﻟﻌﻼﺠﻴﺔ ﻭﻁﺭﻕ ﺍﻹﻋﻁﺎﺀ‪:‬‬

‫• ﺍﻟﺒﻴﻎ‪-‬ﺃﻨﺘﺭﻓﻴﺭﻭﻥ ‪ ١٨٠ :PEG- IFN&2A‬ﻤﻜﻎ ﻤﺭﺓ ﺒﺎﻷﺴﺒﻭﻉ ﺘﺤﺕ ﺍﻟﺠﻠﺩ‪.‬‬
‫• ﺍﻟﺒﻴﻎ‪-‬ﺃﻨﺘﺭﻓﻴﺭﻭﻥ ‪ ١.٥ :PEG-IFN&2b‬ﻤﻜﻎ‪/‬ﻜﻎ‪.‬‬
‫‪ ٢‬ﻭ‪٣‬‬ ‫• ﺍﻟﺭﻴﺒﺎﻓﻴﺭﻴﻥ ﻋﻥ ﻁﺭﻴﻕ ﺍﻟﻔﻡ )‪ (٨٠٠‬ﻤﻎ ﻴﻭﻤﻴﹰﺎ )ﺍﻟﻘﺭﺹ ‪ ٥٠٠‬ﻤﻎ( ﻓﻲ ﺍﻷﻨﻤﺎﻁ ﺍﻟﺠﻴﻨﻴﺔ‬
‫ﻭ )‪ (١٠٠٠‬ﻤﻠﻎ ﻓﻲ ﺒﻘﻴﺔ ﺍﻷﻨﻤﺎﻁ ﻟﻠﻤﺭﻀﻰ ﺒﻭﺯﻥ ﺃﻗل ﻤﻥ )‪ (٧٥‬ﻜﻎ ﻭ)‪ (١٢٠٠‬ﻤﻠﻎ ﻟﻠﻤﺭﻀﻰ ﺒﻭﺯﻥ ﺃﻜﺜﺭ‬
‫ﻤﻥ )‪ (٧٥‬ﻜﻎ‪.‬‬

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 ‫ﻋﻼﺝ ﺍﻷﻁﻔﺎل‪:‬‬
‫• ﻻ ﻴﻌﻁﻰ ﻟﻸﻁﻔﺎل ﺩﻭﻥ ﺍﻟﺨﻤﺱ ﺴﻨﻭﺍﺕ‪.‬‬
‫• ﺍﻟﻌﻼﺝ ﺒﺎﻷﻨﺘﺭﻓﻴﺭﻭﻥ ‪ IFN‬ﺃﻭ ﺍﻟﺒﻴﻎ‪-‬ﺃﻨﺘﺭﻓﻴﺭﻭﻥ ‪ PEG-IFN&2b‬ﻤﻊ ﺍﻟﺭﻴﺒﺎﻓﻴﺭﻴﻥ‪.‬‬
‫• ﺍﻟـ ‪ (٣) :IFN‬ﻤﻠﻴﻭﻥ ‪/‬ﻡ‪ ٣ /٢‬ﻤﺭﺍﺕ ﺒﺎﻷﺴﺒﻭﻉ ﺃﻭ ﺍﻟـ ‪ ١.٥ :PEG-IFN&2b‬ﻤﻜﻎ‪/‬ﻜﻎ‪/‬ﻤﺭﺓ ﺒﺎﻷﺴﺒﻭﻉ‬
‫ﻤﻊ ﺍﻟﺭﻴﺒﺎﻓﻴﺭﻴﻥ‪١٥ :‬ﻤﻠﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﺒﺠﺭﻋﺘﻴﻥ‪.‬‬
‫• ﻤﺩﺓ ﺍﻟﻌﻼﺝ )‪ (٤٨‬ﺃﺴﺒﻭﻉ ‪١‬ﻭ‪٤‬ﻭ‪ ٥‬ﻭ)‪ (٢٤‬ﺃﺴﺒﻭﻉ ﻓﻲ ﺍﻷﻨﻤﺎﻁ ‪٢‬ﻭ‪.٣‬‬

‫ﻋﻼﺝ ﺍﻟﺤﺎﻤل‪:‬‬
‫ﻴﻤﻨﻊ ﺍﻟﻌﻼﺝ ﺒﺴﺒﺏ ﺍﻟﺘﺄﺜﻴﺭﺍﺕ ﺍﻟﺠﺎﻨﺒﻴﺔ ﻟﻸﺩﻭﻴﺔ ﺨﺎﺼﺔ ﺃﻥ ﺍﻟﺭﻴﺒﺎﻓﻴﺭﻴﻥ ﻟﻪ ﺘﺄﺜﻴﺭ ﻤﺸﻭﻩ ﻟﻸﺠﻨﺔ‪.‬‬

‫ﻋﻼﺝ ﻤﺭﺽ ﻗﺼﻭﺭ ﺍﻟﻜﻠﻴﺔ‪:‬‬

‫• ﻏﻴﺭ ﺨﺎﻀﻌﻴﻥ ﻟﻠﺘﺤﺎل‪ :‬ﻋﻼﺝ ﻤﺸﺘﺭﻙ ﻭﺘﻌﺩل ﺍﻟﺠﺭﻋﺔ ﺤﺴﺏ ﺩﺭﺠﺔ ﺍﻟﺘﺼﻔﻴﺔ‪.‬‬
‫• ﺨﺎﻀﻌﻴﻥ ﻟﻠﺘﺤﺎل‪ PEG-IFN :‬ﺃﻭ ‪.IFN‬‬

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 ‫‪‬‬
‫א‪‬א‪‬א‪D‬‬
‫ﻤﺭﺽ ﻓﻴﺭﻭﺴﻲ‪ ،‬ﻴﺒﺩﺃ ﻋﺎﺩﺓ ﺒﺸﻜل ﻤﻔﺎﺠﺊ‪ ،‬ﺘﺘﺸﺎﺒﻪ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻓﻴﻪ ﻤﻊ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ‬
‫ﺍﻟﺒﺎﺌﻲ‪،‬ﻭﻴﺘﺭﺍﻓﻕ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺩﻟﺘﺎﻭﻱ ﺩﺍﺌﻤﹰﺎ ﻤﻊ ﻭﺠﻭﺩ ﻋﺩﻭﻯ ﺒﻔﻴﺭﻭﺱ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ‪.‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﻓﻴﺭﻭﺱ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺩﻟﺘﺎﻭﻱ ‪ Hepatitis D Virus‬ﻭﻫﻭ ﺒﺤﺎﺠﺔ ﺇﻟﻰ ﻭﺠﻭﺩ ﻓﻴﺭﻭﺱ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ ﻟﻴﺘﻡ‬
‫ﺩﻭﺭﺘﻪ ﺍﻟﺘﻜﺎﺜﺭﻴﺔ‪.‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﺭﻴﺽ ﻭﺍﻟﺤﺎﻤل‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﻨﻔﺱ ﻁﺭﻕ ﺍﻨﺘﻘﺎل ﻓﻴﺭﻭﺱ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺠﻤﻴﻊ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﺴﺘﻌﺩﻴﻥ ﻟﻠﺨﻤﺞ ﺒﺎﻟﺘﻬﺎﺏ ﺍﻟﺒﺎﺌﻲ ﺃﻭ ﺍﻟﺤﻤﻠﺔ ﻟﻔﻴﺭﻭﺱ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ ﻴﻤﻜﻥ ﺃﻥ‬
‫ﻴﻨﺨﻤﺠﻭﺍ ﺒﺎﻟﻌﺎﻤل ﺩﻟﺘﺎ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫ﻓﻲ ﺍﻷﺨﻤﺎﺝ ﺍﻟﺘﺠﺭﻴﺒﻴﺔ ‪ ١٠ - ٢‬ﺃﺴﺎﺒﻴﻊ‪ ،‬ﻟﻜﻨﻪ ﻟﻡ ﻴﻌﻴﻥ ﺒﺎﻟﺘﺤﺩﻴﺩ ﻓﻲ ﺍﻹﻨﺴﺎﻥ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﺨﻼل ﻤﺨﺘﻠﻑ ﻤﺭﺍﺤل ﺍﻟﻤﺭﺽ‪ ،‬ﻭﻴﺒﻠﻎ ﺫﺭﻭﺘﻪ ﻓﻲ ﺍﻟﻔﺘﺭﺓ ﺍﻟﻘﺼﻴﺭﺓ ﺍﻟﺘﻲ ﺘﺴﺒﻕ ﻅﻬﻭﺭ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺴﺭﻴﺭﻴﺔ‪،‬‬
‫ﻭﻴﻤﻜﻥ ﺃﻥ ﺘﺴﺘﻤﺭ ﺍﻟﻌﺩﻭﻯ ﻓﻲ ﺤﺎﻻﺕ ﺍﻟﺨﻤﺞ ﺍﻟﻤﺯﻤﻥ‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﺍﻋﺘﻤﺎﺩﹰﺍ ﻋﻠﻰ ﺍﻷﻤﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‪ ،‬ﻭﻭﺠﻭﺩ ﺃﻀﺩﺍﺩ ﺍﻟﻔﻴﺭﻭﺱ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻤﻤﺎﺜﻠﺔ ﻟﻺﺠﺭﺍﺀﺍﺕ ﺍﻟﻭﺍﺠﺏ ﺇﺘﺒﺎﻋﻬﺎ ﺒﺎﻟﻨﺴﺒﺔ ﻻﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ‪ ،‬ﺇﻀﺎﻓﺔ ﺇﻟﻰ ﺘﺠﻨﻴﺏ ﺤﻤﻠﺔ ﻓﻴﺭﻭﺱ ﺍﻟﺘﻬﺎﺏ‬
‫ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ ﺍﻟﺘﻌﺭﺽ ﻷﻱ ﻤﺼﺩﺭ ﻤﺤﺘﻤل ﻟﻠﻌﺩﻭﻯ ﺒﻔﻴﺭﻭﺱ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺩﻟﺘﺎﻭﻱ‪.‬‬

‫‪١٠٦‬‬
 ‫‪‬‬
‫א‪‬א‪ E‬‬
‫ﻤﺭﺽ ﻓﻴﺭﻭﺴﻲ‪ ،‬ﺘﺘﺸﺎﺒﻪ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻓﻴﻪ ﻤﻊ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻷﻟﻔﻲ‪ ،‬ﻭﻻ ﺘﻭﺠﺩ ﺒﻴﻨﺎﺕ ﻋﻠﻰ‬
‫ﻭﺠﻭﺩ ﺸﻜل ﻤﺯﻤﻥ‪.‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﻓﻴﺭﻭﺱ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ‪ E‬ﻭﻫﻭ ﻓﻴﺭﻭﺱ ﺭﻨﺎﻭﻱ )‪ (RNA‬ﻤﻥ ﺯﻤﺭﺓ ﺍﻟﻔﻴﺭﻭﺴﺎﺕ ﺍﻟﻜﺄﺴﻴﺔ‪.‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﺭﻴﺽ‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﻨﻔﺱ ﻁﺭﻕ ﺍﻨﺘﻘﺎل ﻓﻴﺭﻭﺱ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻷﻟﻔﻲ )ﻋﻥ ﻁﺭﻴﻕ ﻤﺎﺀ ﻤﻠﻭﺙ‪ ،‬ﺃﻭ ﺒﺎﻻﻨﺘﻘﺎل ﻤﻥ ﺸﺨﺹ ﻟﺸﺨﺹ‬
‫ﺒﺎﻟﻁﺭﻴﻕ ﺍﻟﺒﺭﺍﺯﻱ ﺍﻟﻔﻤﻭﻱ(‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻏﻴﺭ ﻤﻌﺭﻭﻑ‪ ،‬ﻭﺍﺤﺘﻤﺎﻻﺕ ﺍﻻﻨﺘﻘﺎل ﺍﻟﺜﺎﻨﻭﻱ ﻓﻲ ﺍﻷﺴﺭﺓ ﻤﻨﺨﻔﻀﺔ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫‪ ٦٤-١٥‬ﻴﻭﻡ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻼ ﻻﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻷﻟﻔﻲ‪.‬‬
‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‪ ،‬ﻟﻜﻥ ﻗﺩ ﻴﻜﻭﻥ ﻤﻤﺎﺜ ﹰ‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﺍﻋﺘﻤﺎﺩﹰﺍ ﻋﻠﻰ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‪ ،‬ﻭﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺼﻠﻴﺔ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻤﻤﺎﺜﻠﺔ ﻟﻺﺠﺭﺍﺀﺍﺕ ﺍﻟﻭﺍﺠﺏ ﺇﺘﺒﺎﻋﻬﺎ ﺒﺎﻟﻨﺴﺒﺔ ﻻﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻷﻟﻔﻲ‪.‬‬

‫‪١٠٧‬‬
 ‫ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻤﺨﺒﺭﻱ ﻻﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﻔﻴﺭﻭﺴﻲ‬
Laboratory Diagnosis of A VH

Suspected Case of A VH
HBsAg and or Anti-HBC Igm

-ve +ve

Non-B HB

Anti-HAV IgM Anti-HDV

-ve +ve -ve +ve

Non-A Non B HA HB HB+D

Anti-HCV
-ve +ve

Non-A /B/C HC

Anti-HEV IgM
-ve +ve

Non-A /B/C/E HE

١٠٨
١١٠
 ‫‪ ‬‬
‫א‪‬א‪ ‬‬
‫‪ Tetanus‬‬
‫ﻫﻭ ﻤﺭﺽ ﺤﺎﺩ ﻴﺤﺩﺜﻪ ﺍﻟﺫﻴﻔﺎﻥ ﺍﻟﺨﺎﺭﺠﻲ ﻟﻌﺼﻴﺔ ﺍﻟﻜﺯﺍﺯ )ﺍﻟﻤﻁﺜﻴﺔ( ﺍﻟﺘﻲ ﺘﻨﻤﻭ ﻻ ﻫﻭﺍﺌﻴﹰﺎ ﻓﻲ ﻤﻭﻗﻊ ﺍﻹﺼﺎﺒﺔ‪،‬‬
‫ﻻ ﻓﻲ ﺍﻟﻌﻀﻼﺕ ﺍﻟﻤﺎﻀﻐﺔ ﻭﺜﺎﻨﻴ ﹰﺎ ﻓﻲ ﻋﻀﻼﺕ ﺍﻟﺠﺫﻉ‪ ،‬ﻭﺼﻤل ﺍﻟﺒﻁﻥ‬
‫ﻭﻴﺘﻤﻴﺯ ﺒﺘﻘﻠﺼﺎﺕ ﻋﻀﻠﻴﺔ ﻤﺅﻟﻤﺔ ﺘﺤﺩﺙ ﺃﻭ ﹰ‬
‫ﺃﻭل ﻋﻼﻤﺔ ﺸﺎﺌﻌﺔ ﺘﻭﺤﻲ ﺒﻭﺠﻭﺩ ﺍﻟﻜﺯﺍﺯ‪ ،‬ﻭﺘﺤﺩﺙ ﺘﺸﻨﺠﺎﺕ ﻋﺎﻤﺔ ﻜﺜﻴﺭﹰﺍ ﻤﺎ ﺘﺜﻴﺭﻫﺎ ﻤﻨﺒﻬﺎﺕ ﺤﺴﻴﺔ‪ .‬ﻭﺍﻟﻤﻅﺎﻫﺭ‬
‫ﺍﻟﻨﻤﻭﺫﺠﻴﺔ ﻟﻠﺘﺸﻨﺞ ﺍﻟﻜﺯﺍﺯﻱ ﻫﻭ ﻭﻀﻊ ﺍﻟﻘﻌﺱ ﺍﻟﺘﺸﻨﺠﻲ )ﺍﻟﺘﺸﻨﺞ ﺍﻟﻅﻬﺭﻱ( ﻭﺍﻟﺘﻌﺒﻴﺭ ﺍﻟﻭﺠﻬﻲ ﺍﻟﻤﺴﻤﻰ‬
‫ﺒﺎﻟﺴﺎﺭﺩﻭﻨﻴﺔ‪ .‬ﻤﻌﺩل ﺍﻹﻤﺎﺘﺔ )‪ (% ٩٠ - ٣٠‬ﻤﻥ ﺍﻟﺤﺎﻻﺕ‪.‬‬

‫ﺴﻠﺴﻠﺔ ﺍﻟﻌﺩﻭﻯ‪:‬‬
‫• ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪ :‬ﺍﻟﻤﻁﺜﻴﺔ ﺍﻟﻜﺯﺍﺯﻴﺔ ‪.Ciotridium Tetani‬‬

‫• ﺍﻟﻤﺴﺘﻭﺩﻉ‪ :‬ﺃﻤﻌﺎﺀ ﺍﻟﺤﻴﻭﺍﻨﺎﺕ ﻭﺍﻹﻨﺴﺎﻥ ﺤﻴﺙ ﺘﻜﻭﻥ ﺍﻟﻌﺼﻴﺎﺕ ﺍﻟﻘﺎﻁﻨﺔ ﻋﺎﺩﻴﺔ ﻭﻏﻴﺭ ﻀﺎﺭﺓ‪ ،‬ﻭﺍﻟﺘﺭﺒﺔ ﺍﻟﻤﻠﻭﺜﺔ‬
‫ﺒﺒﺭﺍﺯ ﺍﻟﺤﻴﻭﺍﻨﺎﺕ‪ ،‬ﻭﻨﺎﺩﺭﹰﺍ ﻤﺎ ﻴﺤﻭﻱ ﺒﺭﺍﺯ ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﻁﺜﻴﺎﺕ‪.‬‬

‫• ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪ :‬ﻋﻥ ﻁﺭﻴﻕ ﺩﺨﻭل ﺃﺒﻭﺍﻍ ﺍﻟﻜﺯﺍﺯ ﻓﻲ ﺍﻟﺠﺴﻡ ﻤﻥ ﺨﻼل ﺠﺭﺡ ﻭﺨﺯﻱ ﻤﻠﻭﺙ ﺒﺎﻟﺘﺭﺒﺔ ﺃﻭ ﻏﺒﺎﺭ‬
‫ﺍﻟﺸﺎﺭﻉ ﺃﻭ ﺒﺭﺍﺯ ﺍﻟﺤﻴﻭﺍﻨﺎﺕ ﻭﺍﻹﻨﺴﺎﻥ ﺃﻴﻀﺎﹰ‪ ،‬ﻭﻤﻥ ﺨﻼل ﺘﻬﺘﻙ ﺃﻭ ﺤﺭﻭﻕ‪ ،‬ﺃﻭ ﺠﺭﻭﺡ ﺒﺴﻴﻁﺔ ﺃﻭ ﻏﻴﺭ‬
‫ﻤﻠﺤﻭﻅﺔ‪ ،‬ﺃﻭ ﻭﺠﻭﺩ ﻨﺴﺞ ﻨﺨﺭﻴﺔ‪ ،‬ﺃﻭ ﺃﺠﺴﺎﻡ ﻏﺭﻴﺒﺔ ﺃﻭ ﻜﻠﻴﻬﻤﺎ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﺨﻤﺞ ﻋﺎﻡ‪ ،‬ﻭﻴﺴﺒﺏ ﺫﻭﻓﺎﻥ ﺍﻟﻜﺯﺍﺯ ﻤﻨﺎﻋﺔ ﻓﺎﻋﻠﺔ ﺘﺒﻘﻰ ﻟﻤﺩﺓ ﻋﺸﺭ ﺴﻨﻭﺍﺕ ﻋﻠﻰ ﺍﻷﻗل ﺒﻌﺩ ﺘﻤﻨﻴﻊ‬
‫ﻜﺎﻤل‪ ،‬ﻭﺘﺤﺩﺙ ﻤﻨﺎﻋﺔ ﻤﻨﻔﻌﻠﺔ ﻤﺅﻗﺘﺔ ﻋﻘﺏ ﺍﻟﺯﺭﻕ ﺒﺎﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ﺍﻟﻤﻀﺎﺩ ﻟﻠﻜﺯﺍﺯ‪ ،‬ﻭﻗﺩ ﻻ ﻴﻨﺘﺞ ﻋﻥ ﺍﻟﺸﻔﺎﺀ‬
‫ﻤﻥ ﺍﻟﻜﺯﺍﺯ ﻤﻨﺎﻋﺔ ﻭﻴﻤﻜﻥ ﺃﻥ ﺘﺤﺩﺙ ﺇﺼﺎﺒﺎﺕ ﺜﺎﻨﻴﺔ‪ ،‬ﻭﻴﻭﺼﻰ ﺒﻌﻤل ﺘﻤﻨﻴﻊ ﺒﻌﺩ ﺍﻟﺸﻔﺎﺀ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫ﻤﻥ ‪ ٢١ - ٣‬ﻴﻭﻡ ﻋﺎﺩﺓ ﻭﻟﻭ ﺃﻨﻪ ﻴﺘﺭﺍﻭﺡ ﺒﻴﻥ ﻴﻭﻡ ﻭﺍﺤﺩ ﻭﻋﺩﺓ ﺸﻬﻭﺭ‪ ،‬ﻭﺘﺭﺘﺒﻁ ﺃﺩﻭﺍﺭ ﺍﻟﺤﻀﺎﻨﺔ ﺍﻷﻗﺼﺭ‬
‫ﻋﻤﻭﻤﹰﺎ ﺒﺠﺭﻭﺡ ﺃﻜﺜﺭ ﺘﻠﻭﺜﹰﺎ ﻭﺒﻤﺭﺽ ﺃﺸﺩ ﻭﺒﺈﻨﺫﺍﺭ ﺃﺴﻭﺃ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻻ ﻴﻨﺘﻘل ﺍﻟﺨﻤﺞ ﻤﻥ ﺇﻨﺴﺎﻥ ﺇﻟﻰ ﺇﻨﺴﺎﻥ ﺁﺨﺭ‪.‬‬

‫‪١١١‬‬
 ‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﺒﺎﻷﻋﺭﺍﺽ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻭﻨﺎﺩﺭﹰﺍ ﻤﺎ ﻴﻤﻜﻥ ﺍﺴﺘﻔﺭﺍﺩ ﺍﻟﻌﺼﻴﺎﺕ ﻤﻥ ﻤﻭﻗﻊ ﺍﻟﺨﻤﺞ ﻜﻤﺎ ﻻ ﺘﻭﺠﺩ ﺍﺴﺘﺠﺎﺒﺔ ﻀﺩﻴﺔ‬
‫ﻴﻤﻜﻥ ﺍﻜﺘﺸﺎﻓﻬﺎ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻭﺍﺠﺏ ﺍﺘﺨﺎﺫﻫﺎ‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ‪:‬‬
‫• ﻴﺘﻡ ﺘﺸﺨﻴﺹ ﺍﻟﺤﺎﻟﺔ ﺍﺴﺘﻨﺎﺩﹰﺍ ﺇﻟﻰ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‪.‬‬

‫• ﺍﻟﻌﻼﺝ ﺍﻟﻨﻭﻋﻲ‪:‬‬
‫‪ -‬ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ﺍﻹﻨﺴﺎﻨﻲ )‪ (TIG‬ﺒﺎﻟﻌﻀل ﺒﻤﻘﺩﺍﺭ ﻤﻥ ‪ ٣٠٠٠-٥٠٠‬ﻭﺤﺩﺓ ﺃﻭ ﺍﻟﺘﺭﻴﺎﻕ ﺍﻟﻜﺯﺍﺯﻱ‬
‫)ﺍﻟﻤﺼل ﺍﻟﻌﻀﻠﻲ ‪ (Anti Toxin‬ﻤﻥ ﻤﺼﺩﺭ ﺨﻴﻠﻲ ﺒﻤﻘﺩﺍﺭ ‪ ٢٠٠-٥٠‬ﺃﻟﻑ ﻭﺤﺩﺓ‪.‬‬
‫‪ -‬ﺍﻟﺒﻨﺴﻠﻴﻥ ﺝ ﺤﻘﻨﹰﺎ ﻋﻀﻠﻴﹰﺎ ﺒﺠﺭﻋﺎﺕ ﻜﺒﻴﺭﺓ ﻴﻭﻤﻴﹰﺎ ﻟﻤﺩﺓ ‪ ١٤-١٠‬ﻴﻭﻤﹰﺎ ﻭﺫﻟﻙ ﻟﻠﻤﺴﺎﻋﺩﺓ ﻓﻲ ﺇﺒﺎﺩﺓ ﺍﻷﺸﻜﺎل‬
‫ﺍﻟﻔﻌﺎﻟﺔ ﻟﻠﺠﺭﺜﻭﻡ‪ ،‬ﻴﻌﻁﻰ ﺍﻟﺘﺘﺭﺍﺴﻜﻠﻴﻥ ﻋﻨﺩ ﻭﺠﻭﺩ ﺘﺤﺴﺱ ﻟﻠﺒﻨﺴﻠﻴﻥ )ﺒﻌﻤﺭ ﺃﻜﺒﺭ ﻤﻥ ‪ ١٢‬ﺴﻨﺔ(‪ ،‬ﻜﻤﺎ ﻴﻤﻜﻥ‬
‫ﺇﻋﻁﺎﺀ ﺍﻟﺴﻔﺎﻟﻭﺴﺒﻭﺭﻴﻥ‪.‬‬
‫‪ -‬ﻤﻌﺎﻟﺠﺔ ﻋﺭﻀﻴﺔ ﺤﺴﺏ ﺍﻟﺤﺎﻟﺔ )ﻭﻀﻊ ﺍﻟﻤﺭﻴﺽ ﻓﻲ ﻏﺭﻓﺔ ﻤﻅﻠﻤﺔ‪ ،‬ﺇﻋﻁﺎﺀ ﺍﻟﺩﻴﺎﺯﻴﺒﺎﻡ ﻭﺍﻟﻔﻴﻨﻭﺒﺎﺭﺒﻴﺘﺎل ﻤﻊ‬
‫ﺘﻐﺫﻴﺔ ﻓﻤﻭﻴﺔ ﺃﻭ ﻭﺭﻴﺩﻴﺔ‪ ،‬ﻭﺘﺄﻤﻴﻥ ﻤﺴﻠﻙ ﻫﻭﺍﺌﻲ ‪ ...‬ﺇﻟﺦ(‪.‬‬
‫‪ -‬ﻴﺠﺏ ﺍﻟﺒﺩﺀ ﺒﺎﻟﺘﻤﻨﻴﻊ ﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻠﺘﺭﺼﺩ‪.‬‬

‫• ﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻟﺤﺎﻟﺔ ﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻠﺘﺭﺼﺩ‪.‬‬

‫• ﺘﻘﺼﻲ ﺍﻟﺤﺎﻟﺔ ﻤﻥ ﻗﺒل ﺍﻟﻔﺭﻴﻕ ﺍﻟﻤﺤﻠﻲ ﻟﺘﺤﺩﻴﺩ ﻅﺭﻭﻑ ﺍﻹﺼﺎﺒﺔ ﻭﺍﻟﺒﺤﺙ ﻋﻥ ﺇﺼﺎﺒﺎﺕ ﺃﺨﺭﻯ‪.‬‬

‫• ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﻋﻥ ﺍﻟﻤﺭﺽ ﻭﺒﺨﺼﻭﺹ ﺍﺴﺘﻜﻤﺎل ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻠﻘﻴﺤﻲ ﻭﺍﻟﺤﺎﺠﺔ ﻟﻼﺘﻘﺎﺀ ﺍﻟﻔﺎﻋل ﺃﻭ ﺍﻟﻤﻨﻔﻌل ﺃﻭ‬
‫ﻜﻠﻴﻬﻤﺎ ﺒﻌﺩ ﺍﻹﺼﺎﺒﺔ‪.‬‬

‫ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻭﻗﺎﺌﻴﺔ‪:‬‬
‫• ﺇﻋﻁﺎﺀ ﺍﻟﺘﻤﻨﻴﻊ ﺍﻟﻔﺎﻋل ﺒﺯﻭﻓﺎﻨﺎﺕ ﺍﻟﻜﺯﺍﺯ ﺍﻟﺫﻱ ﻴﻌﻁﻲ ﺤﻤﺎﻴﺔ ﻤﺴﺘﻤﺭﺓ ﻤﺩﺓ ﻋﺸﺭ ﺴﻨﻭﺍﺕ ﻋﻠﻰ ﺍﻷﻗل ﺒﻌﺩ ﺇﺘﻤﺎﻡ‬
‫ﺍﻟﻤﺠﻤﻭﻋﺔ ﺍﻷﺴﺎﺴﻴﺔ‪.‬‬
‫ﻴﻌﻁﻰ ﺍﻟﻠﻘﺎﺡ ﻤﻊ ﻟﻘﺎﺡ ﺍﻟﺨﻨﺎﻕ ﻭﺍﻟﺸﺎﻫﻭﻕ ﻭﺍﻟﻤﺴﺘﺩﻤﻴﺔ ﺍﻟﻨﺯﻟﻴﺔ ﻜﻤﺴﺘﻀﺩ ﺭﺒﺎﻋﻲ‪ ،‬ﺃﻭ ﻤﻊ ﻟﻘﺎﺡ ﺍﻟﺨﻨﺎﻕ ﻜﻤﺴﺘﻀﺩ‬
‫ﺜﻨﺎﺌﻲ ﻜﻤﺎ ﻴﻌﻁﻰ ﻤﻔﺭﺩﹰﺍ‪ .‬ﺍﻨﻅﺭ ﺍﻟﻤﻼﺤﻕ )‪.(١١-١٠‬‬
‫ﻭﻓﻲ ﺒﻌﺽ ﺍﻟﺩﻭل ﻴﺘﻡ ﺍﻟﺤﻔﺎﻅ ﻋﻠﻰ ﺍﻟﺤﻤﺎﻴﺔ ﺍﻟﻔﺎﻋﻠﺔ ﺒﺈﻋﻁﺎﺀ ﺠﺭﻋﺎﺕ ﻤﻌﺯﺯﺓ ﻜل ﻋﺸﺭ ﺴﻨﻭﺍﺕ ﻭﺒﻌﺩ ﺍﺴﺘﻜﻤﺎل‬
‫ﺍﻟﺠﺩﻭل ﺍﻟﻨﻅﺎﻤﻲ‪.‬‬

‫‪١١٢‬‬
‫• ﺍﻻﺘﻘﺎﺀ ﻓﻲ ﺘﺩﺒﻴﺭ ﺍﻟﺠﺭﻭﺡ‪ :‬ﻴﺒﻨﻰ ﺍﻟﺘﺩﺒﻴﺭ ﺍﻟﺼﺤﻴﺢ ﻋﻠﻰ ﺍﻟﺘﺤﺩﻴﺩ ﺒﻌﻨﺎﻴﺔ ﻟﻤﺩﻯ ﻨﻅﺎﻓﺔ ﺍﻟﺠﺭﺡ ﺃﻭ ﺘﻠﻭﺜﻪ‪ ،‬ﻭﺤﺎﻟﺔ‬
‫ﺍﻟﻤﺭﻴﺽ ﺍﻟﻤﻨﺎﻋﻴﺔ ﻭﻋﻠﻰ ﺍﻻﺴﺘﻌﻤﺎل ﺍﻟﺼﺤﻴﺢ ﻟﺫﻭﻓﺎﻥ ﺍﻟﻜﺯﺍﺯ ﺃﻭ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ﺍﻟﻜﺯﺍﺯﻱ ﺃﻭ ﻜﻠﻴﻬﻤﺎ‪،‬‬
‫ﻭﻋﻠﻰ ﺘﻨﻅﻴﻑ ﺍﻟﺠﺭﺡ ﺃﻭ ﺍﻟﺘﻨﻀﻴﺭ ﺍﻟﺠﺭﺍﺤﻲ ﻭﺍﻻﺴﺘﻌﻤﺎل ﻟﻠﺼﺎﺩﺍﺕ‪.‬‬

‫ﻭﻓﻴﻤﺎ ﻴﻠﻲ ﻤﺭﺸﺩ ﻤﻭﺠﺯ ﻟﻜﻴﻔﻴﺔ ﺍﺘﻘﺎﺀ ﺍﻟﻜﺯﺍﺯ ﻓﻲ ﺍﻟﺘﺩﺒﻴﺭ ﺍﻟﺭﻭﺘﻴﻨﻲ ﻟﻠﺠﺭﻭﺡ‪:‬‬

‫ﺠﺭﻭﺡ ﺼﻐﻴﺭﺓ‬
‫ﺍﻟﺠﺭﻭﺡ ﺍﻷﺨﺭﻯ‬
‫ﻭﻨﻅﻴﻔﺔ‬ ‫ﺍﻟﺯﻤﻥ ﺒﻌﺩ ﺁﺨﺭ‬ ‫ﺴﺎﺒﻘﺔ ﺘﻤﻨﻴﻊ ﻀﺩ ﺍﻟﻜﺯﺍﺯ‬
‫ﺍﻟﺫﻭﻓﺎﻥ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﺫﻭﻓﺎﻥ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ‬ ‫ﺠﺭﻋﺔ‬ ‫)ﺍﻟﺠﺭﻋﺎﺕ(‬
‫ﺍﻟﻤﻨﺎﻋﻲ‬ ‫ﺍﻟﺒﺎﻟﻎ‬ ‫ﺍﻟﻤﻨﺎﻋﻲ‬ ‫ﺍﻟﺒﺎﻟﻎ‬
‫ﻨﻌﻡ‬ ‫ﻨﻌﻡ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫‪-‬‬ ‫ﻏﻴﺭ ﻤﺅﻜﺩ ﺃﻭ ﺃﻗل ﻤﻥ ‪ ٣‬ﺠﺭﻋﺎﺕ‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫‪> ١٠‬‬ ‫‪ ٣‬ﺠﺭﻋﺎﺕ ﻓﺄﻜﺜﺭ ﺃﻭ ﻜﺎﻤل‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻻ‬ ‫ﻻ‬ ‫‪١٠-٥‬‬
‫ﻻ‬ ‫ﻻ‬ ‫ﻻ‬ ‫ﻻ‬ ‫‪<٥‬‬

‫ﻤﻼﺤﻅﺔ‪:‬‬
‫•‬ ‫ﻴﻌﻁﻰ ﺍﻟﺘﻤﻨﻴﻊ ﺍﻟﻤﻨﻔﻌل ﺒﻤﻘﺩﺍﺭ ‪ ٢٥٠‬ﻭﺤﺩﺓ ﻋﻠﻰ ﺍﻷﻗل ﻤﻥ ﺍﻟﻐﻠﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ﺍﻟﻜﺯﺍﺯﻱ ﻓﻲ ﺍﻟﻌﻀل ﺃﻭ‬
‫‪ ٥٠٠٠ - ١٥٠٠‬ﻭﺤﺩﺓ ﻤﻥ ﺍﻟﺘﺭﻴﺎﻕ ﺍﻟﺤﻴﻭﺍﻨﻲ ﺍﻟﻤﻨﺸﺄ ﺒﻌﺩ ﺍﺴﺘﺒﻌﺎﺩ ﺍﻟﺘﺤﺴﺱ‪.‬‬

‫• ﻋﻨﺩ ﺇﻋﻁﺎﺀ ﺍﻟﻠﻘﺎﺡ ﻭﺍﻟﻤﺼل ﺃﻭ ﻏﺎﻤﺎ ﻏﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻜﺯﺍﺯ ﻴﺠﺏ ﺍﺴﺘﻌﻤﺎل ﻤﺤﻘﻨﺔ ﻟﻜل ﻨﻭﻉ ﻭﺇﻥ ﺍﻟﺤﻘﻥ ﻴﺠﺏ ﺃﻥ‬
‫ﻴﺘﻡ ﻓﻲ ﻤﻜﺎﻨﻴﻥ ﻤﺨﺘﻠﻔﻴﻥ‪.‬‬

‫• ﺍﻟﺠﺭﺡ ﻏﻴﺭ ﺍﻟﻨﻅﻴﻑ ﻫﻭ ﻜل ﺠﺭﺡ ﻤﻠﻭﺙ ﺒﺎﻟﺘﺭﺍﺏ ﺃﻭ ﺒﺭﻭﺙ ﺍﻟﺤﻴﻭﺍﻨﺎﺕ ﺃﻭ ﻋﻀﺔ ﺤﻴﻭﺍﻥ ﺃﻭ ﺃﻀﻴﻑ ﺇﻟﻴﻪ‬
‫ﺒﻬﺩﻑ ﺍﻟﻌﻼﺝ ﻭﺍﻹﺴﻌﺎﻑ ﺍﻷﻭﻟﻲ ﺒﻌﺽ ﺍﻟﻤﻭﺍﺩ ﺍﻟﺘﻘﻠﻴﺩﻴﺔ ﻏﻴﺭ ﺍﻟﻁﺒﻴﺔ‪.‬‬

‫• ﻀﺭﻭﺭﺓ ﺘﻭﻓﺭ ﺍﻟﻠﻘﺎﺡ ﺍﻟﻤﻀﺎﺩ ﻟﻠﻜﺯﺍﺯ ﻓﻲ ﻜل ﺃﻗﺴﺎﻡ ﺍﻹﺴﻌﺎﻑ‪.‬‬

‫‪١١٣‬‬
 ‫‪‬‬
‫‪‬א‪‬א‪ ‬‬
‫‪ Neonatal Tetanus‬‬
‫ﻤﻘﺩﻤﺔ‪:‬‬
‫ﻜﺯﺍﺯ ﺍﻟﻭﻟﻴﺩ ﻫﻭ ﻤﺭﺽ ﺠﺭﺜﻭﻤﻲ ﺤﺎﺩ ﻴﺴﺒﺒﻪ ﺍﻟﺫﻴﻔﺎﻥ ﺍﻟﺨﺎﺭﺠﻲ ﻟﻌﺼﻴﺔ ﺍﻟﻜﺯﺍﺯ‪ ،‬ﻭﻴﺘﻅﺎﻫﺭ ﻋﻨﺩ ﺍﻟﻭﻟﻴﺩ‬
‫ﺒﺼﻌﻭﺒﺔ ﻓﻲ ﺍﻟﺒﻠﻊ ﻭﺍﻟﺭﻀﺎﻋﺔ )ﺒﻌﺩ ﺃﻥ ﻜﺎﻥ ﺍﻟﻁﻔل ﻁﺒﻴﻌﻲ ﻓﻲ ﺍﻷﻴﺎﻡ ﺍﻟﻘﻠﻴﻠﺔ ﺍﻷﻭﻟﻰ ﺒﻌﺩ ﺍﻟﻭﻻﺩﺓ( ﺤﻴﺙ ﻴﺒﺩﺃ‬
‫ﺍﻟﻤﺭﺽ ﺒﻴﻥ ﺍﻟﻴﻭﻤﻴﻥ )‪ (٢٨-٣‬ﺒﻌﺩ ﺍﻟﻭﻻﺩﺓ‪ ،‬ﻭﻴﺼﺒﺢ ﺍﻟﻁﻔل ﻏﻴﺭ ﻗﺎﺩﺭ ﻋﻠﻰ ﺍﻟﻤﺹ‪ ،‬ﻭﻴﺘﺒﻊ ﺫﻟﻙ ﺘﺼﻠﺏ ﻋﻀﻠﻲ‬
‫ﻭﺘﺸﻨﺠﺎﺕ‪ ،‬ﻭﻗﺩ ﺘﺤﺩﺙ ﺍﺨﺘﻼﺠﺎﺕ ﺜﻡ ﻴﺘﻭﻓﻰ ﺍﻟﻁﻔل ﻏﺎﻟﺒﹰﺎ‪.‬‬

‫ﻭﻤﻌﺩﻻﺕ ﺍﻹﻤﺎﺘﺔ ﻤﺭﺘﻔﻌﺔ ﺠﺩﹰﺍ ﺤﻴﺙ ﺘﺯﻴﺩ ﻋﻥ ‪ %٨٠‬ﻤﻥ ﺍﻟﺤﺎﻻﺕ‪.‬‬

‫ﺴﻠﺴﻠﺔ ﺍﻟﻌﺩﻭﻯ‪:‬‬
‫• ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪ :‬ﺍﻟﻤﻁﺜﻴﺔ ﺍﻟﻜﺯﺍﺯﻴﺔ ‪ Clostridium Tetani‬ﻭﻫﻲ ﻋﺼﻴﺎﺕ ﻻ ﻫﻭﺍﺌﻴﺔ ﻤﺒﻭﻏﺔ‪.‬‬

‫• ﺍﻟﻤﺴﺘﻭﺩﻉ‪ :‬ﺃﻤﻌﺎﺀ ﺍﻟﺤﻴﻭﺍﻨﺎﺕ ﻭﺍﻹﻨﺴﺎﻥ‪ ،‬ﺤﻴﺙ ﺘﻜﻭﻥ ﺍﻟﻌﺼﻴﺎﺕ ﻗﺎﻁﻨﺔ ﻋﺎﺩﻴﺔ ﻭﻏﻴﺭ ﻀﺎﺭﺓ‪ ،‬ﻭﺍﻟﺘﺭﺒﺔ ﺍﻟﻤﻠﻭﺜﺔ‬
‫ﺒﺒﺭﺍﺯ ﺍﻟﺤﻴﻭﺍﻨﺎﺕ ﻭﻨﺎﺩﺭﹰﺍ ﺒﺒﺭﺍﺯ ﺍﻹﻨﺴﺎﻥ‪.‬‬

‫• ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫‪ -‬ﺩﺨﻭل ﺃﺒﻭﺍﻍ ﺍﻟﻜﺯﺍﺯ ﺇﻟﻰ ﺠﺴﻡ ﺍﻟﻤﻭﻟﻭﺩ ﺃﺜﻨﺎﺀ ﺍﻟﻭﻻﺩﺓ‪ ،‬ﺒﻘﻁﻊ ﺍﻟﺤﺒل ﺍﻟﺴﺭﻱ ﺒﺄﺩﺍﺓ ﻤﻠﻭﺜﺔ ﺒﻬﺫﻩ ﺍﻷﺒﻭﺍﻍ‪.‬‬
‫‪ -‬ﺩﺨﻭل ﺃﺒﻭﺍﻍ ﺍﻟﻜﺯﺍﺯ ﺇﻟﻰ ﺠﺴﻡ ﺍﻟﻭﻟﻴﺩ ﺒﻌﺩ ﺍﻟﻭﻻﺩﺓ ﺒﻭﻀﻊ ﺃﻭ ﺘﻀﻤﻴﺩ ﺍﻟﺠﺫﻤﻭﺭ ﺍﻟﺴﺭﻱ ﺒﻤﻭﺍﺩ ﺸﺩﻴﺩﺓ ﺍﻟﺘﻠﻭﺙ‬
‫ﺒﻬﺫﻩ ﺍﻷﺒﻭﺍﻍ )ﻜﺎﻟﻜﺤل ﻭﺍﻟﺒﻥ ﻭﺍﻟﻤﻠﺢ ‪ ..‬ﺇﻟﺦ(‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫• ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﺨﻤﺞ ﻋﺎﻡ‪.‬‬

‫• ﺘﺤﺩﺙ ﻤﻨﺎﻋﺔ ﻤﻨﻔﻌﻠﺔ ﻤﺅﻗﺘﺔ ﻋﻘﺏ ﺍﻟﺯﺭﻕ ﺒﺎﻟﻐﺎﻤﺎﻏﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﺒﺸﺭﻱ ﺍﻟﻤﻨﺎﻋﻲ ﻀﺩ ﺍﻟﻜﺯﺍﺯ ﺃﻭ ﺍﻟﻤﺼل ﺍﻟﻤﻀﺎﺩ‬
‫ﻟﻠﻜﺯﺍﺯ‪ ،‬ﻗﺩ ﻻ ﻴﻨﺘﺞ ﻋﻥ ﺍﻟﺸﻔﺎﺀ ﻤﻥ ﺍﻟﻤﺭﺽ ﻤﻨﺎﻋﺔ‪ ،‬ﻭﻴﻤﻜﻥ ﺃﻥ ﺘﺤﺩﺙ ﺇﺼﺎﺒﺎﺕ ﺜﺎﻨﻴﺔ ﺒﻤﺭﺽ ﺍﻟﻜﺯﺍﺯ‪،‬‬
‫ﻭﻴﻭﺼﻰ ﺒﻌﻤل ﺘﻤﻨﻴﻊ ﺒﻌﺩ ﺍﻟﺸﻔﺎﺀ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫ﺍﻟﻤﺘﻭﺴﻁ ﺤﻭﺍﻟﻲ ‪ ٦‬ﺃﻴﺎﻡ‪ ،‬ﻀﻤﻥ ﻤﺠﺎل ﻴﺘﺭﺍﻭﺡ ﺒﻴﻥ )‪ (٢٨ - ٣‬ﻴﻭﻤﹰﺎ‪.‬‬

‫‪١١٤‬‬
 ‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻻ ﻴﻨﺘﻘل ﺍﻟﺨﻤﺞ ﻤﻥ ﺇﻨﺴﺎﻥ ﺇﻟﻰ ﺇﻨﺴﺎﻥ‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﻴﻌﺘﻤﺩ ﻋﻠﻰ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺭﻴﺭﻴﺔ‪ ،‬ﻭﻨﺎﺩﺭﹰﺍ ﻤﺎ ﻴﻤﻜﻥ ﺍﺴﺘﻔﺭﺍﺩ ﺍﻟﻌﺼﻴﺎﺕ ﻤﻥ ﻤﻭﻗﻊ ﺍﻟﺨﻤﺞ ﻜﻤﺎ ﻻ ﺘﻭﺠﺩ ﺍﺴﺘﺠﺎﺒﺔ‬
‫ﻀﺩﻴﺔ ﻴﻤﻜﻥ ﻜﺸﻔﻬﺎ‪.‬‬

‫ﻭﺇﻥ ﺴﻭﺭﻴﺔ ﻗﺩ ﺍﻟﺘﺯﻤﺕ ﺒﻬﺩﻑ ﻤﻨﻅﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ )ﺍﻟﻘﻀﺎﺀ ﻋﻠﻰ ﻜﺯﺍﺯ ﺍﻟﻭﻟﻴﺩ(‪ ،‬ﻭﻴﻌﻨﻲ ﺇﻨﻘﺎﺹ ﻤﻌﺩل‬
‫ﺤﺩﻭﺙ ﻜﺯﺍﺯ ﺍﻟﻭﻟﻴﺩ ﺇﻟﻰ ﺃﻗل ﻤﻥ ﺤﺎﻟﺔ ﻟﻜل ﺃﻟﻑ ﻭﻻﺩﺓ ﺤﻴﺔ‪ ،‬ﻭﻗﺩ ﺤﻘﻘﺕ ﺴﻭﺭﻴﺔ ﻫﺩﻑ ﺍﻟﻘﻀﺎﺀ ﻋﻠﻰ ﺍﻟﻤﺭﺽ ﻤﻨﺫ‬
‫ﻋﺎﻡ ‪ ١٩٩٧‬ﻭﺤﺎﻓﻅﺕ ﻋﻠﻴﻪ ﺤﺘﻰ ﺍﻵﻥ‪.‬‬

‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ‬

‫ﺤﺎﻟﺔ ﻜﺯﺍﺯ ﺍﻟﻭﻟﻴﺩ )‪:(N.T‬‬

‫ﻗﺼﺔ ﻤﺹ ﻁﺒﻴﻌﻲ ﺨﻼل ﺍﻟﻴﻭﻤﻴﻥ ﺍﻷﻭﻟﻴﻥ ﻤﻥ ﺍﻟﻭﻻﺩﺓ‪ ،‬ﺜﻡ ﻴﺒﺩﺃ ﺍﻟﻤﺭﺽ ﺒﻴﻥ ﺍﻟﻴﻭﻡ )‪ (٢٨ - ٣‬ﺒﻌﺩ ﺍﻟﻭﻻﺩﺓ‬
‫ﺤﻴﺙ ﻴﺼﺒﺢ ﺍﻟﻁﻔل ﻏﻴﺭ ﻗﺎﺩﺭ ﻋﻠﻰ ﺍﻟﻤﺹ ﻭﺍﻟﺭﻀﺎﻋﺔ ﻭﻴﺘﺒﻊ ﺫﻟﻙ ﺘﺼﻠﺏ ﻋﻀﻠﻲ ﻭﺘﺸﻨﺠﺎﺕ ﻭﻗﺩ ﺘﺤﺩﺙ‬
‫ﺍﺨﺘﻼﺠﺎﺕ‪ ،‬ﻭﻏﺎﻟﺒﹰﺎ ﻤﺎ ﻴﺘﻭﻓﻰ ﺍﻟﻁﻔل‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻭﺍﺠﺏ ﺍﺘﺨﺎﺫﻫﺎ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬

‫• ﺍﻟﻜﺸﻑ ﺍﻟﻤﺒﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻟﺔ ﺤﺴﺏ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ‪.‬‬

‫• ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻥ ﺍﻟﺤﺎﻟﺔ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪ ،‬ﻭﺘﺴﺠل ﻀﻤﻥ ﺘﻘﺭﻴﺭ ﺍﻹﺒﻼﻍ ﺍﻷﺴﺒﻭﻋﻲ ﺍﻟﺼﻔﺭﻱ ﻭﺘﺭﺴل‬
‫ﻟﻠﻤﺴﺘﻭﻯ ﺍﻷﻋﻠﻰ‪.‬‬

‫• ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﻨﻭﻋﻴﺔ ﻓﻲ ﺍﻟﻤﺸﻔﻰ‪ ،‬ﻭﻴﺘﻀﻤﻥ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ﺍﻹﻨﺴﺎﻨﻲ ﺃﻭ ﺍﻟﻤﺼل ﺍﻟﻤﻀﺎﺩ ‪ ..‬ﺇﻀﺎﻓﺔ ﺇﻟﻰ‬
‫ﺍﻟﺒﻨﺴﻠﻴﻥ‪.‬‬

‫• ﻤﻌﺎﻟﺠﺔ ﻋﺭﻀﻴﺔ ﺤﺴﺏ ﺍﻟﺤﺎﻟﺔ‪.‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ ﻋﻨﺩ ﺇﺠﺭﺍﺀ ﺍﻻﺴﺘﺴﻘﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ‪.‬‬

‫‪١١٥‬‬
‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻠﻘﻴﺢ ﻭﻓﺭﻴﻕ ﺘﺩﺭﻴﺏ ﺍﻟﺩﺍﻴﺎﺕ ﻭﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ ﻋﻨﺩ ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ‬
‫ﺍﻟﻤﻜﺎﻓﺤﺔ‪.‬‬

‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻟﺔ ﻓﻲ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻠﺘﺭﺼﺩ ﺍﻟﺫﻱ ﻴﺭﺴل ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬

‫• ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻭﻗﺎﻴﺔ ﻭﺘﺘﻀﻤﻥ‪:‬‬

‫‪ -‬ﺍﻟﻭﻻﺩﺓ ﺍﻟﻨﻅﻴﻔﺔ )ﺃﺩﻭﺍﺕ ﻨﻅﻴﻔﺔ ﻭﺃﻴﺩﻱ ﻤﺩﺭﺒﺔ(‪.‬‬
‫‪ -‬ﺍﻟﺘﻌﺎﻤل ﺍﻟﺼﺤﻴﺢ ﻤﻊ ﺴﺭﺓ ﺍﻟﻭﻟﻴﺩ )ﻋﺩﻡ ﻭﻀﻊ ﺃﻱ ﻤﻭﺍﺩ ﻋﻠﻰ ﺍﻟﺠﺯﻤﻭﺭ ﺍﻟﺴﺭﻱ ﻭﺘﻐﻁﻴﺘﻬﺎ ﺒﻘﻁﻌﺔ ﻗﻤﺎﺵ‬
‫ﻨﻅﻴﻔﺔ(‪.‬‬
‫‪ -‬ﺘﻠﻘﻴﺢ ﺍﻟﻨﺴﺎﺀ ﻓﻲ ﺴﻥ ﺍﻹﻨﺠﺎﺏ ﺒﺠﺭﻋﺘﻴﻥ ﻤﻥ ﻟﻘﺎﺡ ﺍﻟﻜﺯﺍﺯ )ﺍﻟﻤﻠﺤﻕ ‪ (١١‬ﻤﻊ ﺍﻷﺨﺫ ﺒﻌﻴﻥ ﺍﻻﻋﺘﺒﺎﺭ ﻟﻘﺎﺤﺎﺕ‬
‫ﺍﻟﻁﻔﻭﻟﺔ ﻭﺍﻟﻤﺩﺭﺴﺔ )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ ‪.(١٠‬‬
‫‪ -‬ﺘﺜﻘﻴﻑ ﺍﻟﺠﻤﻬﻭﺭ ﺤﻭل ﻤﺭﺽ ﻜﺯﺍﺯ ﺍﻟﻭﻟﻴﺩ ﻭﻁﺭﻕ ﺍﻨﺘﻘﺎﻟﻪ ﻭﺍﻟﻭﻗﺎﻴﺔ ﻤﻨﻪ ﻭﺃﻫﻤﻴﺔ ﺘﻠﻘﻴﺢ ﺍﻷﻁﻔﺎل ﻭﺍﻟﻨﺴﺎﺀ‬
‫ﻭﺨﺎﺼﺔ ﺍﻟﺤﻭﺍﻤل ﻟﺤﻤﺎﻴﺘﻬﻥ ﻭﺤﻤﺎﻴﺔ ﺃﻁﻔﺎﻟﻬﻥ ﻭﻜﺫﻟﻙ ﺤﻭل ﺴﻼﻤﺔ ﺍﻟﻠﻘﺎﺡ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫• ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻥ ﺍﻟﺤﺎﻟﺔ ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪.‬‬

‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﺤﺎﻟﺔ ﺨﻼل ‪ ٤٨‬ﺴﺎﻋﺔ ﻤﻥ ﺍﻹﺒﻼﻍ )ﻋﻥ ﺍﻹﺼﺎﺒﺔ ﻭﺍﻟﻤﺸﺭﻑ ﻋﻠﻰ ﺍﻟﻭﻻﺩﺓ ﻭﺍﻟﺤﺎﻟﺔ‬
‫ﺍﻟﺘﻠﻘﻴﺤﻴﺔ ﻟﻸﻡ( ﻭﻓﻕ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ )ﺍﻟﻤﻠﺤﻕ ‪ (١٥‬ﻭﺇﺭﺴﺎل ﺍﻻﺴﺘﻤﺎﺭﺓ ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ‪ -‬ﻤﺩﻴﺭﻴﺔ‬
‫ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ ‪ -‬ﺩﺍﺌﺭﺓ ﺍﻟﻁﻔل ﻭﺫﻟﻙ ﺒﻌﺩ ﺍﻻﺤﺘﻔﺎﻅ ﺒﻨﺴﺨﺔ ﻤﻨﻬﺎ‪.‬‬

‫• ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺨﻼل ‪ ٧٢‬ﺴﺎﻋﺔ ﻤﻥ ﺘﺎﺭﻴﺦ ﺍﻟﺘﻘﺼﻲ‪.‬‬

‫‪ -‬ﺘﻠﻘﻴﺢ ﺍﻟﻨﺴﺎﺀ ﻓﻲ ﺴﻥ ﺍﻹﻨﺠﺎﺏ ﻓﻲ ﻤﻨﻁﻘﺔ ﺍﻹﺼﺎﺒﺔ ﺒﺠﺭﻋﺘﻴﻥ ﻤﻥ ﻟﻘﺎﺡ ﺍﻟﻜﺯﺍﺯ ﺇﺫﺍ ﻜﻥ ﻤﺴﺘﺤﻘﺎﺕ )ﺤﺴﺏ‬
‫ﺴﻭﺍﺒﻘﻬﻥ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ ﻓﻲ ﺍﻟﻁﻔﻭﻟﺔ ﻭﻓﻲ ﺍﻟﻤﺩﺭﺴﺔ ﻭﻓﻲ ﺴﻥ ﺍﻹﻨﺠﺎﺏ ﻭﺤﺴﺏ ﺠﺩﻭل ﻟﻘﺎﺡ ﺍﻟﻜﺯﺍﺯ( ﻭﺫﻟﻙ ﻋﻠﻰ‬
‫ﺯﻴﺎﺭﺘﻴﻥ ﺒﻔﺎﺼل ﺸﻬﺭ ﺒﻴﻨﻬﻤﺎ‪.‬‬
‫‪ -‬ﻤﺘﺎﺒﻌﺔ ﺍﻟﻤﺸﺭﻓﻴﻥ ﻋﻠﻰ ﺍﻟﻭﻻﺩﺕ ﻓﻲ ﺍﻟﻤﻨﻁﻘﺔ ﻭﺨﺎﺼﺔ ﺍﻟﺩﺍﻴﺎﺕ‪.‬‬
‫‪ -‬ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﺤﻭل ﺍﻟﻤﺭﺽ ﻭﻁﺭﻕ ﺍﻨﺘﻘﺎﻟﻪ ﻭﺍﻟﻭﻗﺎﻴﺔ ﻤﻨﻪ ﻟﻸﻤﻬﺎﺕ ﻭﺍﻷﻫﺎﻟﻲ ﻭﺍﻟﻤﺸﺭﻓﻴﻥ ﻋﻠﻰ‬
‫ﺍﻟﻭﻻﺩﺍﺕ ﻭﻴﺠﺏ ﺇﺭﺴﺎل ﺍﻟﻤﻌﻠﻭﻤﺎﺕ ﺤﻭل ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻫﺫﻩ ﻭﻓﻕ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ ﺇﻟﻰ ﻭﺯﺍﺭﺓ‬
‫ﺍﻟﺼﺤﺔ ـ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ ـ ﺩﺍﺌﺭﺓ ﺼﺤﺔ ﺍﻟﻁﻔل‪.‬‬

‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻟﺔ ﻓﻲ ﺴﺠل ﺤﺎﻻﺕ ﻜﺯﺍﺯ ﺍﻟﻭﻟﻴﺩ ﻟﻠﻤﺤﺎﻓﻅﺔ ﻭﺍﻟﻤﻨﻁﻘﺔ‪ ،‬ﻭﻓﻲ ﺘﻘﺭﻴﺭ ﺍﻹﺒﻼﻍ ﺍﻷﺴﺒﻭﻋﻲ ﺍﻟﺼﻔﺭﻱ‬
‫ﺍﻟﺫﻱ ﻴﺭﺴل ﺇﻟﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻷﻋﻠﻰ )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ ‪.(٦ ،٥ ،٤‬‬

‫• ﺍﻟﺘﺩﺭﻴﺏ ﻋﻠﻰ ﻭﺒﺎﺌﻴﺎﺕ ﺍﻟﻤﺭﺽ ﻭﺇﺠﺭﺍﺀ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‪.‬‬

‫‪١١٦‬‬
 ‫• ﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ ﻭﺇﻋﺩﺍﺩ ﺘﻐﺫﻴﺔ ﺭﺍﺠﻌﺔ ﺒﺫﻟﻙ ﻭﺇﺭﺴﺎل ﺘﻘﺭﻴﺭ ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪.‬‬

‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻟﺔ ﻓﻲ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻠﺘﺭﺼﺩ ﺍﻟﺫﻱ ﻴﺭﺴل ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ – ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ‪-‬‬
‫ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﺃﻭ ﺘﻘﺭﻴﺭ ﺍﻟﺘﺭﺼﺩ ﻟﻤﺭﺍﻜﺯ ﺍﻹﺒﻼﻍ ﺍﻟﻤﺨﺘﺎﺭﺓ ﺍﻟﺫﻱ ﻴﺭﺴل ﻟﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ ‪-‬‬
‫ﺩﺍﺌﺭﺓ ﺼﺤﺔ ﺍﻟﻁﻔل‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬

‫• ﺘﺤﻠﻴل ﺍﺴﺘﻤﺎﺭﺓ ﻟﺘﻘﺼﻲ ﺍﻟﺨﺎﺼﺔ ﺒﻜل ﺤﺎﻟﺔ ﻭﻜﺫﻟﻙ ﺍﻟﻤﻌﻠﻭﻤﺎﺕ ﺤﻭل ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‪.‬‬

‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻟﺔ ﻓﻲ ﺍﻟﺴﺠل ﺍﻟﻭﻁﻨﻲ ﻟﺤﺎﻻﺕ ﻜﺯﺍﺯ ﺍﻟﻭﻟﻴﺩ‪.‬‬

‫• ﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻷﺩﻨﻰ )ﻤﻥ ﺤﻴﺙ ﺍﻹﺒﻼﻍ‪ ،‬ﺍﻻﺴﺘﻘﺼﺎﺀ‪ ،‬ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ(‪.‬‬

‫• ﺍﻟﺘﻘﻭﻴﻡ )ﻋﻥ ﻁﺭﻴﻕ ﺍﻟﺯﻴﺎﺭﺍﺕ ﺍﻹﺸﺭﺍﻓﻴﺔ ﻭﻤﺅﺸﺭﺍﺕ ﺍﻟﺘﺭﺼﺩ(‪.‬‬

‫• ﺍﻟﺘﺩﺭﻴﺏ ﻋﻠﻰ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﻟﺠﻤﻴﻊ ﺍﻟﻘﻁﺎﻋﺎﺕ ﺍﻟﺼﺤﻴﺔ ﻭﺠﻤﻴﻊ ﺍﻟﻤﺴﺘﻭﻴﺎﺕ‪.‬‬

‫• ﻭﻀﻊ ﺤﻤﻠﺔ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﻤﺭﺽ‪.‬‬

‫• ﺍﻟﺘﻨﺴﻴﻕ ﻭﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ )ﺍﻟﻘﻁﺎﻋﺎﺕ ﺍﻟﺼﺤﻴﺔ‪ ،‬ﺍﻹﻋﻼﻡ‪ ،‬ﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺸﻌﺒﻴﺔ ﻭﺍﻟﺩﻭﻟﻴﺔ(‪.‬‬

‫‪١١٧‬‬
١١٨
١٢٠
 ‫‪ ‬‬
‫‪‬א‪‬א‪ ‬‬
‫ﻤﺭﺽ ﻁﻔﻴﻠﻲ ﻤﺘﻌﺩﺩ ﺍﻷﺸﻜﺎل ﻴﺼﻴﺏ ﺍﻟﺠﻠﺩ ﻭﺍﻷﻏﺸﻴﺔ ﺍﻟﻤﺨﺎﻁﻴﺔ )ﺩﺍﺀ ﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﺠﻠﺩﻱ ﺍﻟﻤﺨﺎﻁﻲ( ﺃﻭ‬
‫ﺍﻷﺤﺸﺎﺀ )ﺩﺍﺀ ﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﺤﺸﻭﻴﺔ(‪.‬‬

‫ﻭﺴﻴﺘﻡ ﺒﺤﺙ ﺩﺍﺀ ﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﺠﻠﺩﻴﺔ ﻨﻅﺭﹰﺍ ﻻﺴﺘﻴﻁﺎﻨﻪ ﻭﺍﻨﺘﺸﺎﺭﻩ ﻓﻲ ﻤﻌﻅﻡ ﻤﺤﺎﻓﻅﺎﺕ ﺍﻟﻘﻁﺭ ﺒﻴﻨﻤﺎ ﻴﻨﺘﺸﺭ ﺩﺍﺀ‬
‫ﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﺤﺸﻭﻴﺔ ﻓﻲ ﺃﻤﺎﻜﻥ ﻤﺤﺩﻭﺩﺓ ﻓﻲ ﻤﺤﺎﻓﻅﺎﺕ ﺤﻠﺏ‪ ،‬ﺍﻟﻼﺫﻗﻴﺔ‪ ،‬ﺇﺩﻟﺏ‪ ،‬ﺩﺭﻋﺎ‪ ...‬ﻭﻻ ﻴﺸﻜل ﻤﺸﻜﻠﺔ ﺼﺤﻴﺔ‬
‫ﻫﺎﻤﺔ ﻨﻅﺭﹰﺍ ﻟﺘﺴﺠﻴل ﻋﺩﺩ ﻗﻠﻴل ﻤﻥ ﺍﻹﺼﺎﺒﺎﺕ ﺴﻨﻭﻴﹰﺎ‪.‬‬

‫ﻋﻠﻤﹰﺎ ﺒﺄﻥ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻻ ﺘﺨﺘﻠﻑ ﻜﺜﻴﺭﹰﺍ ﻋﻥ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﺠﻠﺩﻴﺔ )ﺍﻟﻜﺸﻑ‬
‫ﺍﻟﺒﺎﻜﺭ ﻭﺍﻟﻌﻼﺝ ﻭﺍﻟﻤﺸﻔﻰ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺫﺒﺎﺒﺔ ﺍﻟﻨﺎﻗﻠﺔ ﻟﻠﻁﻔﻴﻠﻲ ﻭﻤﻜﺎﻓﺤﺔ ﺍﻟﻘﻭﺍﺭﺽ‪ ...‬ﺍﻟﺦ(‪.‬‬

‫‪١٢١‬‬
 ‫‪‬‬
‫‪‬א‪‬א‪‬א‪ ‬‬
‫‪ Cutaneous Leshmanasis‬‬
‫ﺍﻟﺘﻌﺭﻴﻑ‪:‬‬
‫ﻫﻭ ﻤﺭﺽ ﻁﻔﻴﻠﻲ ﻤﺘﻌﺩﺩ ﺍﻷﺸﻜﺎل ﻓﻲ ﺍﻟﺠﻠﺩ ﻭﺍﻷﻏﺸﻴﺔ ﺍﻟﻤﺨﺎﻁﻴﺔ ﺘﺴﺒﺒﻪ ﺴﻭﺍﺌﻁ ﻨﺴﺠﻴﺔ ﻴﺒﺩﺃ ﺒﺂﻓﺔ ﻋﻘﻴﺩﻴﺔ )ﻗﺩ‬
‫ﺘﻜﻭﻥ ﻤﺅﻟﻤﺔ ﺃﻭ ﻏﻴﺭ ﻤﺅﻟﻤﺔ( ﺜﻡ ﺘﺘﻘﺭﺡ‪ ،‬ﻭﺘﻜﻭﻥ ﺍﻵﻓﺎﺕ ﻤﻔﺭﺩﺓ ﺃﻭ ﻤﺘﻌﺩﺩﺓ ﺃﻭ ﻤﻨﺘﺸﺭﺓ ﻴﻤﻜﻥ ﺃﻥ ﺘﻠﺘﺌﻡ ﺫﺍﺘﻴﹰﺎ ﺃﻭ‬
‫ﺘﺼﺒﺢ ﻤﺯﻤﻨﺔ‪.‬‬

‫ﺴﻠﺴﻠﺔ ﺍﻟﻌﺩﻭﻯ‪:‬‬
‫ﺍﻟﻌﻭﺍﻤل ﺍﻟﺨﺎﻤﺠﺔ‪:‬‬
‫ﻋﺩﻴﺩﺓ ﻭﺘﻭﺠﺩ ﻓﻲ ﺴﻭﺭﻴﺔ ﺸﻜﻼﻥ ﺭﺌﻴﺴﻴﺎﻥ‪:‬‬

‫• ﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﻤﺩﺍﺭﻴﺔ ‪ Tropica‬ﻭﻤﺴﺘﻭﺩﻋﻬﺎ ﺍﻹﻨﺴﺎﻥ ﻭﺘﻨﺘﺸﺭ ﻓﻲ ﻤﺤﺎﻓﻅﺎﺕ )ﺤﻠﺏ‪ ،‬ﺇﺩﻟﺏ‪ ،‬ﺍﻟﻼﺫﻗﻴﺔ‪،‬‬

‫ﻁﺭﻁﻭﺱ‪ ،‬ﺤﻤﺎﻩ‪ ،‬ﺤﻤﺹ‪ ،‬ﺩﻤﺸﻕ‪ ،‬ﺭﻴﻑ ﺩﻤﺸﻕ(‪.‬‬

‫• ﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﻜﺒﻴﺭﺓ ‪ Major‬ﻭﻤﺴﺘﻭﺩﻋﻬﺎ ﺍﻟﻘﺎﺭﺽ )‪ (Marionis psamosis‬ﻭﺍﻹﻨﺴﺎﻥ ﻭﺘﻨﺘﺸﺭ ﻓﻲ ﺍﻟﻤﻨﺎﻁﻕ‬

‫ﺍﻟﺼﺤﺭﺍﻭﻴﺔ ﻤﻥ ﻤﺤﺎﻓﻅﺎﺕ ﺭﻴﻑ ﺩﻤﺸﻕ )ﺍﻟﻀﻤﻴﺭ ﻭﻗﺭﻯ ﺍﻟﻘﻠﻤﻭﻥ(‪ ،‬ﺤﻤﺹ )ﺘﺩﻤﺭ( ﺩﻴﺭ ﺍﻟﺯﻭﺭ‪ ،‬ﺍﻟﺤﺴﻜﺔ‬
‫ﻭﺍﻟﺭﻗﺔ‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﻤﻥ ﺍﻟﻤﺴﺘﻭﺩﻉ ﺍﻹﻨﺴﺎﻨﻲ ﺃﻭ ﺍﻟﺤﻴﻭﺍﻨﻲ ﺒﻠﺩﻍ ﺍﻷﻨﺜﻰ ﺍﻟﺨﺎﻤﺠﺔ ﻟﺫﺒﺎﺒﺔ ﺍﻟﺭﻤل ‪ Flies‬ﺍﻟﺘﻲ ﺘﺯﺭﻑ ﺍﻷﺸﻜﺎل‬
‫ﺍﻟﺨﺎﻤﺠﺔ ﺃﺜﻨﺎﺀ ﺍﻟﻠﺩﻍ ﺃﻭ ﺘﻠﻭﺙ ﺠﺭﺡ ﺍﻟﻠﺩﻏﺔ‪.‬‬

‫ﻭﺘﺤﺘﺎﺝ ﺍﻷﺸﻜﺎل ﺍﻟﺴﻭﻁﻴﺔ ﺇﻟﻰ ‪ ٢٥-٨‬ﻴﻭﻡ ﻟﺘﺘﻁﻭﺭ ﻀﻤﻥ ﻤﻌﻲ ﺍﻟﻔﺎﺼﺩﺓ ﻟﺘﺼﺒﺢ ﺨﺎﻤﺠﺔ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﺨﻤﺞ ﻋﺎﻡ ﻭﺘﺤﺩﺙ ﻤﻨﺎﻋﺔ ﺒﻌﺩ ﺍﻟﺘﺌﺎﻡ ﺍﻵﻓﺎﺕ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫ﻤﻥ ﺃﺴﺒﻭﻉ ﻟﻌﺩﺓ ﺸﻬﻭﺭ‪.‬‬

‫‪١٢٢‬‬
 ‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻤﺎ ﺩﺍﻤﺕ ﺍﻟﻁﻔﻴﻠﻴﺎﺕ ﻓﻲ ﺍﻵﻓﺎﺕ )ﻋﺎﺩﺓ ﻤﻥ ‪ ٢٤-٥‬ﺸﻬﺭ ﺇﺫﺍ ﻟﻡ ﺘﻌﺎﻟﺞ(‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﻴﻌﺘﻤﺩ ﻋﻠﻰ ﺍﻟﺼﻭﺭﺓ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻭﻴﺅﻜﺩ ﻤﺨﺒﺭﻴﹰﺎ ﺒﺎﻟﺘﻤﻴﻴﺯ ﺍﻟﻤﺠﻬﺭﻱ ﻟﻠﺸﻜل ﺍﻟﻼﺴﻭﻁﻲ ﻓﻲ ﻟﻁﺎﺨﺎﺕ ﻤﻠﻭﻨﺔ ﻤﻥ‬
‫ﻜﺸﺎﻁﺎﺕ ﺃﻭ ﺭﺸﻔﺎﺕ ﻤﻥ ﺤﻭﺍﻓﻲ ﺍﻵﻓﺎﺕ‪.‬‬

‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ‬
‫ﺘﻌﺭﻑ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ ﺒﺄﻨﻬﺎ ﺍﻨﺩﻓﺎﻉ ﺠﻠﺩﻱ ﻋﻘﻴﺩﻱ ﻭﺤﻴﺩ ﺃﻭ ﻤﺘﻌﺩﺩ ﻏﻴﺭ ﻤﺅﻟﻡ ﻭﻻ ﺤﺎﻙ ﻴﺴﺘﻤﺭ ﻟﻔﺘﺭﺓ ﺘﺯﻴﺩ‬
‫ﻋﻥ ﺍﻟﺜﻼﺜﺔ ﺃﺴﺎﺒﻴﻊ‪ ،‬ﺭﻏﻡ ﺍﻟﻌﻼﺝ ﺒﺎﻷﺩﻭﻴﺔ ﺍﻟﻼﻨﻭﻋﻴﺔ ﻟﻠﻤﺭﺽ ﺃﻤﺎ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺅﻜﺩﺓ ﻓﻬﻲ ﺤﺎﻟﺔ ﻤﺸﺘﺒﻬﺔ ﺘﻡ ﺇﻅﻬﺎﺭ‬
‫ﻁﻔﻴﻠﻲ ﺒﺎﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ ﻟﻠﻁﺎﺨﺎﺕ ﺍﻟﻤﺄﺨﻭﺫﺓ ﻤﻥ ﺍﻵﻓﺎﺕ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬
‫• ﻜﺸﻑ ﺍﻟﺤﺎﻻﺕ ﺍﺴﺘﻨﺎﺩﹰﺍ ﻟﻠﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ‪ ،‬ﻭﻴﺘﻡ ﺍﻟﻔﺤﺹ ﺍﻟﻤﺨﺒﺭﻱ ﻓﻲ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﺍﻟﺘﻲ ﺃﺩﺨﻠﺕ ﺇﻟﻴﻬﺎ‬
‫ﺨﺩﻤﺎﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ )ﺍﻟﺘﺸﺨﻴﺹ ﻭﺍﻟﻌﻼﺝ ﺃﻭ ﺍﻟﻌﻼﺝ‪ ،‬ﺍﻟﺘﻘﺼﻲ ﺍﻟﻭﺒﺎﺌﻲ( ﻭﻋﻨﺩ ﻋﺩﻡ ﺘﻭﻓﺭ ﻭﺴﺎﺌل ﺍﻟﺘﺸﺨﻴﺹ ﻴﺤﺎل‬
‫ﺍﻟﻤﺭﻴﺽ ﻟﻤﺭﻜﺯ ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﺘﺨﺼﺼﻲ‪ .‬ﺘﺭﺴل ﺒﻌﺽ ﺍﻟﻌﻴﻨﺎﺕ ﺍﻹﻴﺠﺎﺒﻴﺔ ﻭﺍﻟﺴﻠﺒﻴﺔ ﺇﻟﻰ ﻤﺨﺒﺭ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ ﻓﻲ‬
‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻟﺘﻘﻴﻴﻡ ﺩﻗﺔ ﺍﻟﺘﺸﺨﻴﺹ‪.‬‬
‫• ﺇﺭﺴﺎل ﺘﻘﺭﻴﺭ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺇﻟﻰ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(٢٥‬‬
‫• ﺍﻟﻌﻼﺝ ﺍﻟﺼﺤﻴﺢ ﻟﻠﺤﺎﻻﺕ ﺍﻟﻤﺅﻜﺩﺓ ﺤﺴﺏ ﺨﻁﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﻤﺭﻓﻘﺔ‪.‬‬
‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﻤﺭﻀﻰ ﻭﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﻭﺇﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ ﻟﺘﺤﺩﻴﺩ ﻤﺼﺩﺭ ﺍﻟﺨﻤﺞ ﻭﻁﺭﻕ ﺍﻨﺘﻘﺎل‬
‫ﺍﻟﻌﺩﻭﻯ ﻭﺍﻟﺒﺤﺙ ﻋﻥ ﺤﺎﻻﺕ ﺃﺨﺭﻯ ﻏﻴﺭ ﻤﺒﻠﻎ ﻋﻨﻬﺎ ﻭﺘﺭﺴل ﺍﻻﺴﺘﻤﺎﺭﺓ ﻟﻤﺭﻜﺯ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ‬
‫ﺍﻟﺘﺨﺼﺼﻲ‪ ،‬ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(٢٦‬‬
‫• ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﻋﻥ ﺍﻟﻤﺭﺽ ﻭﻁﺭﻕ ﺍﻟﻭﻗﺎﻴﺔ ﻤﻨﻪ )ﺍﺴﺘﻌﻤﺎل ﺍﻟﻨﺎﻤﻭﺴﻴﺎﺕ ﺃﻭ ﺍﻟﻤﻨﻔﺭﺍﺕ ﺍﻟﺤﺸﺭﻴﺔ‪ ،‬ﺘﻐﻁﻴﺔ ﺍﻵﻓﺔ‬
‫ﻓﻲ ﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﻤﺩﺍﺭﻴﺔ‪.(...‬‬
‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﺒﻴﺌﻲ ﻭﺍﻟﺤﺸﺭﻱ ﻟﺩﺭﺍﺴﺔ ﺍﻟﻌﻭﺍﻤل ﺍﻟﺨﺎﻤﺠﺔ ﻭﺍﻟﻤﺴﺘﻭﺩﻉ ﻭﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ )ﺭﺵ‬
‫ﺍﻟﻤﺒﻴﺩﺍﺕ‪ ،‬ﻤﻜﺎﻓﺤﺔ ﺍﻟﻘﻭﺍﺭﺽ‪ ،(...‬ﻭﺇﺭﺴﺎل ﺘﻘﺭﻴﺭ ﺸﻬﺭﻱ )ﻤﻠﺤﻕ ﺭﻗﻡ )‪.(٢٧‬‬
‫• ﻴﻘﻭﻡ ﺒﺎﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ ﺍﻟﺫﻱ ﺃﺩﺨﻠﺕ ﺇﻟﻴﻪ ﺨﺩﻤﺎﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ )ﻤﺭﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ‪ (...‬ﻭﺍﻟﻤﺭﻜﺯ‬
‫ﺍﻟﺘﺨﺼﺼﻲ ﻭﻴﻘﻭﻡ ﺒﺎﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﺒﻴﺌﻲ ﻭﺍﻟﺤﺸﺭﻱ ﻋﻨﺎﺼﺭ ﺍﻟﺘﻘﺼﻲ ﺒﺎﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﻋﻨﺎﺼﺭ‬
‫ﻤﻥ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ ﻟﻤﻨﻁﻘﺔ ﺍﻹﺼﺎﺒﺎﺕ ﻭﻴﺅﺍﺯﺭﻫﻡ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﺤﺸﺭﻱ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻋﻨﺩ ﺍﻟﻠﺯﻭﻡ‬

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‫ﻭﻴﺭﻓﻊ ﺘﻘﺭﻴﺭ ﻤﻔﺼل ﻋﻥ ﺍﻟﻭﻀﻊ ﺍﻟﻭﺒﺎﺌﻲ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ ﻓﻲ‬
‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻋﺒﺭ ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪.‬‬
‫• ﺍﻟﺘﺭﺼﺩ ﺍﻟﺤﺸﺭﻱ ﻭﻴﻬﺩﻑ ﻟﻜﺸﻑ ﺒﺅﺭ ﺍﻟﺨﻤﺞ ﺍﻟﺠﺩﻴﺩﺓ‪ ،‬ﻭﺘﺤﺩﻴﺩ ﺍﻷﻨﻭﺍﻉ ﺍﻟﻁﻔﻴﻠﻴﺔ ﻭﺍﻟﺤﺸﺭﻴﺔ ﺍﻟﻤﺴﺒﺒﺔ ﻟﻠﺨﻤﺞ‬
‫ﻭﻭﺠﻭﺩ ﺍﻟﻤﺴﺘﻭﺩﻉ ﺍﻟﺤﻴﻭﺍﻨﻲ‪ ،‬ﻭﻴﻘﻭﻡ ﺒﻪ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﺤﺸﺭﻱ ﻓﻲ ﺩﺍﺌﺭﺓ ﺍﻟﻤﻼﺭﻴﺎ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ‬
‫ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﻓﺭﻴﻕ ﻤﺭﻜﺯ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﺘﺨﺼﺼﻲ ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫ﻭﻴﺘﻀﻤﻥ ﻤﺭﻜﺯ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﺘﺨﺼﺹ‪:‬‬
‫• ﺘﻠﻘﻲ ﺍﻟﺘﻘﺎﺭﻴﺭ ﻤﻥ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺘﻲ ﺃﺩﺨﻠﺕ ﺇﻟﻴﻬﺎ ﺨﺩﻤﺎﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﺇﻋﺩﺍﺩ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻭﺭﻓﻌﻪ ﻟﺩﺍﺌﺭﺓ ﺍﻟﺒﺭﺩﺍﺀ‬
‫ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﺒﺎﻟﺘﻌﺎﻭﻥ ﺒﻴﻥ ﻤﺭﻜﺯ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﺘﺨﺼﺼﻲ ﻭﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ‬
‫ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬
‫• ﻭﻀﻊ ﺨﻁﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﺤﻠﻴﺔ ﻭﺘﺘﻀﻤﻥ ﺘﻘﺩﻴﺭ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﺒﻴﺩﺍﺕ ﺍﻟﺤﺸﺭﻴﺔ‪...‬ﺍﻟﺦ‪ ،‬ﻭﺍﻟﻌﻤل‬
‫ﻋﻠﻰ ﺘﻭﻓﻴﺭ ﻤﺴﺘﻠﺯﻤﺎﺘﻬﺎ‪ ،‬ﻭﻴﻘﻭﻡ ﺒﻬﺎ ﻤﺭﻜﺯ ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﺘﺨﺼﺼﻲ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫ﻭﺍﻟﻤﺯﻤﻨﺔ ﻭﻤﺴﺎﻋﺩﺓ ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪.‬‬
‫• ﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﻋﻤل ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﺍﻟﺘﻲ ﺃﺩﺨﻠﺕ ﺇﻟﻴﻬﺎ ﺨﺩﻤﺎﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ‪ :‬ﻭﻴﻘﻭﻡ ﺒﻪ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﻭﻤﺴﺎﻋﺩﺓ‬
‫ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪.‬‬
‫• ﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺤﻤﻼﺕ ﺍﻟﺭﺵ ﺍﻟﺘﻲ ﺘﻘﻭﻡ ﺒﻬﺎ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬
‫• ﺇﺭﺴﺎل ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﻤﺘﻌﻠﻘﺔ ﺒﺎﻟﻔﺤﻭﺹ ﺍﻟﻤﺨﺒﺭﻴﺔ ﻭﺤﻤﻼﺕ ﺍﻟﺭﺵ ﻭﺍﻟﻤﺼﺭﻭﻑ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﺒﻴﺩﺍﺕ ﻭﺍﻟﻤﻌﺩﺓ‬
‫ﻓﻲ ﻤﺭﻜﺯ ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﺘﺨﺼﺼﻲ‪.‬‬
‫• ﺍﻟﺘﻭﻋﻴﺔ ﺍﻟﺼﺤﻴﺔ ﻋﻥ ﺍﻟﻤﺭﺽ ﻭﻁﺭﻕ ﺍﻟﻭﻗﺎﻴﺔ ﻤﻨﻪ‪.‬‬
‫• ﺇﺠﺭﺍﺀ ﺍﻟﺩﺭﺍﺴﺎﺕ ﻭﺍﻟﺒﺤﻭﺙ ﺃﻭ ﺍﻟﻤﺴﻭﺡ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺩﺍﺌﺭﺓ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ ﺒﺎﻟﻭﺯﺍﺭﺓ‪.‬‬
‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻻﺕ ﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺇﺭﺴﺎﻟﻪ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻓﻲ‬
‫ﺍﻟﻭﺯﺍﺭﺓ )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ ‪.(٣‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬

‫• ﺘﻠﻘﻲ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺸﻬﺭﻴﺔ ﻭﺇﺠﺭﺍﺀ ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻭﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ‪.‬‬
‫• ﻭﻀﻊ ﺨﻁﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻋﻠﻰ ﻤﺴﺘﻭﻯ ﺍﻟﻘﻁﺭ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﺍﺤﺘﻴﺎﺠﺎﺕ ﻋﻤﻠﻴﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻤﻥ ﺃﺩﻭﻴﺔ ﻭﻤﺒﻴﺩﺍﺕ ﻭﻤﻭﺍﺩ ﻤﺨﺒﺭﻴﺔ‪...‬ﺍﻟﺦ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺘﻨﻔﻴﺫ ﺒﻨﻭﺩ ﺍﻟﺨﻁﺔ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﻭﺴﺎﺌل ﻭﻤﻭﺍﺩ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪.‬‬

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 ‫• ﺘﻘﻭﻴﻡ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﻋﻤﻠﻴﺔ ﺘﻨﻔﻴﺫ ﺍﻟﺨﻁﺔ ﻭﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ )ﺇﺩﺍﺭﺓ ﻤﺤﻠﻴﺔ‪ (...،‬ﻭﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬
‫• ﺇﺠﺭﺍﺀ ﺍﻟﺩﺭﺍﺴﺎﺕ ﻭﺍﻟﺒﺤﻭﺙ ﺃﻭ ﺍﻟﻤﺴﻭﺡ )ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﺩﻉ ﺍﻹﻨﺴﺎﻨﻲ ﺃﻭ ﺍﻟﺤﻴﻭﺍﻨﻲ ﺃﻭ ﺍﻟﻨﺎﻗل ﺍﻟﺤﺸﺭﻱ(‪.‬‬

‫ﺩﻟﻴل ﻋﻼﺝ ﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﺠﻠﺩﻴﺔ‬

‫ﺘﺨﺘﻠﻑ ﻁﺭﻕ ﻤﻌﺎﻟﺠﺔ ﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﺠﻠﺩﻴﺔ ﺤﺴﺏ‪ :‬ﻋﻤﺭ ﻭﻋﺩﺩ ﻭﺸﻜل ﻭﺘﻭﺯﻉ ﺍﻻﻨﺩﻓﺎﻋﺎﺕ‪ ،‬ﻭﻋﻤﺭ ﺍﻟﻤﺼﺎﺏ‬
‫ﻭﺤﺎﻟﺘﻪ ﺍﻟﻔﻴﺯﻟﻭﺠﻴﺔ )ﺃﻁﻔﺎل‪ -‬ﺤﻭﺍﻤل(‪.‬‬

‫ﻁﺭﻕ ﻋﻼﺝ ﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ‪:‬‬

‫• ﻋﻼﺝ ﻤﻭﻀﻌﻲ‪.‬‬
‫• ﻋﻼﺝ ﻋﺎﻡ )ﻋﻀﻠﻲ(‪.‬‬

‫ﺍﻟﻌﻼﺝ ﺍﻟﻤﻭﻀﻌﻲ‪:‬‬
‫• ﺍﺴﺘﻁﺒﺎﺒﺎﺘﻪ‪ :‬ﺍﻻﻨﺩﻓﺎﻉ ﺍﻟﻭﺤﻴﺩ ﺃﻭ ﺍﻻﻨﺩﻓﺎﻋﺎﺕ ﻗﻠﻴﻠﺔ ﺍﻟﻌﺩﺩ ﻭﺼﻐﻴﺭﺓ ﺍﻟﺤﺠﻡ ﻭﻏﻴﺭ ﺍﻟﻤﺘﺭﺍﻓﻘﺔ ﺒﺈﻨﺘﺎﻥ‪ -‬ﺍﻟﻨﺴﺎﺀ ﺍﻟﺤﻭﺍﻤل‪.‬‬
‫• ﻤﻀﺎﺩ ﺍﺴﺘﻁﺒﺎﺒﺎﺘﻪ‪ :‬ﺍﻻﻨﺩﻓﺎﻋﺎﺕ ﻓﻲ )ﺍﻟﺠﻔﻥ‪ ،‬ﺍﻷﺫﻥ‪ ،‬ﺍﻷﻨﻑ‪ ،‬ﺍﻟﻌﻴﻥ‪ ،‬ﻨﻬﺎﻴﺎﺕ ﺍﻷﻁﺭﺍﻑ( ﺍﻻﻨﺩﻓﺎﻋﺎﺕ ﺍﻟﻌﺩﻴﺩﺓ‬
‫ﺃﻜﺜﺭ ﻤﻥ ﺨﻤﺱ ﺍﻨﺩﻓﺎﻋﺎﺕ ﻭﺍﻟﻜﺒﻴﺭﺓ ﺍﻟﺤﺠﻡ‪.‬‬
‫ﻟﻠﻌﻼﺝ ﺍﻟﻤﻭﻀﻌﻲ ﻨﻭﻋﺎﻥ‪:‬‬
‫‪ -‬ﺍﻟﻌﻼﺝ ﺍﻟﻤﻭﻀﻌﻲ ﺒﺎﻟﻐﻠﻭﻜﺎﻨﺘﻴﻡ ﺃﻭ ﺍﻟﺒﻨﺘﻭﺴﺘﺎﻡ‪ :‬ﻴﻁﺒﻕ ﻓﻲ ﺠﻤﻴﻊ ﺍﻟﻤﺭﺍﻜﺯ ﻭﺍﻟﻨﻘﺎﻁ ﺍﻟﻁﺒﻴﺔ ﻭﺍﻟﻔﺭﻕ ﺍﻟﺠﻭﺍﻟﺔ‪.‬‬
‫ﻴﺘﻡ ﺒﺈﺒﺭﺓ ﺃﻨﺴﻭﻟﻴﻥ ﺒﺤﻘﻥ ‪ ٣-١‬ﻤل ﺤﻭل ﺍﻻﻨﺩﻓﺎﻉ ﻭﻤﻥ ﻋﺩﺓ ﺠﻬﺎﺕ )ﺤﺴﺏ ﺤﺠﻡ ﺍﻻﻨﺩﻓﺎﻉ( ﺤﺘﻰ ﻴﺘﻡ‬
‫ﺸﺤﻭﺏ ﺍﻻﻨﺩﻓﺎﻉ ﺃﻭ ﺍﺒﻴﻀﺎﺽ ﺍﻵﻓﺔ ﺃﺜﻨﺎﺀ ﺍﻟﺤﻘﻥ ﻭﺍﻟﺘﻲ ﺘﺸﺒﻪ ﻋﻼﻤﺔ ﻗﺸﺭ ﺍﻟﺒﺭﺘﻘﺎل )ﺩﻻﻟﺔ ﻋﻠﻰ ﺤﻘﻥ‬
‫ﺼﺤﻴﺢ( ﺘﻜﺭﺭ ﺍﻟﺠﻠﺴﺎﺕ ﺒﻔﺎﺼل ‪ ٦-٣‬ﺃﻴﺎﻡ ﺤﺘﻰ ﺘﻤﺎﻡ ﺍﻟﺸﻔﺎﺀ‪.‬‬

‫ﺘﺤﺫﻴﺭﺍﺕ‪:‬‬
‫‪ o‬ﺍﻟﺤﻘﻥ ﻤﺅﻟﻡ‪.‬‬
‫‪ o‬ﻻ ﻴﺠﻭﺯ ﺍﻟﺤﻘﻥ ﺍﻟﺴﻁﺤﻲ‪ ،‬ﻭﻻ ﺍﻟﺤﻘﻥ ﺍﻟﻌﻤﻴﻕ‪ ،‬ﻭﻻ ﻓﻲ ﺍﻷﻨﺴﺠﺔ ﺍﻟﻤﺘﻤﻭﺘﺔ ﻟﻼﻨﺩﻓﺎﻉ‪ ...‬ﺒل ﺍﻟﺤﻘﻥ ﻓﻲ‬
‫ﺍﻷﺩﻤﺔ ﻭﺍﻟﻨﺴﺞ ﺍﻟﺴﻠﻴﻤﺔ ﻓﻲ ﻤﺤﻴﻁ ﺍﻷﺩﻤﺔ ﻟﺘﺤﺎﺸﻲ ﺍﻟﺘﻬﺎﺏ ﺍﻷﺩﻤﺔ ﺍﻟﻠﻤﻔﺎﻭﻱ‪.‬‬

‫‪ -‬ﺍﻟﻌﻼﺝ ﺍﻟﻤﻭﻀﻌﻲ ﺒﺎﻟﺘﺒﺭﻴﺩ‪ :‬ﻴﺘﻡ ﺘﻁﺒﻴﻘﻪ ﻓﻲ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺭﺌﻴﺴﻴﺔ ﺒﺎﻟﻤﺤﺎﻓﻅﺎﺕ ﻓﻘﻁ‪.‬‬

‫‪ o‬ﺒﺎﻵﺯﻭﺕ ﺍﻟﺴﺎﺌل ‪١٩٠ْ-‬ﻡ ﺃﻭ ﻏﺎﺯ ﺍﻟﻨﻴﺘﺭﻭﺯ ﺃﻭ ﺍﻟﺜﻠﺞ ﺍﻟﻔﺤﻤﻲ ‪٧٠ْ-‬ﻡ‪.‬‬
‫‪ o‬ﻤﺩﺓ ﺍﻟﺘﻁﺒﻴﻕ ‪ ٦٠-٤٥-٣٠-١٥‬ﺜﺎ ﺤﺴﺏ ﻋﻤﺭ ﻭﻤﻜﺎﻥ ﺍﻻﻨﺩﻓﺎﻉ ﻭﺘﻜﺭﺭ ﺍﻟﺠﻠﺴﺎﺕ ﺒﻔﺎﺼل ‪٢-١‬‬
‫ﺃﺴﺒﻭﻉ ﻋﻠﻰ ﺃﻻ ﺘﺯﻴﺩ ﻋﻥ ‪ /٤/‬ﺠﻠﺴﺎﺕ‪.‬‬

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 ‫ﺘﺤﺫﻴﺭﺍﺕ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺒﺎﻟﺘﺒﺭﻴﺩ‪:‬‬
‫‪ o‬ﻻ ﻴﺴﺘﺤﺏ ﺘﻁﺒﻴﻘﻪ ﻓﻲ ﺍﻵﻓﺎﺕ ﺍﻟﻤﺘﻘﺭﺤﺔ ﻭﺍﻟﺘﻲ ﻴﺯﻴﺩ ﻗﻁﺭﻫﺎ ﻋﻥ‪ ٢.٥‬ﺴﻡ ﺃﻭ ﻋﻤﺭ ﺍﻻﻨﺩﻓﺎﻉ ﺃﻜﺜﺭ ﻤﻥ‬
‫ﺨﻤﺴﺔ ﺃﺸﻬﺭ‪.‬‬
‫‪ o‬ﻴﺠﺏ ﻋﺩﻡ ﺍﺴﺘﻨﺸﺎﻕ ﻏﺎﺯ ﺍﻟﻨﻴﺘﺭﻭﺯ ﻭﻋﺩﻡ ﻤﺱ ﺍﻷﻨﺴﺠﺔ ﺍﻟﺴﻠﻴﻤﺔ‪ ،‬ﻷﻨﻪ ﻴﺅﺩﻱ ﺇﻟﻰ ﻨﻘﺹ ﺍﺼﻁﺒﺎﻍ ﻤﺅﻗﺕ‬
‫ﻤﻜﺎﻥ ﺘﻁﺒﻴﻕ ﺍﻟﻌﻼﺝ‪.‬‬
‫‪ o‬ﻗﺩ ﻴﺅﺩﻱ ﺍﻟﻌﻼﺝ ﺇﻟﻰ ﺘﺸﻜل ﻓﻘﺎﻋﺔ ﻤﻠﻴﺌﺔ ﺒﺴﺎﺌل ﻤﺼﻠﻲ ﻭﺃﺤﻴﺎﻨ ﹰﺎ ﻤﺩﻤﻰ ﻴﻤﻜﻥ ﺘﻔﺭﻴﻎ ﻫﺫﻩ ﺍﻟﻔﻘﺎﻋﺔ ﺒﻭﺍﺴﻁﺔ‬
‫ﺭﺃﺱ ﺴﻴﺭﻨﻎ ﻋﻘﻴﻡ ﺩﻭﻥ ﻜﺸﻁﻬﺎ ﻴﺠﺏ ﺇﺯﺍﻟﺔ ﺍﻟﻘﺸﺭﺓ ﺍﻟﻘﺎﺴﻴﺔ ﻗﺒل ﺠﻠﺴﺔ ﺍﻟﻌﻼﺝ ﺒﻨﻘﻊ ﺍﻵﻓﺔ ﺒﺎﻟﻤﺎﺀ ﺃﻭ ﺍﻟﻤﻌﻘﻡ‬
‫ﻟﺘﻁﺭﻴﺘﻬﺎ ﻭﺜﻡ ﺇﺯﺍﻟﺘﻬﺎ‪.‬‬
‫‪ o‬ﻗﺩ ﻴﺘﺭﺍﻓﻕ ﺍﻟﻌﻼﺝ ﻤﻊ ﺘﻭﺭﻡ ﻭﺘﻭﺫﻡ ﺍﻟﻨﺴﻴﺞ ﺍﻟﻤﺤﻴﻁﺔ ﻭﺨﺎﺼ ﹰﺔ ﻓﻲ ﺍﻟﻭﺠﻪ ﻭﺍﻟﻌﻨﻕ‪.‬‬

‫ﺍﻟﻌﻼﺝ ﺍﻟﻌﺎﻡ‪:‬‬
‫ﻴﺘﻡ ﺘﻁﺒﻴﻘﻪ ﻓﻲ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺭﺌﻴﺴﻴﺔ ﺒﺎﻟﻤﺤﺎﻓﻅﺎﺕ ﻓﻘﻁ‪.‬‬
‫• ﺍﺴﺘﻁﺒﺎﺒﺎﺘﻪ‪:‬‬
‫‪ -‬ﺍﻻﻨﺩﻓﺎﻋﺎﺕ ﺍﻟﻌﺩﻴﺩﺓ ﺃﻜﺜﺭ ﻤﻥ ﺨﻤﺱ ﺍﻨﺩﻓﺎﻋﺎﺕ ﻭﺍﻻﻨﺩﻓﺎﻋﺎﺕ ﺫﺍﺕ ﺍﻟﻘﻁﺭ ﺃﻜﺒﺭ ﻤﻥ ‪ ٥‬ﺴﻡ‪.‬‬
‫‪ -‬ﻭﺠﻭﺩ ﺍﻻﻨﺩﻓﺎﻋﺎﺕ ﻋﻠﻰ ﺃﻤﺎﻜﻥ ﻻ ﻴﻤﻜﻥ ﻤﻌﺎﻟﺠﺘﻬﺎ ﺤﻘﻨﹰﺎ ﻤﻭﻀﻌﻴﹰﺎ )ﻏﻀﺎﺭﻴﻑ ﺍﻷﺫﻥ ﻭﺍﻷﻨﻑ‪ ،‬ﺍﻟﻌﻴﻥ‪ ،‬ﻨﻬﺎﻴﺎﺕ‬
‫ﺍﻷﺼﺎﺒﻊ(‪.‬‬
‫‪ -‬ﺍﻻﻨﺩﻓﺎﻋﺎﺕ ﺍﻟﺩﺭﻨﻴﺔ ﺃﻭ ﺍﻟﻭﺭﻤﻴﺔ ﺍﻟﺸﻜل ﺃﻭ ﺍﻟﻨﺎﻜﺴﺔ‪.‬‬
‫‪ -‬ﺍﻻﻨﺩﻓﺎﻉ ﺍﻟﺠﻠﺩﻱ ﺍﻟﻤﺘﻘﻴﺢ ﺍﻟﺫﻱ ﻟﻡ ﻴﺴﺘﺠﺏ ﻟﻠﻌﻼﺝ ﺒﺎﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ‪.‬‬
‫• ﺍﻟﻌﻼﺝ ﺍﻟﻌﺎﻡ ﻋﻀﻠﻴ ﹰﺎ ﺒﺎﻟﻐﻠﻭﻜﺎﻨﺘﻴﻡ‪:‬‬
‫ﻴﺤﻘﻥ ﻋﻀﻠﻴ ﹰﺎ ‪ ٢٠-١٠‬ﻤﻊ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﻤﻥ ﻤﺭﻜﺒﺎﺕ ﺍﻷﻨﺘﻤﻭﺍﻥ ﺍﻟﺨﻤﺎﺴﻴﺔ )‪ (Sb5+‬ﺃﻱ ﻤﺎ ﻴﻌﺎﺩل ‪٧٥-٣٧.٥‬‬
‫ﻤﻊ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﻤﻥ ﺍﻟﻐﻠﻭﻜﺎﻨﺘﻴﻡ )ﺍﻨﺘﻴﻤﻭﺍﻥ ﺍﻟﻤﻴﻐﻠﻭﻤﻴﻥ( ﻟﻤﺩﺓ ﻻ ﺘﺯﻴﺩ ﻋﻥ ﻋﺸﺭﻭﻥ ﻴﻭﻤﹰﺎ )ﺍﻷﻤﺒﻭﻟﺔ ‪ ٥‬ﻤل ‪ ٤٠٠‬ﻤﻎ‬
‫‪ Sb5+‬ﺃﻴﻤﺎ ﻴﻌﺎﺩل ‪ ١٥٠٠‬ﻤﻊ ﻏﻠﻭﻜﺎﻨﺘﻴﻡ(‪.‬‬
‫• ﺍﻟﻌﻼﺝ ﺍﻟﻌﺎﻡ ﻋﻀﻠﻴ ﹰﺎ ﺒﺎﻟﺒﻨﺘﻭﺴﺘﺎﻡ‪:‬‬
‫ﻴﺤﻘﻥ ﻋﻀﻠﻴ ﹰﺎ ‪٢٠-١٠‬ﻤﻎ‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﻤﻥ ﻤﺭﻜﺒﺎﺕ ﺍﻷﻨﺘﻤﻭﺍﻥ ﺍﻟﺨﻤﺎﺴﻴﺔ )‪ (Sb5+‬ﺃﻱ ﻤﺎ ﻴﻌﺎﺩل‪٠.٢-٠.١‬‬
‫ﻤل‪/‬ﻜﻎ‪/‬ﻴﻭﻡ ﻤﻥ ﺍﻟﺒﻨﺘﻭﺴﺘﺎﻡ ﻟﻤﺩﺓ ﻻ ﺘﺯﻴﺩ ﻋﻥ ﻋﺸﺭﻭﻥ ﻴﻭﻤﹰﺎ )‪ ١‬ﻤل ﻤﻥ ﻓﻼﻜﻭﻨﺔ ﺍﻟﺒﻨﺘﻭﺴﺘﺎﻡ ‪ ١٠٠‬ﻤل ﻓﻴﻪ ‪١٠٠‬‬
‫ﻤﻎ ‪.(Sb5+‬‬

‫ﺘﺤﺫﻴﺭﺍﺕ‪:‬‬
‫‪ o‬ﻴﺠﺏ ﺘﺤﺭﻱ ﻭﻅﺎﺌﻑ ﺍﻟﻜﺒﺩ ﻭﺍﻟﻜﻠﻴﺔ ﻭﺍﻷﻤﻴﻼﺯ ﻓﻲ ﺍﻟﺩﻡ ﻭﻴﺭﺼﺩ ﻤﺨﻁﻁ ﺍﻟﻘﻠﺏ ﺍﻟﻜﻬﺭﺒﺎﺌﻲ ﻗﺒل ﺍﻟﻌﻼﺝ‬
‫ﻭﺃﺴﺒﻭﻋﻴﹰﺎ ﺃﺜﻨﺎﺀ ﺍﻟﻌﻼﺝ‪.‬‬
‫‪ o‬ﻤﻀﺎﺩ ﺍﻻﺴﺘﻁﺒﺎﺏ‪ :‬ﺍﻵﻓﺎﺕ ﺍﻟﻘﻠﺒﻴﺔ ﺃﻭ ﺍﻟﻜﺒﺩﻴﺔ ﺃﻭ ﺍﻟﻜﻠﻭﻴﺔ‪ ،‬ﺍﻟﺤﻭﺍﻤل ﻭﺍﻟﻤﺭﻀﻌﺎﺕ ﻭﺍﻷﻁﻔﺎل ﻤﺎ ﺩﻭﻥ ﺍﻟﺴﻨﺔ‪.‬‬

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 ‫‪‬‬
‫א‪‬א‪‬‬
‫‪ Malaria‬‬
‫ﺍﻟﺘﻌﺭﻴﻑ‪:‬‬
‫ﻫﻭ ﻤﺭﺽ ﻁﻔﻴﻠﻲ ﻴﺘﻅﺎﻫﺭ ﺒﺄﺤﺩ ﺃﺭﺒﻊ ﺃﺸﻜﺎل ﺴﺭﻴﺭﻴﺔ‪:‬‬

‫• ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﺜﻼﺜﻴﺔ ﺍﻟﺤﻤﻴﺩﺓ ﺍﻟﻨﺎﺠﻤﺔ ﻋﻥ ﺍﻟﻤﺘﺼﻭﺭﺓ ﺍﻟﻨﺸﻴﻁﺔ ‪ plasmodium Vivax‬ﻭﻫﻲ ﻤﻨﺘﺸﺭﺓ ﻓﻲ ﺴﻭﺭﻴﺔ‬
‫ﻭﺍﻟﺩﻭل ﺍﻟﻤﺠﺎﻭﺭﺓ‪ ،‬ﻋﻠﻤﹰﺎ ﺒﺄﻨﻪ ﻟﻡ ﺘﻌﺩ ﺘﺴﺠل ﺤﺎﻻﺕ ﻤﺤﻠﻴﺔ ﻤﻨﺫ ﻋﺎﻡ ‪.٢٠٠٥‬‬

‫• ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﺜﻼﺜﻴﺔ ﺍﻟﺨﺒﻴﺜﺔ ﺍﻟﻨﺎﺠﻤﺔ ﻋﻥ ﺍﻟﻤﺘﺼﻭﺭﺓ ﺍﻟﻤﻨﺠﻠﻴﺔ ‪ Plasmodium Falciparum‬ﻭﺍﻟﺤﺎﻻﺕ‬

‫ﺍﻟﻤﻭﺠﻭﺩﺓ ﻤﻨﻬﺎ ﻓﻲ ﺴﻭﺭﻴﺔ ﻤﺴﺘﻭﺭﺩﺓ ﻤﻥ ﺍﻷﻗﻁﺎﺭ ﺍﻟﺘﻲ ﺘﻨﺘﺸﺭ ﻓﻴﻬﺎ )ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﻤﺩﺍﺭﻴﺔ(‪.‬‬

‫• ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﺜﻼﺜﻴﺔ ﺍﻟﺤﻤﻴﺩﺓ ﺍﻟﻨﺎﺠﻤﺔ ﻋﻥ ﺍﻟﻤﺘﺼﻭﺭﺓ ﺍﻟﺒﻴﻀﻭﻴﺔ ‪.Plasmodium Ovale‬‬

‫• ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﺭﺒﺎﻋﻴﺔ ﺍﻟﺤﻤﻴﺩﺓ ﺍﻟﻨﺎﺠﻤﺔ ﻋﻥ ﺍﻟﻤﺘﺼﻭﺭﺓ ﺍﻟﻭﺒﺎﺌﻴﺔ ‪.Plasmodium Malaria‬‬

‫ﺘﻅﻬﺭ ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﻤﻨﺠﻠﻴﺔ ﻓﻲ ﺼﻭﺭﺓ ﺴﺭﻴﺭﻴﺔ ﻤﺘﺒﺎﻴﻨﺔ ﺠﺩﹰﺍ ﺘﺸﻤل ﺍﻟﺤﻤﻰ‪ ،‬ﺍﻟﻨﻭﺍﻗﺹ‪ ،‬ﺍﻟﺘﻌﺭﻕ‪ ،‬ﺍﻟﺼﺩﺍﻉ‪ ،‬ﻭﻗﺩ‬
‫ﺘﺘﺭﻗﻰ ﻟﻴﺭﻗﺎﻥ ﻭﻋﻴﻭﺏ ﻓﻲ ﺍﻟﺘﺨﺜﺭ ﻭﺼﺩﻤﺔ ﻭﻗﺼﻭﺭ ﻜﻠﻭﻱ ﻭﻜﺒﺩﻱ ﻭﺍﻋﺘﻼل ﺩﻤﺎﻏﻲ ﻭﺴﺒﺎﺕ‪.‬‬

‫ﺃﻤﺎ ﺍﻷﻨﻭﺍﻉ ﺍﻷﺨﺭﻯ ﻓﻠﻬﺎ ﻤﻅﺎﻫﺭ ﺴﺭﻴﺭﻴﺔ ﻤﺘﺸﺎﺒﻬﺔ ﺤﻴﺙ ﺘﺒﺩﺃ ﺒﻔﺘﻭﺭ ﻴﻌﻘﺒﻪ ﻋﺭﻭﺍﺀ ﻭﺍﺭﺘﻔﺎﻉ ﺴﺭﻴﻊ ﻓﻲ ﺩﺭﺠﺔ‬
‫ﺍﻟﺤﺭﺍﺭﺓ ﻤﺼﺤﻭﺒﹰﺎ ﻋﺎﺩﺓ ﺒﺼﺩﺍﻉ ﻭﺁﻻﻡ ﻋﻀﻠﻴﺔ ﻭﻏﺜﻴﺎﻥ ﻭﺃﺤﻴﺎﻨﹰﺎ ﺇﻗﻴﺎﺀ ﻭﺇﺴﻬﺎل ﻭﺴﻌﺎل‪ ،‬ﻭﺘﻨﺘﻬﻲ ﺒﺘﻌﺭﻕ ﻏﺯﻴﺭ‪،‬‬
‫ﻭﺒﻌﺩ ﻓﺘﺭﺓ ﺨﺎﻟﻴﺔ ﻤﻥ ﺍﻟﺤﻤﻰ ﺘﺘﻜﺭﺭ ﺩﻭﺭﺓ ﺍﻟﻌﺭﻭﺀﺍﺕ ﻭﺍﻟﺤﻤﻰ ﻭﺍﻟﺘﻌﺭﻕ ﺒﺸﻜل ﺩﻭﺭﻱ ﻜل ﺜﻼﺜﺔ ﺃﻭ ﺃﺭﺒﻌﺔ ﺃﻴﺎﻡ‪.‬‬

‫‪‬‬ ‫‪‬‬

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‫א‪‬א‪‬א‪‬א‪ ‬‬
‫• ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪ :‬ﺍﻟﻤﺘﺼﻭﺭﺓ ﺍﻟﻨﺸﻴﻁﺔ ﻭﺘﺤﺘﺎﺝ ﻟﺩﻭﺭﺓ ﺘﻁﻭﺭﻴﺔ ﻓﻲ ﺃﻨﺜﻰ ﺍﻟﺒﻌﻭﻀﺔ ﺤﺘﻰ ﺘﺼﺒﺢ ﺨﺎﻤﺠﺔ ﺘﺴﺘﻐﺭﻕ‬
‫‪ ٣٥-٨‬ﻴﻭﻡ ﺤﺴﺏ ﻨﻭﻉ ﺍﻟﻁﻔﻴﻠﻲ ﻭﺩﺭﺠﺔ ﺍﻟﺤﺭﺍﺭﺓ ﺍﻟﺘﻲ ﻴﺘﻌﺭﺽ ﻟﻬﺎ ﺍﻟﻨﺎﻗل‪.‬‬
‫• ﺍﻟﻤﺴﺘﻭﺩﻉ‪ :‬ﺍﻹﻨﺴﺎﻥ‪.‬‬
‫• ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪ :‬ﺒﻠﺩﻏﺔ ﺃﻨﻰ ﺒﻌﻭﻀﺔ ﺍﻷﻨﻭﻓﻴل ﺍﻟﺨﺎﻤﺠﺔ ﻟﻠﺜﺩﻱ ﺍﻟﻤﺴﺘﻌﺩ ﻭﻓﻲ ﺤﺎﻻﺕ ﻗﻠﻴﻠﺔ ﺘﻨﺘﻘل ﺒﻨﻘل ﺩﻡ ﻤﺨﻤﻭﺝ‬
‫ﺒﺎﻷﻁﻭﺍﺭ ﻏﻴﺭ ﺍﻟﺠﻨﺴﻴﺔ ﺃﻭ ﺍﺴﺘﻌﻤﺎل ﺇﺒﺭ ﻭﻤﺤﺎﻗﻥ ﻤﻠﻭﺜﺔ‪.‬‬
‫• ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪ :‬ﺍﻻﺴﺘﻌﺩﺍﺩ ﻟﻠﺨﻤﺞ ﻋﺎﻡ‪ ،‬ﻭﻴﻭﺠﺩ ﺘﺤﻤل ﻟﻠﻤﺭﻀﻰ ﻭﺍﺴﺘﻌﺼﺎﺀ ﻋﻠﻴﻪ ﻟﺩﻯ ﺍﻟﺒﺎﻟﻐﻴﻥ ﻓﻲ‬
‫ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﻌﺎﻟﻴﺔ ﺍﻟﺘﻭﻁﻥ‪.‬‬
‫• ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪ ١٤ :‬ﻴﻭﻡ ﺒﻴﻥ ﻟﺩﻏﺔ ﺍﻟﺒﻌﻭﻀﺔ ﺍﻟﺨﺎﻤﺠﺔ ﻭﻅﻬﻭﺭ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺴﺭﻴﺭﻴﺔ‪.‬‬
‫• ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪ :‬ﻴﻤﺘﺩ ﻁﺎﻟﻤﺎ ﺒﻘﻴﺕ ﺍﻷﻁﻭﺍﺭ ﺍﻟﺠﻨﺴﻴﺔ ﺍﻟﺨﺎﻤﺠﺔ ﻟﻠﻁﻔﻴﻠﻲ ﻓﻲ ﺩﻡ ﺍﻟﻤﺭﻴﺽ‪ ،‬ﻭﻫﻭ ﺤﻭﺍﻟﻲ ﺍﻟﺴﻨﺘﻴﻥ ﺇﺫﺍ‬
‫ﻟﻡ ﻴﻌﺎﻟﺞ ﺍﻟﻤﺭﻴﺽ ﺃﻭ ﺇﺫﺍ ﻋﻭﻟﺞ ﻤﻌﺎﻟﺠﺔ ﻨﺎﻗﺼﺔ‪.‬‬
‫• ﺍﻟﺘﺸﺨﻴﺹ‪ :‬ﻴﻌﺘﻤﺩ ﻋﻠﻰ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻭﻴﺅﻜﺩ ﺒﺎﻟﻔﺤﺹ ﺍﻟﻤﺨﺒﺭﻱ ﺒﺈﻅﻬﺎﺭ ﺍﻟﻁﻔﻴﻠﻴﺎﺕ ﻓﻲ ﻟﻁﺎﺨﺔ ﺩﻤﻭﻴﺔ‪.‬‬

‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ‬
‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ‪ :‬ﻜل ﻤﺭﻴﺽ ﻴﺸﻜﻭ ﻤﻥ ﺘﺭﻓﻊ ﺤﺭﻭﺭﻱ ﻤﻊ ﺃﻋﺭﺍﺽ ﺍﻟﻤﺭﺽ ﺍﻟﻤﺫﻜﻭﺭﺓ ﻓﻲ ﻓﻘﺭﺓ ﺘﻌﺭﻴﻑ ﺍﻟﻤﺭﺽ‪.‬‬
‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺅﻜﺩﺓ‪ :‬ﺤﺎﻟﺔ ﻤﺸﺘﺒﻬﺔ ﻤﻊ ﺇﻅﻬﺎﺭ ﺍﻟﻁﻔﻴﻠﻴﺎﺕ ﻓﻲ ﻟﻁﺎﺨﺔ ﺩﻤﻭﻴﺔ ﺒﺎﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ‪.‬‬
‫• ﺍﻟﻤﻼﺭﻴﺎ ﺍﻟﻭﺨﻴﻤﺔ‪ :‬ﺤﺎﻟﺔ ﻤﻼﺭﻴﺎ ﻤﺸﺘﺒﻬﺔ ﺘﺘﻁﻠﺏ ﺍﻟﺩﺨﻭل ﻟﻠﻤﺸﻔﻰ ﻟﺘﻠﻘﻲ ﺍﻟﻌﻼﺝ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬

‫• ﺍﻟﻜﺸﻑ ﺍﻟﺒﺎﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺒﺈﻅﻬﺎﺭ ﺍﻟﻁﻔﻴﻠﻴﺎﺕ ﻓﻲ ﻟﻁﺎﺨﺔ ﺩﻤﻭﻴﺔ ﻭﻓﻲ ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﻤﻭﺒﻭﺀﺓ ﺃﻭ ﺍﻟﺘﻲ ﻴﺴﺘﻭﻁﻥ‬
‫ﻓﻴﻬﺎ ﺍﻟﻤﺭﺽ ﻴﺠﺏ ﺃﺨﺫ ﻟﻁﺎﺨﺔ ﺩﻤﻭﻴﺔ ﻟﻠﻔﺤﺹ ﺍﻟﻤﺨﺒﺭﻱ ﻤﻥ ﻜل ﻤﺭﻴﺽ ﻴﺸﻜﻭ ﻤﻥ ﺘﺭﻓﻊ ﺤﺭﻭﺭﻱ ﻤﻊ‬
‫ﺃﻋﺭﺍﺽ ﻤﻭﺤﻴﺔ ﺒﺎﻹﺼﺎﺒﺔ ﺒﻌﺩ ﺍﺴﺘﺒﻌﺎﺩ ﺍﻷﻤﺭﺍﺽ ﺍﻷﺨﺭﻯ ﺍﻟﻤﺴﺒﺒﺔ ﻟﻠﺘﺭﻓﻊ ﺍﻟﺤﺭﻭﺭﻱ‪.‬‬
‫ﻴﺘﻡ ﺍﻟﻔﺤﺹ ﺍﻟﻤﺨﺒﺭﻱ ﻓﻲ ﻤﺭﻜﺯ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺃﻭ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ )ﻤﺭﺍﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ( ﺍﻟﺘﻲ ﺃﺩﺨﻠﺕ ﺇﻟﻴﻬﺎ‬
‫ﺨﺩﻤﺎﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﺘﺭﺴل ﺍﻟﻌﻴﻨﺎﺕ ﺍﻹﻴﺠﺎﺒﻴﺔ ﻭﺒﻌﺽ ﺍﻟﺴﻠﺒﻴﺔ ﺇﻟﻰ ﻤﺨﺒﺭ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ ﺒﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻟﺘﻘﻴﻴﻡ‬
‫ﺩﻗﺔ ﺍﻟﺘﺸﺨﻴﺹ ﻭﻋﻨﺩ ﻋﺩﻡ ﺘﻭﻓﺭ ﻭﺴﺎﺌل ﺍﻟﺘﺸﺨﻴﺹ ﻴﺤﺎل ﺍﻟﻤﺸﺘﺒﻪ ﺒﺈﺼﺎﺒﺘﻪ ﺇﻟﻰ ﻤﺭﻜﺯ ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﺘﺨﺼﺼﻲ‪.‬‬
‫• ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ ﺒﺎﻟﻬﺎﺘﻑ ﺇﻟﻰ ﻤﺭﻜﺯ ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﺘﺨﺼﺼﻲ‪.‬‬
‫• ﺍﻟﻌﻼﺝ ﺍﻟﻨﻭﻋﻲ ﻟﻠﺤﺎﻻﺕ ﺍﻟﻤﺸﺨﺼﺔ ﻤﺨﺒﺭﻴﹰﺎ‪.‬‬

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‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﻤﺭﻀﻰ ﻭﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﻹﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ ﻟﺘﺤﺩﻴﺩ ﺘﺎﺭﻴﺦ ﺍﻟﻌﺩﻭﻯ ﻭﺍﻟﻤﺠﻤﻭﻋﺎﺕ‬
‫ﺍﻟﺴﻜﺎﻨﻴﺔ ﺍﻟﻤﻌﺭﻀﺔ ﻟﻠﺨﻁﺭ ﻭﺘﺤﺭﻜﺎﺕ ﺍﻟﻤﺭﻴﺽ ﺨﻼل ﺍﻟﻔﺘﺭﺓ ﺍﻟﺴﺎﺒﻘﺔ ﻟﻺﺼﺎﺒﺔ ‪ ...‬ﺇﻟﺦ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٢٨‬‬
‫ﻭﻴﻘﻭﻡ ﺒﻪ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺒﻤﺭﻜﺯ ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﺘﺨﺼﺼﻲ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﻓﺭﻴﻕ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ ﺃﻭ ﻤﺭﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ‪.‬‬
‫• ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﻋﻥ ﺍﻟﻤﺭﺽ ﻭﻁﺭﻕ ﺍﻨﺘﻘﺎﻟﻪ ﻭﺍﻟﻭﻗﺎﻴﺔ ﻤﻨﻪ )ﺍﺴﺘﻌﻤﺎل ﺤﻭﺍﺠﺯ ﺴﻠﻜﻴﺔ‪ ،‬ﺍﺴﺘﻌﻤﺎل ﺍﻟﻨﺎﻤﻭﺴﻴﺎﺕ ﺃﻭ‬
‫ﺍﻟﻤﻨﻔﺭﺍﺕ ﺍﻟﺤﺸﺭﻴﺔ ﻋﻠﻰ ﺍﻟﺠﻠﺩ ﺍﻟﻐﻴﺭ ﻤﻐﻁﻰ‪ ..‬ﺇﻟﺦ(‪.‬‬
‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﺒﻴﺌﻲ ﻭﺍﻟﺤﺸﺭﻱ ﻟﺩﺭﺍﺴﺔ ﺍﻟﻌﻭﺍﻤل ﺍﻟﺨﺎﻤﺠﺔ ﻭﺘﻁﺒﻴﻕ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ )ﺭﺩﻡ ﻭﻨﺯﺡ ﻤﻨﺎﻁﻕ ﺍﻟﻤﺎﺀ‬
‫ﺍﻟﻤﺘﺠﻤﻊ‪ ،‬ﺍﻟﺭﺵ ﺒﺎﻟﻤﺒﻴﺩﺍﺕ ﺍﻟﺤﺸﺭﻴﺔ‪ ...‬ﺇﻟﺦ( ﻴﻘﻭﻡ ﺒﻪ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﺤﺸﺭﻱ ﺒﻤﺭﻜﺯ ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﺘﺨﺼﺼﻲ‬
‫ﻭﻴﻌﺎﻭﻨﻪ ﻓﺭﻴﻕ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻋﻨﺩ ﺍﻟﻀﺭﻭﺭﺓ‪.‬‬
‫• ﻜﺘﺎﺒﺔ ﺘﻘﺭﻴﺭ ﻤﻔﺼل ﻋﻥ ﺍﻟﻭﻀﻊ ﺍﻟﻭﺒﺎﺌﻲ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﺘﺨﺫﺓ ﻭﺭﻓﻌﻪ ﺇﻟﻰ ﺸﻌﺒﺔ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ‬
‫ﺍﻟﺒﻴﺌﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﺒﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪ ،‬ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(٢٩‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫• ﺘﻠﻘﻲ ﺍﻟﺘﻘﺎﺭﻴﺭ ﻤﻥ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺘﻲ ﺃﺩﺨﻠﺕ ﺇﻟﻴﻬﺎ ﺨﺩﻤﺎﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﺇﻋﺩﺍﺩ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻭﺭﻓﻌﻪ ﺇﻟﻰ ﺩﺍﺌﺭﺓ‬
‫ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ ‪.(٢٩‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﺒﺎﻟﺘﻌﺎﻭﻥ ﺒﻴﻥ ﻤﺭﻜﺯ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﺘﺨﺼﺼﻲ ﻭﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ‬
‫ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬
‫• ﻭﻀﻊ ﺨﻁﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﺤﻠﻴﺔ ﻭﺘﺘﻀﻤﻥ ﺘﻘﺩﻴﺭ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﺒﻴﺩﺍﺕ ﺍﻟﺤﺸﺭﻴﺔ‪ ...‬ﺍﻟﺦ‪ ،‬ﻭﺍﻟﻌﻤل‬
‫ﻋﻠﻰ ﺘﻭﻓﻴﺭ ﻤﺴﺘﻠﺯﻤﺎﺘﻬﺎ‪ ،‬ﻭﻴﻘﻭﻡ ﺒﻬﺎ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺸﻌﺒﺔ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺒﻴﺌﻴﺔ‪ ،‬ﻭﺩﺍﺌﺭﺓ‬
‫ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﻓﻲ ﺍﻟﻭﺯﺍﺭﺓ‪.‬‬
‫• ﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﻋﻤل ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﺍﻟﺘﻲ ﺃﺩﺨﻠﺕ ﺇﻟﻴﻬﺎ ﺨﺩﻤﺎﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﺤﻭل ﻭﺒﺎﺌﻴﺎﺕ ﺍﻟﻤﺭﺽ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﻴﻘﻭﻡ ﺒﻪ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ‬
‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﻭﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﺒﺎﻟﻭﺯﺍﺭﺓ‪.‬‬
‫• ﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺤﻤﻼﺕ ﺍﻟﺭﺵ ﺍﻟﺘﻲ ﺘﻘﻭﻡ ﺒﻬﺎ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬
‫• ﺇﺭﺴﺎل ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﻤﺘﻌﻠﻘﺔ ﺒﺎﻟﻔﺤﻭﺹ ﺍﻟﻤﺨﺒﺭﻴﺔ ﻭﺤﻤﻼﺕ ﺍﻟﺭﺵ ﻭﺍﻟﻤﻌﺭﻭﻑ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﺒﻴﺩﺍﺕ ﻭﺍﻟﻤﻌﺩﺓ ﻓﻲ‬
‫ﻤﺭﻜﺯ ﺍﻟﺒﺭﺩﺍﺀ ﺍﻟﺘﺨﺼﺼﻲ‪ ،‬ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ ﻓﻲ ﺍﻟﻭﺯﺍﺭﺓ‪.‬‬
‫• ﺍﻟﺘﻭﻋﻴﺔ ﺍﻟﺼﺤﻴﺔ ﻋﻥ ﺍﻟﻤﺭﺽ ﻭﻁﺭﻕ ﺍﻨﺘﻘﺎﻟﻪ ﻭﻁﺭﻕ ﺍﻟﻭﻗﺎﻴﺔ ﻤﻨﻪ‪.‬‬
‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻻﺕ ﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺇﺭﺴﺎﻟﻪ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻓﻲ ﺍﻟﻭﺯﺍﺭﺓ‪.‬‬

‫‪١٢٩‬‬
 ‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬
‫• ﺘﻠﻘﻲ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺸﻬﺭﻴﺔ ﻭﺇﺠﺭﺍﺀ ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻭﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ‪.‬‬
‫• ﻭﻀﻊ ﺨﻁﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻋﻠﻰ ﻤﺴﺘﻭﻯ ﺍﻟﻘﻁﺭ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﺍﺤﺘﻴﺎﺠﺎﺕ ﺩﺍﺌﺭﺓ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻤﻥ ﺃﺩﻭﻴﺔ ﻭﻤﺒﻴﺩﺍﺕ ﻭﻤﻭﺍﺩ ﻤﺨﺒﺭﻴﺔ‪...‬ﺍﻟﺦ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺘﻨﻔﻴﺫ ﺒﻨﻭﺩ ﺍﻟﺨﻁﺔ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﻭﺴﺎﺌل ﻭﻤﻭﺍﺩ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪.‬‬
‫• ﺘﻘﻭﻴﻡ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﻋﻤﻠﻴﺔ ﺘﻨﻔﻴﺫ ﺍﻟﺨﻁﺔ ﺍﻟﺭﺍﺠﻌﺔ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ )ﺇﺩﺍﺭﺓ ﻤﺤﻠﻴﺔ‪ (...‬ﻭﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬
‫• ﺇﺠﺭﺍﺀ ﺍﻟﺩﺭﺍﺴﺎﺕ ﻭﺍﻟﺒﺤﻭﺙ ﺃﻭ ﺍﻟﻤﺴﻭﺡ )ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﺩﻉ ﺍﻹﻨﺴﺎﻨﻲ ﺃﻭ ﺍﻟﺤﻴﻭﺍﻨﻲ ﺃﻭ ﺍﻟﻨﺎﻗل ﺍﻟﺤﺸﺭﻱ(‪.‬‬

‫ﺨﻁﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻭﺍﻟﻭﻗﺎﻴﺔ ﻤﻥ ﺍﻟﻤﻼﺭﻴﺎ‬

‫ﻤﻌﺎﻟﺠﺔ ﻤﺭﻴﺽ ﻤﺼﺎﺏ ﺒﺎﻟﻤﻼﺭﻴﺎ ﺍﻟﻨﺸﻴﻁﺔ ﺃﻭ ﺍﻟﺒﻴﻀﻭﻴﺔ‪:‬‬
‫ﻴﻌﻁﻰ ﺍﻟﻜﻠﻭﺭﻭﻜﻴﻥ ‪ ٢٥‬ﻤﻎ ﺃﺴﺎﺱ‪/‬ﻜﻎ ﻤﻭﺯﻋﺔ ﻋﻠﻰ ﺜﻼﺜﺔ ﺃﻴﺎﻡ‪.‬‬

‫ﺍﻟﻴﻭﻡ ﺍﻷﻭل‪ :‬ﺍﻟﺠﺭﻋﺔ ﺍﻷﻭﻟﻰ‪ ٦٠٠ :‬ﻤﻎ ﻜﻠﻭﺭﻜﻴﻥ ﺃﺴﺎﺱ‪.‬‬

‫)ﻗﺭﺼﻴﻥ ﻋﻴﺎﺭ ‪ ٥٠٠‬ﻤﻎ ﺃﻭ ‪ ٤‬ﺃﻗﺭﺍﺹ ﻋﻴﺎﺭ ‪ ٢٥٠‬ﻤﻎ( ﻟﻠﺒﺎﻟﻐﻴﻥ‪.‬‬

‫‪ ١٠‬ﻤﻎ ﺃﺴﺎﺱ‪/‬ﻜﻎ ﺒﺠﺭﻋﺔ ﻭﺍﺤﺩﺓ ﻟﻸﻁﻔﺎل‪.‬‬

‫ﺍﻟﻴﻭﻡ ﺍﻟﺜﺎﻨﻲ‪ :‬ﺍﻟﺠﺭﻋﺔ ﺍﻟﺜﺎﻨﻴﺔ ‪ ٦٠٠ -‬ﻤﻎ ﻜﻠﻭﺭﻭﻜﻴﻥ ﺃﺴﺎﺱ‪.‬‬

‫)ﻗﺭﺼﻴﻥ ﻋﻴﺎﺭ ‪ ٥٠٠‬ﻤﻎ ﺃﻭ ‪ ٤‬ﺃﻗﺭﺍﺹ ﻋﻴﺎﺭ ‪ ٢٥٠‬ﻤﻎ( ﻟﻠﺒﺎﻟﻐﻴﻥ‪.‬‬

‫‪ ١٠‬ﻤﻎ ﺃﺴﺎﺱ‪/‬ﻜﻎ ﺒﺠﺭﻋﺔ ﻭﺍﺤﺩﺓ ﻟﻸﻁﻔﺎل‪.‬‬

‫ﺍﻟﻴﻭﻡ ﺍﻟﺜﺎﻟﺙ‪ :‬ﺍﻟﺠﺭﻋﺔ ﺍﻟﺜﺎﻟﺜﺔ‪ ٣٠٠ :‬ﻤﻎ ﻜﻠﻭﺭﻜﻴﻥ ﺃﺴﺎﺱ‪.‬‬

‫)ﻗﺭﺹ ﻭﺍﺤﺩ ﻋﻴﺎﺭ ‪ ٥٠٠‬ﻤﻎ ﺃﻭ ﻗﺭﺼﻴﻥ ﻋﻴﺎﺭ ‪ ٢٥٠‬ﻤﻎ( ﻟﻠﺒﺎﻟﻐﻴﻥ‪.‬‬

‫‪ ٥‬ﻤﻎ ﺃﺴﺎﺱ‪/‬ﻜﻎ ﺒﺠﺭﻋﺔ ﻭﺍﺤﺩﺓ ﻟﻸﻁﻔﺎل‪.‬‬

‫ﺍﻟﻴﻭﻡ ﺍﻟﺭﺍﺒﻊ ﻭﺤﺘﻰ ﺍﻟﻴﻭﻡ ﺍﻟﺴﺎﺒﻊ ﻋﺸﺭ‪ :‬ﻴﻌﻁﻰ ‪ ٠.٢٥‬ﻤﻎ ﺃﺴﺎﺱ‪/‬ﻜﻎ ﺃﻱ ﻗﺭﺹ ﻭﺍﺤﺩ ﺒﺭﻴﻤﺎﻜﻴﻥ )‪ ١٥‬ﻤﻎ( ﻟﻤﺩﺓ‬
‫‪ ١٤‬ﻴﻭﻡ ﻟﻠﺒﺎﻟﻐﻴﻥ‪.‬‬

‫‪١٣٠‬‬
 ‫ﻋﻼﺝ ﻤﺭﻴﺽ ﻤﺼﺎﺏ ﺒﺎﻟﻤﻼﺭﻴﺎ ﺍﻟﺨﺒﻴﺜﺔ ﺃﻭ ﺍﻟﻤﻌﻨﺩﺓ ﻋﻠﻰ ﺍﻟﻜﻠﻭﺭﻭﻜﻴﻥ‪:‬‬
‫• ﻋﻼﺝ ﺍﻟﻤﻼﺭﻴﺎ ﺍﻟﺨﺒﻴﺜﺔ )ﺍﻟﻤﺭﻴﺽ ﻗﺎﺩﺭ ﻋﻠﻰ ﺒﻠﻊ ﺍﻟﺩﻭﺍﺀ(‪:‬‬

‫ﺍﻟﺨﻁ ﺍﻷﻭل‪ :‬ﻜﻭﺍﺭﺘﻴﻡ )ﺍﺭﺘﻴﻤﻴﺴﻴﺭ ‪ +‬ﻟﻭﻤﻴﻐﺎﻨﺘﺭﻴﻥ ‪ ١٢٠/٢٠‬ﻤﻎ( ﻟﺜﻼﺜﺔ ﺃﻴﺎﻡ ‪ ٠.٧٥ +‬ﻤﻎ ﺃﺴﺎﺱ‪/‬ﻜﻎ‬
‫ﺒﺭﻴﻤﺎﻜﻴﻥ ﺃﻱ ﺜﻼﺜﺔ ﺃﻗﺭﺍﺹ ﺒﺭﻴﻤﺎﻜﻴﻥ )‪ ١٥‬ﻤﻎ( ﺠﺭﻋﺔ ﻭﺍﺤﺩﺓ ﻟﻠﺒﺎﻟﻐﻴﻥ‪.‬‬

‫ﺍﻟﺨﻁ ﺍﻟﺜﺎﻨﻲ‪ :‬ﻜﻴﻨﻴﻥ ﺤﺏ )‪ ١٠‬ﻤﻎ‪/‬ﻜﻎ ﻜل ‪ ٨‬ﺴﺎﻋﺎﺕ( ﻤﻊ ﺩﻭﻜﺴﻴﺴﻴﻜﻠﻴﻥ )‪ ١٠٠‬ﻤﻎ( ﻗﺭﺹ ﻭﺍﺤﺩ ﺒﺎﻟﻴﻭﻡ ﻟﻤﺩﺓ‬
‫ﻻ ﻤﻨﻪ ﻜﻭﺍﺭﺘﻴﻡ )ﺍﺭﺘﻴﻤﻴﺴﻴﺭ‬
‫‪ ٧‬ﺃﻴﺎﻡ ﻤﻊ ﻤﻼﺤﻅﺔ ﺃﻥ ﺩﻭﻜﺴﻴﺴﻜﻠﻴﻥ ﻻ ﻴﻌﻁﻰ ﺘﺤﺕ ﻋﻤﺭ ‪ ١٢‬ﺴﻨﺔ ﺇﻨﻤﺎ ﻴﻌﻁﻰ ﺒﺩ ﹰ‬
‫‪ +‬ﻟﻭﻤﻴﻐﺎﻨﺘﺭﻴﻥ ‪ ١٢٠/٢٠‬ﻤﻎ(‪.‬‬

‫• ﻋﻼﺝ ﺍﻟﻤﻼﺭﻴﺎ ﺍﻟﺨﺒﻴﺜﺔ ﺍﻟﻭﺨﻴﻤﺔ )ﺍﻟﻤﺨﻴﺔ( ﺍﻟﻤﺭﻴﺽ ﻴﺤﺘﺎﺝ ﻟﻠﻤﺸﻔﻰ‪:‬‬

‫‪ -‬ﺍﺭﺘﻴﺴﻭﻨﺎﺕ ‪ ٢,٤‬ﻤﻎ‪/‬ﻜﻎ ﻭﺭﻴﺩﻱ ﺃﻭ ﻋﻀﻠﻲ ﺠﺭﻋﺔ ﺍﻟﺘﺤﻤﻴل ﺜﻡ ﺒﻌﺩ ‪ ١٢‬ﺴﺎﻋﺔ ﺜﻡ ﺒﻌﺩ ‪ ٢٤‬ﺴﺎﻋﺔ ﺜﻡ ﺠﺭﻋﺔ‬
‫ﺒﺎﻟﻴﻭﻡ ﺤﺘﻰ ﻴﺼﺒﺢ ﺍﻟﻤﺭﻴﺽ ﻗﺎﺩﺭﹰﺍ ﻋﻠﻰ ﺍﻟﺒﻠﻊ ﻴﻌﻁﻰ ﻤﻌﺎﻟﺠﺔ ﻜﺎﻤﻠﺔ ﺒﺎﻟﻜﻭﺍﺭﺘﻴﻡ ﻟﻤﺩﺓ ﺜﻼﺜﺔ ﺃﻴﺎﻡ‪ .‬ﺃﻭ‪.‬‬
‫‪ -‬ﻜﻴﻨﺩﻴﻥ ﺃﻤﺒﻭل ‪ ٢٠‬ﻤﻎ ﻤﻥ ﻤﻠﺢ ﺍﻟﻜﻴﻨﻴﻥ‪/‬ﻜﻎ ﺠﺭﻋﺔ ﺘﺤﻤﻴل ﻴﺨﻔﻑ ﺒـ ‪ ١٠‬ﻤل ﻤﻥ ﺴﺎﺌل ﺍﺴﻭﻱ ﺍﻟﺘﻭﺘﺭ ﻟﻜل‬
‫ﻜﻎ ﻭﻴﻌﻁﻰ ﺘﺴﺭﻴﺒﹰﺎ ﺒﺎﻟﻭﺭﻴﺩ ﻋﻠﻰ ﻤﺩﻯ ﺃﺭﺒﻊ ﺴﺎﻋﺎﺕ ﺜﻡ ﺒﻌﺩ ﻤﻀﻲ ﺜﻤﺎﻥ ﺴﺎﻋﺎﺕ ﻤﻥ ﻭﻗﺕ ﺍﻟﺒﺩﺀ ﺒﺘﺴﺭﻴﺏ‬
‫ﺠﺭﻋﺔ ﺍﻟﺘﺤﻤﻴل ﻴﻌﻁﻰ ﺠﺭﻋﻰ ﻤﺩﺍﻭﻤﺔ ﻤﻥ ﺍﻟﻜﻴﻨﻴﻥ ﺒﻤﻘﺩﺍﺭ ‪ ١٠‬ﻤﻎ ﻤﻥ ﻤﻠﺢ‪/‬ﻜﻎ ﻋﻠﻰ ﻤﺩﻯ ﺃﺭﺒﻊ ﺴﺎﻋﺎﺕ‬
‫ﺜﻡ ﺘﻌﺎﺩ ﺍﻟﺠﺭﻋﺔ ﻜل ﺜﻤﺎﻨﻲ ﺴﺎﻋﺎﺕ ﺒﺎﺒﺘﺩﺍﺀ ﺍﻟﺤﺴﺎﺏ ﻤﻥ ﺒﺩﺀ ﺍﻟﺘﺴﺭﻴﺏ ﻟﻠﺠﺭﻋﺔ ﺍﻟﺴﺎﺒﻘﺔ ﻭﻴﻜﺭﺭ ﺫﻟﻙ ﺤﺘﻰ‬
‫ﻴﺼﺒﺢ ﺍﻟﻤﺭﻴﺽ ﻗﺎﺩﺭﹰﺍ ﻋﻠﻰ ﺍﻟﺒﻠﻊ ﻟﻴﺤﻭل ﺍﻟﻤﺭﻴﺽ ﻟﻠﻌﻼﺝ ﺍﻟﻔﻤﻭﻱ ﻓﻴﻌﻁﻰ ﺃﻗﺭﺍﺹ ﺍﻟﻜﻴﻨﻴﻥ ﺒﻤﻘﺩﺍﺭ ‪ ١٠‬ﻤﻎ‬
‫ﻤﻥ ﻤﻠﺤﺔ‪/‬ﻜﻎ ﺒﻔﺎﺼل ﺜﻤﺎﻨﻲ ﺴﺎﻋﺎﺕ ﺤﺘﻰ ﺘﻤﺎﻡ ﺩﻭﺭﺓ ﻤﻌﺎﻟﺠﺔ ﻤﺩﺘﻬﺎ ﺴﺒﻌﺔ ﺃﻴﺎﻡ‪.‬‬

‫ﻋﻼﺝ ﺍﻟﻤﻼﺭﻴﺎ ﺍﻟﻤﺨﺘﻠﻁﺔ )ﻤﻼﺭﻴﺎ ﺨﺒﻴﺜﺔ ‪ +‬ﻤﻼﺭﻴﺎ ﻨﺸﻴﻁﺔ(‪:‬‬

‫ﻜﻭﺍﺭﺘﻴﻡ )ﺍﺭﺘﻴﻤﻴﺴﻴﺭ‪ +‬ﻟﻭﻤﻴﻐﺎﺭﻨﺘﺭﻴﻥ ‪ ١٢٠/١٠‬ﻤﻎ( ﺜﻼﺜﺔ ﺃﻴﺎﻡ ‪ +‬ﺍﻟﻴﻭﻡ ﺍﻟﺭﺍﺒﻊ ﻭﺤﺘﻰ ﺍﻟﻴﻭﻡ ﺍﻟﺴﺎﺒﻊ ﻋﺸﺭ‪ :‬ﻴﻌﻁﻰ‬
‫‪ ٠.٢٥‬ﻤﻎ ﺃﺴﺎﺱ‪/‬ﻜﻎ ﺃﻱ ﻗﺭﺹ ﻭﺍﺤﺩ ﺒﺭﻴﻤﺎﻜﻴﻥ )‪ ١٥‬ﻤﻎ( ﻟﻤﺩﺓ ‪ ١٤‬ﻴﻭﻡ ﻟﻠﺒﺎﻟﻐﻴﻥ‪.‬‬

‫ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﻭﻗﺎﺌﻴﺔ ﻟﻠﻤﺴﺎﻓﺭﻴﻥ ﻟﻠﻤﻨﺎﻁﻕ ﺍﻟﻤﻭﺒﻭﺀﺓ ﺒﺎﻟﻤﻼﺭﻴﺎ‪:‬‬

‫• ﺍﻟﻭﻗﺎﻴﺔ ﻓﻲ ﺍﻟﺒﻠﺩﺍﻥ ﺍﻟﺘﻲ ﻴﺭﺘﻔﻊ ﻓﻴﻬﺎ ﺨﻁﺭ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﻤﻼﺭﻴﺎ ﺍﻟﻤﺘﺤﺴﺴﺔ ﻋﻠﻰ ﺍﻟﻜﻠﻭﺭﻭﻜﻴﻥ‪:‬‬

‫ﺍﻟﻜﻠﻭﺭﻜﻴﻥ ‪ ٥‬ﻤﻎ ﺃﺴﺎﺱ‪/‬ﻜﻎ ﺃﺴﺒﻭﻋﻴﹰﺎ ‪ ٥٠٠‬ﻤﻎ )‪ ٣٠٠‬ﻤﻎ ﺃﺴﺎﺱ( )ﻗﺭﺹ ﻜل ﺃﺴﺒﻭﻉ( ﻗﺒل ﺍﻟﺴﻔﺭ ﺒﺄﺴﺒﻭﻉ‬
‫ﻭﺨﻼل ﺍﻟﺴﻔﺭ ﻭ ‪ ٤‬ﺃﺴﺎﺒﻴﻊ ﺒﻌﺩ ﺍﻟﻌﻭﺩﺓ ﻟﻠﺒﺎﻟﻐﻴﻥ‪.‬‬

‫• ﺍﻟﻭﻗﺎﻴﺔ ﻓﻲ ﺍﻟﺒﻠﺩﺍﻥ ﺍﻟﺘﻲ ﻴﺭﺘﻔﻊ ﻓﻴﻬﺎ ﺨﻁﺭ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﻤﻼﺭﻴﺎ ﺍﻟﺨﺒﻴﺜﺔ ﺃﻭ ﺍﻟﻤﻌﻨﺩﺓ ﻋﻠﻰ ﺍﻟﻜﻠﻭﺭﻭﻜﻴﻥ‪:‬‬

‫ﺍﻟﻤﻔﻠﻭﻜﻭﻴﻥ ‪ ٥‬ﻤﻎ‪/‬ﻜﻎ ﺃﺴﺒﻭﻋﻴﹰﺎ ﺃﻱ ﻗﺭﺹ ﻭﺍﺤﺩ ﻤﻔﻠﻭﻜﻭﻴﻥ ‪ ٢٥٠‬ﻤﻎ ﻗﺒل ﺍﻟﺴﻔﺭ ﺒﺄﺴﺒﻭﻋﻴﻥ ﻭﺨﻼل ﺍﻟﺴﻔﺭ‬
‫ﻭ ‪ ٤‬ﺃﺴﺎﺒﻴﻊ ﺒﻌﺩ ﺍﻟﻌﻭﺩﺓ ﻋﻠﻰ ﺃﻻ ﺘﺘﺠﺎﻭﺯ ﺍﻟﺠﺭﻋﺔ ﺍﻟﻤﻌﻁﺎﺓ ‪ ١٠‬ﺤﺒﺎﺕ ﻤﻊ ﺍﻟﺘﺄﻜﻴﺩ ﻋﻠﻰ ﻤﺭﺍﺠﻌﺔ ﺍﻟﻤﺭﺍﻜﺯ‬
‫ﺍﻟﺘﺨﺼﺼﻴﺔ ﻓﻲ ﺍﻟﺒﻠﺩ ﺍﻟﻤﺴﺎﻓﺭ ﺇﻟﻴﻪ‪.‬‬

‫‪١٣١‬‬
 ‫ﻤﻼﺤﻅﺔ‪ :‬ﻨﺅﻜﺩ ﻋﻠﻰ ﺇﻋﻁﺎﺀ ﺍﻟﻜﻭﺍﺭﺘﻴﻡ ﻤﻊ ﻭﺠﺒﺔ ﺩﺴﻤﺔ ﻭﺇﻻ ﻓﺎﻟﻨﺘﺎﺌﺞ ﻏﻴﺭ ﻤﺭﻀﻴﺔ‪.‬‬

‫ﻭﻓﻲ ﺤﺎل ﺍﻹﻗﻴﺎﺀ ﺨﻼل ﺴﺎﻋﺔ ﻤﻥ ﺇﻋﻁﺎﺀ ﻟﻌﻼﺝ ﻴﺠﺏ ﺇﻋﺎﺩﺓ ﺍﻟﺠﺭﻋﺔ‪.‬‬

‫ﺠﺭﻋﺎﺕ ﺍﻟﻜﻭﺍﺭﺘﻴﻡ ﻋﻠﻰ ﺍﻟﺸﻜل ﺍﻟﺘﺎﻟﻲ‪:‬‬

‫ﺍﻟﻜﻭﺭﺱ ﺍﻟﻜﺎﻤل‬ ‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﺍﻟﻭﺯﻥ‬

‫‪ ٦‬ﺤﺒﺎﺕ‬ ‫ﺤﺒﺔ ﻭﺍﺤﺩﺓ × ‪ ٢‬ﻤﺭﺓ ﻟﻤﺩﺓ ‪ ٣‬ﺃﻴﺎﻡ‬ ‫ﻤﻥ ‪ ٥‬ﻜﻎ ﺇﻟﻰ > ‪ ١٥‬ﻜﻎ‬

‫‪ ١٢‬ﺤﺒﺔ‬ ‫‪ ٢‬ﺤﺒﺔ × ‪ ٢‬ﻤﺭﺓ ﻟﻤﺩﺓ ‪ ٣‬ﺃﻴﺎﻡ‬ ‫ﻤﻥ ‪ ١٥‬ﻜﻎ ﺇﻟﻰ > ‪ ٢٥‬ﻜﻎ‬

‫‪ ١٨‬ﺤﺒﺔ‬ ‫‪ ٣‬ﺤﺒﺔ × ‪ ٢‬ﻤﺭﺓ ﻟﻤﺩﺓ ‪ ٣‬ﺃﻴﺎﻡ‬ ‫ﻤﻥ ‪ ٢٥‬ﻜﻎ ﺇﻟﻰ > ‪ ٣٥‬ﻜﻎ‬

‫‪ ٢٤‬ﺤﺒﺔ‬ ‫‪ ٤‬ﺤﺒﺔ × ‪ ٢‬ﻤﺭﺓ ﻟﻤﺩﺓ ‪ ٣‬ﺃﻴﺎﻡ‬ ‫‪ ٣٥‬ﻜﻎ ﻓﻤﺎ ﻓﻭﻕ‬

‫‪‬‬

‫‪١٣٢‬‬
 ‫‪‬‬
‫‪‬א‪‬א‪ ‬‬
‫‪ Shistosomiasis‬‬
‫ﻟﻬﺫﺍ ﺍﻟﻤﺭﺽ ﺜﻼﺜﺔ ﺃﺸﻜﺎل ﺴﺭﻴﺭﻴﺔ‪:‬‬

‫• ﺩﺍﺀ ﺍﻟﺒﻠﻬﺎﺭﺴﻴﺎ ﺍﻟﺒﻭﻟﻴﺔ ﺍﻟﻨﺎﺠﻡ ﻋﻥ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﻤﻨﺸﻘﺔ ﺍﻟﺩﻤﻭﻴﺔ ‪.Shistosoma hematobium‬‬

‫• ﺩﺍﺀ ﺍﻟﺒﻠﻬﺎﺭﺴﻴﺎ ﺍﻟﻤﻌﻭﻴﺔ ﺍﻟﻨﺎﺠﻡ ﻋﻥ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﻤﻨﺸﻘﺔ ﺍﻟﻤﺎﻨﺴﻭﻨﻴﺔ ‪.S.Mansoni‬‬

‫• ﺩﺍﺀ ﺍﻟﺒﻠﻬﺎﺭﺴﻴﺎ ﺍﻵﺴﻴﻭﻴﺔ ﺍﻟﻨﺎﺠﻡ ﻋﻥ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﻤﻨﺸﻘﺔ ﺍﻟﻴﺎﺒﺎﻨﻴﺔ ‪.S.japonicum‬‬

‫ﻭﻤﺎ ﻴﻬﻤﻨﺎ ﻫﻭ ﺍﻟﻨﻭﻉ ﺍﻷﻭل ﺤﻴﺙ ﻜﺎﻥ ﺍﻟﻤﺭﺽ ﻴﺴﺘﻭﻁﻥ ﻓﻲ ﻤﺤﺎﻓﻅﺘﻲ ﺍﻟﺭﻗﺔ ﻭﺩﻴﺭ ﺍﻟﺯﻭﺭ‪ ،‬ﻭﺤﺎﻟﻴﹰﺎ ﻟﻡ ﺘﻌﺩ ﺘﺴﺠل‬
‫ﺇﺼﺎﺒﺎﺕ‪.‬‬

‫‪‬א‪‬א‪‬א‪ ‬‬
‫ﺍﻟﺘﻌﺭﻴﻑ‪:‬‬
‫ﻫﻭ ﺨﻤﺞ ﺒﺩﻭﺩﺓ ﻤﻥ ﺍﻟﻤﺜﻘﻭﺒﺎﺕ ﺍﻟﺩﻤﻭﻴﺔ‪ ،‬ﺤﻴﺙ ﺘﻌﻴﺵ ﺍﻟﺩﻴﺩﺍﻥ ﺍﻟﺒﺎﻟﻐﺔ ﺍﻟﺫﻜﻭﺭ ﻭﺍﻹﻨﺎﺙ ﻓﻲ ﺍﻷﻭﺭﺩﺓ ﺍﻟﻤﺜﺎﻨﻴﺔ ﻟﻠﺜﻭﻱ‬
‫ﻋﻠﻰ ﻤﺩﻯ ﺴﻨﻭﺍﺕ ﻜﺜﻴﺭﺓ ﻭﺘﺤﺩﺙ ﺍﻟﺒﻴﻭﺽ ﺃﻭﺭﺍﻡ ﺤﺒﻴﺒﻴﺔ ﻭﻨﺩﺒﺎﺕ ﺼﻐﻴﺭﺓ ﻓﻲ ﺍﻷﻋﻀﺎﺀ ﺍﻟﺘﻲ ﺘﺘﺭﺴﺏ ﻓﻴﻬﺎ‪.‬‬

‫ﻭﺃﻫﻡ ﺍﻷﻋﺭﺍﺽ ﻋﺴﺭﺓ ﺍﻟﺘﺒﻭل ﻭﺘﻌﺩﺩ ﺍﻟﺒﻴﻼﺕ ﻭﺍﻟﺒﻴﻠﺔ ﺍﻟﺩﻤﻭﻴﺔ ﺍﻟﺨﺘﺎﻤﻴﺔ‪.‬‬

‫ﻭﺃﻫﻡ ﺍﻵﺜﺎﺭ ﺍﻟﻤﺭﻀﻴﺔ ﻫﻲ ﻤﻀﺎﻋﻔﺎﺕ ﺍﻟﺨﻤﺞ ﺍﻟﻤﺯﻤﻥ ﻓﻴﺤﺩﺙ ﺍﻋﺘﻼل ﺒﻭﻟﻲ ﺍﻨﺴﺩﺍﺩﻱ‪ ،‬ﺨﻤﺞ ﺠﺭﺜﻭﻤﻲ ﺇﻀﺎﻓﻲ‪،‬‬
‫ﻭﺍﺤﺘﻤﺎل ﺴﺭﻁﺎﻥ ﺍﻟﻤﺜﺎﻨﺔ‪.‬‬

‫ﺴﻠﺴﻠﺔ ﺍﻟﻌﺩﻭﻯ‪:‬‬
‫• ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪ :‬ﺍﻟﻤﻨﺸﻘﺔ ﺃﻭ ﺍﻟﺒﻠﻬﺎﺭﺴﻴﺎ ﺍﻟﺩﻤﻭﻴﺔ ‪.Shistosoma hematobium‬‬

‫• ﺍﻟﻤﺴﺘﻭﺩﻉ‪ :‬ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﺼﺎﺏ ﺒﺎﻟﺨﻤﺞ ﻭﻴﻌﺘﻤﺩ ﺒﻘﺎﺀ ﺍﻟﻁﻔﻴﻠﻲ ﻋﻠﻰ ﻭﺠﻭﺩ ﺤﻠﺯﻭﻥ ﺍﻟﻤﺤﺎﺭ ﺍﻟﻤﻠﺘﻭﻱ ‪Bolinus‬‬
‫ﻜﺜﻭﻱ ﻭﺴﻴﻁ‪.‬‬

‫• ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪ :‬ﺒﺎﻟﺘﻤﺎﺱ ﺍﻟﺼﻤﻴﻤﻲ ﻤﻊ ﺍﻟﻤﺎﺀ ﺍﻟﺤﺎﻭﻱ ﻋﻠﻰ ﺍﻷﺸﻜﺎل ﺍﻟﻴﺭﻗﻴﺔ ﻟﻠﺩﻴﺩﺍﻥ )ﺍﻟﺫﻭﺍﺌﺏ( ﺍﻟﺘﻲ ﻨﺸﺄﺕ‬
‫ﺩﺍﺨل ﺍﻟﺤﻠﺯﻭﻥ ﻤﻥ ﺘﻁﻭﺭ ﺍﻟﻁﻔﻴﻠﻴﺎﺕ ﺤﻴﺙ ﺘﺩﺨل ﻫﺫﻩ ﺍﻟﺫﻭﺍﺌﺏ ﻋﺒﺭ ﺍﻟﺠﻠﺩ ﺍﻟﺭﻁﺏ ﺇﻟﻰ ﺍﻷﻭﻋﻴﺔ ﺍﻟﺩﻤﻭﻴﺔ ﻟﺘﻜﻤل‬
‫ﺩﻭﺭﺘﻬﺎ ﺍﻟﺘﻁﻭﺭﻴﺔ ﺇﻟﻰ ﺍﻟﺩﻴﺩﺍﻥ ﺍﻟﺒﺎﻟﻐﺔ ﺍﻟﺘﻲ ﺘﻁﺭﺡ ﺒﻴﻭﻀﻬﺎ ﻤﻊ ﺍﻟﺒﻭل ﺇﻟﻰ ﺍﻟﻤﺎﺀ‪ ،‬ﻭﻫﺫﻩ ﺒﺩﻭﺭﻫﺎ ﺘﻔﻘﺱ ﻓﺘﺨﺭﺝ‬
‫ﻤﻨﻬﺎ ﺍﻟﻁﻔﻴﻠﻴﺎﺕ‪.‬‬

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 ‫• ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪ :‬ﺍﻻﺴﺘﻌﺩﺍﺩ ﺍﻟﺨﻤﺞ ﻋﺎﻡ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ ﻏﻴﺭ ﻤﺤﺩﺩﺓ‪.‬‬

‫• ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪ ٦-٢ :‬ﺃﺴﺎﺒﻴﻊ ﻤﻥ ﺍﻟﺘﻌﺭﺽ ﻟﻠﻌﺩﻭﻯ‪.‬‬

‫• ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪ :‬ﺇﻥ ﺍﻟﺸﺨﺹ ﺍﻟﻤﺨﻤﻭﺝ ﻴﺴﺘﻤﺭ ﻓﻲ ﻁﺭﺡ ﺍﻟﺒﻴﻭﺽ ﻓﻲ ﺍﻟﺒﻭل ﻟﻤﺩﺓ ﺘﻘﺎﺭﺏ ﺍﻟﺨﻤﺱ ﺴﻨﻭﺍﺕ‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﻴﻌﺘﻤﺩ ﻋﻠﻰ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻭﻋﻠﻰ ﻜﺸﻑ ﺍﻟﺒﻴﻭﺽ ﻓﻲ ﺍﻟﺒﻭل‪.‬‬

‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ‬
‫ﺘﻌﺭﻑ ﺤﺎﻟﺔ ﺍﻟﺒﻠﻬﺎﺭﺴﻴﺎ ﺍﻟﻤﺅﻜﺩﺓ ﺒﻭﺠﻭﺩ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺴﺭﻴﺭﻴﺔ‪ ،‬ﻋﺴﺭ ﺍﻟﺘﺒﻭل‪ ،‬ﺘﻌﺩﺩ ﺍﻟﺒﻴﻼﺕ‪ ،‬ﺍﻟﺒﻴﻠﺔ ﺍﻟﺩﻤﻭﻴﺔ‪ ،‬ﻤﻊ‬
‫ﻅﻬﻭﺭ ﺍﻟﺒﻴﻭﺽ ﻓﻲ ﺍﻟﺒﻭل‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻱ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬

‫• ﺍﻟﻜﺸﻑ ﺍﻟﺒﺎﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ ﺤﺴﺏ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ‪ ،‬ﻭﺇﺤﺎﻟﺘﻬﺎ ﺇﻟﻰ ﻤﺭﻜﺯ ﺍﻟﺒﻠﻬﺎﺭﺴﻴﺎ ﺍﻟﺘﺨﺼﺼﻲ‬
‫ﻭﻤﺭﺍﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺘﻲ ﺃﺩﺨﻠﺕ ﺇﻟﻴﻬﺎ ﺨﺩﻤﺎﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻤﻥ ﺃﺠل ﺘﺄﻜﻴﺩ ﺍﻟﺘﺸﺨﻴﺹ ﻭﺍﻟﻌﻼﺝ‪.‬‬
‫• ﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ ﺇﻟﻰ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ‪.‬‬
‫• ﺍﻟﻤﺴﺎﻫﻤﺔ ﻓﻲ ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﺤﺎﻻﺕ ﻭﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﺒﻴﺌﻲ ﺍﻟﺫﻱ ﻴﻘﻭﻡ ﺒﻪ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ‪ ،‬ﻭﺍﻟﺘﺭﺼﺩ‬
‫ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﻤﺭﺽ ﻜﺫﻟﻙ ﺍﻟﻤﺴﺎﻫﻤﺔ ﻓﻲ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪.‬‬

‫ﺜﺎﻨﻴ ﹰﺎ‪ -‬ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫• ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻤﺨﺒﺭﻱ ﻟﻠﺤﺎﻻﺕ ﺍﻟﻤﺸﺘﺒﻬﺔ‪ ،‬ﻭﺘﺭﺴل ﺍﻟﻌﻴﻨﺎﺕ ﺍﻹﻴﺠﺎﺒﻴﺔ ﻭﺒﻌﺽ ﺍﻟﻌﻴﻨﺎﺕ ﺍﻟﺴﻠﺒﻴﺔ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﻤﺨﺎﺒﺭ‬
‫ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ ﻟﺘﻘﻴﻴﻡ ﺩﻗﺔ ﺍﻟﺘﺸﺨﻴﺹ‪.‬‬
‫• ﻋﻼﺝ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺨﺼﺔ ﺒﺈﻋﻁﺎﺀ ﺍﻟﺒﺭﺍﺯﻴﻜﻭﺍﻨﺘﻴل )ﺒﻠﺘﺭﻴﺴﻴﺩ‪ :‬ﻋﻴﺎﺭ ﺍﻟﺤﺒﺔ ‪ ٦٠٠‬ﻤﻠﻎ( ﺒﻤﻘﺩﺍﺭ ‪٤٠‬ﻤﻠﻎ‪/‬ﻜﻎ )ﺃﺭﺒﻊ‬
‫ﺤﺒﺎﺕ ﻟﻠﺒﺎﻟﻐﻴﻥ( ﺩﻓﻌﺔ ﻭﺍﺤﺩﺓ ﺒﻌﺩ ﺍﻟﻁﻌﺎﻡ‪.‬‬
‫ﻻ ﻴﻌﻁﻰ ﺍﻟﺩﻭﺍﺀ ﻟﻠﻨﺴﺎﺀ ﺍﻟﺤﻭﺍﻤل ﺨﻼل ﺍﻷﺸﻬﺭ ﺍﻟﺜﻼﺜﺔ ﺍﻷﻭﻟﻰ ﻤﻥ ﺍﻟﺤﻤل‪ ،‬ﻭﻴﻌﻁﻰ ﻟﻠﻤﺭﻀﻊ ﻋﻠﻰ ﺃﻥ ﺘﻭﻗﻑ‬
‫ﺇﺭﻀﺎﻉ ﻁﻔﻠﻬﺎ ﺨﻼل ‪ ٧٢‬ﺴﺎﻋﺔ ﺍﻷﻭﻟﻰ ﺍﻟﺘﻲ ﺘﻠﻲ ﺃﺨﺫ ﺍﻟﻌﻼﺝ ﻭﻴﺠﺏ ﺇﻋﺎﺩﺓ ﻓﺤﺹ ﺍﻟﺒﻭل ﺒﻌﺩ ﺸﻬﺭ ﻤﻥ‬
‫ﺍﻟﻤﻌﺎﻟﺠﺔ‪ ،‬ﻭﻓﻲ ﺤﺎل ﺍﻹﻴﺠﺎﺒﻴﺔ ﻴﻌﺎﺩ ﺍﻟﻌﻼﺝ ﺒﻨﻔﺱ ﺍﻷﺴﻠﻭﺏ‪.‬‬
‫• ﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺨﺼﺔ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ‬
‫ﺍﻟﺴﺎﺭﻴﺔ ﻭﻴﺭﺴل ﺘﻘﺭﻴﺭ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ )ﺍﻟﻤﺘﻀﻤﻥ ﺘﻘﺎﺭﻴﺭ ﻤﺭﺍﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ( ﺸﻬﺭﻴﹰﺎ ﺇﻟﻰ ﺍﻟﺩﺍﺌﺭﺓ‪.‬‬

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‫• ﺍﺴﺘﻘﺼﺎﺀ ﺍﻟﺤﺎﻟﺔ ﻭﺇﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺘﻘﺼﻲ ﻟﺘﺤﺩﻴﺩ ﻤﺼﺩﺭ ﺍﻟﺨﻤﺞ ﻭﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل ﻭﺩﺭﺍﺴﺔ ﺍﻟﻤﻌﺭﻀﻴﻥ ﻟﺨﻁﺭ‬
‫ﺍﻹﺼﺎﺒﺔ ﻭﺍﻟﺒﺤﺙ ﻋﻥ ﺤﺎﻻﺕ ﺃﺨﺭﻯ ﻭﻴﻘﻭﻡ ﺒﻪ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ ﻭﻤﺭﺍﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ ﻭﺘﺭﺴل ﺍﻻﺴﺘﻤﺎﺭﺓ ﺇﻟﻰ‬
‫ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ ﻋﺒﺭ ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﻓﻲ ﻤﺩﻴﺭﻴﺔ‬
‫ﺍﻟﺼﺤﺔ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(٣٠‬‬
‫• ﺍﺴﺘﻘﺼﺎﺀ ﺍﻟﺒﻴﺌﺔ ﻟﻠﺒﺤﺙ ﻋﻥ ﻭﺠﻭﺩ ﺍﻟﺤﻠﺯﻭﻥ ﻭﺍﻟﻘﻀﺎﺀ ﻋﻠﻴﻪ ﺒﺎﺴﺘﻌﻤﺎل ﻤﺎﺩﺓ ﺍﻟﺒﺎﻴﻠﻭﺴﻴﺩ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺍﺘﺨﺎﺫ‬
‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﺘﺤﺴﻴﻥ ﻭﺴﺎﺌل ﻤﻤﺎﺭﺴﺎﺕ ﺍﻟﺭﻱ ﻭﺍﻟﺯﺭﺍﻋﺔ‪ ،‬ﺩﻡ ﻭﻨﺯﺡ ﺃﻤﺎﻜﻥ ﺘﻭﺍﻟﺩ ﺍﻟﺤﻠﺯﻭﻥ‪...‬ﺍﻟﺦ( ﺍﻟﺘﻲ‬
‫ﺘﻘﻭﻡ ﺒﻬﺎ ﺍﻟﺠﻬﺎﺕ ﺫﺍﺕ ﺍﻟﻌﻼﻗﺔ ﻭﻴﺭﻓﻊ ﺘﻘﺭﻴﺭ ﺸﻬﺭﻱ ﻋﻥ ﺍﻟﻭﻀﻊ ﺍﻟﻭﺒﺎﺌﻲ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺇﻟﻰ ﺩﺍﺌﺭﺓ‬
‫ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ ﻋﺒﺭ ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪.‬‬
‫• ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﻋﻥ ﺍﻟﻤﺭﺽ ﻭﻁﺭﻕ ﺍﻨﺘﻘﺎﻟﻪ ﻭﺍﻟﻭﻗﺎﻴﺔ ﻤﻨﻪ )ﺍﻻﻤﺘﻨﺎﻉ ﻋﻥ ﺍﻟﺘﺒﻭل ﻓﻲ ﺍﻟﺠﺩﺍﻭل ﻭﺃﻗﻨﻴﺔ ﺍﻟﺭﻱ‬
‫ﻭﺍﻻﻤﺘﻨﺎﻉ ﻋﻥ ﺍﻟﺘﻌﺭﺽ ﻟﻠﻤﺎﺀ ﺍﻟﻤﻠﻭﺙ ﺒﻠﺒﺱ ﺃﺤﺫﻴﺔ ﻤﻁﺎﻁﻴﺔ ﻁﻭﻴﻠﺔ ﻭﺍﻻﻤﺘﻨﺎﻉ ﻋﻥ ﺍﻟﺴﺒﺎﺤﺔ ﻓﻴﻪ‪...‬ﺍﻟﺦ(‪.‬‬
‫• ﺍﻟﺘﺭﺼﺩ ﺍﻟﻭﺒﺎﺌﻲ ﺒﻔﺤﺹ ﻋﻴﻨﺎﺕ ﺒﻭﻟﻴﺔ ﻤﻥ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﻌﺭﻀﻴﻥ ﻟﺨﻁﺭ ﺍﻹﺼﺎﺒﺔ ﻜﻁﻼﺏ ﺍﻟﻤﺩﺍﺭﺱ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﺤﺎﻻﺕ ﻭﺘﺴﺠﻴﻠﻬﺎ ﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﺒﺎﻟﺘﻌﺎﻭﻥ ﺒﻴﻥ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺘﺨﺼﺼﻲ ﻭﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﻭﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ‬
‫ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ‪.‬‬
‫• ﻭﻀﻊ ﺨﻁﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﺤﻠﻴﺔ ﻭﺘﻭﻓﻴﺭ ﻤﺴﺘﻠﺯﻤﺎﺘﻬﺎ )ﻤﺘﻀﻤﻨﺔ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﺒﻴﺩﺍﺕ‪ ،(...‬ﺒﺈﺸﺭﺍﻑ‬
‫ﻭﻤﺴﺎﻋﺩﺓ ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ‪.‬‬
‫• ﺇﺭﺴﺎل ﺘﻘﺭﻴﺭ ﺒﺎﻟﻔﺤﻭﺹ ﺍﻟﻤﺨﺒﺭﻴﺔ ﻭﺍﻟﻤﺼﺭﻭﻑ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﺒﻴﺩﺍﺕ‪...‬ﺍﻟﺦ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬

‫• ﺘﻠﻘﻲ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺸﻬﺭﻴﺔ ﻭﺇﺠﺭﺍﺀ ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻭﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ‪.‬‬
‫• ﻭﻀﻊ ﺨﻁﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻋﻠﻰ ﻤﺴﺘﻭﻯ ﺍﻟﻘﻁﺭ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﺍﺤﺘﻴﺎﺠﺎﺕ ﻋﻤﻠﻴﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻤﻥ ﺃﺩﻭﻴﺔ ﻭﻤﺒﻴﺩﺍﺕ ﻭﻤﻭﺍﺩ ﻤﺨﺒﺭﻴﺔ‪...‬ﺍﻟﺦ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﺘﻨﻔﻴﺫ ﺒﻨﻭﺩ ﺍﻟﺨﻁﺔ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﻭﺴﺎﺌل ﻭﻤﻭﺍﺩ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪.‬‬
‫• ﺘﻘﻭﻴﻡ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﻭﻋﻤﻠﻴﺔ ﺘﻨﻔﻴﺫ ﺍﻟﺨﻁﺔ ﻭﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻭﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬

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١٣٦
١٣٨
 ‫‪ ‬‬
‫‪‬א‪‬א‪ Brucellosis‬‬
‫א‪‬א‪J‬א‪‬א‪J‬א‪‬א‪‬א‪ ‬‬
‫ﻤﺭﺽ ﺠﺭﺜﻭﻤﻲ ﻋﺎﻡ‪ ،‬ﺫﻭ ﺒﺩﺀ ﻓﺠﺎﺌﻲ ﺃﻭ ﻤﺨﺎﺘل‪ ،‬ﻴﺘﻤﻴﺯ ﺒﺤﻤﻰ ﻤﺴﺘﻤﺭﺓ ﺃﻭ ﻤﺘﻘﻁﻌﺔ‪ -‬ﺼﺩﺍﻉ‪ -‬ﻀﻌﻑ‪-‬‬
‫ﺘﻌﺭﻕ ﻏﺯﻴﺭ‪ -‬ﻨﻭﺍﻓﺽ‪ -‬ﺃﻟﻡ ﻤﻔﺼﻠﻲ‪ -‬ﺃﻟﻡ ﻓﻲ ﻤﺅﺨﺭ ﺍﻟﻌﻨﻕ‪ -‬ﺁﻻﻡ ﻋﺎﻤﺔ‪ -‬ﻗﻤﻪ‪ -‬ﻨﻘﺹ ﻭﺯﻥ‪ -‬ﻗﺩ ﺘﺤﺩﺙ ﺃﺨﻤﺎﺝ‬
‫ﻤﻭﻀﻌﻴﺔ ﻗﻴﺤﻴﺔ‪ -‬ﻴﻤﻜﻥ ﺃﻥ ﺘﺤﺩﺙ ﺃﻋﺭﺍﺽ ﻨﻔﺴﻴﺔ )ﺍﻜﺘﺌﺎﺏ‪ -‬ﻫﻴﺠﺎﻥ‪ -‬ﺃﺭﻕ‪ -‬ﻋﺩﻡ ﺜﺒﺎﺕ ﻋﺎﻁﻔﻲ( – ﺍﻷﺨﻤﺎﺝ‬
‫ﺩﻭﻥ ﺍﻟﺴﺭﻴﺭﻴﺔ ﺃﻭ ﻏﻴﺭ ﺍﻟﻤﻤﻴﺯﺓ ﻜﺜﻴﺭﺓ ﺍﻟﺤﺩﻭﺙ‪.‬‬
‫ﻴﺤﺩﺙ ﻀﺨﺎﻤﺔ ﻁﺤﺎل‪ -‬ﻀﺨﺎﻤﺔ ﻤﻌﺘﺩﻟﺔ ﺃﻭ ﺒﺴﻴﻁﺔ ﻓﻲ ﺍﻟﻌﻘﺩ ﺍﻟﻠﻤﻔﺎﻭﻴﺔ‪ -‬ﻀﺨﺎﻤﺔ ﻜﺒﺩ‪.‬‬
‫ﻴﻤﻜﻥ ﺃﻥ ﻴﺨﺘﻠﻁ ﺍﻟﻤﺭﺽ ﺒﺎﻟﺘﻬﺎﺏ ﻋﻅﻡ ﺍﻟﻔﻘﺎﺭ‪ -‬ﺃﺫﻴﺎﺕ ﻋﻅﻤﻴﺔ‪ -‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﺨﺼﻴﺔ ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﺒﺭﺒﺦ‪ -‬ﺍﻟﺘﻬﺎﺏ‬
‫ﺍﻟﺸﻐﺎﻑ ﺘﺤﺕ ﺍﻟﺤﺎﺩ‪ -‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﺩﻤﺎﻍ‪.‬‬
‫ﻤﻌﺩل ﺍﻹﻤﺎﺘﺔ ﺃﻗل ﻤﻥ ‪ %٢‬ﻭﺍﻟﺸﻔﺎﺀ ﻫﻭ ﺍﻟﻤﻌﺘﺎﺩ ﻭﻟﻜﻥ ﺍﻟﻌﺠﺯ ﻴﻜﻭﻥ ﻭﺍﻀﺤﹰﺎ ﻓﻲ ﺍﻟﻐﺎﻟﺏ‪.‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫• ﺍﻟﺒﺭﻭﺴﻴﻼ ﺍﻟﻤﺠﻬﻀﺔ )‪.(br.abortus‬‬
‫• ﺍﻟﺒﺭﻭﺴﻴﻼ ﺍﻟﻤﺎﻟﻁﻴﺔ )‪.(br.Melitensis‬‬
‫• ﺍﻟﺒﺭﻭﺴﻴﻼ ﺍﻟﺨﺘﺭﻴﺭﻴﺔ )‪.(br.suis‬‬
‫• ﺍﻟﺒﺭﻭﺴﻴﻼ ﺍﻟﻜﻠﺒﻴﺔ )‪.(br.canis‬‬

‫ﺴﺠل ﻓﻲ ﺴﻭﺭﻴﺔ ﺍﻟﺒﺭﻭﺴﻴﻼ ﺍﻟﻤﺠﻬﻀﺔ ﻭﺍﻟﻤﺎﻟﻁﻴﺔ ﻓﻘﻁ‪.‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻟﻤﺎﺸﻴﺔ‪ ،‬ﺍﻷﻏﻨﺎﻡ‪ ،‬ﺍﻟﻤﺎﻋﺯ‪ ،‬ﺍﻟﺨﻨﺎﺯﻴﺭ‪ ،‬ﺍﻟﻜﻼﺏ )ﺍﻟﻤﺨﻤﻭﺠﺔ( ﻻ ﺘﻌﺘﺒﺭ ﺍﻟﺨﻨﺎﺯﻴﺭ ﻭﺍﻟﻜﻼﺏ ﻤﺴﺘﻭﺩﻋﹰﺎ ﻟﻠﻤﺭﺽ‬
‫ﻓﻲ ﺴﻭﺭﻴﺔ‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫• ﺍﻟﻁﺭﻴﻕ ﺍﻟﻬﻀﻤﻲ‪ :‬ﺘﻨﺎﻭل ﻤﻨﺘﺠﺎﺕ ﺍﻟﺤﻴﻭﺍﻥ ﺍﻟﻤﺼﺎﺏ ﻭﺨﺎﺼﺔ ﺍﻟﺤﻠﻴﺏ ﺍﻟﻨﻴﺊ ﺃﻭ ﺃﺤﺩ ﻤﺸﺘﻘﺎﺘﻪ )ﺍﻟﺠﺒﻥ(‪.‬‬
‫• ﺍﻟﺘﻤﺎﺱ ﻤﻊ ﺃﻨﺴﺠﺔ ﺍﻟﺤﻴﻭﺍﻥ‪) :‬ﺍﻟﺩﻡ‪ ،‬ﺍﻟﺒﻭل‪ ،‬ﺍﻟﻤﻔﺭﺯﺍﺕ ﺍﻟﻤﻬﺒﻠﻴﺔ‪ ،‬ﺍﻷﺠﻨﺔ ﺍﻟﻤﺠﻬﻀﺔ‪ ،‬ﺍﻟﻤﺸﻴﻤﺔ( ﻤﻥ ﺨﻼل‬
‫ﺴﺤﺠﺎﺕ ﺠﻠﺩﻴﺔ )ﻋﺩﻭﻯ ﻤﻬﻨﻴﺔ(‪.‬‬
‫• ﺍﻻﺴﺘﻨﺸﺎﻕ‪ :‬ﻓﻲ ﺍﻟﺤﻅﺎﺌﺭ ﻭﺍﻻﺼﻁﺒﻼﺕ‪ ،‬ﻭﺃﺤﻴﺎﻨﹰﺎ ﻓﻲ ﺍﻟﻤﺨﺎﺒﺭ ﻭﺍﻟﻤﺴﺎﻟﺦ‪.‬‬

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 ‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺇﻥ ﺸﺩﺓ ﻭﺩﻴﻤﻭﻤﺔ ﺍﻟﻤﺭﺽ ﻤﺘﻐﻴﺭﺓ‪ ،‬ﻜﻤﺎ ﺃﻥ ﻤﺩﺓ ﺍﻟﻤﻨﺎﻋﺔ ﺍﻟﻤﻜﺘﺴﺒﺔ ﻏﻴﺭ ﻤﺤﺩﺩﺓ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫‪ ٦٠-٥‬ﻴﻭﻡ‪ ،‬ﻭﺴﻁﻴﹰﺎ ‪ ٢-١‬ﺸﻬﺭ‪ ،‬ﺃﺤﻴﺎﻨﹰﺎ ﻨﺎﺩﺭﺓ ﻋﺩﺓ ﺃﺸﻬﺭ )ﺤﺘﻰ ‪ ٧‬ﺃﺸﻬﺭ(‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﺍﻹﻨﺴﺎﻥ ﻏﻴﺭ ﻤﻌﺩﻱ ﻟﻺﻨﺴﺎﻥ‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﺍﻋﺘﻤﺎﺩﹰﺍ ﻋﻠﻰ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻭﺒﻤﻌﺎﻭﻨﺔ ﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺨﺒﺭﻴﺔ‪.‬‬
‫• ﻨﻘﺹ ﺍﻟﻜﺭﻴﺎﺕ ﺍﻟﺒﻴﺽ ﻤﻊ ﺭﺠﺤﺎﻥ ﻨﺴﺒﻲ ﻟﻠﻤﻔﺎﻭﻴﺎﺕ‪.‬‬
‫• ﻋﺯل ﺍﻟﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ )ﺍﻟﺩﻡ‪ -‬ﻨﻘﻲ ﺍﻟﻌﻅﺎﻡ‪ -‬ﺴﺎﺌل ﺩﻤﺎﻏﻲ ﺸﻭﻜﻲ‪ -‬ﺃﻨﺴﺠﺔ ﺃﺨﺭﻯ(‪.‬‬
‫• ﺃﻜﺜﺭ ﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺨﺒﺭﻴﺔ ﺍﻟﻤﻌﺘﻤﺩﺓ ﻓﻲ ﺍﻟﺘﺸﺨﻴﺹ ﻫﻲ ﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺼﻠﻴﺔ )ﺘﻔﺎﻋل ﺭﺍﻴﺕ(‪ ،‬ﺤﻴﺙ ﻴﻜﻭﻥ ﻋﻴﺎﺭ‬
‫ﺍﻷﻀﺩﺍﺩ ﻤﺭﺘﻔﻊ ﺃﻭ ﺘﺭﺘﻔﻊ ﺍﻷﻀﺩﺍﺩ ﻓﻲ ﻓﺤﺼﻴﻥ ﻤﺘﺘﺎﻟﻴﻴﻥ ﻭﻗﺩ ﺘﻔﻴﺩ ﺍﻟﻔﺤﻭﺹ ﺍﻟﺘﻲ ﺘﻌﺎﻴﺭ ﺍﻷﻀﺩﺍﺩ ) ‪IgG‬‬
‫‪ (IgM‬ﻓﻲ ﺍﻟﺘﻔﺭﻴﻕ ﺒﻴﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺤﺎﺩﺓ )ﺍﺭﺘﻔﺎﻉ ﺍﻟـ ‪ (IgM‬ﻭﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺯﻤﻨﺔ )ﺍﺭﺘﻔﺎﻉ ﺍﻟـ ‪ ،(IgG‬ﻜﺘﻔﺎﻋل‬
‫ﻜﻭﻤﺒﺱ )‪ (CT‬ﻭﺘﺜﺒﻴﺕ ﺍﻟﻤﺘﻤﻤﺔ )‪ (CFT‬ﻭﺍﻻﻴﻠﻴﺯﺍ )‪.(ELISA‬‬

‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ ﻟﻠﺤﻤﻰ ﺍﻟﻤﺎﻟﻁﻴﺔ‬

‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ‪ :‬ﺤﺎﻟﺔ ﻤﺭﻴﺽ ﻴﺸﻜﻭ ﻤﻥ ﺤﺭﺍﺭﺓ ﻤﻊ ﻭﺍﺤﺩ ﺃﻭ ﺃﻜﺜﺭ ﻤﻥ ﺍﻷﻋﺭﺍﺽ ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‪:‬‬
‫ﺼﺩﺍﻉ‪ ،‬ﺘﻌﺭﻕ ﻏﺯﻴﺭ )ﺨﺎﺼﺔ ﻟﻴﻠﻲ(‪ ،‬ﻨﻭﺍﻓﺽ‪ ،‬ﺁﻻﻡ ﻤﻔﺼﻠﻴﺔ‪ ،‬ﺘﻌﺏ‪ ،‬ﺃﻋﺭﺍﺽ ﻨﻔﺴﻴﺔ‪ ،‬ﻀﺨﺎﻤﺔ ﻁﺤﺎل‪،‬‬
‫ﻀﺨﺎﻤﺔ ﻜﺒﺩ‪...‬‬

‫ﺃﻭ ﺤﺎﻟﺔ ﻤﺭﺘﺒﻁﺔ ﻭﺒﺎﺌﻴﹰﺎ ﺒﺤﺎﻟﺔ ﺤﻴﻭﺍﻥ )ﻤﺼﺎﺏ ﺃﻭ ﻤﺸﺘﺒﻪ ﺇﺼﺎﺒﺘﻪ( ﺃﻭ ﺒﻤﻨﺘﺠﺎﺘﻪ‪.‬‬

‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺭﺠﺤﺔ‪ :‬ﺤﺎﻟﺔ ﻤﺸﺘﺒﻬﺔ ﻤﻊ ﻋﻴﺎﺭ ﺃﻀﺩﺍﺩ ﻤﺭﺘﻔﻊ )ﺘﻔﺎﻋل ﺭﺍﻴﺕ < ‪ (١٦٠/١‬ﻭﺍﺭﺘﻔﺎﻉ ﻋﻴﺎﺭ ﺍﻷﻀﺩﺍﺩ‬
‫ﺒﻔﺤﺼﻴﻥ ﻤﺘﺘﺎﻟﻴﻴﻥ‪.‬‬
‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺅﻜﺩﺓ‪ :‬ﺤﺎﻟﺔ ﻤﺭﺠﺤﺔ ﻤﻊ ﻋﺯل ﻟﻠﻌﺎﻤل ﺍﻟﻤﻤﺭﺽ )ﺍﻟﺩﻡ‪ ،‬ﻨﻘﻲ ﺍﻟﻌﻅﺎﻡ‪ ،‬ﺍﻟﺠﻬﺎﺯ ﺍﻟﺸﺒﻜﻲ ﺍﻟﺒﻁﺎﻨﻲ‪.(...‬‬

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 ‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬

‫• ﺍﻟﻜﺸﻑ ﺍﻟﻤﺒﻜﺭ ﻋﻥ ﺍﻟﺤﺎﻻﺕ ﻭﺇﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ ﺃﻭ ﺍﻟﻤﺭﺠﺤﺔ )ﻭﻓﻕ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ( ﺇﻟﻰ ﺍﻟﻤﺭﺍﻜﺯ‬
‫ﺍﻟﻤﺨﺼﺼﺔ ﻟﺘﺩﺒﻴﺭ ﺍﻟﺤﺎﻻﺕ )ﻴﻭﺠﺩ ﻤﺭﻜﺯ ﻭﺍﺤﺩ ﻓﻲ ﻜل ﻤﺤﺎﻓﻅﺔ(‪.‬‬
‫• ﻴﺘﻡ ﻓﻲ ﺍﻟﻤﺭﻜﺯ ﺘﻌﺒﺌﺔ ﺍﺴﺘﻤﺎﺭﺓ ﺨﺎﺼﺔ ﺒﺎﻟﻤﺭﻀﻰ ﺘﻔﺭﻍ ﺒﺘﻘﺭﻴﺭ ﺸﻬﺭﻱ ﻴﺘﻀﻤﻥ ﺒﻴﺎﻨﺎﺕ ﻋﻥ ﺍﻟﻤﺭﻴﺽ )ﺍﻟﺴﻥ‪،‬‬
‫ﺍﻟﺠﻨﺱ‪ ،‬ﺍﻟﻤﻬﻨﺔ( ﻨﺘﺎﺌﺞ ﺍﻟﻔﺤﺹ ﺍﻟﻤﺨﺒﺭﻱ‪ ...‬ﺍﻟﺦ( ﻴﺭﺴل ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ‬
‫ﺍﻟﻤﺸﺘﺭﻜﺔ ﻋﺒﺭ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪ (٢٣‬ﻭﻴﺘﻡ ﻓﻲ ﺍﻟﻤﺭﻜﺯ‬
‫ﺘﻘﺩﻴﻡ ﺍﻟﻌﻼﺝ ﺤﺴﺏ ﺍﻟﺨﻁﺔ ﺍﻟﻭﻁﻨﻴﺔ ﻜﻤﺎ ﻴﺘﻡ ﺘﺤﺩﻴﺩ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻷﺩﻭﻴﺔ ﻭﻁﻠﺒﻬﺎ ﻓﻲ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻷﻋﻠﻰ‪.‬‬
‫• ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻥ ﺍﻟﻔﺎﺸﻴﺎﺕ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ‪.‬‬
‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﻔﺎﺸﻴﺎﺕ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻭﺒﺎﺌﻲ ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ ﻭﺍﻟﻤﺴﺎﻫﻤﺔ ﻓﻲ‬
‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‪.‬‬
‫• ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﺤﻭل ﻀﺭﻭﺭﺓ ﻏﻠﻲ ﺃﻭ ﺘﻌﻘﻴﻡ ﺃﻭ ﺒﺴﺘﺭﺓ ﺍﻟﺤﻠﻴﺏ ﻭﻤﻨﺘﺠﺎﺘﻪ ﻭﻁﻬﻲ ﺍﻟﻁﻌﺎﻡ ﺒﺸﻜل ﺠﻴﺩ‪،‬‬
‫ﻭﺘﻭﻋﻴﺔ ﺍﻟﻤﺯﺍﺭﻋﻴﻥ ﻭﺍﻟﺒﻴﻁﺭﻴﻴﻥ ﻭﻋﻤﺎل ﺍﻟﻤﺴﺎﻟﺦ ﻭﺍﻟﻤﺒﺎﻗﺭ ﻋﻥ ﻁﺭﻕ ﺍﻟﻌﺩﻭﻯ ﻭﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻤﺎﺭﺴﺔ ﺍﻟﺴﻠﻤﻴﺔ‬
‫ﻋﻨﺩ ﺍﻟﺘﻌﺎﻤل ﻤﻊ ﺍﻟﻤﺎﺸﻴﺔ ﻭﺍﻷﻏﻨﺎﻡ )ﻟﺒﺱ ﺍﻟﻘﻔﺎﺯﺍﺕ ﻭﺍﻟﺤﺫﺍﺀ ﻭﺍﻟﻜﻤﺎﻤﺎﺕ‪ ...‬ﺇﻟﺦ(‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻤﺤﻠﻲ )ﻤﺭﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ( ﻋﻨﺩ ﺤﺩﻭﺙ ﺍﻟﻔﺎﺸﻴﺎﺕ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻠﻔﺎﺸﻴﺎﺕ ﻟﻤﻌﺭﻓﺔ ﻤﺼﺩﺭ ﺍﻟﻌﺩﻭﻯ‪.‬‬
‫• ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ ﺤﺴﺏ ﻨﺘﺎﺌﺞ ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﺒﺎﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻟﺤﻜﻭﻤﻴﺔ ﻭﺍﻟﺨﺎﺼﺔ( ﻤﺜل‬
‫ﺴﺤﺏ ﺍﻟﻤﺎﺩﺓ ﺍﻟﻤﺘﻬﻤﺔ ﻤﻥ ﺍﻟﺴﻭﻕ ﻭﺃﺨﺫ ﻋﻴﻨﺎﺕ ﻟﻠﺘﺤﻠﻴل ﺍﻟﻤﺨﺒﺭﻱ ﻭﺇﻴﻘﺎﻑ ﺍﻹﻨﺘﺎﺝ ﻭﺍﻟﺘﻭﺯﻴﻊ ﺤﺘﻰ ﺍﻟﺘﺄﻜﺩ ﻤﻥ‬
‫ﺍﺘﺨﺎﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻁﻠﻭﺒﺔ‪ ،‬ﻭﺍﻟﺘﺄﻜﺩ ﻤﻥ ﻗﻴﺎﻡ ﺍﻟﻭﺤﺩﺍﺕ ﺍﻟﺒﻴﻁﺭﻴﺔ ﺒﺈﺠﺭﺍﺀ ﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺼﻠﻴﺔ ﻋﻠﻰ ﺍﻟﺤﻴﻭﺍﻨﺎﺕ‬
‫ﺍﻟﻤﺸﺘﺒﻪ ﺇﺼﺎﺒﺘﻬﺎ‪ ،‬ﻭﻋﺯل ﺍﻟﻤﺼﺎﺒﺔ ﻤﻨﻬﺎ‪ ،‬ﻭﻤﺭﺍﻗﺒﺔ ﺍﻟﺤﻠﻴﺏ ﺍﻟﻨﺎﺘﺞ ﺒﺈﺠﺭﺍﺀ ﺍﺨﺘﺒﺎﺭ ﺍﻟﺤﻠﻘﺔ‪ ،‬ﻭﺘﻤﻨﻴﻴﻊ ﺍﻟﻤﺎﻋﺯ‬
‫ﻭﺍﻟﺨﺭﻓﺎﻥ ﺍﻟﺼﻐﻴﺭﺓ ﺒﺎﻟﺫﺭﻴﺔ ﺍﻟﺤﻴﺔ ﺍﻟﻤﻭﻫﻨﺔ ﻤﻥ ﺍﻟﺒﺭﻭﺴﻴﻼ ﺍﻟﻤﺎﻟﻁﻴﺔ )‪ (Rev1‬ﻭﺘﻤﻨﻴﻊ ﺍﻟﻌﺠﻭل ﺒﺎﻟﺫﺭﻴﺔ )‪(١٩‬‬
‫ﻤﻥ ﺍﻟﺒﺭﻭﺴﻴﻼ ﺍﻟﻤﺠﻬﻀﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬
‫• ﺭﻓﻊ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺸﻬﺭﻴﺔ ﻭﺘﻘﺎﺭﻴﺭ ﺍﻟﻔﺎﺸﻴﺎﺕ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﺸﺘﺭﻜﺔ ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪.‬‬
‫• ﺘﺴﺠﻴل ﺍﻟﺤﺎﻻﺕ ﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺭﻓﻌﻪ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﻓﻲ ﻤﺩﻴﺭﻴﺔ‬
‫ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ )ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ‪.(٣‬‬
‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﻟﻠﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ‪.‬‬

‫‪١٤١‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﻋﻤل ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﻤﺨﺼﺼﺔ ﻟﺘﺩﺒﻴﺭ ﺍﻟﺤﺎﻻﺕ ﻭﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ‪ ،‬ﺨﺎﺼﺔ ﺒﻤﺎ ﻴﺘﻌﻠﻕ‬
‫ﺒﺘﻨﻔﻴﺫ ﺨﻁﺔ ﺍﻟﻌﻼﺝ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﻭﺘﻭﺯﻴﻊ ﺍﻷﺩﻭﻴﺔ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﻤﻭﺍﺩ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ ﻭﺍﻟﻤﺴﺎﻫﻤﺔ ﻓﻲ ﻋﻤﻠﻴﺔ ﺍﻟﺘﺜﻘﻴﻑ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻤﻥ ﺨﻼل ﺍﻟﻤﺠﻠﺱ ﺍﻟﺼﺤﻲ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻁﺎﺭﺌﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻘﻁﺭ‪.‬‬
‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﻟﻠﻤﺴﺘﻭﻴﺎﺕ ﺍﻷﺩﻨﻰ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﻋﻤل ﺍﻟﻤﺭﺍﻜﺯ ﺩﻭﺍﺌﺭ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﻤﺨﺼﺼﺔ ﻟﺘﺩﺒﻴﺭ ﺍﻟﺤﺎﻻﺕ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﻭﺴﺎﺌل ﻭﻤﻭﺍﺩ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪.‬‬
‫• ﺘﻘﺩﻴﺭ ﺍﻻﺤﺘﻴﺎﺠﺎﺕ ﻤﻥ ﺍﻷﺩﻭﻴﺔ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﺍﻟﺩﺭﺍﺴﺎﺕ ﻭﺍﻟﻤﺴﻭﺡ ﻟﻤﻌﺭﻓﺔ ﻤﻌﺩل ﺍﻨﺘﺸﺎﺭ ﺍﻟﻤﺭﺽ ﺨﺎﺼﺔ ﺍﻟﻔﺌﺎﺕ ﺍﻟﻤﻌﺭﻀﺔ ﻟﻺﺼﺎﺒﺔ )ﺍﻟﻤﺯﺍﺭﻋﻴﻥ‪،‬‬
‫ﻋﻤﺎل ﺍﻟﻤﺴﺎﻟﺦ ﻭﺍﻟﻤﺒﺎﻗﺭ‪...‬ﺍﻟﺦ(‪.‬‬
‫• ﻭﻀﻊ ﺍﻟﺨﻁﺔ ﺍﻟﻌﻼﺠﻴﺔ ﻭﻤﺘﺎﺒﻌﺔ ﺘﻁﺒﻴﻘﻬﺎ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻤﻥ ﺨﻼل ﺍﻟﻠﺠﻨﺔ ﺍﻟﻭﻁﻨﻴﺔ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﺸﺘﺭﻜﺔ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬

‫ﺨﻁﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ‬
‫ﻤﺩﺓ ﺍﻟﻌﻼﺝ ‪ ٦‬ﺃﺴﺎﺒﻴﻊ ﻋﻠﻰ ﺍﻷﻗل ﺤﺘﻰ ﻭﻟﻭ ﺯﺍﻟﺕ ﻜﺎﻓﺔ ﺍﻷﻋﺭﺍﺽ ﺍﻟﻤﺭﻀﻴﺔ ﺒﺼﻭﺭﺓ ﻤﺒﻜﺭﺓ‪ ،‬ﻴﻭﺠﺩ ﻋﺩﺓ‬
‫ﺃﻨﻅﻤﺔ ﻋﻼﺠﻴﺔ ﻤﻌﺘﻤﺩﺓ ﻤﻥ ﻗﺒل ﻤﻨﻅﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ‪ ،‬ﻴﻤﻜﻥ ﻟﻠﻁﺒﻴﺏ ﺍﺨﺘﻴﺎﺭ ﺃﺤﺩﻫﺎ ﺘﺒﻌﹰﺎ ﻟﻠﺤﺎﻟﺔ ﺍﻟﻤﺭﻴﺽ‬
‫ﻭﻋﻤﺭﻩ ﻭﺘﻭﻓﺭ ﺍﻟﺩﻭﺍﺀ‪ ،‬ﻭﻫﺫﻩ ﺍﻷﻨﻅﻤﺔ ﺍﻟﻌﻼﺠﻴﺔ ﻫﻲ‪:‬‬

‫‪ -‬ﺘﺘﺭﺍﺴﻴﻜﻠﻴﻥ ﻟﻤﺩﺓ ‪ ٦‬ﺃﺴﺎﺒﻴﻊ )‪ ٥٠٠‬ﻤﻎ ‪ ٤‬ﻤﺭﺍﺕ ﻴﻭﻤﻴﹰﺎ = ‪ ٥٠ - ٣٠‬ﻤﻎ‪/‬ﻜﻎ(‪.‬‬ ‫• ﺍﻟﻨﻅﺎﻡ ﺍﻷﻭل‪:‬‬

‫‪ -‬ﺴﺘﺭﺒﺘﻭﻤﺎﻴﺴﻴﻥ ﻟﻤﺩﺓ ﺃﺴﺒﻭﻋﻴﻥ )‪ ٠.٥‬ﻍ ﻤﺭﺘﻴﻥ ﻴﻭﻤﻴﹰﺎ = ‪ ٢٠‬ﻤﻎ‪/‬ﻜﻎ(‪.‬‬

‫ﻻ ﻴﺴﺘﻌﻤل ﻫﺫﺍ ﺍﻟﻨﻅﺎﻡ ﻋﻨﺩ ﺍﻷﻁﻔﺎل ﺩﻭﻥ ﺍﻟﺜﻤﺎﻨﻲ ﺴﻨﻭﺍﺕ ﻭﻋﻨﺩ ﺍﻟﻨﺴﺎﺀ ﺍﻟﺤﻭﺍﻤل‪.‬‬

‫‪ -‬ﺩﻭﻜﺴﻴﺴﻴﻜﻠﻴﻥ ﻟﻤﺩﺓ ‪ ٦‬ﺃﺴﺎﺒﻴﻊ )‪ ٢٠٠‬ﻤﻎ ﻴﻭﻤﻴﹰﺎ = ‪ ٤‬ﻤﻎ‪/‬ﻜﻎ(‪.‬‬ ‫• ﺍﻟﻨﻅﺎﻡ ﺍﻟﺜﺎﻨﻲ‪:‬‬

‫‪ -‬ﺭﻴﻔﺎﻤﺒﻴﺴﻴﻥ ﻟﻤﺩﺓ ‪ ٦‬ﺃﺴﺎﺒﻴﻊ )‪ ٩٠٠ - ٦٠٠‬ﻤﻎ ﻴﻭﻤﻴﹰﺎ = ‪ ١٥ - ١٠‬ﻤﻎ‪/‬ﻜﻎ(‪.‬‬

‫ﻴﺸﺒﻪ ﻫﺫﺍ ﺍﻟﻨﻅﺎﻡ ﻤﺎ ﺴﺒﻘﻪ ﻤﻥ ﺤﻴﺙ ﺍﻟﺘﺤﺫﻴﺭﺍﺕ ﻟﻜﻨﻪ ﺃﺴﻬل ﻭﺃﻜﺜﺭ ﻜﻠﻔﺔ‪.‬‬

‫‪١٤٢‬‬
 ‫‪ -‬ﺭﻴﻔﺎﻤﺒﻴﺴﻴﻥ ﻟﻤﺩﺓ ‪ ٦‬ﺃﺴﺎﺒﻴﻊ )‪ ٩٠٠ - ٦٠٠‬ﻤﻎ ﻴﻭﻤﻴﹰﺎ = ‪ ١٥ - ١٠‬ﻤﻎ‪/‬ﻜﻎ(‪.‬‬ ‫• ﺍﻟﻨﻅﺎﻡ ﺍﻟﺜﺎﻟﺙ‪:‬‬
‫‪ -‬ﻜﻭﺘﺭﻴﻤﻭﻜﺴﺎﺯﻭل ﻟﻤﺩﺓ ‪ ٦‬ﺃﺴﺎﺒﻴﻊ )‪ ٦‬ﺤﺒﺎﺕ ﻟﻤﺩﺓ ﺃﺴﺒﻭﻋﻴﻥ‪ ،‬ﺜﻡ ‪ ٤‬ﺤﺒﺎﺕ ﻟﻤﺩﺓ ‪٤‬‬
‫ﺃﺴﺎﺒﻴﻊ(‪.‬‬

‫ﻴﻌﺘﺒﺭ ﻫﺫﺍ ﺍﻟﻨﻅﺎﻡ ﻫﻭ ﺍﻟﻤﻔﻀل ﻋﻨﺩ ﺍﻷﻁﻔﺎل ﻭﺍﻟﺤﻭﺍﻤل‪.‬‬

‫ﻴﺤﺩﺙ ﺍﻟﻨﻜﺱ ﻓﻲ ‪ %٥‬ﻤﻥ ﺍﻟﻤﺭﻀﻰ ﺍﻟﻤﻌﺎﻟﺠﻴﻥ )ﻟﻴﺱ ﺒﺴﺒﺏ ﺍﻟﻤﻘﺎﻭﻤﺔ ﺍﻟﺠﺭﺜﻭﻤﻴﺔ( ﻟﺫﻟﻙ ﻴﺠﺏ ﺇﻋﺎﺩﺓ ﻨﻔﺱ‬
‫ﺍﻟﻌﻼﺝ ﺍﻷﺼﻠﻲ‪.‬‬

‫ﻋﻼﺝ ﺍﻻﺨﺘﻼﻁﺎﺕ ﻭﺍﻟﺤﺎﻻﺕ ﺍﻟﺸﺩﻴﺩﺓ )ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﻭﺍﻟﺩﻤﺎﻍ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﻌﻅﻡ ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﻤﻔﺼل‪،‬‬
‫ﺍﻟﺘﻬﺎﺏ ﺍﻟﺸﻐﺎﻑ ﺍﻟﻘﻠﺏ‪ ...‬ﺇﻟﺦ(‪:‬‬
‫ﻴﺴﺘﺨﺩﻡ ﻓﻲ ﺍﻟﻌﻼﺝ ﺜﻼﺙ ﺃﺩﻭﻴﺔ )ﺍﻟﺴﺘﺭﺒﺘﻭﻤﻴﺴﻴﻥ ﻭﺍﻟﺩﻭﻜﺴﻴﺴﻴﻜﻠﻴﻥ ﻤﻊ ﺍﻟﻜﻭﺘﺭﻴﻤﻭﻜﺴﺎﺯﻭل ﺃﻭ ﺍﻟﺭﻴﻔﺎﻤﺒﻴﺴﻴﻥ(‪،‬‬
‫ﻭﺘﻤﺩﺩ ﻓﺘﺭﺓ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺤﺘﻰ ‪ ٨‬ﺃﺴﺎﺒﻴﻊ ﺃﻭ ﺃﻜﺜﺭ‪.‬‬

‫‬

‫‪‬‬ ‫‬

‫‪١٤٣‬‬
 ‫‪‬‬
‫‪‬א‪ Rabies‬‬
‫‪‬א‪‬א‪ ‬‬
‫ﺍﻟﺘﻬﺎﺏ ﺩﻤﺎﻏﻲ ﻨﺨﺎﻋﻲ ﻓﻴﺭﻭﺴﻲ ﺤﺎﺩ ﻤﻤﻴﺕ ﺩﺍﺌﻤ ﹰﺎ ﻴﻜﻭﻥ ﺍﻟﺒﺩﺀ ﺒﺄﻟﻡ ﻭﺸﻭﺍﺵ ﺍﻟﺤﺱ ﻤﻜﺎﻥ ﺍﻟﻌﻀﺔ‪ ،‬ﺜﻡ ﻴﻠﻴﻬﺎ‬
‫ﺃﻋﺭﺍﺽ ﻋﺎﻤﺔ )ﺤﻤﻰ ﺨﻔﻴﻔﺔ‪ ،‬ﻗﻠﻕ‪ ،‬ﺼﺩﺍﻉ‪ ،‬ﻗﻬﻡ‪ ،‬ﻏﺜﻴﺎﻥ‪ ،‬ﺇﻗﻴﺎﺀ‪ ،‬ﺃﻟﻡ ﻓﻲ ﺍﻟﺒﻠﻌﻭﻡ(‪ ،‬ﺜﻡ ﻓﺭﻁ ﺍﻟﺤﺱ ﻭﺴﺭﻋﺔ‬
‫ﺍﻻﺴﺘﺜﺎﺭﺓ ﺒﻤﻨﺒﻬﺎﺕ ﺨﻔﻴﻔﺔ )ﺍﻟﻀﻭﺀ‪ ،‬ﺍﻟﻀﺠﻴﺞ‪ ،‬ﺍﻟﻠﻤﺱ‪ ،‬ﺸﺭﺏ ﺍﻟﻤﺎﺀ‪ (...‬ﺤﻴﺙ ﺘﺜﺎﺭ ﻤﺭﺍﻜﺯ ﺍﻟﺒﻠﻊ ﻭﺍﻟﺘﻨﻔﺱ ﻭﺘﺅﺩﻱ‬
‫ﺇﻟﻰ ﺘﺸﻨﺠﺎﺕ ﻤﺅﻟﻤﺔ ﻓﻲ ﻋﻀﻼﺕ ﺍﻟﺒﻠﻌﻭﻡ ﻭﺍﺨﺘﻼﺠﺎﺕ ﻓﻲ ﺍﻟﺤﺠﺎﺏ ﺍﻟﺤﺎﺠﺯ ﻭﺍﻟﻌﻀﻼﺕ ﺍﻟﺘﻨﻔﺴﻴﺔ ﻋﻨﺩ ﻤﺤﺎﻭﻟﺔ‬
‫ﺸﺭﺏ ﺍﻟﻤﺎﺀ‪ ،‬ﻭﺍﻟﻨﺘﻴﺠﺔ ﺃﻥ ﻻ ﻴﺘﻤﻜﻥ ﺍﻟﻤﺭﻴﺽ ﻤﻥ ﺍﻟﺸﺭﺏ ﺭﻏﻡ ﻋﻁﺸﻪ ﺍﻟﺸﺩﻴﺩ )ﻟﺫﻟﻙ ﻴﺘﺠﻨﺏ ﺍﻟﻤﺭﻴﺽ ﻟﺸﺭﺏ‬
‫ﺍﻟﻤﺎﺀ ﻭﻫﺫﺍ ﻤﺎ ﻴﺴﻤﻰ ﺒﺭﻫﺎﺏ ﺍﻟﻤﺎﺀ(‪.‬‬
‫ﻴﺘﻁﻭﺭ ﺍﻟﻬﻤﻭﺩ ﺍﻟﻌﻘﻠﻲ ﺇﻟﻰ ﻫﻴﺎﺝ ﻭﻫﺫﻴﺎﻨﺎﺕ ﻭﺇﻫﻼﺴﺎﺕ ﻭﺘﺼﺭﻓﺎﺕ ﺠﻨﻭﻨﻴﺔ ﺤﺘﻰ ﻴﺼل ﺍﻟﻤﺭﻴﺽ ﺇﻟﻰ ﺍﻟﺴﺒﺎﺕ‪،‬‬
‫ﻓﺎﻟﻤﻭﺕ ﺒﺈﺼﺎﺒﺔ ﻤﺭﺍﻜﺯ ﺍﻟﺘﻨﻔﺱ‪.‬‬

‫ﺍﻟﻌﺎﻤل ﺍﻟﺨﺎﻤﺞ‪:‬‬
‫ﻓﻴﺭﻭﺱ ﺍﻟﻜﻠﺏ ‪ Rabies Virus‬ﻤﻥ ﺍﻟﻔﻴﺭﻭﺴﺎﺕ ﺍﻟﺭﺒﺩﻴﺔ ‪.Rhabdoviruses‬‬

‫ﺍﻟﻤﺴﺘﻭﺩﻉ‪:‬‬
‫ﺍﻟﺤﻴﻭﺍﻨﺎﺕ ﺍﻟﺒﺭﻴﺔ ﺍﻟﻤﺨﻤﻭﺠﺔ ﻤﻥ ﻓﺼﻴﻠﺔ ﺍﻟﻠﻭﺍﺤﻡ )ﺍﻟﻜﻠﺏ‪ ،‬ﺍﻟﺜﻌﻠﺏ‪ ،‬ﺍﻟﺫﺌﺏ‪ ،‬ﺍﻟﺭﺍﻜﻭﻥ‪ ،‬ﺍﻟﻅﺭﺒﺎﻥ‪ ،‬ﺒﻨﺎﺕ ﺁﻭﻯ‪،‬‬
‫ﺍﻟﺜﻌﺎﻟﺏ ﺍﻟﻘﻁﺒﻴﺔ‪ ،‬ﺍﻟﺨﻔﺎﻓﻴﺵ ﺍﻟﻤﺎﺼﺔ ﻟﻠﺩﻤﺎﺀ ﻭﺁﻜﻠﺔ ﺍﻟﺤﺸﺭﺍﺕ ﻭﺍﻟﻔﻭﺍﻜﻪ ﻓﻲ ﺃﻤﺭﻴﻜﺎ(‪ .‬ﺤﻴﺙ ﻴﻤﻜﻥ ﺃﻥ ﺘﻨﻘل ﺍﻟﻤﺭﺽ‬
‫ﺒﺎﻟﻌﺽ ﺇﻟﻰ ﺠﻤﻴﻊ ﺍﻟﺤﻴﻭﺍﻨﺎﺕ ﺍﻟﺒﺭﻴﺔ ﺍﻟﻌﺎﺸﺒﺔ ﻭﺍﻷﻟﻴﻔﺔ ﻭﺍﻹﻨﺴﺎﻥ )ﺫﻭﺍﺕ ﺍﻟﺩﻡ ﺍﻟﺤﺎﺭ(‪ .‬ﻨﺎﺩﺭﹰﺍ ﻤﺎ ﺘﻨﺨﻤﺞ ﺍﻷﺭﺍﻨﺏ‬
‫ﻭﺍﻟﺴﻨﺎﺠﺏ ﻭﺍﻟﺠﺭﺫﺍﻥ ﻭﺍﻟﻔﺌﺭﺍﻥ‪ ،‬ﻭﻋﻀﺎﺘﻬﺎ ﻻ ﺘﺴﺘﺩﻋﻲ ﺇﺠﺭﺍﺀ ﺍﻻﺘﻘﺎﺀ ﻀﺩ ﺩﺍﺀ ﺍﻟﻜﻠﺏ‪.‬‬

‫ﻁﺭﻕ ﺍﻻﻨﺘﻘﺎل‪:‬‬
‫ﺘﻤﺎﺱ ﻤﻊ ﻟﻌﺎﺏ ﺍﻟﺤﻴﻭﺍﻥ ﺍﻟﻤﺨﻤﻭﺝ ﻤﻥ ﺨﻼل ﺠﺭﻭﺡ ﺍﻟﻌﻀﺎﺕ‪ ،‬ﻭﺍﻟﺨﺩﻭﺵ‪ ،‬ﺃﻭ ﻨﺎﺩﺭﹰﺍ ﻤﻥ ﺨﻼل ﺍﻷﻏﺸﻴﺔ‬
‫ﺍﻟﻤﺨﺎﻁﻴﺔ ﺍﻟﺴﻠﻴﻤﺔ‪ ،‬ﻭﺍﻻﻨﺘﻘﺎل ﻤﻥ ﺸﺨﺹ ﻟﺸﺨﺹ ﻤﻤﻜﻥ ﻷﻥ ﻟﻌﺎﺏ ﺍﻹﻨﺴﺎﻥ ﺍﻟﻤﺨﻤﻭﺝ ﻴﺤﻭﻱ ﺍﻟﻔﻴﺭﻭﺱ‪.‬‬

‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻭﺍﻟﻤﻘﺎﻭﻤﺔ‪:‬‬
‫ﺍﻻﺴﺘﻌﺩﺍﺩ ﻋﺎﻡ ﻋﻨﺩ ﺍﻟﺒﺸﺭ ﻭﺠﻤﻴﻊ ﺍﻟﺜﺩﻴﻴﺎﺕ ﻤﻥ ﺫﻭﺍﺕ ﺍﻟﺩﻡ ﺍﻟﺤﺎﺭ‪ ،‬ﻭﻻ ﺘﻭﺠﺩ ﻤﻨﺎﻋﺔ ﻁﺒﻴﻌﻴﺔ ﻋﻨﺩ ﺍﻹﻨﺴﺎﻥ‪.‬‬

‫ﺩﻭﺭ ﺍﻟﺤﻀﺎﻨﺔ‪:‬‬
‫‪ ١٠‬ﺃﻴﺎﻡ ﺤﺘﻰ ﺴﻨﺔ ﺃﻭ ﺃﻜﺜﺭ‪ ،‬ﻭﺴﻁﻴﹰﺎ )‪ (٨-٤‬ﺃﺴﺎﺒﻴﻊ‪ ،‬ﻭﻫﻭ ﻴﺘﻭﻗﻑ ﻋﻠﻰ ﺸﺩﺓ ﺍﻟﺠﺭﺡ ﻭﻤﻭﻗﻌﻪ ﻭﻤﺩﻯ ﻏﻨﺎﻩ‬
‫ﺒﺎﻷﻋﺼﺎﺏ ﻭﺒﻌﺩ ﺍﻟﺠﺭﺡ ﻋﻥ ﺍﻟﻤﺦ ﻭﻤﻘﺩﺍﺭ ﺍﻟﻔﻴﺭﻭﺱ ﺍﻟﻤﺩﺨل‪.‬‬

‫‪١٤٤‬‬
 ‫ﺩﻭﺭ ﺍﻟﺴﺭﺍﻴﺔ‪:‬‬
‫ﻓﻲ ﺍﻟﻜﻼﺏ ﻭﺍﻟﻘﻁﻁ ﻟﻤﺩﺓ )‪ (٥-٣‬ﺃﻴﺎﻡ ﻗﺒل ﺒﺩﺀ ﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻭﺃﺜﻨﺎﺀ ﺴﻴﺭ ﺍﻟﻤﺭﺽ‪.‬‬

‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫ﻋﻨﺩ ﺍﻟﺤﻴﻭﺍﻥ ﺒﻔﺤﺹ ﺩﻤﺎﻍ ﺍﻟﺤﻴﻭﺍﻥ ﺒﻌﺩ ﻗﺘﻠﻪ ﺒﺎﻟﻤﺠﻬﺭ ﺍﻟﻭﻤﻀﺎﺌﻲ )ﺍﺨﺘﺒﺎﺭ ﺍﻷﻀﺩﺍﺩ ﺍﻟﻤﺘﺄﻟﻘﺔ(‪.‬‬

‫ﻋﻨﺩ ﺍﻹﻨﺴﺎﻥ‪ :‬ﺒﺎﻻﻋﺘﻤﺎﺩ ﻋﻠﻰ ﺍﻟﻘﺼﺔ ﺍﻟﻤﺭﻀﻴﺔ )ﺘﻌﺭﺽ ﻟﻌﻀﺔ ﺤﻴﻭﺍﻥ ﻤﺸﺘﺒﻪ(‪ ،‬ﺇﻀﺎﻓﺔ ﺇﻟﻰ ﺍﻷﻋﺭﺍﺽ‬
‫ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‪.‬‬

‫ﺨﻁﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ‪:‬‬
‫ﺇﻥ ﻤﻌﺎﻟﺠﺔ ﺍﻟﻤﺭﻀﻰ ﻫﻲ ﻤﻌﺎﻟﺠﺔ ﻋﺭﻀﻴﺔ ﻟﺩﻋﻡ ﺍﻟﺠﻬﺎﺯ ﺍﻟﺘﻨﻔﺴﻲ ﻭﺍﻟﺩﻭﺭﺍﻨﻲ ﻭﺍﻟﻌﺼﺒﻲ‪ ،‬ﻫﺫﻩ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻗﺩ‬
‫ﺘﺅﺨﺭ ﺍﻟﻤﺼﻴﺭ ﺍﻟﻤﺤﺘﻭﻡ ﻟﻠﻤﺭﻴﺽ ﻭﻟﻜﻨﻬﺎ ﻻ ﺘﻐﻴﺭﻩ ﻭﻫﻭ ﺍﻟﻤﻭﺕ‪.‬‬

‫ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻘﻴﺎﺴﻲ ﻟﺩﺍﺀ ﺍﻟﻜﻠﺏ‬

‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺸﺘﺒﻬﺔ‪ :‬ﺸﺨﺹ ﻅﻬﺭﺕ ﻋﻠﻴﻪ ﺃﻋﺭﺍﺽ ﻭﻋﻼﻤﺎﺕ ﺍﻟﻤﺭﺽ ﺍﻟﺴﺭﻴﺭﻴﺔ‪ ،‬ﺒﺩﻭﻥ ﻤﻌﺭﻓﺔ ﻗﺼﺘﻪ ﺍﻟﻤﺭﻀﻴﺔ‪.‬‬

‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺭﺠﺤﺔ‪ :‬ﺤﺎﻟﺔ ﻤﺸﺘﺒﻬﺔ ﻤﻊ ﻗﺼﺔ ﺘﻤﺎﺱ ﻤﻊ ﺤﻴﻭﺍﻥ ﻤﺸﺘﺒﻪ ﺇﺼﺎﺒﺘﻪ‪.‬‬

‫• ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺅﻜﺩﺓ‪ :‬ﺤﺎﻟﺔ ﻤﺸﺘﺒﻬﺔ ﻤﻊ ﺘﺄﻜﻴﺩ ﻤﺨﺒﺭﻱ‪.‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺭﺼﺩ ﻭﺍﻟﻤﻜﺎﻓﺤﺔ‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺤﻴﻁﻲ‪:‬‬

‫• ﺘﺩﺒﻴﺭ ﺤﺎﻻﺕ ﺍﻟﻌﺽ ﺒﺎﻹﺴﻌﺎﻓﺎﺕ ﺍﻷﻭﻟﻴﺔ ﺍﻟﺘﻲ ﺘﺘﻀﻤﻥ ﺘﻨﻅﻴﻑ ﺍﻟﺠﺭﺡ ﺠﻴﺩﹰﺍ ﺒﺎﻟﻤﺎﺀ ﻭﺍﻟﺼﺎﺒﻭﻥ ﺃﻭ ﺍﻟﻤﻁﻬﺭﺍﺕ‬
‫ﻭﻋﺩﻡ ﺨﻴﺎﻁﺘﻪ ﺃﻭ ﺘﻨﻀﻴﺭﻩ‪ ،‬ﻭﺇﺤﺎﻟﺔ ﺍﻟﺸﺨﺹ ﺍﻟﻤﻌﻀﻭﺽ ﻤﺒﺎﺸﺭﺓ ﺇﻟﻰ ﺃﻗﺭﺏ ﻤﺭﻜﺯ ﻟﻤﻌﺎﻟﺠﺔ ﺍﻷﺸﺨﺎﺹ‬
‫ﺍﻟﻤﻌﻀﻭﻀﻴﻥ‪ ،‬ﻭﻤﺘﺎﺒﻌﺔ ﺍﻟﻤﺘﺨﻠﻔﻴﻥ ﻋﻥ ﺍﻟﻌﻼﺝ ﺍﻟﻭﻗﺎﺌﻲ ﻭﺇﺭﺴﺎﻟﻬﻡ ﺇﻟﻰ ﻤﺭﻜﺯ ﺍﻟﻤﻌﺎﻟﺠﺔ‪.‬‬

‫• ﺍﻟﻜﺸﻑ ﺍﻟﻤﺒﻜﺭ ﻋﻥ ﺤﺎﻻﺕ ﺩﺍﺀ ﺍﻟﻜﻠﺏ ﻤﻥ ﺨﻼل ﺍﻟﻘﺼﺔ ﺍﻟﺴﺭﻴﺭﻴﺔ )ﺒﻤﺎ ﻓﻲ ﺫﻟﻙ ﺤﺎﺩﺜﺔ ﺍﻟﻌﺽ( ﻭﺍﻷﻋﺭﺍﺽ‬
‫ﻭﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﻌﺼﺒﻴﺔ ﻭﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻟﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬

‫• ﺘﺴﺠﻴل ﺤﺎﻟﺔ ﺍﻟﻜﻠﺏ ﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪.‬‬

‫• ﺍﻻﺴﺘﻘﺼﺎﺀ ﺍﻟﻭﺒﺎﺌﻲ ﻟﺤﺎﻟﺔ ﺍﻟﻜﻠﺏ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻋﻨﺩ ﺍﻹﻨﺴﺎﻥ ﺒﺯﻴﺎﺭﺓ ﺍﻟﻤﺭﻴﺽ ﺃﻭ ﺍﻟﻤﺘﻭﻓﻲ‪ ،‬ﻭﺩﺭﺍﺴﺔ ﻅﺭﻭﻑ ﺤﺎﻟﺔ‬
‫ﺍﻟﻌﺽ‪ ،‬ﻭﺤﺎﻟﺔ ﺍﻟﺤﻴﻭﺍﻥ ﺍﻟﻌﺎﺽ‪ ،‬ﻭﺍﺤﺘﺠﺎﺯﻩ ﺇﺫﺍ ﺃﻤﻜﻥ ﻟﻤﺩﺓ )‪ (٥‬ﺃﻴﺎﻡ ﺒﻌﺩ ﺤﺎﺩﺜﺔ ﺍﻟﻌﺽ )ﻁﺒﻌﹰﺎ ﻤﻊ ﺍﻟﺒﺩﺀ ﺒﺎﻟﻌﻼﺝ‬

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‫ﺍﻟﻭﻗﺎﺌﻲ ﻓﻲ ﻤﺭﻜﺯ ﺍﻟﻤﻌﺎﻟﺠﺔ( ﺃﻭ ﻗﺘﻠﻪ ﻭﺇﺭﺴﺎل ﺍﻟﺩﻤﺎﻍ ﺇﻟﻰ ﻤﺭﺍﻜﺯ ﺍﻟﺘﺸﺨﻴﺹ ﺒﺎﻟﻤﺠﻬﺭ ﺍﻟﻭﻤﻀﺎﻨﻲ ﻓﻲ ﺤﺎل‬
‫ﺘﻭﻓﺭﻫﺎ ﻭﺍﻟﺒﺤﺙ ﻋﻥ ﺃﺸﺨﺎﺹ ﻤﻌﻀﻭﻀﻴﻥ ﺁﺨﺭﻴﻥ ﻟﻡ ﻴﺘﻠﻘﻭﺍ ﻤﻌﺎﻟﺠﺔ ﻭﻗﺎﺌﻴﺔ‪ ،‬ﻭﺩﺭﺍﺴﺔ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﺘﻤﺎﺴﻴﻥ‬
‫ﻤﻊ ﺍﻟﻤﺭﻴﺽ ﺃﻭ ﺍﻟﺫﻴﻥ ﻗﺎﻤﻭﺍ ﺒﺨﺩﻤﺔ ﻭﺘﻤﺭﻴﺽ ﺍﻟﻤﺭﻴﺽ ﻭﺇﺭﺴﺎﻟﻬﻡ ﺇﻟﻰ ﻤﺭﻜﺯ ﻤﻌﺎﻟﺠﺔ ﺍﻷﺸﺨﺎﺹ‬
‫ﺍﻟﻤﻌﻀﻭﻀﻴﻥ ﻟﺘﻠﻘﻲ ﺍﻟﻌﻼﺝ ﺍﻟﻭﻗﺎﺌﻲ‪.‬‬

‫ﺍﺘﺨﺎﺫ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‪:‬‬

‫• ﺘﺜﻘﻴﻑ ﺍﻟﺠﻤﻬﻭﺭ ﺤﻭل ﻀﺭﻭﺭﺓ ﻤﺭﺍﺠﻌﺔ ﻤﺭﺍﻜﺯ ﻤﻌﺎﻟﺠﺔ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﻌﻀﻭﻀﻴﻥ ﻓﻲ ﺤﺎل ﺍﻟﺘﻌﺭﺽ ﻟﻌﻀﺔ‬
‫ﺤﻴﻭﺍﻥ‪.‬‬

‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺒﻠﺩﻴﺎﺕ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ ﻟﺘﻨﺸﻴﻁ ﻋﻤل ﻤﻔﺎﺭﺯ ﻤﻜﺎﻓﺤﺔ ﺍﻟﻜﻼﺏ ﺍﻟﺸﺎﺭﺩﺓ ﻭﺇﺘﻼﻑ ﺠﺜﺙ ﺍﻟﺤﻴﻭﺍﻨﺎﺕ‬
‫ﺍﻟﻤﺼﺎﺒﺔ ﺒﺎﻟﺤﺭﻕ‪.‬‬

‫ﻤﺴﺘﻭﻯ ﻤﺭﺍﻜﺯ ﻤﻌﺎﻟﺠﺔ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﻌﻀﻭﻀﻴﻥ‪:‬‬

‫ﻴﻭﺠﺩ ﻓﻲ ﺴﻭﺭﻴﺔ ‪ ٣٤‬ﻤﺭﻜﺯﹰﺍ ﻟﻤﻌﺎﻟﺠﺔ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﻌﻀﻭﻀﻴﻥ‪ ،‬ﻤﺭﻜﺯ ﻓﻲ ﻜل ﻤﺤﺎﻓﻅﺔ )ﻓﻲ ﻗﺴﻡ ﺍﻹﺴﻌﺎﻑ‬
‫ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﺍﻟﻭﻁﻨﻲ( ﺇﻀﺎﻓﺔ ﺇﻟﻰ ﻤﺭﺍﻜﺯ ﺇﻀﺎﻓﻴﺔ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ ﺫﺍﺕ ﺍﻻﻤﺘﺩﺍﺩ ﺍﻟﺠﻐﺭﺍﻓﻲ ﺍﻟﻭﺍﺴﻊ )ﺘﺩﻤﺭ‪ ،‬ﺍﻟﺒﻨﻙ‪،‬‬
‫ﺍﻟﺒﻭﻜﻤﺎل‪ ،‬ﺍﻟﻘﺎﻤﺸﻠﻲ‪ ،‬ﻤﻨﺒﺞ‪ ،‬ﺍﻟﻤﺨﺭﻡ‪ ،‬ﺘﻠﻜﺦ‪ ،‬ﺍﻟﻘﺼﻴﺭ‪ ،‬ﺭﺃﺱ ﺍﻟﻌﻴﻥ‪ ،‬ﺍﻟﺯﺒﺩﺍﻨﻲ‪ ،‬ﺍﻟﻤﻴﺎﺩﻴﻥ‪ ،‬ﺍﻟﺴﻠﻤﻴﺔ‪ ،‬ﻤﺼﻴﺎﻑ‪،‬‬
‫ﺩﻭﻤﺎ‪ ...‬ﺍﻟﺦ(‪.‬‬

‫ﺘﺩﺒﻴﺭ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﻌﻀﻭﻀﻴﻥ‪:‬‬

‫• ﻋﻼﺝ ﺍﻟﺠﺭﻭﺡ‪ :‬ﺒﻐﺴﻠﻬﺎ ﺒﺎﻟﻤﺎﺀ ﻭﺍﻟﺼﺎﺒﻭﻥ ﺃﻭ ﺒﻤﻨﻅﻑ ﺼﻨﺎﻋﻲ ﺜﻡ ﺒﺎﻟﻤﻭﺍﺩ ﺍﻟﻤﻌﻘﻤﺔ )ﺍﻟﻜﺤﻭل‪ /‬ﺍﻟﻴﻭﺩ( ﻭﺘﺭﻙ‬
‫ﺍﻟﺠﺭﻭﺡ ﻤﻔﺘﻭﺤﺔ ﺇﻻ ﻓﻲ ﺤﺎﻻﺕ ﺍﻟﻀﺭﻭﺭﺓ ﺍﻟﻘﺼﻭﻯ‪ ،‬ﺜﻡ ﺇﻋﻁﺎﺀ ﺍﻟﻤﺼل ﺍﻟﻤﻀﺎﺩ ﻟﻠﻜﻠﺏ ﻓﻲ ﺍﻟﺠﺭﺡ ﺇﻀﺎﻓﺔ ﺇﻟﻰ‬
‫ﺇﻋﻁﺎﺀ ﺍﻟﻤﺭﻴﺽ ﺍﻟﻌﻼﺠﺎﺕ ﺍﻟﺩﺍﻋﻤﺔ ﺍﻷﺨﺭﻯ )ﺍﻟﺼﺎﺩﺍﺕ‪ ،‬ﺍﻟﻭﻗﺎﻴﺔ ﻤﻥ ﺍﻟﻜﺯﺍﺯ(‪.‬‬
‫• ﺍﻟﺘﻤﻨﻴﻊ )ﺍﻟﻔﺎﻋل ﺃﻭ ﺍﻟﻔﺎﻋل ﻭﺍﻟﻤﻨﻔﻌل(‪:‬‬
‫‪ -‬ﻴﻌﻁﻰ ﺍﻟﻤﺼل ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺘﺎﻟﻴﺔ ﻓﻘﻁ‪:‬‬
‫‪ o‬ﻋﻀﺎﺕ ﺃﻭ ﺨﺩﻭﺵ ﻋﻤﻴﻘﺔ ﻓﻲ ﺍﻟﻭﺠﻪ‪ ،‬ﺍﻟﺭﺃﺱ‪ ،‬ﺍﻟﺭﻗﺒﺔ‪ ،‬ﺃﺼﺎﺒﻊ ﺍﻟﻴﺩﻴﻥ ﻭﺍﻟﻘﺩﻤﻴﻥ‪ ،‬ﺍﻷﻏﺸﻴﺔ ﺍﻟﻤﺨﺎﻁﻴﺔ‪.‬‬
‫‪ o‬ﻋﻀﺎﺕ ﻤﺘﻌﺩﺩﺓ ﺃﻭ ﺠﺭﻭﺡ ﺃﻭ ﺨﺩﻭﺵ ﻋﻤﻴﻘﺔ‪.‬‬

‫ﻴﻌﻁﻰ ﺍﻟﻤﺼل ﺍﻟﻤﻀﺎﺩ ﻟﺩﺍﺀ ﺍﻟﻜﻠﺏ ﺩﺍﺌﻤﹰﺎ ﻤﻊ ﺍﻟﻠﻘﺎﺡ ﻭﻟﻴﺱ ﻟﻭﺤﺩﻩ ﺤﻴﺙ ﺘﻌﻁﻰ ﻨﺼﻑ ﺍﻟﻜﻤﻴﺔ ﺤﻘﻨﹰﺎ ﻓﻲ ﻋﻤﻕ‬
‫ﺍﻟﺠﺭﺡ ﻭﺘﺸﺭﻴﺏ ﺤﻭل ﺍﻟﺠﺭﺡ )ﺨﺎﺼﺔ ﺇﺫﺍ ﺘﻤﺕ ﺍﻟﺨﻴﺎﻁﺔ(‪ ،‬ﻭﺍﻟﻨﺼﻑ ﺍﻟﺒﺎﻗﻲ ﺤﻘﻨﹰﺎ ﻓﻲ ﺍﻟﻌﻀﻠﺔ ﺍﻷﻟﻴﻭﻴﺔ‪.‬‬

‫ﻴﻌﻁﻰ ﺍﻟﻤﺼل ﺍﻹﻨﺴﺎﻨﻲ ﺒﺠﺭﻋﺔ ‪ ٢٠‬ﻭﺤﺩﺓ ﺩﻭﻟﻴﺔ‪/‬ﻜﻎ ﻤﻥ ﻭﺯﻥ ﺍﻹﻨﺴﺎﻥ ﺒﻴﻨﻤﺎ ﻴﻌﻁﻰ ﺍﻟﻤﺼل ﺍﻟﺤﻴﻭﺍﻨﻲ‬
‫ﺒﺠﺭﻋﺔ ‪ ٤٠‬ﻭﺤﺩﺓ ﺩﻭﻟﻴﺔ‪/‬ﻜﻎ )ﺒﻌﺩ ﺇﺠﺭﺍﺀ ﺍﺨﺘﺒﺎﺭ ﺍﻟﺘﺤﺴﺱ(‪.‬‬

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‫‪ -‬ﻴﻌﻁﻰ ﺍﻟﻠﻘﺎﺡ ﻓﻲ ﺠﻤﻴﻊ ﺤﺎﻻﺕ ﺍﻟﻌﺽ ﺍﻟﻤﺸﺘﺒﻬﺔ ﻭﺍﻟﻠﻘﺎﺡ ﺍﻟﻤﺴﺘﻌﻤل ﻓﻲ ﺴﻭﺭﻴﺔ ﻫﻭ ﻟﻘﺎﺡ ‪Inactivated‬‬
‫‪rabies vaccine prepared on vero cells: Verorab‬‬
‫ﻴﻌﻁﻰ ﺯﺭﻗﺘﺎﻥ ﻓﻲ ﺍﻟﻴﻭﻡ ﺼﻔﺭ ﻋﻨﺩ ﺃﻭل ﺯﻴﺎﺭﺓ‪ ،‬ﻓﻲ ﺍﻟﻌﻀﻠﺔ ﺍﻟﺩﺍﻟﻴﺔ ﻟﻠﺒﺎﻟﻐﻴﻥ )ﺯﺭﻗﺔ ﻓﻲ ﻜل ﻴﺩ( ﺃﻭ ﻓﻲ ﻜل‬
‫ﻓﺨﺫ ﻟﻸﻁﻔﺎل‪.‬‬

‫ﺯﺭﻗﺔ ﻭﺍﺤﺩﺓ ﻓﻲ ﺍﻟﻴﻭﻡ ‪٧‬‬

‫ﺯﺭﻗﺔ ﻭﺍﺤﺩﺓ ﻓﻲ ﺍﻟﻴﻭﻡ ‪٢١‬‬

‫ﻴﻭﻗﻑ ﺇﻋﻁﺎﺀ ﺍﻟﺠﺭﻋﺎﺕ ﺍﻟﺘﺎﻟﻴﺔ ﻤﻥ ﺍﻟﻠﻘﺎﺡ ﻓﻲ ﺤﺎل ﺒﻘﺎﺀ ﺍﻟﻜﻠﺏ ﺃﻭ ﺍﻟﻘﻁﺔ ﺍﻟﻌﺎﻀﺔ ﺴﻠﻴﻤﺔ ﺒﻌﺩ ﺨﻤﺴﺔ ﺃﻴﺎﻡ‬
‫)ﺒﺼﺤﺔ ﺠﻴﺩﺓ( ﺃﻭ ﻓﻲ ﺤﺎل ﺇﺠﺭﺍﺀ ﻓﺤﺹ ﻤﺨﺒﺭﻱ ﻟﺩﻤﺎﻍ ﺍﻟﺤﻴﻭﺍﻥ ﺍﻟﻌﺎﺽ ﻭﻜﺎﻥ ﺴﻠﻴﻤﹰﺎ‪.‬‬

‫ﻴﺘﻡ ﺭﻓﻊ ﺍﻟﺘﻘﺎﺭﻴﺭ ﻋﻥ ﻋﻤل ﻤﺭﻜﺯ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺒﺸﻜل ﺸﻬﺭﻱ ﺇﻟﻰ ﺸﻌﺒﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻓﻲ ﻤﺩﻴﺭﻴﺔ‬
‫ﺍﻟﺼﺤﺔ ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪.(٢٤‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪:‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻤﺤﻠﻲ ﻓﻲ ﺍﺴﺘﻘﺼﺎﺀ ﺍﻟﺤﺎﻻﺕ ﺃﻭ ﺍﻟﻔﺎﺸﻴﺎﺕ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﺤﺎﻻﺕ ﺍﻟﻌﺽ ﻭﺇﺼﺎﺒﺎﺕ ﺩﺍﺀ ﺍﻟﻜﻠﺏ‪.‬‬
‫• ﺭﻓﻊ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﺸﻬﺭﻴﺔ ﻋﻥ ﻋﺩﺩ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﻌﻀﻭﻀﻴﻥ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﺸﺘﺭﻜﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ ﻋﻠﻰ ﻋﻤل ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺼﺤﻴﺔ ﻭﻤﺭﺍﻜﺯ ﻤﻌﺎﻟﺠﺔ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﻌﻀﻭﻀﻴﻥ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻤﻥ ﺨﻼل ﺍﻟﻤﺠﻠﺱ ﺍﻟﺼﺤﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ ﻭﺘﻨﺸﻴﻁ ﻋﻤل ﻤﻔﺎﺭﺯ ﺍﻟﻤﻜﺎﻓﺤﺔ‪.‬‬

‫ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺭﻜﺯﻱ‪:‬‬

‫• ﻤﺅﺍﺯﺭﺓ ﻓﺭﻴﻕ ﺍﻟﺘﻘﺼﻲ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻁﺎﺭﺌﺔ‪.‬‬
‫• ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻟﻺﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻘﻁﺭ‪.‬‬
‫• ﺍﻟﺘﻐﺫﻴﺔ ﺍﻟﺭﺍﺠﻌﺔ ﺇﻟﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻤﺘﻭﺴﻁ‪.‬‬
‫• ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻹﺸﺭﺍﻑ‪.‬‬
‫• ﺇﻋﺩﺍﺩ ﻭﺴﺎﺌل ﻭﻤﻭﺍﺩ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪.‬‬
‫• ﺘﺄﻤﻴﻥ ﺍﻟﻠﻘﺎﺤﺎﺕ ﻭﺍﻟﻤﺼﻭل ﻭﺍﻷﺩﻭﻴﺔ ﻭﺍﻟﻤﻭﺍﺩ ﺍﻟﻤﺨﺒﺭﻴﺔ ﻭﺍﻟﺴﻤﻭﻡ ﺍﻟﻤﺴﺘﺨﺩﻤﺔ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻜﻼﺏ ﺍﻟﺸﺎﺭﺩﺓ‬
‫ﻭﺘﻭﺯﻴﻌﻬﺎ ﺇﻟﻰ ﺍﻟﻤﺤﺎﻓﻅﺎﺕ‪.‬‬
‫• ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻷﺨﺭﻯ ﻤﻥ ﺨﻼل ﺍﻟﻠﺠﻨﺔ ﺍﻟﻭﻁﻨﻴﺔ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﺸﺘﺭﻜﺔ – ﺍﻟﺘﻌﺎﻭﻥ ﻤﻊ‬
‫ﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ‪.‬‬

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 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(١‬‬

‫ﻗﺭﺍﺭ ﺘﻨﻅﻴﻤﻲ ﺭﻗﻡ ‪/٣٨/‬‬

‫ﻭﺯﻴﺭ ﺍﻟﺼﺤﺔ‬
‫ﺒﻨﺎﺀ ﻋﻠﻰ ﺃﺤﻜﺎﻡ ﺍﻟﻤﺭﺴﻭﻡ ﺍﻟﺘﺸﺭﻴﻌﻲ ﺭﻗﻡ ‪ ١١١‬ﻟﻌﺎﻡ ‪ ١٩٦٦‬ﺍﻟﻨﺎﻅﻡ ﻟﻤﻼﻙ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻭﺘﻌﺩﻴﻼﺘﻪ‪.‬‬
‫ﻭﻋﻠﻰ ﺃﺤﻜﺎﻡ ﺍﻟﻘﺎﻨﻭﻥ ﺭﻗﻡ ‪ /١٤٨/‬ﻟﻌﺎﻡ ‪.١٩٤٩‬‬
‫ﻭﻋﻠﻰ ﺍﻟﻘﺎﻨﻭﻥ ﺭﻗﻡ ‪ ٥٠‬ﻟﻌﺎﻡ ‪ ٢٠٠٢‬ﺍﻟﺨﺎﺹ ﺒﻬﻴﺌﺔ ﺍﻟﺒﻴﺌﺔ‪.‬‬
‫ﻭﻋﻠﻰ ﺍﻟﻘﺎﻨﻭﻥ ﺭﻗﻡ ‪ ٤٩‬ﻟﻌﺎﻡ ‪ ٢٠٠٤‬ﺍﻟﻨﺎﻅﻡ ﻟﻠﻨﻅﺎﻓﺔ ﺍﻟﻌﺎﻤﺔ‪.‬‬
‫ﻭﻋﻠﻰ ﺃﺤﻜﺎﻡ ﺍﻟﻤﺭﺴﻭﻡ ﺍﻟﺘﺸﺭﻴﻌﻲ ﺭﻗﻡ ‪ /٧/‬ﻟﻌﺎﻡ ‪ ٢٠٠٧‬ﺍﻟﻨﺎﻅﻡ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫ﻴﻘﺭﺭ ﻤﺎ ﻴﻠﻲ‪:‬‬
‫ﻤﺎﺩﺓ ‪ - ٦‬ﻋﻠﻰ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ ﺍﻟﺨﺎﺼﺔ ﺃﻭ ﺍﻟﺘﺎﺒﻌﺔ ﻟﻠﺠﻬﺎﺕ ﺍﻟﻌﺎﻤﺔ ﺍﺘﺨﺎﺫ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻵﺘﻴﺔ‪:‬‬
‫ﺃﻭ ﹰﻻ ‪ -‬ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻁﻠﻭﺒﺔ ﻟﺘﺭﺼﺩ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻤﻥ ﺃﺠل ﻨﺠﺎﺡ ﻋﻤﻠﻴﺔ ﺍﻟﻤﻜﺎﻓﺤﺔ‪:‬‬
‫ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﺃﻭ ﺨﻼل ‪ ٢٤‬ﺴﺎﻋﺔ ﻤﻥ ﻗﺒل ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺎﺕ ﺍﻟﺼﺤﺔ ﺃﻭ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪ ،‬ﻭﺫﻟﻙ ﻋﻥ‬ ‫ﺃ‪-‬‬
‫ﺍﻷﻤﺭﺍﺽ ﺍﻟﺘﺎﻟﻴﺔ‪ :‬ﺍﻟﺸﻠل ﺍﻟﺭﺨﻭ ﺍﻟﺤﺎﺩ‪ ،‬ﻜﺯﺍﺯ ﺍﻟﻭﻟﻴﺩ‪ ،‬ﺍﻟﺩﻓﺘﺭﻴﺎ‪ ،‬ﺍﻟﻜﻭﻟﻴﺭﺍ‪ ،‬ﺍﻟﻤﻼﺭﻴﺎ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ‪ ،‬ﺍﻟﺤﺼﺒﺔ‪ ،‬ﺍﻟﺤﺼﺒﺔ‬
‫ﺍﻷﻟﻤﺎﻨﻴﺔ )ﻤﺘﻀﻤﻨﺔ ﺍﻟﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ ﺍﻟﺨﻠﻘﻴﺔ(‪ ،‬ﺍﻟﻜﻠﺏ‪ ،‬ﺍﻹﻴﺩﺯ‪ ،‬ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﺴﺘﺠﺩﺓ‪.‬‬
‫ﺍﻹﺒﻼﻍ ﺍﻟﺸﻬﺭﻱ )ﺒﺘﻘﺭﻴﺭ ﺸﻬﺭﻱ( ﻋﻥ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺘﺎﻟﻴﺔ‪ :‬ﺍﻟﺘﺩﺭﻥ‪ ،‬ﺍﻟﺴﻌﺎل ﺍﻟﺩﻴﻜﻲ‪ ،‬ﺍﻟﻨﻜﺎﻑ‪ ،‬ﺍﻟﺤﻤﻰ‪ ،‬ﺍﻟﺘﻴﻔﻴﺔ‪،‬‬ ‫ﺏ‪-‬‬
‫ﺍﻟﺤﻤﻰ ﺍﻟﻤﺎﻟﻁﻴﺔ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﻔﻴﺭﻭﺴﻲ ﺒﻜﺎﻓﺔ ﺃﺸﻜﺎﻟﻪ‪ ،‬ﺍﻟﻜﺯﺍﺯ ﺍﻟﻐﻴﺭ ﻭﻟﻴﺩﻱ‪ ،‬ﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﺠﻠﺩﻴﺔ ﺃﻭ ﺍﻟﺤﺸﻭﻴﺔ‪،‬‬
‫ﺍﻟﺒﻠﻬﺎﺭﺴﻴﺎ‪ ،‬ﺍﻷﻤﺭﺍﺽ ﺍﻟﺸﺒﻴﻬﺔ ﺒﺎﻷﻨﻔﻠﻭﻨﺯﺍ‪ ،‬ﺍﻹﺴﻬﺎل ﺍﻟﻤﺩﻤﻰ ﻭﻏﻴﺭ ﺍﻟﻤﺩﻤﻰ‪ ،‬ﺩﺍﺀ ﺍﻟﻜﻴﺴﺎﺕ ﺍﻟﻤﺎﺌﻴﺔ‪ ،‬ﺩﺍﺀ ﺍﻟﻤﻘﻭﺴﺎﺕ‪،‬‬
‫ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﻨﻘﻭﻟﺔ ﺒﺎﻟﺠﻨﺱ‪.‬‬
‫ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻥ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻭﺍﺭﺩﺓ ﻓﻲ ﺍﻟﻔﻘﺭﺓ )ﺏ( ﻋﻨﺩ ﺤﺩﻭﺙ ﺯﻴﺎﺩﺓ ﻓﻲ ﻋﺩﺩ ﺍﻹﺼﺎﺒﺎﺕ ﻋﻥ ﺍﻟﻤﺘﻭﻗﻊ‬ ‫ﺝ‪-‬‬
‫)ﺤﺩﻭﺙ ﻭﺒﺎﺀ ﺃﻭ ﻓﺎﺸﻴﺔ(‪ ،‬ﻜﻤﺎ ﻴﺘﻡ ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻥ ﺃﻱ ﺍﺭﺘﻔﺎﻉ ﻤﻔﺎﺠﻰﺀ ﺒﻌﺩﺩ ﺍﻹﺼﺎﺒﺎﺕ ﻷﻱ ﻤﺭﺽ ﺃﻭ ﻋﻨﺩ‬
‫ﻤﺸﺎﻫﺩﺓ ﺃﻴﺔ ﻅﺎﻫﺭﺓ ﻤﺭﻀﻴﺔ ﺠﻤﺎﻋﻴﺔ ﺃﻭ ﺃﻋﺭﺍﺽ ﻤﺭﻀﻴﺔ ﻤﺠﻬﻭﻟﺔ ﺍﻟﺴﺒﺏ ﺃﻭ ﺍﻟﻬﻭﻴﺔ‪.‬‬
‫ﺠﻤﻊ ﺍﻟﺒﻴﺎﻨﺎﺕ ﻋﻥ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻤﻥ ﻗﺒل ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ ﻭﺇﺠﺭﺍﺀ ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ‪ ،‬ﻭﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ‬ ‫ﺩ‪-‬‬
‫ﻟﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ ﻋﻨﺩ ﻤﻼﺤﻅﺔ ﺃﻱ ﺍﺭﺘﻔﺎﻉ ﺒﻌﺩﺩ ﺍﻹﺼﺎﺒﺎﺕ ﻋﻥ ﺍﻟﻤﺘﻭﻗﻊ‪.‬‬
‫ﺍﻟﺘﻘﺼﻲ ﻟﻸﻤﺭﺍﺽ ﺍﻟﻭﺍﺭﺩﺓ ﻓﻲ ﺍﻟﻔﻘﺭﺓ )ﺃ( ﺍﻟﻭﺍﺠﺏ ﺍﻹﺒﻼﻍ ﻋﻨﻬﺎ ﺒﺸﻜل ﻓﻭﺭﻱ‪ ،‬ﺇﻀﺎﻓ ﹰﺔ ﺇﻟﻰ ﺍﻷﻭﺒﺌﺔ ﻭﺍﻟﻔﺎﺸﻴﺎﺕ‬ ‫ﻩ‪-‬‬
‫ﻟﻸﻤﺭﺍﺽ ﺍﻟﻭﺍﺭﺩﺓ ﻓﻲ ﺍﻟﻔﻘﺭﺓ )ﺏ( ﻭﺇﻤﻼﺀ ﺍﺴﺘﻤﺎﺭﺍﺕ ﺍﻟﺘﻘﺼﻲ ﺍﻟﻼﺯﻤﺔ ﻋﻥ ﻫﺫﻩ ﺍﻷﻤﺭﺍﺽ ﻭﺇﺭﺴﺎﻟﻬﺎ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ‬
‫ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻓﻲ ﺍﻟﻭﺯﺍﺭﺓ‪.‬‬
‫ﺍﻟﺘﻨﺴﻴﻕ ﻤﻊ ﺍﻟﺠﻬﺎﺕ ﺍﻟﺤﻜﻭﻤﻴﺔ ﻭﺍﻟﺨﺎﺼﺔ ﺍﻟﻤﻌﻨﻴﺔ ﺒﺘﻘﺩﻴﻡ ﺍﻟﺨﺩﻤﺎﺕ ﺍﻟﺼﺤﻴﺔ‪ :‬ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ ﺍﻟﺘﺎﺒﻌﺔ ﻟﻭﺯﺍﺭﺍﺕ‬ ‫ﻭ‪-‬‬
‫ﺍﻟﺩﻓﺎﻉ ـ ﺍﻟﺩﺍﺨﻠﻴﺔ ـ ﺍﻟﺘﺭﺒﻴﺔ ـ ﺍﻟﺘﻌﻠﻴﻡ ﺍﻟﻌﺎﻟﻲ ـ ﺍﻟﺸﺅﻭﻥ ﺍﻻﺠﺘﻤﺎﻋﻴﺔ ﻭﺍﻟﻌﻤل‪ ...‬ﺇﻟﺦ‪ ،‬ﻭﺍﻷﻁﺒﺎﺀ ﺍﻟﺨﺎﺼﻭﻥ‬
‫ﻟﻠﻤﺸﺎﺭﻜﺔ ﻓﻲ ﻋﻤﻠﻴﺔ ﺍﻹﺒﻼﻍ ﻋﻥ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﻤﻜﺎﻓﺤﺘﻬﺎ‪.‬‬
‫ﻗﻴﺎﻡ ﺩﻭﺍﺌﺭ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻓﻲ ﻤﺩﻴﺭﻴﺎﺕ ﺍﻟﺼﺤﺔ ﺒﺈﻋﺩﺍﺩ )ﺘﻘﺭﻴﺭ ﺸﻬﺭﻱ( ﻋﻥ ﻋﻤل )ﺍﻟﺩﺍﺌﺭﺓ(‪ ،‬ﻴﺘﻀﻤﻥ‬ ‫ﺯ‪-‬‬
‫ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﺍﻟﻤﺒﻠﻎ ﻋﻨﻬﺎ ﻤﻥ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﻴﺔ ﻟﻠﻘﻁﺎﻋﻴﻥ ﺍﻟﻌﺎﻡ ﻭﺍﻟﺨﺎﺹ ﻤﻊ ﺍﻟﺘﺤﻠﻴل ﺍﻟﻭﺒﺎﺌﻲ ﻭﺇﺠﺭﺍﺀﺍﺕ‬
‫ﺍﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﻤﺘﺨﺫﺓ‪ ،‬ﻭﺇﺭﺴﺎﻟﻪ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪.‬‬

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 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٢‬‬
‫‪......................................................................................................................‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‪:‬‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫‪.........................................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﻨﻁﻘﺔ‪:‬‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫‪................................................................................................................‬‬ ‫ﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ‪:‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ‬

‫ﺜﺎﻨﻴ ﹰﺎ ‪ -‬ﻨﺸﺎﻁﺎﺕ ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬

‫‪...............................................‬‬ ‫ﻋﺎﻡ‬ ‫‪..............................................‬‬ ‫ﺸﻬﺭ‬

‫‪ - ١‬ﺘﻘﺭﻴﺭ ﺍﻟﺘﺭﺼﺩ ﺍﻟﺸﻬﺭﻱ ﻟﻸﻤﺭﺍﺽ ﺍﻟﻤﺸﻤﻭﻟﺔ ﺒﺎﻟﺘﻠﻘﻴﺢ )ﻤﺘﻀﻤﻨ ﹰﺎ ﻟﻠﺘﻘﺭﻴﺭ ﺍﻟﺼﻔﺭﻱ(‪:‬‬

‫ﺘﻭﺯﻉ ﺍﻹﺼﺎﺒﺎﺕ ﺤﺴﺏ ﺍﻟﻔﺌﺔ ﺍﻟﻌﻤﺭﻴﺔ ﻭﺍﻟﺤﺎﻟﺔ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ‬
‫ﺒﺎﻗﻲ ﺍﻟﻔﺌﺎﺕ ﺍﻟﻌﻤﺭﻴﺔ‬

‫ﻤﻥ ﺨﻤﺱ ﺴﻨﻭﺍﺕ ﺇﻟﻰ ‪ ١٤‬ﺴﻨﺔ‬ ‫ﻤﻥ ﺴﻨﺔ ﺇﻟﻰ ﺃﺭﺒﻊ ﺴﻨﻭﺍﺕ‬ ‫ﺃﻗل ﻤﻥ ﺴﻨﺔ‬

‫ﺇﺠﻤﺎﻟﻲ ﺍﻹﺼﺎﺒﺎﺕ‬
‫ﺍﻟﻤﺭﺽ‬
‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬

‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬

‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬
‫ﻤﻠﻘﺢ ﺠﺯﺌﻲ‬

‫ﻤﻠﻘﺢ ﺠﺯﺌﻲ‬

‫ﻤﻠﻘﺢ ﺠﺯﺌﻲ‬
‫ﻤﻠﻘﺢ ﻜﺎﻤل‬

‫ﻤﻠﻘﺢ ﻜﺎﻤل‬

‫ﻤﻠﻘﺢ ﻜﺎﻤل‬
‫ﻏﻴﺭ ﻤﻠﻘﺢ‬

‫ﻏﻴﺭ ﻤﻠﻘﺢ‬

‫ﻏﻴﺭ ﻤﻠﻘﺢ‬
‫ﺍﻟﻤﺠﻤﻭﻉ‬

‫ﺍﻟﻤﺠﻤﻭﻉ‬

‫ﺍﻟﻤﺠﻤﻭﻉ‬
‫ﺸﻠل ﺭﺨﻭ ﺤﺎﺩ‬
‫ﻜﺯﺍﺯ ﻭﻟﻴﺩﻱ‬
‫ﺤﺼﺒﺔ‬
‫ﺩﻓﺘﺭﻴﺎ‬
‫ﺴﻌﺎل ﺩﻴﻜﻲ‬
‫ﺍﻟﺘﻬﺎﺏ ﻜﺒﺩ ﺏ‬
‫ﺘﺩﺭﻥ‬
‫ﺤﺼﺒﺔ ﺃﻟﻤﺎﻨﻴﺔ‬
‫ﻨﻜﺎﻑ‬
‫ﺴﺤﺎﻴﺎ‬

‫‪ -‬ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪:‬‬
‫ﺍﻟﻔﺌﺔ ﺍﻟﻌﻤﺭﻴﺔ‬
‫ﺃﻤﺭﺍﺽ ﺸﺒﻴﻬﺔ‬
‫ﻋﻀﺔ ﺤﻴﻭﺍﻥ‬
‫ﺇﺴﻬﺎل ﻤﺩﻤﻰ‬

‫ﺤﻤﻰ ﻤﺎﻟﻁﻴﺔ‬
‫ﺇﺴﻬﺎل ﻏﻴﺭ‬

‫ﺤﻤﻰ ﺘﻴﻔﻴﺔ‬

‫ﺍﻟﺘﻬﺎﺏ ﻜﺒﺩ‬
‫ﺒﺎﻷﻨﻔﻠﻭﻨﺯﺍ‬

‫ﻜﺯﺍﺯ ﻏﻴﺭ‬
‫ﻻﻴﺸﻤﺎﻨﻴﺎ‬
‫ﺒﻠﻬﺎﺭﺴﻴﺎ‬

‫ﻓﻴﺭﻭﺴﻲ‬

‫ﻜﻭﻟﻴﺭﺍ‬
‫ﻭﻟﻴﺩﻱ‬

‫ﻤﻼﺭﻴﺎ‬
‫ﺠﻠﺩﻴﺔ‬
‫ﻤﺩﻤﻰ‬

‫ﺃﻗل ﻤﻥ ﺴﻨﺔ‬
‫ﻤﻥ ‪ ١‬ـ ‪ ٤‬ﺴﻨﺔ‬
‫ﻤﻥ ‪ ٥‬ـ ‪ ١٤‬ﺴﻨﺔ‬
‫ﺒﻘﻴﺔ ﺍﻷﻋﻤﺎﺭ‬
‫ﺍﻟﻤﺠﻤﻭﻉ‬

‫‪...............................................................................‬‬ ‫ﺍﺴﻡ ﻤﻨﻅﻡ ﺍﻟﺘﻘﺭﻴﺭ‪:‬‬

‫‪١٥٢‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٣‬‬
‫ﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ‪:‬‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﺍﻟﻤﺸﻔﻰ‪:‬‬ ‫ﻤﺤﺎﻓﻅﺔ‬
‫ﻋﻴﺎﺩﺓ‪:‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‬
‫ﺘﻘﺭﻴﺭ ﺍﻟﺘﺭﺼﺩ ﺍﻟﺸﻬﺭﻱ‬
‫‪٢٠‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‬
‫ﻋﺩﺩ ﺍﻹﺼﺎﺒﺎﺕ ﺒﺎﻷﻤﺭﺍﺽ‬ ‫ﻋﺩﺩ ﺍﻹﺼﺎﺒﺎﺕ ﺒﺎﻷﻤﺭﺍﺽ ﺍﻟﺘﻲ ﺘﻡ ﺍﻹﺒﻼﻍ ﻋﻨﻬﺎ ﻫﺎﺘﻔﻴ ﹰﺎ‬
‫ﺍﺴﻡ ﺍﻷﻤﺭﺍﺽ‬
‫ﺩﺍﺀ ﺍﻟﻜﻴﺴﺎﺕ ﺍﻟﻤﺎﺌﻴﺔ‬

‫ﺍﻟﻨﻜﺎﻑ‬
‫ﺍﻹﺴﻬﺎل ﺍﻟﻤﺩﻤﻰ‬

‫ﺍﻟﺸﻠل ﺍﻟﺭﺨﻭ ﺍﻟﺤﺎﺩ‬

‫ﺍﻹﺴﻬﺎل ﻏﻴﺭ ﺍﻟﻤﺩﻤﻰ‬

‫ﺍﻷﻤﺭﺍﺽ ﺍﻟﺸﺒﻴﻬﺔ ﺒﺎﻷﻨﻔﻠﻭﻨﺯﺍ‬

‫ﺍﻟﺤﻤﻰ ﺍﻟﺘﻴﻔﻴﺔ‬

‫ﺍﻟﺤﻤﻰ ﺍﻟﻤﺎﻟﻁﻴﺔ‬

‫ﺍﻟﻜﺯﺍﺯ ﺍﻟﻜﻬﻠﻲ‬

‫ﺍﻟﺴﻌﺎل ﺍﻟﺩﻴﻜﻲ‬

‫ﺍﻟﻜﻠﺏ‬

‫ﺍﻟﺤﺼﺒﺔ‬
‫ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﻔﻴﺭﻭﺴﻲ‬

‫ﺍﻟﺘﺩﺭﻥ‬

‫ﺍﻟﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ‬

‫ﺍﻟﻤﻼﺭﻴﺎ‬

‫ﺍﻟﻜﻭﻟﻴﺭﺍ‬

‫ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ‬

‫ﺍﻟﻜﺯﺍﺯ ﺍﻟﻭﻟﻴﺩﻱ‬
‫ﺍﻟﺒﻠﻬﺎﺭﺴﻴﺎ‬

‫ﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﺤﺸﻭﻴﺔ‬

‫ﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﺠﻠﺩﻴﺔ‬

‫ﺍﻟﺩﻓﺘﺭﻴﺎ‬
‫ﺍﻟﻔﺌﺔ ﺍﻟﻌﻤﺭﻴﺔ‬
‫ﺍﻗل ﻤﻥ ‪ ٥‬ﺴﻨﻭﺍﺕ‬
‫ﻤﻥ ‪ ٥‬ﺇﻟﻰ ‪ ١٤‬ﺴﻨﺔ‬
‫ﺒﻘﻴﺔ ﺍﻷﻋﻤﺎﺭ‬
‫ﺍﻟﻤﺠﻤﻭﻉ‬
‫ﺍﺴﻡ ﺭﺌﻴﺱ ﺍﻟﻤﺭﻜﺯ ‪ /‬ﺍﻟﻤﺸﻔﻰ‪:‬‬ ‫ﺍﺴﻡ ﻤﻨﻅﻡ ﺍﻟﺘﻘﺭﻴﺭ‪:‬‬
‫ﺍﻟﺘﻭﻗﻴﻊ‪:‬‬ ‫ﺍﻟﺘﻭﻗﻴﻊ‪:‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪) (٤‬ﺃ(‬
‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫‪.............................................................................................................‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‪:‬‬
‫‪......................................................................................................................................‬‬ ‫ﻤﻨﻁﻘﺔ‪:‬‬
‫‪.........................................................................................................................................‬‬ ‫ﻤﺭﻜﺯ‪:‬‬

‫ﺍﻟﺘﻘﺭﻴﺭ ﺍﻷﺴﺒﻭﻋﻲ ﺍﻟﺼﻔﺭﻱ ﻟﻺﺒﻼﻍ ﻋﻥ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬

‫‪٢٠‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺇﻟﻰ‬ ‫‪٢٠‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﻤﻥ‬ ‫ﺭﻗﻡ ﺍﻷﺴﺒﻭﻉ‬

‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫‪ - ١‬ﻫل ﺘﻡ ﺍﻜﺘﺸﺎﻑ ﺤﺎﻻﺕ ﺸﻠل ﺭﺨﻭ ﺤﺎﺩ؟‬

‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫‪ - ٢‬ﻫل ﺘﻡ ﺍﻜﺘﺸﺎﻑ ﺤﺎﻻﺕ ﺤﺼﺒﺔ ﻭﺤﺼﺒﺔ ﺃﻟﻤﺎﻨﻴﺔ ﻤﺸﺘﺒﻬﺔ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫‪ - ٣‬ﻫل ﺘﻡ ﺍﻜﺘﺸﺎﻑ ﺤﺎﻻﺕ ﻜﺯﺍﺯ ﺍﻟﻭﻟﻴﺩ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫‪ - ٤‬ﻫل ﺘﻡ ﺍﻜﺘﺸﺎﻑ ﺘﺄﺜﻴﺭﺍﺕ ﺠﺎﻨﺒﻴﺔ ﺘﺎﻟﻴﺔ ﻟﻠﻘﺎﺡ*؟‬
‫‪...................................................................................................................................................................‬‬ ‫‪ - ٥‬ﻫل ﺘﻡ ﺍﻜﺘﺸﺎﻑ ﺃﻤﺭﺍﺽ ﺴﺎﺭﻴﺔ ﺃﺨﺭﻯ؟ )ﺤﺩﺩﻫﺎ(‬

‫‪ -‬ﻓﻲ ﺤﺎل ﺍﻜﺘﺸﺎﻑ ﺤﺎﻻﺕ‪:‬‬

‫ﻫل ﺘﻡ ﺍﻹﺒﻼﻍ‬ ‫ﺘﺎﺭﻴﺦ‬ ‫ﺍﻟﺘﺸﺨﻴﺹ‬
‫ﺠﻬﺔ ﺍﻹﺒﻼﻍ‬ ‫ﺍﻟﻌﻨﻭﺍﻥ‬ ‫ﺍﺴﻡ ﺍﻟﺤﺎﻟﺔ‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺍﻟﻤﺸﺎﻫﺩﺓ‬ ‫ﺍﻟﻤﺒﺩﺌﻲ‬

‫‪ ٢٠‬ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻹﺭﺴﺎل‬ ‫‪ ٢٠‬ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺇﻤﻼﺀ ﺍﻟﺘﻘﺭﻴﺭ‬

‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﺭﺌﻴﺱ ﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ‬ ‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﻤﺴﺅﻭل ﺍﻟﺘﺭﺼﺩ‬

‫ﻤﻼﺤﻅﺎﺕ‪ - :‬ﻴﺭﺴل ﻫﺫﺍ ﺍﻟﺘﻘﺭﻴﺭ ﻴﻭﻡ ﺍﻷﺤﺩ ﻤﻥ ﻜل ﺃﺴﺒﻭﻉ ﺇﻟﻰ ﺭﺌﺎﺴﺔ ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺼﺤﻴﺔ )ﺒﻌﺩ ﺘﺭﻙ ﻨﺴﺨﺔ ﻤﻨﻪ ﻓﻲ ﺍﻟﻤﺭﻜﺯ(‪.‬‬

‫‪ -‬ﻓﻲ ﺤﺎل ﻤﺸﺎﻫﺩﺓ ﺃﻭ ﺍﻜﺘﺸﺎﻑ ﺃﻴﺔ ﺤﺎﻟﺔ ﻴﺘﻡ ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻨﻬﺎ ﻫﺎﺘﻔﻴﹰﺎ ﺇﻟﻰ ﻤﺭﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ ﻭﺘﺭﺴل ﻨﺴﺨﺔ ﻤﻥ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻹﺒﻼﻍ‬
‫ﻋﻥ ﻤﺭﺽ ﺴﺎﺭ ﻭﺘﺘﺭﻙ ﻨﺴﺨﺔ ﻤﻥ ﺍﻟﻤﺭﻜﺯ‪.‬‬

‫ﺍﻟﺘﺄﺜﻴﺭﺍﺕ ﺍﻟﺠﺎﻨﺒﻴﺔ ﺍﻟﺘﺎﻟﻴﺔ ﻟﻠﻘﺎﺡ‪) :‬ﺨﺭﺍﺠﺎﺕ ﻤﻭﻀﻊ ﺍﻟﺤﻘﻥ‪ ،‬ﺼﺩﻤﺎﺕ ﺘﺤﺴﺴﻴﺔ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﻋﻘﺩ ﻟﻤﻔﻴﺔ‪ ،‬ﺍﺨﺘﻼﺠﺎﺕ(‪.‬‬

‫‪١٥٤‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪) (٤‬ﺏ(‬
‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫‪.............................................................................................................‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‪:‬‬
‫‪......................................................................................................................................‬‬ ‫ﻤﻨﻁﻘﺔ‪:‬‬
‫ﺍﻟﺘﻘﺭﻴﺭ ﺍﻷﺴﺒﻭﻋﻲ ﺍﻟﺼﻔﺭﻱ ﻟﻺﺒﻼﻍ ﻋﻥ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫ﺍﺴﻡ ﺍﻟﻤﺸﻔﻰ‬

‫‪٢٠‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺇﻟﻰ‬ ‫‪٢٠‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﻤﻥ‬ ‫ﺭﻗﻡ ﺍﻷﺴﺒﻭﻉ‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﺸﻠل ﺭﺨﻭ ﺤﺎﺩ ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﺤﺼﺒﺔ ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﺤﺼﺒﺔ ﺃﻟﻤﺎﻨﻴﺔ ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﺤﺼﺒﺔ ﺃﻟﻤﺎﻨﻴﺔ ﺨﻠﻘﻴﺔ ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﻜﺯﺍﺯ ﻭﻟﻴﺩ ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﺍﻟﺘﻬﺎﺏ ﺴﺤﺎﻴﺎ ﻗﻴﺤﻲ ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﺩﻓﺘﺭﻴﺎ ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﺴﻌﺎل ﺩﻴﻜﻲ ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﻜﻭﻟﻴﺭﺍ ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺘﺄﺜﻴﺭﺍﺕ ﺠﺎﻨﺒﻴﺔ ﺘﺎﻟﻴﺔ ﻟﻠﻘﺎﺡ*؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺃﻴﺔ ﺤﺎﻟﺔ ﻤﺭﺽ ﺴﺎﺭ ﺨﻁﻴﺭ ﻏﻴﺭ ﻤﺎ ﺴﺒﻕ؟ ﻭﻤﺎ ﻫﻭ؟‬
‫‪ -‬ﻓﻲ ﺤﺎل ﺍﻜﺘﺸﺎﻑ ﺤﺎﻻﺕ ﻤﺎ ﻫﻲ‪:‬‬
‫* ﺍﻟﺘﺩﺍﺒﻴﺭ ﺍﻟﻤﺘﺨﺫﺓ‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻤﺸﺎﻫﺩﺓ‬ ‫ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻤﺒﺩﺌﻲ‬ ‫ﺍﺴﻡ ﺍﻟﺤﺎﻟﺔ‬

‫‪ ٢٠‬ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻹﺭﺴﺎل‬ ‫‪ ٢٠‬ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺇﻤﻼﺀ ﺍﻟﺘﻘﺭﻴﺭ‬
‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﻤﺩﻴﺭ ﺍﻟﻤﺸﻔﻰ‬ ‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﻤﺴﺅﻭل ﺍﻹﺒﻼﻍ ﻓﻲ ﺍﻟﻤﺸﻔﻰ‬

‫ﻻ ﻋﻥ ﺍﻟﻤﻌﻠﻭﻤﺎﺕ ﺍﻟﻭﺍﺭﺩﺓ ﻓﻴﻪ‪.‬‬

‫ﻤﻼﺤﻅﺎﺕ‪ - :‬ﻴﻤﻸ ﻫﺫﺍ ﺍﻟﺘﻘﺭﻴﺭ ﻤﻥ ﻗﺒل ﻤﺴﺅﻭل ﺍﻹﺒﻼﻍ ﺍﻟﻤﻌﺘﻤﺩ ﻓﻲ ﺍﻟﻤﺸﻔﻰ ﻭﻴﻜﻭﻥ ﻤﺴﺅﻭ ﹰ‬
‫‪ -‬ﻴﺭﺴل ﻫﺫﺍ ﺍﻟﺘﻘﺭﻴﺭ ﺇﻟﻰ ﺍﻟﻤﻨﻁﻘﺔ ﻴﻭﻡ ﺍﻷﺤﺩ ﻜل ﺃﺴﺒﻭﻉ‪.‬‬
‫‪ -‬ﻓﻲ ﺤﺎل ﺍﻜﺘﺸﺎﻑ ﺃﻱ ﻤﺭﺽ ﻤﻥ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺒﻘﺔ ﻴﺠﺏ ﺍﻹﺒﻼﻍ ﻋﻨﻪ ﻓﻭﺭﹰﺍ ﺒﺎﻟﻬﺎﺘﻑ ﺇﻟﻰ ﺭﺌﺎﺴﺔ ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺼﺤﻴﺔ ﺃﻭ ﻤﺩﻴﺭﻴﺔ‬
‫ﺍﻟﺼﺤﺔ ‪ /‬ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ ‪ /‬ﺇﻀﺎﻓﺔ ﺇﻟﻰ ﺇﻤﻼﺀ ﺍﻻﺴﺘﻤﺎﺭﺓ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻹﺒﻼﻍ ﻋﻥ ﺍﻟﻤﺭﺽ ﺍﻟﺴﺎﺭﻱ ﻭﺇﺭﺴﺎﻟﻬﺎ ﺒﺎﻟﻔﺎﻜﺱ ﻤﺒﺎﺸﺭﺓ ﺇﻟﻰ‬
‫ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬
‫ﺍﻟﺘﺄﺜﻴﺭﺍﺕ ﺍﻟﺠﺎﻨﺒﻴﺔ ﺍﻟﺘﺎﻟﻴﺔ ﻟﻠﻘﺎﺡ‪) :‬ﺨﺭﺍﺠﺎﺕ ﻤﻭﻀﻊ ﺍﻟﺤﻘﻥ‪ ،‬ﺼﺩﻤﺎﺕ ﺘﺤﺴﺴﻴﺔ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﻋﻘﺩ ﻟﻤﻔﻴﺔ‪ ،‬ﺍﺨﺘﻼﺠﺎﺕ(‪.‬‬

‫‪١٥٥‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪) (٤‬ﺠـ(‬
‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫‪.............................................................................................................‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‪:‬‬
‫‪......................................................................................................................................‬‬ ‫ﻤﻨﻁﻘﺔ‪:‬‬
‫ﺍﻟﺘﻘﺭﻴﺭ ﺍﻷﺴﺒﻭﻋﻲ ﺍﻟﺼﻔﺭﻱ ﻟﻺﺒﻼﻍ ﻋﻥ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻓﻲ ﺍﻟﻌﻴﺎﺩﺍﺕ ﺍﻟﺨﺎﺼﺔ‬
‫ﺍﺴﻡ ﺍﻟﻁﺒﻴﺏ‬

‫‪٢٠‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺇﻟﻰ‬ ‫‪٢٠‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﻤﻥ‬ ‫ﺭﻗﻡ ﺍﻷﺴﺒﻭﻉ‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﺸﻠل ﺭﺨﻭ ﺤﺎﺩ ﻓﻲ ﺍﻟﻌﻴﺎﺩﺓ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﺤﺼﺒﺔ ﻓﻲ ﺍﻟﻌﻴﺎﺩﺓ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﺤﺼﺒﺔ ﺃﻟﻤﺎﻨﻴﺔ ﻓﻲ ﺍﻟﻌﻴﺎﺩﺓ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﺤﺼﺒﺔ ﺃﻟﻤﺎﻨﻴﺔ ﺨﻠﻘﻴﺔ ﻓﻲ ﺍﻟﻌﻴﺎﺩﺓ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﻜﺯﺍﺯ ﻭﻟﻴﺩ ﻓﻲ ﺍﻟﻌﻴﺎﺩﺓ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﺍﻟﺘﻬﺎﺏ ﺴﺤﺎﻴﺎ ﻗﻴﺤﻲ ﻓﻲ ﺍﻟﻌﻴﺎﺩﺓ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﺩﻓﺘﺭﻴﺎ ﻓﻲ ﺍﻟﻌﻴﺎﺩﺓ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﺴﻌﺎل ﺩﻴﻜﻲ ﻓﻲ ﺍﻟﻌﻴﺎﺩﺓ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺤﺎﻻﺕ ﻜﻭﻟﻴﺭﺍ ﻓﻲ ﺍﻟﻌﻴﺎﺩﺓ ﻫﺫﺍ ﺍﻷﺴﺒﻭﻉ؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺘﺄﺜﻴﺭﺍﺕ ﺠﺎﻨﺒﻴﺔ ﺘﺎﻟﻴﺔ ﻟﻠﻘﺎﺡ*؟‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺍﻜﺘﺸﻔﺕ ﺃﻴﺔ ﺤﺎﻟﺔ ﻤﺭﺽ ﺴﺎﺭ ﺨﻁﻴﺭ ﻏﻴﺭ ﻤﺎ ﺴﺒﻕ؟ ﻭﻤﺎ ﻫﻭ؟‬
‫‪ -‬ﻓﻲ ﺤﺎل ﺍﻜﺘﺸﺎﻑ ﺤﺎﻻﺕ ﻤﺎ ﻫﻲ‪:‬‬
‫* ﺍﻟﺘﺩﺍﺒﻴﺭ ﺍﻟﻤﺘﺨﺫﺓ‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻤﺸﺎﻫﺩﺓ‬ ‫ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻤﺒﺩﺌﻲ‬ ‫ﺍﺴﻡ ﺍﻟﺤﺎﻟﺔ‬

‫‪ ٢٠‬ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻹﺭﺴﺎل‬ ‫‪ ٢٠‬ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺇﻤﻼﺀ ﺍﻟﺘﻘﺭﻴﺭ‬
‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﺍﻟﻁﺒﻴﺏ‬

‫ﻻ ﻋﻥ ﺍﻟﻤﻌﻠﻭﻤﺎﺕ ﺍﻟﻭﺍﺭﺩﺓ ﻓﻴﻪ‪.‬‬

‫ﻤﻼﺤﻅﺎﺕ‪ - :‬ﻴﻤﻸ ﻫﺫﺍ ﺍﻟﺘﻘﺭﻴﺭ ﻤﻥ ﻗﺒل ﺍﻟﻁﺒﻴﺏ ﻭﻴﻜﻭﻥ ﻤﺴﺅﻭ ﹰ‬
‫‪ -‬ﻴﺭﺴل ﻫﺫﺍ ﺍﻟﺘﻘﺭﻴﺭ ﺇﻟﻰ ﺍﻟﻤﻨﻁﻘﺔ ﻴﻭﻡ ﺍﻷﺤﺩ ﻓﻲ ﻜل ﺃﺴﺒﻭﻉ‪.‬‬
‫‪ -‬ﻓﻲ ﺤﺎل ﺍﻜﺘﺸﺎﻑ ﺃﻱ ﻤﺭﺽ ﻤﻥ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺒﻘﺔ ﻴﺠﺏ ﺍﻹﺒﻼﻍ ﻋﻨﻪ ﻓﻭﺭﹰﺍ ﺒﺎﻟﻬﺎﺘﻑ ﺇﻟﻰ ﺭﺌﺎﺴﺔ ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺼﺤﻴﺔ ﺃﻭ ﻤﺩﻴﺭﻴﺔ‬
‫ﺍﻟﺼﺤﺔ ‪ /‬ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ ‪ /‬ﺇﻀﺎﻓﺔ ﺇﻟﻰ ﺇﻤﻼﺀ ﺍﻻﺴﺘﻤﺎﺭﺓ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻹﺒﻼﻍ ﻋﻥ ﺍﻟﻤﺭﺽ ﺍﻟﺴﺎﺭﻱ ﻭﺇﺭﺴﺎﻟﻬﺎ ﺒﺎﻟﻔﺎﻜﺱ ﻤﺒﺎﺸﺭﺓ ﺇﻟﻰ‬
‫ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬
‫ﺍﻟﺘﺄﺜﻴﺭﺍﺕ ﺍﻟﺠﺎﻨﺒﻴﺔ ﺍﻟﺘﺎﻟﻴﺔ ﻟﻠﻘﺎﺡ‪) :‬ﺨﺭﺍﺠﺎﺕ ﻤﻭﻀﻊ ﺍﻟﺤﻘﻥ‪ ،‬ﺼﺩﻤﺎﺕ ﺘﺤﺴﺴﻴﺔ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﻋﻘﺩ ﻟﻤﻔﻴﺔ‪ ،‬ﺍﺨﺘﻼﺠﺎﺕ(‪.‬‬

‫‪١٥٦‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٥‬‬
‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫‪.............................................................................................................‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‪:‬‬
‫‪......................................................................................................................................‬‬ ‫ﻤﻨﻁﻘﺔ‪:‬‬

‫ﺍﻟﺼﺤﻴﺔ‬ ‫‪.............................................................................................................‬‬ ‫ﺍﻟﺘﻘﺭﻴﺭ ﺍﻷﺴﺒﻭﻋﻲ ﺍﻟﺼﻔﺭﻱ ﻟﻭﺤﺩﺍﺕ ﻤﻨﻁﻘﺔ‬

‫‪٢٠‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺇﻟﻰ‬ ‫‪٢٠ /‬‬ ‫‪/‬‬ ‫ﻤﻥ‬ ‫ﺭﻗﻡ ﺍﻷﺴﺒﻭﻉ‬ ‫ﻋﺩﺩ ﺍﻟﻭﺤﺩﺍﺕ ﺍﻟﺼﺤﻴﺔ‬
‫ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﻜﺘﺸﻔﺔ‬ ‫ﻫل ﺘﻡ ﺍﻹﺒﻼﻍ‬
‫ﺒﺎﻟﻭﻗﺕ‬
‫ﻤﺭﺽ‬ ‫** ﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺤﺼﺒﺔ ﺃﻟﻤﺎﻨﻴﺔ ‪+‬‬ ‫ﺸﻠل ﺭﺨﻭ‬ ‫* ﺍﺴﻡ ﺍﻟﻭﺤﺩﺓ ﺍﻟﺼﺤﻴﺔ‬
‫ﻜﺯﺍﺯ‬ ‫ﺤﺼﺒﺔ‬ ‫ﺍﻟﻤﺤﺩﺩ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬
‫ﺁﺨﺭ‬ ‫ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﺃﻟﻤﺎﻨﻴﺔ ﺨﻠﻘﻴﺔ‬ ‫ﺤﺎﺩ‬

‫ﺍﻟﻤﺠﻤﻭﻉ‬
‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ ﺍﻟﻭﺤﺩﺍﺕ ﺍﻟﺘﻲ ﻗﺎﻤﺕ ﺒﺎﻹﺒﻼﻍ‪:‬‬
‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ ﻟﻠﻭﺤﺩﺍﺕ ﺍﻟﺘﻲ ﺒﻠﻐﺕ ﺒﺎﻟﻭﻗﺕ ﺍﻟﻤﺤﺩﺩ‪:‬‬
‫ﻤﻌﻠﻭﻤﺎﺕ ﺘﻔﺼﻴﻠﻴﺔ ﻋﻥ ﺍﻟﺤﺎﻻﺕ‪:‬‬
‫ﺍﻟﻭﺤﺩﺓ ﺍﻟﺼﺤﻴﺔ ﺍﻟﺘﻲ‬
‫*** ﺍﻟﺘﺩﺍﺒﻴﺭ ﺍﻟﻤﺘﺨﺫﺓ‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻤﺸﺎﻫﺩﺓ‬ ‫ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻤﺒﺩﺌﻲ‬ ‫ﺍﺴﻡ ﺍﻟﺤﺎﻟﺔ‬
‫ﻗﺎﻤﺕ ﺒﺎﻹﺒﻼﻍ‬

‫‪ ٢٠‬ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻹﺭﺴﺎل‬ ‫‪ ٢٠‬ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺇﻤﻼﺀ ﺍﻟﺘﻘﺭﻴﺭ‬
‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﺭﺌﻴﺱ ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺼﺤﻴﺔ‬ ‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﻤﺴﺅﻭل ﺍﻟﺘﺭﺼﺩ ﻓﻲ ﺍﻟﻤﻨﻁﻘﺔ‬

‫* ﺍﻟﻭﺤﺩﺓ ﺍﻟﺼﺤﻴﺔ‪ :‬ﻫﻲ ﻜل‪ :‬ﻤﺭﻜﺯ ﺼﺤﻲ‪ ،‬ﻋﻴﺎﺩﺍﺕ ﺸﺎﻤﻠﺔ‪ ،‬ﻤﺭﻜﺯ ﻤﻨﻁﻘﺔ‪ ،‬ﻤﺸﻔﻰ ﻋﺎﻡ‪ ،‬ﻤﺸﻔﻰ ﺨﺎﺹ‪....‬‬
‫** ﺍﻟﺘﺄﺜﻴﺭﺍﺕ ﺍﻟﺠﺎﻨﺒﻴﺔ ﺍﻟﺘﺎﻟﻴﺔ ﻟﻠﻘﺎﺡ‪) :‬ﺨﺭﺍﺠﺎﺕ ﻤﻭﻀﻊ ﺍﻟﺤﻘﻥ‪ ،‬ﺼﺩﻤﺎﺕ ﺘﺤﺴﺴﻴﺔ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﻋﻘﺩ ﻟﻤﻔﻴﺔ‪ ،‬ﺍﺨﺘﻼﺠﺎﺕ(‪.‬‬
‫*** ﺍﻟﺘﺩﺍﺒﻴﺭ ﺍﻟﻤﺘﺨﺫﺓ ﺘﺠﺎﻩ ﻫﺫﻩ ﺍﻟﺤﺎﻻﺕ‪) :‬ﺇﺒﻼﻍ ﻓﻭﺭﻱ‪ ،‬ﺘﻘﺼﻲ‪.(...... ،‬‬
‫ﻤﻼﺤﻅﺎﺕ‪ - :‬ﻴﺩﻭﻥ ﺘﺎﺭﻴﺦ ﺇﺒﻼﻍ ﻜل ﻭﺤﺩﺓ ﺇﻟﻰ ﺍﻟﻤﻨﻁﻘﺔ ﻋﻠﻰ ﺠﺩﻭل ﺍﻜﺘﻤﺎل ﻭﺘﻭﻗﻴﺕ ﺇﺒﻼﻍ ﺍﻟﻭﺤﺩﺍﺕ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫‪ -‬ﻴﺭﺴل ﻫﺫﺍ ﺍﻟﺘﻘﺭﻴﺭ ﻴﻭﻡ ﺍﻻﺜﻨﻴﻥ ﻤﻥ ﻜل ﺃﺴﺒﻭﻉ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ )ﺒﻌﺩ ﺘﺭﻙ ﻨﺴﺨﺔ ﻤﻨﻪ ﻓﻲ ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺼﺤﻴﺔ(‪.‬‬
‫‪ -‬ﻓﻲ ﺤﺎل ﻤﺸﺎﻫﺩﺓ ﺃﻭ ﺍﻜﺘﺸﺎﻑ ﺃﻴﺔ ﺤﺎﻟﺔ ﻴﺘﻡ ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻨﻬﺎ ﻫﺎﺘﻔﻴﹰﺎ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ ﻭﺘﺭﺴل ﻨﺴﺨﺔ ﻤﻥ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻹﺒﻼﻍ ﻋﻥ ﻤﺭﺽ‬
‫ﺴﺎﺭ ﻭﺘﺘﺭﻙ ﻨﺴﺨﺔ ﻓﻲ ﺍﻟﻤﻨﻁﻘﺔ‪.‬‬

‫‪١٥٧‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٦‬‬
‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫‪.............................................................................................................‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‪:‬‬
‫‪.........................................................................................‬‬ ‫ﺍﻟﺘﻘﺭﻴﺭ ﺍﻷﺴﺒﻭﻋﻲ ﺍﻟﺼﻔﺭﻱ ﻟﻤﻨﺎﻁﻕ ﻤﺤﺎﻓﻅﺔ‬
‫‪٢٠‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺇﻟﻰ‬ ‫‪٢٠ /‬‬ ‫‪/‬‬ ‫ﻤﻥ‬ ‫ﺭﻗﻡ ﺍﻷﺴﺒﻭﻉ‬ ‫ﻋﺩﺩ ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﺼﺤﻴﺔ‬
‫ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﻜﺘﺸﻔﺔ‬ ‫ﺍﻹﺒﻼﻍ‬ ‫ﺍﻟﻭﺤﺩﺍﺕ‬
‫ﻋﺩﺩ‬
‫ﻤﺭﺽ‬ ‫*ﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺤﺼﺒﺔ ﺃﻟﻤﺎﻨﻴﺔ ‪+‬‬ ‫ﺸﻠل ﺭﺨﻭ‬ ‫ﺒﺎﻟﻭﻗﺕ‬ ‫ﺍﻟﺘﻲ ﻗﺎﻤﺕ‬ ‫ﺍﺴﻡ ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺼﺤﻴﺔ‬
‫ﻜﺯﺍﺯ‬ ‫ﺤﺼﺒﺔ‬ ‫ﺍﻟﻭﺤﺩﺍﺕ‬
‫ﺁﺨﺭ‬ ‫ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﺃﻟﻤﺎﻨﻴﺔ ﺍﻟﺨﻠﻘﻴﺔ‬ ‫ﺤﺎﺩ‬ ‫ﺍﻟﻤﺤﺩﺩ‬ ‫ﺒﺎﻹﺒﻼﻍ‬

‫ﺍﻟﻤﺠﻤﻭﻉ‬
‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﺘﻲ ﻗﺎﻤﺕ ﺒﺎﻹﺒﻼﻍ‪:‬‬
‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﺘﻲ ﺒﻠﻐﺕ ﺒﺎﻟﻭﻗﺕ ﺍﻟﻤﺤﺩﺩ‪:‬‬
‫ﻤﻌﻠﻭﻤﺎﺕ ﺘﻔﺼﻴﻠﻴﺔ ﻋﻥ ﺍﻟﺤﺎﻻﺕ‪:‬‬
‫ﺘﺎﺭﻴﺦ‬ ‫ﺍﻟﻭﺤﺩﺓ ﺍﻟﺼﺤﻴﺔ‬
‫* ﺍﻟﺘﺩﺍﺒﻴﺭ ﺍﻟﻤﺘﺨﺫﺓ‬ ‫ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻤﺒﺩﺌﻲ‬ ‫ﺍﺴﻡ ﺍﻟﺤﺎﻟﺔ‬
‫ﺍﻟﻤﺸﺎﻫﺩﺓ‬ ‫ﺍﻟﺘﻲ ﻗﺎﻤﺕ ﺒﺎﻹﺒﻼﻍ‬

‫‪ ٢٠‬ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻹﺭﺴﺎل‬ ‫‪ ٢٠‬ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺇﻤﻼﺀ ﺍﻟﺘﻘﺭﻴﺭ‬
‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﺭﺌﻴﺱ ﺸﻌﺒﺔ ﺼﺤﺔ ﺍﻷﻁﻔﺎل ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﺭﺌﻴﺱ ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ‬ ‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﻤﺴﺅﻭل ﺍﻟﺘﺭﺼﺩ ﻓﻲ ﺍﻟﻤﺩﻴﺭﻴﺔ‬

‫* ﺍﻟﺘﺄﺜﻴﺭﺍﺕ ﺍﻟﺠﺎﻨﺒﻴﺔ ﺍﻟﺘﺎﻟﻴﺔ ﻟﻠﻘﺎﺡ‪) :‬ﺨﺭﺍﺠﺎﺕ ﻤﻭﻀﻊ ﺍﻟﺤﻘﻥ‪ ،‬ﺼﺩﻤﺎﺕ ﺘﺤﺴﺴﻴﺔ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﻋﻘﺩ ﻟﻤﻔﻴﺔ‪ ،‬ﺍﺨﺘﻼﺠﺎﺕ(‪.‬‬
‫** ﺍﻟﺘﺩﺍﺒﻴﺭ ﺍﻟﻤﺘﺨﺫﺓ ﺘﺠﺎﻩ ﻫﺫﻩ ﺍﻟﺤﺎﻟﺔ‪) :‬ﺇﺒﻼﻍ ﻓﻭﺭﻱ‪ ،‬ﺘﻘﺼﻲ‪.(.... ،‬‬
‫ﻤﻼﺤﻅﺎﺕ‪ - :‬ﻴﺩﻭﻥ ﺘﺎﺭﻴﺦ ﺇﺒﻼﻍ ﻜل ﻤﻨﻁﻘﺔ ﻋﻠﻰ ﺠﺩﻭل ﺍﻜﺘﻤﺎل ﻭﺘﻭﻗﻴﺕ ﺇﺒﻼﻍ ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﺼﺤﻴﺔ‪.‬‬
‫‪ -‬ﻴﺭﺴل ﻫﺫﺍ ﺍﻟﺘﻘﺭﻴﺭ ﻴﻭﻡ ﺍﻟﺜﻼﺜﺎﺀ ﻤﻥ ﻜل ﺃﺴﺒﻭﻉ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ )ﺒﻌﺩ ﺘﺭﻙ ﻨﺴﺨﺔ ﻤﻨﻪ ﻓﻲ ﺍﻟﻤﺩﻴﺭﻴﺔ(‪.‬‬
‫‪ -‬ﻓﻲ ﺤﺎل ﻤﺸﺎﻫﺩﺓ ﺃﻭ ﺍﻜﺘﺸﺎﻑ ﺃﻴﺔ ﺤﺎﻟﺔ ﻴﺘﻡ ﺍﻹﺒﻼﻍ ﺍﻟﻔﻭﺭﻱ ﻋﻨﻬﺎ ﻫﺎﺘﻔﻴﹰﺎ ﻭﺘﺭﺴل ﻨﺴﺨﺔ ﻤﻥ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻹﺒﻼﻍ ﻋﻥ ﻤﺭﺽ ﺴﺎﺭ ﺇﻟﻰ ﻤﺩﻴﺭﻴﺔ‬
‫ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻭﺘﺘﺭﻙ ﻨﺴﺨﺔ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬

‫‪١٥٨‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٧‬‬
‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫‪.............................................................................................................‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‪:‬‬

‫ﺘﻘﺭﻴﺭ ﺘﺠﻤﻴﻌﻲ ﻟﺯﻴﺎﺭﺍﺕ ﺍﻟﻜﺸﻑ ﺍﻟﻔﻌ‪‬ﺎل ﺍﻷﺴﺒﻭﻋﻴﺔ‬

‫‪...............................................................................‬‬ ‫ﺇﻟﻰ ﺍﻟﻤﺸﺎﻓﻲ ﺍﻟﻤﻌﺘﻤﺩﺓ ﻓﻲ ﻤﻨﻁﻘﺔ‬
‫‪٢٠‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺇﻟﻰ‬ ‫‪٢٠‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﻤﻥ‬ ‫‪........................................................‬‬ ‫ﺨﻼل ﺍﻷﺴﺒﻭﻉ ﺭﻗﻡ‬

‫‪...........................................................‬‬ ‫ﻋﺩﺩ ﺍﻟﻤﺸﺎﻓﻲ ﺍﻟﻤﺯﺍﺭﺓ ﺨﻼل ﺍﻷﺴﺒﻭﻉ‬ ‫‪........................................................‬‬ ‫ﻋﺩﺩ ﺍﻟﻤﺸﺎﻓﻲ ﺍﻟﻤﻌﺘﻤﺩﺓ‬

‫ﻤﺠﻤﻭﻉ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﻜﺘﺸﻔﺔ‪:‬‬

‫ﺍﻟﺤﺼﺒﺔ‬ ‫ﺍﻟﺤﺼﺒﺔ ‪+‬‬ ‫ﺍﻟﺸﻠل‬
‫* ﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺍﻟﺘﻬﺎﺏ‬ ‫ﺍﻟﺴﻌﺎل‬ ‫ﻜﺯﺍﺯ‬
‫ﺃﺨﺭﻯ‬ ‫ﺍﻷﻟﻤﺎﻨﻴﺔ‬ ‫ﺍﻟﺤﺼﺒﺔ‬ ‫ﺍﻟﺭﺨﻭ‬ ‫ﺍﺴﻡ ﺍﻟﻤﺭﺽ‬
‫ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﺴﺤﺎﻴﺎ‬ ‫ﺍﻟﺩﻴﻜﻲ‬ ‫ﺍﻟﻭﻟﻴﺩ‬
‫ﺍﻟﺨﻠﻘﻴﺔ‬ ‫ﺍﻷﻟﻤﺎﻨﻴﺔ‬ ‫ﺍﻟﺤﺎﺩ‬

‫ﺇﺠﻤﺎﻟﻲ ﺍﻟﺤﺎﻻﺕ‬

‫ﺘﺎﺭﻴﺦ ﺩﺨﻭل ﺍﻟﻤﺸﻔﻰ‬ ‫ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻤﺒﺩﺌﻲ‬ ‫ﺍﺴﻡ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﻜﺘﺸﻔﺔ‬

‫‪ ٢٠‬ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻹﺭﺴﺎل‬ ‫‪ ٢٠‬ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺇﻤﻼﺀ ﺍﻟﺘﻘﺭﻴﺭ‬

‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﺭﺌﻴﺱ ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺼﺤﻴﺔ‬ ‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﻤﺴﺅﻭل ﺍﻟﺘﺭﺼﺩ ﻓﻲ ﺍﻟﻤﻨﻁﻘﺔ‬

‫* ﺍﻟﺘﺄﺜﻴﺭﺍﺕ ﺍﻟﺠﺎﻨﺒﻴﺔ ﺍﻟﺘﺎﻟﻴﺔ ﻟﻠﻘﺎﺡ‪) :‬ﺨﺭﺍﺠﺎﺕ ﻤﻭﻀﻊ ﺍﻟﺤﻘﻥ‪ ،‬ﺼﺩﻤﺎﺕ ﺘﺤﺴﺴﻴﺔ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﻋﻘﺩ ﻟﻤﻔﻴﺔ‪ ،‬ﺍﺨﺘﻼﺠﺎﺕ(‪.‬‬
‫ﻴﺭﺴل ﻫﺫﺍ ﺍﻟﺘﻘﺭﻴﺭ ﺃﺴﺒﻭﻋﻴﹰﺎ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ ﻭﻴﺘﺭﻙ ﻨﺴﺨﺔ ﻤﻨﻪ ﻓﻲ ﺍﻟﻤﻨﻁﻘﺔ‪.‬‬

‫‪١٥٩‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٨‬‬
‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫‪.............................................................................................................‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‪:‬‬

‫ﺘﻘﺭﻴﺭ ﺘﺠﻤﻴﻌﻲ ﻟﺯﻴﺎﺭﺍﺕ ﺍﻟﻜﺸﻑ ﺍﻟﻔﻌ‪‬ﺎل ﺍﻷﺴﺒﻭﻋﻴﺔ‬

‫‪...............................................................................‬‬ ‫ﺇﻟﻰ ﺍﻟﻤﺸﺎﻓﻲ ﺍﻟﻤﻌﺘﻤﺩﺓ ﻓﻲ ﻤﺤﺎﻓﻅﺔ‬
‫‪٢٠‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺇﻟﻰ‬ ‫‪٢٠‬‬ ‫ﻤﻥ ‪/ /‬‬ ‫‪........................................................‬‬ ‫ﺨﻼل ﺍﻷﺴﺒﻭﻉ ﺭﻗﻡ‬

‫‪...........................................................‬‬ ‫ﻋﺩﺩ ﺍﻟﻤﺸﺎﻓﻲ ﺍﻟﻤﺯﺍﺭﺓ ﺨﻼل ﺍﻷﺴﺒﻭﻉ‬ ‫‪........................................................‬‬ ‫ﻋﺩﺩ ﺍﻟﻤﺸﺎﻓﻲ ﺍﻟﻤﻌﺘﻤﺩﺓ‬

‫ﻤﺠﻤﻭﻉ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﻜﺘﺸﻔﺔ‪:‬‬

‫ﺍﻟﺤﺼﺒﺔ‬ ‫ﺍﻟﺤﺼﺒﺔ ‪+‬‬ ‫ﺍﻟﺸﻠل‬
‫* ﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺍﻟﺘﻬﺎﺏ‬ ‫ﺍﻟﺴﻌﺎل‬ ‫ﻜﺯﺍﺯ‬
‫ﺃﺨﺭﻯ‬ ‫ﺍﻷﻟﻤﺎﻨﻴﺔ‬ ‫ﺍﻟﺤﺼﺒﺔ‬ ‫ﺍﻟﺭﺨﻭ‬ ‫ﺍﺴﻡ ﺍﻟﻤﺭﺽ‬
‫ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﺴﺤﺎﻴﺎ‬ ‫ﺍﻟﺩﻴﻜﻲ‬ ‫ﺍﻟﻭﻟﻴﺩ‬
‫ﺍﻟﺨﻠﻘﻴﺔ‬ ‫ﺍﻷﻟﻤﺎﻨﻴﺔ‬ ‫ﺍﻟﺤﺎﺩ‬

‫ﺇﺠﻤﺎﻟﻲ ﺍﻟﺤﺎﻻﺕ‬

‫ﺘﺎﺭﻴﺦ ﺩﺨﻭل ﺍﻟﻤﺸﻔﻰ‬ ‫ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻤﺒﺩﺌﻲ‬ ‫ﺍﺴﻡ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﻜﺘﺸﻔﺔ‬

‫‪ ٢٠‬ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻹﺭﺴﺎل‬ ‫‪ ٢٠‬ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺇﻤﻼﺀ ﺍﻟﺘﻘﺭﻴﺭ‬

‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﺭﺌﻴﺱ ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ‬ ‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﻤﺴﺅﻭل ﺍﻟﺘﺭﺼﺩ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‬

‫* ﺍﻟﺘﺄﺜﻴﺭﺍﺕ ﺍﻟﺠﺎﻨﺒﻴﺔ ﺍﻟﺘﺎﻟﻴﺔ ﻟﻠﻘﺎﺡ‪) :‬ﺨﺭﺍﺠﺎﺕ ﻤﻭﻀﻊ ﺍﻟﺤﻘﻥ‪ ،‬ﺼﺩﻤﺎﺕ ﺘﺤﺴﺴﻴﺔ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﻋﻘﺩ ﻟﻤﻔﻴﺔ‪ ،‬ﺍﺨﺘﻼﺠﺎﺕ(‪.‬‬
‫ﻴﺭﺴل ﻫﺫﺍ ﺍﻟﺘﻘﺭﻴﺭ ﺃﺴﺒﻭﻋﻴﹰﺎ ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ‪ -‬ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ ﻭﻴﺘﺭﻙ ﻨﺴﺨﺔ ﻤﻨﻪ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪.‬‬

‫‪١٦٠‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٩‬‬

‫ﺃﺭﻗﺎﻡ ﻫﻭﺍﺘﻑ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻭﻤﺩﻴﺭﻴﺎﺕ ﺍﻟﺼﺤﺔ‬

‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‪:‬‬
‫‪٣٣٢٦٠٥٩‬‬ ‫ﻤﻌﺎﻭﻥ ﻭﺯﻴﺭ ﺍﻟﺼﺤﺔ‬
‫‪٢٧٥٨١٢٢‬‬ ‫ﻤﺩﻴﺭ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫‪٢٧٥٨١٢٣‬‬ ‫ﻤﺩﻴﺭ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ‬

‫‪٢٧٥٧٩٨٨‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ‬

‫‪٢٧٥٨١٢١‬‬ ‫ﺩﺍﺌﺭﺓ ﺼﺤﺔ ﺍﻟﻁﻔل‬
‫‪ ٣٣٩٦٠٠/١/٢/٣‬ـ ‪٣٣١١٠٢٠/١/٢‬‬ ‫ﻤﻘﺴﻡ ﺍﻟﻭﺯﺍﺭﺓ‬

‫‪٢٧٥٨١١٣‬‬ ‫ﻤﻘﺴﻡ ﺍﻟﻭﺯﺍﺭﺓ ـ ﺍﻟﻤﻴﺴﺎﺕ‬

‫ﻤﺩﻴﺭﻴﺎﺕ ﺍﻟﺼﺤﺔ‪:‬‬
‫ﺭﻗﻡ ﺍﻟﻬﺎﺘﻑ‬ ‫ﺍﻟﻤﻜﺎﻥ‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‬ ‫ﺭﻗﻡ ﺍﻟﻬﺎﺘﻑ‬ ‫ﺍﻟﻤﻜﺎﻥ‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‬

‫‪٢٣١٢٠٧‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ‬ ‫ﺩﺭﻋﺎ‬ ‫‪٣٣٣٥١٤٣‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ‬ ‫ﺩﻤﺸﻕ‬

‫‪٢٤٠٠٨٩‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫‪٠١٥‬‬ ‫‪٢٧٦٢٤١٨‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫‪٠١١‬‬

‫‪٢٣٨٠٦٦‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ‬ ‫ﺍﻟﺴﻭﻴﺩﺍﺀ‬ ‫‪٤٤١٨٦٠٥‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ‬ ‫ﺭﻴﻑ ﺩﻤﺸﻕ‬

‫‪٢٢٥٩٩٥‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫‪٠١٦‬‬ ‫‪٤٤١١٧٥‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫‪٠١١‬‬

‫‪٣٦٧٢٧٩‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ‬ ‫ﻁﺭﻁﻭﺱ‬ ‫‪٣٣١٢١٥١٠‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ‬ ‫ﺤﻠﺏ‬

‫‪٣٥٩٢٢٤‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫‪٠٤٣‬‬ ‫‪٤٦٦٥٧٠٠‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫‪٠٢١‬‬

‫‪٣١٠٣٨٨‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ‬ ‫ﺩﻴﺭ ﺍﻟﺯﻭﺭ‬ ‫‪٢٤٨٧٥٠٤‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ‬ ‫ﺤﻤﺹ‬

‫‪٣٢٥٥١٥‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫‪٠٥١‬‬ ‫‪٢٤٨٩٨١٣‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫‪٠٣١‬‬

‫‪٢٢٩٧٩٥‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ‬ ‫ﺍﻟﺭﻗﺔ‬ ‫‪٣٥٢٩٠٨‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ‬ ‫ﺤﻤﺎﻩ‬

‫‪٢١٥٢٦٨‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫‪٠٢٢‬‬ ‫‪٣٥٦١٨٨‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫‪٠٣٣‬‬

‫‪٢٢٦٩٤٦‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ‬ ‫ﺍﻟﺤﺴﻜﺔ‬ ‫‪٣٥٩٣١٨‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ‬ ‫ﺍﻟﻼﺫﻗﻴﺔ‬

‫‪٢٢٣٩٨٦‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫‪٠٥٢‬‬ ‫‪٣٥٥٨١١‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫‪٠٤١‬‬

‫‪٢٤١٩٩٦‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ‬ ‫ﺇﺩﻟﺏ‬ ‫‪٦١١٩٢٥٢‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺭﻋﺎﻴﺔ‬ ‫ﺍﻟﻘﻨﻴﻁﺭﺓ‬

‫‪٢٦٩١٧٨‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫‪٠٢٣‬‬ ‫‪٢٢٣٧١٢٧‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫‪٠١٤‬‬

‫‪١٦١‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(١٠‬‬

‫ﺠﺩﻭل ﺍﻟﻠﻘﺎﺤﺎﺕ ﺍﻟﺭﻭﺘﻴﻨﻴﺔ ﻟﻸﻁﻔﺎل ﺍﻟﻤﻌﺘﻤﺩ ﻤﻨﺫ ‪ ٢٠٠٨/١/١‬ﻡ‬

‫ﺍﻟﻠﻘﺎﺡ ﺍﻟﺫﻱ ﺴﻴﻌﻁﻰ ﺨﻼل ﺍﻟﺯﻴﺎﺭﺓ‬ ‫ﻋﻤﺭ ﺍﻟﻁﻔل‬ ‫ﺍﻟﺯﻴﺎﺭﺓ‬

‫ﺏ ﺙ ﺝ )ﺍﻟﺴل( ‪ +‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ ‪١‬‬ ‫ﻤﻨﺫ ﺍﻟﻭﻻﺩﺓ‬ ‫ﺍﻷﻭﻟﻰ‬

‫ﺍﻟﺨﻤﺎﺴﻲ )ﺭﺒﺎﻋﻲ ‪ + ١‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ ‪ + (٢‬ﺸﻠل ﻋﻀﻠﻲ ‪١‬‬ ‫ﺒﺩﺍﻴﺔ ﺍﻟﺸﻬﺭ ﺍﻟﺜﺎﻟﺙ‬ ‫ﺍﻟﺜﺎﻨﻴﺔ‬

‫ﺭﺒﺎﻋﻲ ‪ + ٢‬ﺸﻠل ﻋﻀﻠﻲ ‪٢‬‬ ‫ﺒﺩﺍﻴﺔ ﺍﻟﺸﻬﺭ ﺍﻟﺭﺍﺒﻊ‬ ‫ﺍﻟﺜﺎﻟﺜﺔ‬

‫ﺭﺒﺎﻋﻲ ‪ + ٣‬ﺸﻠل ﻓﻤﻭﻱ ‪١‬‬ ‫ﺒﺩﺍﻴﺔ ﺍﻟﺸﻬﺭ ﺍﻟﺨﺎﻤﺱ‬ ‫ﺍﻟﺭﺍﺒﻌﺔ‬

‫ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ ‪ + ٣‬ﺸﻠل ﻓﻤﻭﻱ ‪٢‬‬ ‫ﺒﺩﺍﻴﺔ ﺍﻟﺸﻬﺭ ﺍﻟﺴﺎﺒﻊ‬ ‫ﺍﻟﺨﺎﻤﺴﺔ‬

‫‪ + MMR1‬ﺸﻠل ﻓﻤﻭﻱ ‪ + ٣‬ﻓﻴﺘﺎﻤﻴﻥ ﺃ‬ ‫ﺒﻌﻤﺭ ﺍﻟﺴﻨﺔ‬ ‫ﺍﻟﺴﺎﺩﺴﺔ‬

‫‪ + MMR2‬ﺭﺒﺎﻋﻲ ﺩﺍﻋﻤﺔ ‪ +‬ﺸﻠل ﻓﻤﻭﻱ ﺩﺍﻋﻤﺔ‬ ‫ﺒﻌﻤﺭ ﺍﻟﺴﻨﺔ ﻭﺍﻟﻨﺼﻑ‬ ‫ﺍﻟﺴﺎﺒﻌﺔ‬

‫ﺍﻟﺜﻨﺎﺌﻲ ﺍﻟﻁﻔﻠﻲ ‪ +‬ﺸﻠل ﻓﻤﻭﻱ ‪ +‬ﻟﻘﺎﺡ ﺍﻟﻤﻜﻭﺭﺍﺕ ﺍﻟﺴﺤﺎﺌﻴﺔ‬ ‫ﺍﻟﺼﻑ ﺍﻷﻭل‬ ‫ﺍﻟﺜﺎﻤﻨﺔ‬

‫ﺍﻟﺜﻨﺎﺌﻲ ﺍﻟﻜﻬﻠﻲ‬ ‫ﺍﻟﺼﻑ ﺍﻟﺴﺎﺩﺱ‬ ‫ﺍﻟﺘﺎﺴﻌﺔ‬

‫ﺍﻟﻠﻘﺎﺡ ﺍﻟﺭﺒﺎﻋﻲ‪ :‬ﻴﺘﻜﻭﻥ ﻤﻥ ﺍﻟﻠﻘﺎﺤﺎﺕ ‪/‬ﺍﻟﺴﻌﺎل ﺍﻟﺩﻴﻜﻲ‪ ،‬ﺍﻟﻜﺯﺍﺯ‪ ،‬ﺍﻟﺩﻓﺘﺭﻴﺎ‪ ،‬ﺍﻟﻤﺴﺘﺩﻤﻴﺔ ﺍﻟﻨﺯﻟﻴﺔ ﻨﻤﻁ ‪./B‬‬

‫ﺍﻟﻠﻘﺎﺡ ﺍﻟﺨﻤﺎﺴﻲ‪ :‬ﻴﺘﻜﻭﻥ ﻤﻥ ﺍﻟﻠﻘﺎﺤﺎﺕ ‪/‬ﺍﻟﺭﺒﺎﻋﻲ ‪ +‬ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﺒﺎﺌﻲ‪./‬‬

‫ﻟﻘﺎﺡ ﺍﻟـ ‪ :MMR‬ﻴﺘﻜﻭﻥ ﻤﻥ ﺍﻟﻠﻘﺎﺤﺎﺕ ‪/‬ﺍﻟﺤﺼﺒﺔ‪ ،‬ﺍﻟﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ‪ ،‬ﺍﻟﻨﻜﺎﻑ‪./‬‬

‫ﺍﻟﺜﻨﺎﺌﻲ ﺍﻟﻁﻔﻠﻲ ‪ :DT‬ﻴﺘﻜﻭﻥ ﻤﻥ ﻟﻘﺎﺤﻲ ‪/‬ﺍﻟﺩﻓﺘﺭﻴﺎ ‪ +‬ﺍﻟﻜﺯﺍﺯ‪./‬‬

‫ﺍﻟﺜﻨﺎﺌﻲ ﺍﻟﻜﻬﻠﻲ ‪ :Td‬ﻴﺘﻜﻭﻥ ﻤﻥ ﻟﻘﺎﺤﻲ ‪/‬ﺍﻟﻜﺯﺍﺯ ‪ +‬ﺍﻟﺩﻓﺘﺭﻴﺎ ﺒﺠﺭﻋﺔ ﺘﺤﻭﻱ ﻤﻘﺩﺍﺭ ﺃﻗل ﻤﻥ ﺍﻟﻭﺤﺩﺍﺕ‪./‬‬

‫‪١٦٢‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(١١‬‬

‫ﺠﺩﻭل ﻟﻘﺎﺡ ﺍﻟﻜﺯﺍﺯ‬

‫ﻟﻠﻔﺘﻴﺎﺕ ﻭﺍﻟﺤﻭﺍﻤل ﻭﺍﻷﻤﻬﺎﺕ‬
‫ﻭﺠﻤﻴﻊ ﺍﻟﻨﺴﺎﺀ ﻓﻲ ﺴﻥ ﺍﻹﻨﺠﺎﺏ‬

‫ﻓﺘﺭﺓ ﺍﻟﻤﻨﺎﻋﺔ ﺍﻟﺘﻲ ﺘﻌﻁﻴﻬﺎ‬ ‫ﺍﻟﻔﺎﺼل ﺒﻴﻥ ﺍﻟﺠﺭﻋﺎﺕ‬ ‫ﺍﻟﺠﺭﻋﺔ‬

‫ﻻ ﺘﻌﻁﻲ ﻤﻨﺎﻋﺔ‬ ‫ﺘﻌﻁﻰ ﻤﻨﺫ ﺃﻭل ﺯﻴﺎﺭﺓ‬ ‫ﺍﻷﻭﻟﻰ‬

‫‪ ٣‬ﺴﻨﻭﺍﺕ‬ ‫ﺒﻌﺩ ﺸﻬﺭ ﻤﻥ ﺍﻷﻭﻟﻰ‬ ‫ﺍﻟﺜﺎﻨﻴﺔ‬

‫‪ ٥‬ﺴﻨﻭﺍﺕ‬ ‫ﺒﻌﺩ ﺴﺘﺔ ﺃﺸﻬﺭ ﻤﻥ ﺍﻟﺜﺎﻨﻴﺔ‬ ‫ﺍﻟﺜﺎﻟﺜﺔ‬

‫‪ ١٠‬ﺴﻨﻭﺍﺕ‬ ‫ﺒﻌﺩ ﺴﻨﺔ ﻤﻥ ﺍﻟﺜﺎﻟﺜﺔ‬ ‫ﺍﻟﺭﺍﺒﻌﺔ‬

‫ﻁﻭﺍل ﻓﺘﺭﺓ ﺍﻹﻨﺠﺎﺏ‬ ‫ﺒﻌﺩ ﺴﻨﺔ ﻤﻥ ﺍﻟﺭﺍﺒﻌﺔ‬ ‫ﺍﻟﺨﺎﻤﺴﺔ‬

‫ﻤﻊ ﺍﻷﺨﺫ ﺒﻌﻴﻥ ﺍﻻﻋﺘﺒﺎﺭ ﻟﻘﺎﺤﺎﺕ ﺍﻟﻁﻔﻭﻟﺔ ﻭﺍﻟﻤﺩﺭﺴﺔ‪.‬‬

‫‪١٦٣‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(١٢‬‬
‫‪.....................................................................................................................................‬‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫‪...........................................................................................................................................‬‬ ‫ﺍﻟﻤﻨﻁﻘﺔ‪:‬‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫‪..............................................................................................................‬‬ ‫ﺍﻟﺭﻗﻡ ﺍﻟﻤﺘﺴﻠﺴل‪:‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫‪.................................................................................................................................‬‬ ‫ﺍﻟﻤﺴﺘﺸﻔﻰ‪:‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ‬

‫ﺍﺴﺘﻤﺎﺭﺓ ﺘﻘﺼﻲ ﻟﻤﺭﺽ ﺍﻟﻜﻭﻟﻴﺭﺍ‬

‫ﺃﻭ ﹰﻻ ‪ -‬ﺍﻟﻬﻭﻴﺔ ﺍﻟﺸﺨﺼﻴﺔ‪:‬‬
‫‪...............................................................................................................‬‬ ‫ﺍﻟﻤﻬﻨﺔ‪:‬‬ ‫‪.........................................‬‬ ‫ﺍﻟﺠﻨﺱ‪:‬‬ ‫‪..................................................................‬‬ ‫ﺍﻟﻌﻤﺭ‪:‬‬ ‫‪.............................................................................................................................................‬‬ ‫ﺍﻻﺴﻡ‪:‬‬
‫‪..................................................................................................................................................................................................‬‬ ‫ﻤﻜﺎﻥ ﺍﻟﻌﻤل‪:‬‬ ‫‪..........................................................................................................................................................................................‬‬ ‫ﻤﻜﺎﻥ ﺍﻹﻗﺎﻤﺔ‪:‬‬
‫‪...............................................................................................‬‬ ‫ﻋﺩﺩ ﺍﻷﻭﻻﺩ‪:‬‬ ‫‪............................................................................................‬‬ ‫ﺍﻟﻭﻀﻊ ﺍﻟﻌﺎﺌﻠﻲ‪:‬‬ ‫‪............................................................................................................................‬‬ ‫ﺭﻗﻡ ﺍﻟﻬﺎﺘﻑ‪:‬‬

‫ﺜﺎﻨﻴ ﹰﺎ ‪ -‬ﺍﻟﻘﺼﺔ ﺍﻟﻤﺭﻀﻴﺔ‪:‬‬

‫ﺘﺠﻔﻑ‬ ‫ﺇﻗﻴﺎﺀ‬ ‫ﺍﻷﻋﺭﺍﺽ ﺍﻟﺘﻲ ﻴﺸﻜﻭ ﻤﻨﻬﺎ‪ :‬ﺇﺴﻬﺎل‬ ‫‪..........................................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ‪:‬‬

‫ﻓﻘﺩ ﻭﻋﻲ‬
‫‪.................................................................................................................................................................... ...........................................................................................................................................................‬‬ ‫ﻫل ﺘﻡ ﺘﻨﺎﻭل ﺃﺩﻭﻴﺔ ﻗﺒل ﺩﺨﻭل ﺍﻟﻤﺴﺘﺸﻔﻰ؟‪:‬‬
‫ﻭﻓﺎﺓ‬ ‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﺭﺍﻫﻨﺔ‪ :‬ﺸﻔﺎﺀ‬

‫ﺜﺎﻟﺜ ﹰﺎ ‪ -‬ﺍﻟﻤﺸﺎﻫﺩﺍﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ ﺍﻟﻬﺎﻤﺔ‪:‬‬

‫‪....................................................................................................................................................................‬‬ ‫‪ - ١‬ﺘﻨﻘﻼﺕ ﺍﻟﻤﺭﻴﺽ ﺨﻼل ﺍﻷﻴﺎﻡ ﺍﻟﺨﻤﺴﺔ ﺍﻷﻭﻟﻰ ﺍﻟﺘﻲ ﺴﺒﻘﺕ ﺍﻷﻋﺭﺍﺽ‪:‬‬
‫‪.................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪ - ٢‬ﺍﻷﻏﺫﻴﺔ ﺍﻟﺘﻲ ﺘﻨﺎﻭﻟﻬﺎ ﺍﻟﻤﺭﻴﺽ ﺨﻼل ﺍﻷﻴﺎﻡ ﺍﻟﺨﻤﺴﺔ ﺍﻟﺘﻲ ﺴﺒﻘﺕ ﻟﻬﺎ ﺍﻷﻋﺭﺍﺽ‪ :‬ﺤﻠﻴﺏ ﻏﻴﺭ ﻤﻐﻠﻲ‬
‫ﻓﻭﺍﻜﻪ ﻁﺎﺯﺠﺔ‬ ‫ﻋﺼﻴﺭ‬ ‫ﻤﻴﺎﻩ ﻏﺎﺯﻴﺔ‬ ‫ﺒﻭﻅﺔ‬ ‫ﺯﺒﺩﺓ‬ ‫ﻗﺸﺩﺓ‬ ‫ﻤﺸﺘﻘﺎﺕ ﺍﻟﺤﻠﻴﺏ‪ :‬ﺠﺒﻨﺔ‬
‫‪.........................................................................................................................................................................................................................................................................................‬‬ ‫ﺃﺨﺭﻯ )ﺘﺫﻜﺭ(‪:‬‬ ‫ﻟﺤﻡ ﻨﻲﺀ‬ ‫ﺨﻀﺎﺭ ﻨﻴﺌﺔ‬
‫ﻻ‬ ‫‪ - ٣‬ﺍﺨﺘﻼﻁﻪ ﺒﺤﺎﻟﺔ ﻤﺸﺎﺒﻬﺔ‪ :‬ﻨﻌﻡ‬
‫‪........................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﻤﻜﺎﻥ ﻭﺘﺎﺭﻴﺦ ﺍﻟﻤﺨﺎﻟﻁﺔ‪:‬‬

‫ﺭﺍﺒﻌ ﹰﺎ ‪ -‬ﺒﻴﺌﺔ ﺍﻟﻤﺼﺎﺏ‪:‬‬

‫ﻏﻴﺭ ﻓﻨﻲ‬ ‫‪ - ١‬ﺍﻟﻤﺴﻜﻥ‪ :‬ﻓﻨﻲ‬

‫‪.................................................................................................................................................،............................................................‬‬ ‫ﺃﺨﺭﻯ‪:‬‬ ‫ﺤﻔﺭﺓ ﻓﻨﻴﺔ‬ ‫‪ - ٢‬ﺍﻟﺼﺭﻑ ﺍﻟﺼﺤﻲ‪ :‬ﺸﺒﻜﺔ ﻨﻅﺎﻤﻴﺔ‬
‫‪...............................................................................................‬‬ ‫ﻤﺼﺎﺩﺭ ﺃﺨﺭﻯ‪:‬‬ ‫ﺒﺌﺭ ﺨﺎﺹ‬ ‫ﺒﺌﺭ ﻋﺎﻡ‬ ‫‪ - ٣‬ﻤﺼﺎﺩﺭ ﻤﻴﺎﻩ ﺍﻟﺸﺭﺏ‪ :‬ﺸﺒﻜﺔ ﻋﺎﻤﺔ‬

‫‪.............................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺨﺎﻤﺴﹰﺎ ‪ -‬ﻤﻼﺤﻅﺎﺕ‪:‬‬

‫‪..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫ﺍﺴﻡ ﻤﻨﻅﻡ ﺍﻻﺴﺘﻤﺎﺭﺓ ﻭﺘﻭﻗﻴﻌﻪ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‬

‫‪١٦٤‬‬
 ‫ﺨﺎﻤﺴ ﹰﺎ‪ :‬ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﻟﻠﻤﺼﺎﺏ ﻓﻲ ﺍﻟﻤﺴﻜﻥ ﻭﺍﻟﻌﻤل‪:‬‬

‫ﻨﺘﻴﺠﺔ ﺍﻟﺯﺭﻉ‬ ‫ﺍﻟﺸﻜﺎﻴﺔ ﺍﻟﺤﺎﻟﻴﺔ‬ ‫ﺩﺭﺠﺔ ﺍﻟﻘﺭﺍﺒﺔ‬ ‫ﺠﻨﺴﻪ‬ ‫ﻋﻤﺭﻩ‬ ‫ﺍﺴﻡ ﺍﻟﻤﺨﺎﻟﻁ‬ ‫ﺍﻟﺭﻗﻡ‬

‫‪-١‬‬

‫‪-٢‬‬

‫‪-٣‬‬

‫‪-٤‬‬

‫‪-٥‬‬

‫‪-٦‬‬

‫‪-٧‬‬

‫‪-٨‬‬

‫‪-٩‬‬

‫‪- ١٠‬‬

‫‪- ١١‬‬

‫‪- ١٢‬‬

‫‪- ١٣‬‬

‫‪- ١٤‬‬

‫‪- ١٥‬‬

‫‪- ١٦‬‬

‫‪- ١٧‬‬

‫‪- ١٨‬‬

‫‪- ١٩‬‬

‫‪- ٢٠‬‬

‫‪١٦٥‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(١٣‬‬
‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻀﻊ ﺍﻟﻠﺼﺎﻗﺔ ﺍﻟﺨﺎﺼﺔ‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﺒﺎﻟﻤﺭﻴﺽ ﻫﻨﺎ‬ ‫ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻭﻁﻨﻲ ﻟﻠﺘﺭﺼﺩ ﺍﻟﻤﺨﺒﺭﻱ ﻻﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﺠﺭﺜﻭﻤﻲ‬
‫ﻀﻊ ﺩﺍﺌﺭﺓ ﺤﻭل ﺍﻟﺨﻴﺎﺭﺍﺕ ﺍﻟﻤﻤﻜﻨﺔ‪:‬‬
‫ﺍﻟﺒﻴﺎﻨﺎﺕ ﺍﻟﺸﺨﺼﻴﺔ‬
‫ﺭﻗﻡ ﺍﻟﻘﺒﻭل‪:‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﺸﻔﻰ‪:‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬
‫ﺍﻟﻬﺎﺘﻑ‪:‬‬ ‫ﺃﻨﺜﻰ‬ ‫ﺍﻟﺠﻨﺱ‪ :‬ﺫﻜﺭ‬ ‫ﻤﻜﺎﻥ ﺍﻹﻗﺎﻤﺔ‪:‬‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺩﺨﻭل‪:‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﺭﻴﺽ‪:‬‬
‫ﺃﺸﻬﺭ‬ ‫ﺍﻟﻌﻤﺭ ﺒﺎﻷﺸﻬﺭ )ﻓﻲ ﺤﺎل ﺃﻗل ﻤﻥ ﻋﺎﻡ‪:‬‬ ‫ﺴﻨﺔ‬ ‫ﺍﻟﻌﻤﺭ ﺒﺎﻟﺴﻨﻭﺍﺕ‪:‬‬
‫ﺍﻟﺒﻴﺎﻨﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ‪:‬‬
‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺼﺩﺍﻉ‬ ‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺤﻤﻰ‬
‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺍﻨﺘﺒﺎﺝ ﺒﺎﻟﻴﺎﻓﻭﺥ )ﺃﻗل ﻤﻥ ﻋﺎﻡ(‬ ‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺼﻼﺒﺔ ﻨﻘﺭﺓ‬
‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺍﺨﺘﻼﺠﺎﺕ‬ ‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺇﻗﻴﺎﺀ‬
‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺘﻐﻴﺭ ﺒﺎﻟﺤﺎﻟﺔ ﺍﻟﺫﻫﻨﻴﺔ‬ ‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻁﻔﺢ ﺠﻠﺩﻱ‬
‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻏﻴﺒﻭﺒﺔ‬ ‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻓﺭﻓﺭﻴﺎﺕ‬
‫ﺍﻟﺘﺎﺭﻴﺦ ﺍﻟﺼﺤﻲ‬
‫ﺠﺭﻋﺔ‬ ‫ﻓﻲ ﺤﺎل ﻨﻌﻡ ﻋﺩﺩ ﺍﻟﺠﺭﻋﺎﺕ‪:‬‬ ‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺍﻟﺘﻠﻘﻴﺢ ﻀﺩ ﺍﻟﻤﺴﺘﺩﻤﻴﺔ ﺍﻟﻨﺯﻟﻴﺔ )ﺍﻟﺭﺒﺎﻋﻲ(‬
‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺍﻟﺘﻠﻘﻴﺢ ﻀﺩ ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ )ﺒﺎﻟﺴﺤﺎﺌﻴﺎﺕ(‬
‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺃﺼﻴﺏ ﺃﺤﺩ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﺒﻨﻔﺱ ﺍﻷﻋﺭﺍﺽ؟‬
‫ﻓﻲ ﺤﺎل ﻨﻌﻡ ﺍﺫﻜﺭ ﺩﺭﺠﺔ ﺍﻟﻘﺭﺍﺒﺔ‬
‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺴﺒﻕ ﻟﻠﻤﺭﻴﺽ ﺍﻟﻌﻼﺝ ﺒﺼﺎﺩ ﺤﻴﻭﻱ ﺨﻼل ﺍﻷﺴﺒﻭﻉ ﺍﻟﺴﺎﺒﻕ ﻟﻠﺒﺯل؟‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺒﺯل‪:‬‬ ‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺘﻡ ﺒﺯل ﺍﻟﺴﺎﺌل ﺍﻟﺩﻤﺎﻏﻲ ﺍﻟﺸﻭﻜﻲ‬
‫ﺍﺴﻡ ﺍﻟﻁﺒﻴﺏ ﺍﻟﺫﻱ ﺃﺠﺭﻯ ﺍﻟﺒﺯل‪:‬‬
‫ﺨﺼﺎﺌﺹ ﺍﻟﺴﺎﺌل ﺍﻟﺩﻤﺎﻏﻲ ﺍﻟﺸﻭﻜﻲ‬
‫ﻤﺩﻤﻰ‬ ‫ﻋﻜﺭ‬ ‫ﺭﺍﺌﻕ‬ ‫ﺍﻟﻤﻅﻬﺭ‪:‬‬
‫ﻤﻎ‪/‬ﺩل‬ ‫ﻨﺴﺒﺔ ﺍﻟﺒﺭﻭﺘﻴﻥ‪:‬‬ ‫ﻤﻎ‪/‬ﺩل‬ ‫ﻨﺴﺒﺔ ﺍﻟﻐﻠﻭﻜﻭﺯ‪:‬‬
‫ﻟﻤﻔﺎﻭﻴﺎﺕ‪% :‬‬ ‫‪%‬‬ ‫ﻋﺩﻻﺕ‪:‬‬ ‫ﻜﺭﻴﺎﺕ ﺒﻴﺽ‪:‬‬ ‫ﻜﺭﻴﺎﺕ ﺤﻤﺭﺍﺀ‪:‬‬ ‫ﺍﻟﺼﻴﻐﺔ‬
‫ﻨﺘﻴﺠﺔ ﺘﻠﻭﻴﻥ ﺍﻟﻐﺭﺍﻡ‪:‬‬
‫ﻨﺘﻴﺠﺔ ﺍﻟﺯﺭﻉ ﺍﻟﺠﺭﺜﻭﻤﻲ‪:‬‬
‫ﺍﺨﺘﺒﺎﺭﺍﺕ ﺍﻟﺘﺤﺴﺱ‬
‫‪Haemophilus Influenzae‬‬ ‫‪.‬‬ ‫‪Streptococcus Peneumoniae:‬‬
‫‪Vancomycin‬‬ ‫‪.‬‬ ‫‪Ampicillin‬‬ ‫‪.‬‬ ‫‪Ceftriaxone‬‬ ‫‪.‬‬ ‫‪Chloramphenicol‬‬ ‫‪.‬‬
‫‪Cefotaxim‬‬ ‫‪.‬‬ ‫‪Ceftriaxone‬‬ ‫‪.‬‬ ‫‪Penicillin‬‬ ‫‪.‬‬ ‫‪Erythromycin‬‬ ‫‪.‬‬
‫‪.‬‬ ‫‪.‬‬ ‫‪Chloramphenicol‬‬ ‫‪.‬‬ ‫‪.‬‬ ‫‪Oxacillin‬‬ ‫‪.‬‬
‫‪.‬‬ ‫‪.‬‬ ‫‪Rifampicin‬‬ ‫‪.‬‬ ‫‪Trimeth/Sulfa‬‬ ‫‪.‬‬
‫‪Vancomycin‬‬ ‫‪.‬‬
‫ﺒﻴﺎﻨﺎﺕ ﻋﻨﺩ ﺘﺨﺭﺝ ﺍﻟﻤﺭﻴﺽ ﻤﻥ ﺍﻟﻤﺸﻔﻰ‬
‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺘﻡ ﻋﻼﺝ ﺍﻟﻤﺭﻴﺽ ﺒﺼﺎﺩﺍﺕ ﺤﻴﻭﻴﺔ؟‬
‫‪Ceftriaxone‬‬ ‫‪Chloramphenicol‬‬ ‫‪Penicillin‬‬ ‫‪Ampicillin‬‬ ‫ﻓﻲ ﺤﺎل ﻨﻌﻡ ﻤﺎ ﻫﻲ؟ )ﻀﻊ ﻜل ﺍﻟﺨﻴﺎﺭﺍﺕ ﺍﻟﻤﻤﻜﻨﺔ(‬
‫ﺃﺨﺭﻯ‬
‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺤﺩﺜﺕ ﻤﻀﺎﻋﻔﺎﺕ ﻋﺼﺒﻴﺔ؟‬
‫ﺍﺴﻡ ﺍﻟﻁﺒﻴﺏ ﺍﻟﻤﻌﺎﻟﺞ‪:‬‬
‫ﺇﺤﺎﻟﺔ‬ ‫ﻭﻓﺎﺓ‬ ‫ﺸﻔﺎﺀ‬ ‫ﺍﻟﺤﺎﻟﺔ ﻋﻨﺩ ﺍﻟﺨﺭﻭﺝ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺨﺭﻭﺝ‪:‬‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻨﺘﻬﺎﺀ ﻤلﺀ ﺍﻻﺴﺘﻤﺎﺭﺓ‪:‬‬
‫ﺍﻟﺘﻭﻗﻴﻊ‪:‬‬ ‫ﺍﺴﻡ ﻁﺒﻴﺏ ﺍﻹﺒﻼﻍ ﺍﻟﻤﺴﺅﻭل‪:‬‬

‫‪١٦٦‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(١٤‬‬
‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﺩﺍﺌﺭﺓ ﺼﺤﺔ ﺍﻟﻁﻔل‬ ‫ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ‬

‫ﺍﺴﺘﻤﺎﺭﺓ ﺘﻘﺼﻲ ﻤﺭﺽ ﺍﻟﺨﻨﺎﻕ )ﺍﻟﺩﻓﺘﺭﻴﺎ(‬

‫‪..........................................................................................................................................‬‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬
‫‪............................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺘﺒﻠﻴﻎ‪:‬‬ ‫‪................................................................................................................................‬‬ ‫ﺍﻟﺸﺨﺹ ﺍﻟﻤﺒﻠﻎ‪:‬‬ ‫‪.........................................................................‬‬ ‫ﻤﺼﺩﺭ ﺍﻟﺘﺒﻠﻴﻎ‪:‬‬
‫‪..........................................................................................................................................‬‬ ‫ﺭﻗﻡ ﺍﻟﻬﺎﺘﻑ‪:‬‬ ‫‪..........................................................................................................................................‬‬ ‫ﺍﺴﻡ ﻭﻋﻨﻭﺍﻥ ﺍﻟﻤﺅﺴﺴﺔ‪:‬‬
‫ﺘﻌﺭﻴﻑ ﺍﻟﺤﺎﻟﺔ‪:‬‬
‫‪......................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻷﻡ‪:‬‬ ‫‪...........................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻷﺏ‪:‬‬ ‫‪................................................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﺭﻴﺽ‪:‬‬
‫‪..........................................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻭﻻﺩﺓ‪:‬‬ ‫‪..........................................................................................................................................‬‬ ‫ﺍﻟﺠﻨﺱ‪:‬‬
‫‪..........................................................................................................................................‬‬ ‫ﻤﻌﺭﻭﻑ ﻤﻥ ﻗﺒل‪:‬‬ ‫‪..........................................................................................................................................‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ ﺍﻟﺤﺎﻟﻲ‪:‬‬
‫‪..........................................................................................................................................‬‬ ‫ﻤﻌﺭﻭﻑ ﻤﻥ ﻗﺒل‪:‬‬ ‫‪...............................................................................................................................................‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ ﺍﻟﺩﺍﺌﻡ‪:‬‬
‫‪..........................................................................................................................................‬‬ ‫ﻤﺴﺘﺸﻔﻰ‪:‬‬ ‫‪..................................................................................................................................................‬‬ ‫ﻤﻜﺎﻥ ﺇﺠﺭﺍﺀ ﺍﻻﺴﺘﻘﺼﺎﺀ‪ :‬ﻤﻨﺯل‪:‬‬
‫‪..........................................................................................................................................‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‪:‬‬ ‫‪..........................................................................................................................................‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ‪:‬‬
‫ﺍﻟﻘﺼﺔ ﺍﻟﻤﺭﻀﻴﺔ‪:‬‬
‫‪........................................‬‬ ‫ﻻ‬ ‫‪........................................‬‬ ‫ﻨﻌﻡ‬ ‫‪........................................‬‬ ‫ﻻ‬ ‫‪........................................‬‬ ‫ﻨﻌﻡ‬
‫‪........................................................................................................................................................................‬‬ ‫ﺍﻨﺴﺩﺍﺩ ﻤﺠﺭﻯ ﺍﻟﻬﻭﺍﺀ‬ ‫‪.........................................................................................................................................................‬‬ ‫ﻭﺠﻭﺩ ﺃﻏﺸﻴﺔ ﺃﻨﻔﻴﺔ‬
‫‪....................................................................................................................................‬‬ ‫ﺍﻟﺘﻬﺎﺏ ﺃﻋﺼﺎﺏ )ﺸﻠل ﺤﺭﻜﻲ(‬ ‫‪..........................................................................................................................................‬‬ ‫ﻭﺠﻭﺩ ﺃﻏﺸﻴﺔ ﺒﻠﻌﻭﻤﻴﺔ‬
‫‪............................................................................................................................................................................‬‬ ‫ﺍﻟﺘﻬﺎﺏ ﻋﻀﻠﺔ ﺍﻟﻘﻠﺏ‬ ‫‪..........................................................................................................................................‬‬ ‫ﻭﺠﻭﺩ ﺃﻏﺸﻴﺔ ﺒﺎﻟﺤﻨﺠﺭﺓ‬
‫‪..........................................................................................................................................‬‬ ‫ﺘﺭﻓﻊ ﺤﺭﻭﺭﻱ‬
‫‪..........................................................................................................................................‬‬ ‫ﻤﺨﺒﺭﻱ‬ ‫‪..........................................................................................................................................‬‬ ‫ﺍﻟﺘﺸﺨﻴﺹ ﺴﺭﻴﺭﻱ‬
‫ﺍﻟﻠﻘﺎﺤﺎﺕ ﺍﻟﺴﺎﺒﻘﺔ‪ :‬ﻟﻘﺎﺡ ﺜﻨﺎﺌﻲ ﺃﻭ ﺜﻼﺜﻲ‬
‫‪ ٤‬ﺯﻴﺎﺭﺍﺕ‬ ‫‪ ٣‬ﺯﻴﺎﺭﺍﺕ‬ ‫ﺯﻴﺎﺭﺘﻴﻥ‬ ‫ﻤﻠﻘﺢ ﺯﻴﺎﺭﺓ ﻭﺍﺤﺩﺓ‬ ‫ﻏﻴﺭ ﻤﻠﻘﺢ‬
‫‪..........................................................................................................................................‬‬ ‫ﺭﻗﻤﻬﺎ‬ ‫‪..........................................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺁﺨﺭ ﺯﺭﻗﺔ‬
‫ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﺘﺨﺫﺓ‪:‬‬
‫‪..........................................................................................................................................‬‬ ‫ﺍﻟﻤﺤﻴﻁ ﺍﻟﺫﻱ ﺨﺎﻟﻁﻪ ﺍﻟﻤﺭﻴﺽ ﻗﺒل ﺇﺼﺎﺒﺘﻪ‬
‫‪..........................................................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﺴﺘﺸﻔﻰ‬ ‫ﻻ‬ ‫ﺃﺩﺨل ﺍﻟﻤﺭﻴﺽ ﺍﻟﻤﺴﺘﺸﻔﻰ ﻨﻌﻡ‬
‫ﻻ‬ ‫ﺃﻋﻁﻲ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﻭﻗﺎﺌﻴﺔ ﻨﻌﻡ‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺘﻡ ﺃﺨﺫ ﻋﻴﻨﺎﺕ ﺒﻠﻌﻭﻤﻴﺔ ﻟﻠﻔﺤﺹ ﻤﻥ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺘﻡ ﺘﻠﻘﻴﺢ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ‬
‫ﺘﻤﺕ ﻤﺭﺍﺠﻌﺔ ﺍﻟﺤﺎﻟﺔ ﺒﻌﺩ ﺃﺴﺒﻭﻉ ﻭﺘﺒﻴﻥ‪:‬‬
‫‪..........................................................................................................................................‬‬ ‫‪ -‬ﻋﺩﻡ ﻭﺠﻭﺩ ﺤﺎﻻﺕ ﺠﺩﻴﺩﺓ‬
‫‪..........................................................................................................................................‬‬ ‫ﻋﺩﺩﻫﺎ‬ ‫‪...................................................................................................................................................‬‬ ‫‪ -‬ﻅﻬﺭﺕ ﺤﺎﻻﺕ ﺠﺩﻴﺩﺓ‬
‫ﻭﻓﺎﺓ‬ ‫ﺸﻔﺎﺀ‬ ‫ﻨﺘﻴﺠﺔ ﺍﻟﺤﺎﻟﺔ‬
‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﻤﻨﻅﻡ ﺍﻻﺴﺘﻤﺎﺭﺓ‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‪:‬‬

‫‪١٦٧‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(١٥‬‬
‫ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﺩﺍﺌﺭﺓ ﺼﺤﺔ ﺍﻟﻁﻔل‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬

‫ﺍﺴﺘﻤﺎﺭﺓ ﺘﻘﺼﻲ ﺤﺎﻟﺔ ﻜﺯﺍﺯ ﺍﻟﻭﻟﻴﺩ‬

‫ﺭﻗﻡ ﺍﻟﺤﺎﻟﺔ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ ﻟﻬﺫﺍ ﺍﻟﻌﺎﻡ‪:‬‬ ‫ﺍﻟﻤﻨﻁﻘﺔ‪:‬‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬

‫ﻤﺼﺩﺭ ﺍﻟﺘﺒﻠﻴﻎ‪:‬‬ ‫ﺍﻟﺸﺨﺹ ﺍﻟﻤﺒﻠﻎ‪:‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺍﻹﺒﻼﻍ‪ :‬ﺘﺎﺭﻴﺦ ﺍﻹﺒﻼﻍ‪:‬‬

‫ﺭﻗﻡ ﺍﻟﻬﺎﺘﻑ‪:‬‬ ‫ﺍﺴﻡ ﻭﻋﻨﻭﺍﻥ ﺍﻟﻤﺅﺴﺴﺔ‪:‬‬

‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺘﻘﺼﻲ‪:‬‬

‫ﺘﻌﺭﻴﻑ ﺍﻟﺤﺎﻟﺔ‪:‬‬

‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻭﻻﺩﺓ‪:‬‬ ‫ﺠﻨﺱ ﺍﻟﻤﻭﻟﻭﺩ‪:‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﻭﻟﻭﺩ‪:‬‬

‫ﻋﻤﺭ ﺍﻷﻡ‪:‬‬ ‫ﺍﺴﻡ ﺍﻷﻡ‪:‬‬ ‫ﺍﺴﻡ ﺍﻷﺏ‪:‬‬

‫ﻏﻴﺭﻫﺎ )ﺤﺩﺩ(‪:‬‬ ‫ﻋﻴﺎﺩﺓ‪:‬‬ ‫ﻤﺸﻔﻰ‪:‬‬ ‫ﻤﻨﺯل‪:‬‬ ‫ﻤﻜﺎﻥ ﺍﻟﻭﻻﺩﺓ‪:‬‬

‫ﻼ‪:‬‬
‫ﻋﻨﻭﺍﻥ ﺍﻹﻗﺎﻤﺔ ﻤﻔﺼ ﹰ‬

‫ﺍﻟﻤﻬﻨﺔ‪:‬‬ ‫ﺍﻻﺴﻡ‪:‬‬ ‫ﺍﻟﻤﺸﺭﻑ ﻋﻠﻰ ﺍﻟﻭﻻﺩﺓ‪:‬‬

‫ﺍﻟﻀﻤﺎﺩ ﺍﻟﻤﺴﺘﻌﻤل‬ ‫ﺍﻟﺨﻴﻁ ﺍﻟﻤﺴﺘﻌﻤل‬ ‫ﺃﺩﺍﺓ ﻗﻁﻊ ﺍﻟﺤﺒل ﺍﻟﺴﺭﻱ‬

‫ﺍﻟﺸﺨﺹ ﺍﻟﺫﻱ ﻗﺎﻡ ﺒﻭﻀﻌﻬﺎ‪:‬‬ ‫ﺍﻟﻤﻭﺍﺩ ﺍﻟﺘﻲ ﻭﻀﻌﺕ ﻋﻠﻰ ﺍﻟﺴﺭﺓ‬

‫ﻤﻼﺤﻅﺎﺕ ﺃﺨﺭﻯ‪:‬‬

‫ﺭﻗﻡ ﺍﻟﺴﺠل ﺍﻟﻁﺒﻲ‬ ‫ﺍﻟﻌﻼﻤﺎﺕ ﻭﺍﻷﻋﺭﺍﺽ‬

‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ‪:‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫• ﻫل ﻭﻟﺩ ﺍﻟﻁﻔل ﻁﺒﻴﻌﻴﹰﺎ‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺭﻓﺽ ﺍﻟﺭﻀﺎﻋﺔ‪:‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫• ﻫل ﻭﺠﺩ ﺘﻘﻠﺹ ﻋﻀﻠﻲ‪:‬‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺘﻬﻴﺞ‪:‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫• ﺘﺸﻨﺞ ﻭﺼﻼﺒﺔ‪:‬‬

‫ﺍﺴﻡ ﺍﻟﻤﺸﻔﻰ‪:‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‪ :‬ﻫل ﻋﻭﻟﺞ ﺍﻟﻁﻔل ﺒﺎﻟﻤﺸﻔﻰ‬

‫ﺍﻟﺤﺎﻟﺔ ﺤﻴﻥ ﺍﻟﺘﺨﺭﺝ‬ ‫‪/‬‬ ‫‪/‬‬ ‫‪ /‬ﺘﺎﺭﻴﺦ ﺍﻟﺨﺭﻭﺝ‪:‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺩﺨﻭل‪/ :‬‬

‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ ﻟﻸﻡ ﺒﻠﻘﺎﺡ ﺍﻟﻜﺯﺍﺯ‪:‬‬

‫ﻋﺩﺩ ﺍﻟﺠﺭﻋﺎﺕ‬ ‫ﻻ‬ ‫ﻟﻘﺎﺤﺎﺕ ﺍﻟﻤﺩﺭﺴﺔ ﻨﻌﻡ‬ ‫ﻋﺩﺩ ﺍﻟﺠﺭﻋﺎﺕ‬ ‫ﻻ‬ ‫‪ -‬ﻟﻘﺎﺤﺎﺕ ﺍﻟﻁﻔﻭﻟﺔ‪ :‬ﻨﻌﻡ‬

‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺁﺨﺭ ﺠﺭﻋﺔ ﺒﻠﻘﺎﺡ ﺍﻟﻜﺯﺍﺯ‪:‬‬ ‫ﻋﺩﺩ ﺍﻟﺠﺭﻋﺎﺕ‬ ‫ﻻ‬ ‫‪ -‬ﻟﻘﺎﺤﺎﺕ ﺍﻟﻜﺯﺍﺯ‪ :‬ﻨﻌﻡ‬

‫ﻤﺭﺽ ﺁﺨﺭ‪:‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻜﺯﺍﺯ ﺍﻟﻭﻟﻴﺩ‪:‬‬ ‫‪ -‬ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻨﻬﺎﺌﻲ‪:‬‬

‫ﻤﻼﺤﻅﺎﺕ‪:‬‬ ‫ﻭﻓﺎﺓ‬ ‫ﺸﻔﺎﺀ‬ ‫‪ -‬ﺍﻟﻨﺘﻴﺠﺔ‪:‬‬

‫‪١٦٨‬‬
 ‫‪/‬‬ ‫‪/‬‬ ‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‪ :‬ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻹﺠﺭﺍﺀﺍﺕ‪:‬‬

‫• ﻋﺩﺩ ﺍﻟﻤﻭﺍﻟﻴﺩ ﺍﻟﺫﻴﻥ ﺃﺸﺭﻑ ﻋﻠﻰ ﻭﻻﺩﺘﻬﻡ ﻨﻔﺱ ﺍﻟﺸﺨﺹ ﺨﻼل ﺍﻟﺸﻬﺭﻴﻥ ﺍﻟﻤﺎﻀﻴﻴﻥ‬
‫ﻤﻭﻟﻭﺩﹰﺍ ﻤﻨﻬﻡ‪.‬‬ ‫ﺘﻤﺕ ﺯﻴﺎﺭﺓ‬
‫ﻋﺩﺩ ﺍﻹﺼﺎﺒﺔ ﺒﻬﺎ‬ ‫ﻻ‬ ‫• ﻫل ﺘﻡ ﺍﻜﺘﺸﺎﻑ ﺇﺼﺎﺒﺎﺕ ﻜﺯﺍﺯ ﻭﻟﻴﺩ ﺃﺨﺭﻯ‪ :‬ﻨﻌﻡ‬
‫ﻋﺩﺩ ﺍﻟﻭﻓﻴﺎﺕ ﻤﻨﻬﺎ‬
‫• ﻋﺩﺩ ﺍﻟﻨﺴﺎﺀ ﻓﻲ ﺴﻥ ﺍﻹﻨﺠﺎﺏ ﺍﻟﻠﻭﺍﺘﻲ ﺘﻡ ﺘﻠﻘﻴﺤﻬﻥ ﺒﻠﻘﺎﺡ ﺍﻟﻜﺯﺍﺯ ﻓﻲ ﺍﻟﺯﻴﺎﺭﺓ ﺍﻷﻭﻟﻰ‬
‫ﺇﺠﻤﺎﻟﻲ‬ ‫ﻤﺴﺘﻜﻤﻠﺔ‬ ‫ﻟﻡ ﻴﺤﻥ‬ ‫ﺠﺭﻋﺔ )‪ (٢‬ﺠﺭﻋﺔ )‪ (٣‬ﺠﺭﻋﺔ )‪ (٤‬ﺠﺭﻋﺔ )‪(٥‬‬ ‫ﺠﺭﻋﺔ )‪(١‬‬

‫• ﻋﺩﺩ ﺍﻟﻨﺴﺎﺀ ﺍﻟﻠﻭﺍﺘﻲ ﺘﻡ ﺘﻠﻘﻴﺤﻬﻡ ﺒﻠﻘﺎﺡ ﺍﻟﻜﺯﺍﺯ ﻓﻲ ﺍﻟﺯﻴﺎﺭﺓ ﺍﻟﺜﺎﻨﻴﺔ )ﺒﻌﺩ ﺸﻬﺭ ﻤﻥ ﺍﻟﺯﻴﺎﺭﺓ ﺍﻷﻭﻟﻰ(‬
‫ﺇﺠﻤﺎﻟﻲ‬ ‫ﻤﺴﺘﻜﻤﻠﺔ‬ ‫ﻟﻡ ﻴﺤﻥ‬ ‫ﺠﺭﻋﺔ )‪ (٢‬ﺠﺭﻋﺔ )‪ (٣‬ﺠﺭﻋﺔ )‪ (٤‬ﺠﺭﻋﺔ )‪(٥‬‬ ‫ﺠﺭﻋﺔ )‪(١‬‬

‫• ﻫل ﺃﺠﺭﻯ ﺘﺜﻘﻴﻑ ﺼﺤﻲ ﻟﻠﻨﺴﺎﺀ ﻭﺍﻟﻜﺎﺩﺭ ﺍﻟﺼﺤﻲ ﻓﻲ ﻤﻨﻁﻘﺔ ﺍﻹﺼﺎﺒﺔ ﺤﻭل‪:‬‬

‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫• ﺍﻟﻭﻻﺩﺓ ﺍﻵﻤﻨﺔ‪:‬‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫• ﻁﻬﺎﺭﺓ ﺍﻷﺩﻭﺍﺕ ﻭﺍﻟﻀﻤﺎﺩ‪:‬‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫• ﺃﻫﻤﻴﺔ ﺘﻠﻘﻴﺢ ﺍﻟﻨﺴﺎﺀ ﻓﻲ ﺴﻥ ﺍﻹﻨﺠﺎﺏ ﺒﻠﻘﺎﺡ ﺍﻟﻜﺯﺍﺯ‪:‬‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫• ﻜﻴﻔﻴﺔ ﺍﻟﻌﻨﺎﻴﺔ ﺒﺴﺭﺓ ﺍﻟﻭﻟﻴﺩ‪:‬‬

‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺇﺠﺭﺍﺌﻪ‪:‬‬ ‫ﻤﻜﺎﻥ ﺇﺠﺭﺍﺀ ﺍﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪:‬‬

‫ﺍﻟﻘﺎﺌﻡ ﺒﺎﻟﺘﺜﻘﻴﻑ ﺍﻟﺼﺤﻲ‪:‬‬

‫‪/‬‬ ‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‪:‬‬ ‫ﺍﻟﺘﻭﻗﻴﻊ‬ ‫ﺍﺴﻡ ﻤﻨﻅﻡ ﺍﻻﺴﺘﻤﺎﺭﺓ‬

‫‪١٦٩‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(١٦‬‬
‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ‬
‫ﺩﺍﺌﺭﺓ ﺼﺤﺔ ﺍﻟﻁﻔل‬

‫ﺍﺴﺘﻤﺎﺭﺓ ﺘﻘﺼﻲ ﺤﺎﻟﺔ ﺸﻠل ﺃﻁﻔﺎل )ﺍﻟﺘﻬﺎﺏ ﺴﻨﺠﺎﺒﻴﺔ ﺍﻟﻨﺨﺎﻉ(‬

‫‪......................................................................................‬‬ ‫ﺭﻗﻡ ﺍﻟﺤﺎﻟﺔ ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬ ‫ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺼﺤﻴﺔ‪:‬‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬ ‫‪...............................................................................................................‬‬ ‫‪...................................................................................‬‬

‫ﺘﺎﺭﻴﺦ ﺍﻟﺘﺒﻠﻴﻎ‪:‬‬ ‫ﺍﻟﺸﺨﺹ ﺍﻟﻤﺒﻠﻎ‪:‬‬

‫‪....................................................................................................................................‬‬ ‫ﻤﺼﺩﺭ ﺍﻟﺘﺒﻠﻴﻎ‪:‬‬ ‫‪...............................................................................................................‬‬ ‫‪..................................................................‬‬

‫ﺭﻗﻡ ﺍﻟﻬﺎﺘﻑ‪:‬‬
‫‪.........................................................................................................................................‬‬ ‫ﺍﺴﻡ ﻭﻋﻨﻭﺍﻥ ﺍﻟﻤﺅﺴﺴﺔ )ﻤﺼﺩﺭ ﺍﻟﺘﺒﻠﻴﻎ(‪:‬‬ ‫‪.........................................................................................................................................................‬‬

‫ﺘﻌﺭﻴﻑ ﺍﻟﺤﺎﻟﺔ‪:‬‬
‫‪..........................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫ﺍﺴﻡ ﺍﻷﻡ‪:‬‬ ‫ﺍﺴﻡ ﺍﻷﺏ‪:‬‬

‫‪............................................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﺭﻴﺽ‪:‬‬
‫‪.............................................................................................‬‬ ‫‪.........................................................................................................................................‬‬

‫ﺘﺎﺭﻴﺦ ﺍﻟﻭﻻﺩﺓ‪:‬‬ ‫ﺍﻟﺠﻨﺱ‪:‬‬

‫‪..............................................................................................................................................................................................................................................................................‬‬ ‫‪.........................................................................................................................................‬‬

‫ﻤﻌﺭﻭﻑ ﻤﻥ ﻗﺒل‪:‬‬
‫‪..............................................................................................................................‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ ﺍﻟﺤﺎﻟﻲ )ﺍﻟﺘﻔﺼﻴﻠﻲ(‪:‬‬ ‫‪..............................................................................................................................................................................................‬‬

‫ﻤﻌﺭﻭﻑ ﻤﻥ ﻗﺒل‪:‬‬
‫‪..............................................................................................................................‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ ﺍﻟﺩﺍﺌﻡ )ﺍﻟﺘﻔﺼﻴﻠﻲ(‪:‬‬ ‫‪..............................................................................................................................................................................................‬‬

‫ﺘﺎﺭﻴﺦ ﺇﺠﺭﺍﺀ ﺍﻻﺴﺘﻘﺼﺎﺀ‪:‬‬ ‫ﻤﺴﺘﺸﻔﻰ‬

‫‪.................................................................................................................................................‬‬ ‫ﻤﻜﺎﻥ ﺇﺠﺭﺍﺀ ﺍﻻﺴﺘﻘﺼﺎﺀ‪ :‬ﻤﻨﺯل‬ ‫‪............................................‬‬ ‫‪............................................‬‬

‫ﺍﻟﻌﻼﻤﺎﺕ ﻭﺍﻷﻋﺭﺍﺽ‪:‬‬
‫ﺘﺎﺭﻴﺦ ﺒﺩﺍﻴﺔ ﺍﻷﻋﺭﺍﺽ‪:‬‬
‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬
‫ﺇﻤﺴﺎﻙ‬
‫‪....................................................................................................‬‬ ‫ﺃﻟﻡ ﺒﺎﻟﺤﻠﻕ‬ ‫ﺼﺩﺍﻉ‬ ‫ﺤﻤﻰ‬
‫‪..........................................................................................‬‬ ‫‪...........................................................................................‬‬ ‫‪........................................................................................‬‬

‫ﺼﻼﺒﺔ ﻨﻘﺭﺓ‬
‫‪..........................................................................................................‬‬ ‫ﺯﻜﺎﻡ‬ ‫ﺘﻬﻴﺞ‬ ‫ﻏﺜﻴﺎﻥ‬
‫‪...............................................................................‬‬ ‫‪.................................................................................................‬‬ ‫‪.........................................................................................‬‬

‫ﺘﺼﻠﺏ ﻋﻀﻠﻲ‬
‫‪.................................................................................................‬‬ ‫ﻀﻌﻑ‬ ‫ﺁﻻﻡ ﻋﻀﻠﻴﺔ‬ ‫ﺇﻗﻴﺎﺀ‬
‫‪....................................................................‬‬ ‫‪........................................................................‬‬ ‫‪..............................................................................................‬‬

‫ﺇﺴﻬﺎل‬ ‫‪.....................................................................................................................................‬‬

‫ﺤﺎﻟﺔ ﺍﻟﻭﻋﻲ‬
‫‪....................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫ﺒﺩﺍﻴﺔ ﺤﺎﺩﺓ‬ ‫ﻫل ﻜﺎﻥ ﺭﺨﻭﹰﺍ‬

‫‪..............................................................................................................................‬‬ ‫ﻫل ﺤﺩﺙ ﺸﻠل‬ ‫‪.......................................................................................................‬‬ ‫‪.........................................................................................................‬‬

‫ﺘﺎﺭﻴﺦ ﺒﺩﺍﻴﺔ ﺍﻟﺸﻠل ﺃﻭ ﺘﺸﻭﺵ ﺍﻟﺤﺱ‪:‬‬ ‫‪.........................................................................................................................................................................................‬‬

‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺘﻁﻭﺭ ﺍﻟﺸﻠل ﺨﻼل ‪ ٤‬ﺃﻴﺎﻡ‪:‬‬ ‫‪...............................‬‬ ‫‪...............................‬‬

‫ﺩﺭﺠﺔ ﺍﻟﺤﺭﺍﺭﺓ ﻓﻲ ﺤﺎﻟﺔ ﺍﻟﺤﻤﻰ‬ ‫ﻻ‬

‫‪...........................................................................................................................‬‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﻭﺠﺩﺕ ﺤﻤﻰ ﻋﻨﺩ ﺒﺩﺍﻴﺔ ﺍﻟﺸﻠل‬ ‫‪...............................‬‬ ‫‪...............................‬‬

‫ﻤﻭﻀﻊ ﺍﻟﺸﻠل‪:‬‬
‫ﺍﻟﺫﺭﺍﻉ ﺍﻷﻴﻤﻥ‬
‫‪................................................................................‬‬ ‫ﺍﻟﺫﺭﺍﻉ ﺍﻷﻴﺴﺭ‬ ‫ﺍﻟﺴﺎﻕ ﺍﻟﻴﻤﻨﻰ‬ ‫ﺍﻟﺴﺎﻕ ﺍﻟﻴﺴﺭﻯ‬
‫‪.............................................................‬‬ ‫‪.............................................................‬‬ ‫‪.............................................................‬‬

‫‪................................................................‬‬ ‫ﺃﻋﺼﺎﺏ ﻗﺤﻔﻴﺔ ﺃﺨﺭﻯ‬ ‫ﺍﻟﻌﻀﻼﺕ ﺍﻟﺘﻨﻔﺴﻴﺔ‬ ‫ﺍﻟﻭﺠﻪ‬ ‫ﻏﻴﺭ ﻤﺘﻨﺎﻅﺭ‬

‫‪.................................................‬‬ ‫‪..................................................................‬‬ ‫‪....................................................................‬‬

‫ﻤﻭﻀﻊ ﺘﺸﻭﺵ ﺍﻟﺤﺱ‪:‬‬

‫ﺍﻟﺫﺭﺍﻉ ﺍﻷﻴﻤﻥ‬
‫‪................................................................................‬‬ ‫ﺍﻟﺫﺭﺍﻉ ﺍﻷﻴﺴﺭ‬ ‫ﺍﻟﺴﺎﻕ ﺍﻟﻴﻤﻨﻰ‬ ‫ﺍﻟﺴﺎﻕ ﺍﻟﻴﺴﺭﻯ‬
‫‪.............................................................‬‬ ‫‪.............................................................‬‬ ‫‪.............................................................‬‬

‫ﺒﺎﻻﻨﺒﺴﺎﻁ‬ ‫‪ - ١‬ﺍﻟﻤﻨﻌﻜﺱ ﺍﻷﺨﻤﺼﻲ ﺒﺎﻻﻨﻌﻁﺎﻑ‬

‫‪.............................................................................................................................‬‬ ‫‪.............................................................................................‬‬

‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫‪ - ٢‬ﺍﻨﻌﺩﺍﻡ ﺍﻟﻤﻨﻌﻜﺴﺎﺕ ﺍﻟﻭﺘﺭﻴﺔ‬ ‫‪...............................‬‬ ‫‪...............................‬‬

‫ﺍﻟﺘﺼﻨﻴﻑ ﺍﻟﺴﺭﻴﺭﻱ ﺍﻟﻤﺒﺩﺌﻲ‬

‫‪.........................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫ﺍﻟﻌﻼﺝ ﺒﺎﻟﻤﺴﺘﺸﻔﻰ‪:‬‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﻋﻭﻟﺞ ﺒﺎﻟﻤﺴﺘﺸﻔﻰ‪:‬‬ ‫‪...............................‬‬ ‫‪...............................‬‬

‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺨﺭﻭﺝ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺩﺨﻭل ﺍﻟﻤﺴﺘﺸﻔﻰ‬ ‫ﺭﻗﻡ ﺍﻟﺴﺠل ﺍﻟﻁﺒﻲ‬ ‫‪........................................................................‬‬

‫ﺍﻟﻌﻼﺠﺎﺕ ﺍﻟﻤﻭﺼﻭﻓﺔ‬
‫‪....................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫ﺍﺴﻡ ﺍﻟﻁﺒﻴﺏ ﺍﻟﻤﺸﺭﻑ ﻋﻠﻰ ﺍﻟﺘﻘﺼﻲ ﻭﺘﻭﻗﻴﻌﻪ‪:‬‬

‫ﺍﺴﻡ ﺍﻟﻘﺎﺌﻡ ﻋﻠﻰ ﺍﻟﺘﻘﺼﻲ ﻭﺘﻭﻗﻴﻌﻪ‪:‬‬

‫‪١٧٠‬‬

‫ﺍﻟﺒﺭﻭﺘﻴﻥ‬
‫‪..................................................................‬‬
‫‪..................................................................‬‬
‫‪.................................‬‬ ‫ﻻ‬
‫ﻓﺤﺹ ﺍﻟﺴﺎﺌل ﺍﻟﺩﻤﺎﻏﻲ ﺍﻟﺸﻭﻜﻲ ‪CSF‬‬
‫ﺍﻟﻐﻠﻭﻜﻭﺯ‬ ‫ﺍﻟﻜﺭﻴﺎﺕ ﺍﻟﺒﻴﺽ ﺍﻟﻠﻤﻔﺎﻭﻴﺎﺕ‬ ‫ﺍﻟﻜﺭﻴﺎﺕ ﺍﻟﺤﻤﺭ‬
‫‪..................................................................‬‬ ‫‪..................................................................‬‬ ‫‪..................................................................‬‬ ‫‪..................................................................‬‬
‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ ‪/‬‬
‫‪..................................................................‬‬ ‫‪..................................................................‬‬ ‫‪..................................................................‬‬ ‫‪..................................................................‬‬
‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ ‪/‬‬
‫‪.................................‬‬ ‫ﻫل ﺘﻭﺠﺩ ﺒﻁﺎﻗﺔ ﺘﻠﻘﻴﺢ‪ :‬ﻨﻌﻡ‬ ‫‪.................................‬‬ ‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫‪.................................‬‬ ‫ﻻ‬ ‫ﻫل ﺴﺒﻕ ﺘﻠﻘﻴﺤﻪ‪ :‬ﻨﻌﻡ‬
‫‪.................................‬‬

‫‪..................................................................................................................................................................................................‬‬ ‫‪..................................................................................................................................................................................................‬‬
‫ﺍﻟﺠﺭﻋﺔ ﺼﻔﺭ‬
‫‪..................................................................................................................................................................................................‬‬ ‫‪..................................................................................................................................................................................................‬‬
‫ﺍﻟﺠﺭﻋﺔ ﺍﻷﻭﻟﻰ‬
‫‪..................................................................................................................................................................................................‬‬ ‫‪..................................................................................................................................................................................................‬‬
‫ﺍﻟﺠﺭﻋﺔ ﺍﻟﺜﺎﻨﻴﺔ‬
‫‪..................................................................................................................................................................................................‬‬ ‫‪..................................................................................................................................................................................................‬‬
‫ﺍﻟﺠﺭﻋﺔ ﺍﻟﺜﺎﻟﺜﺔ‬
‫‪..................................................................................................................................................................................................‬‬ ‫‪..................................................................................................................................................................................................‬‬
‫ﺍﻟﺠﺭﻋﺔ ﺍﻟﺩﺍﻋﻤﺔ‬
‫‪..................................................................................................................................................................................................‬‬ ‫‪..................................................................................................................................................................................................‬‬
‫ﺠﺭﻋﺎﺕ ﺃﺨﺭﻯ‬
‫‪..................................................................................................................................................................................................‬‬ ‫‪..................................................................................................................................................................................................‬‬
‫ﺠﺭﻋﺎﺕ ﺃﺨﺭﻯ‬
‫‪...................................................................................................................................................................................................................................................................................................................................................................................................................‬‬
‫ﺘﺎﺭﻴﺦ ﺁﺨﺭ ﺠﺭﻋﺔ‬
‫ﻓﺤﺹ ﺒﺭﺍﺯ ﻟﻌﺯل ﺍﻟﺤﻤﺔ‬
‫ﺨﻼﺼﺘﻬﺎ‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻨﺘﻴﺠﺔ‬ ‫ﺘﺎﺭﻴﺦ ﺍﻹﺭﺴﺎل‬ ‫ﺘﺎﺭﻴﺦ ﺃﺨﺫ ﺍﻟﻌﻴﻨﺔ‬
‫‪.............................................................................................‬‬ ‫‪.............................................................................................‬‬ ‫‪.............................................................................................‬‬
‫ﺒﺭﺍﺯ ﻤﺴﺤﺔ ﺃﻭﻟﻰ‬
‫‪.............................................................................................‬‬

‫‪.............................................................................................‬‬ ‫‪.............................................................................................‬‬ ‫‪.............................................................................................‬‬

‫ﺒﺭﺍﺯ ﻤﺴﺤﺔ ﺜﺎﻨﻴﺔ‬
‫‪.............................................................................................‬‬

‫‪.............................................................................................‬‬ ‫‪.............................................................................................‬‬ ‫‪.............................................................................................‬‬

‫ﻋﻴﻨﺎﺕ ﺃﺨﺭﻯ‬
‫‪.............................................................................................‬‬

‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻜﺎﻓﺤﺔ‪:‬‬
‫ﺘﺎﺭﻴﺦ ﺒﺩﺍﻴﺔ ﺍﻹﺠﺭﺍﺀﺍﺕ‪:‬‬
‫‪.............................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪.........................................................................................................................................................................................................................................................................................‬‬‫ﻋﺩﺩ ﺍﻟﻤﻨﺎﺯل ﺍﻟﻤﺯﺍﺭﺓ ﻟﺘﻘﺼﻲ ﻭﺠﻭﺩ ﺤﺎﻻﺕ ﻤﺸﺎﺒﻬﺔ‪:‬‬

‫‪.................................‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺘﻡ ﺍﻟﻌﺜﻭﺭ ﻋﻠﻰ ﺇﺼﺎﺒﺎﺕ ﺃﺨﺭﻯ‪:‬‬
‫‪.................................‬‬

‫‪..................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻷﺴﻤﺎﺀ‪:‬‬
‫‪..................................................................................................................................................................................................................................................................................‬‬

‫‪..................................................................................................................................................................................................................................................................................‬‬

‫ﻁﺭﻴﻘﺔ ﺘﺼﺭﻴﻑ ﺍﻟﻔﻀﻼﺕ‪:‬‬ ‫ﻤﺼﺩﺭ ﻤﻴﺎﻩ ﺍﻟﺸﺭﺏ‪:‬‬

‫‪...............................................................................................................................................................‬‬ ‫‪....................................................................................................................................‬‬

‫ﺴﻭﺍﺒﻕ ﺍﻟﺴﻔﺭ ﻭﺍﻟﻤﺨﺎﻟﻁﺔ‪ :‬ﺍﻷﻤﺎﻜﻥ ﺍﻟﺘﻲ ﺘﻤﺕ ﺯﻴﺎﺭﺘﻬﺎ ﺨﺎﺭﺝ ﺍﻟﻘﺭﻴﺔ ﺨﻼل ﺍﻷﻴﺎﻡ ﺍﻷﺭﺒﻌﺔ ﻋﺸﺭ ﺍﻟﺴﺎﺒﻘﺔ ﻟﺒﺩﺍﻴﺔ ﺍﻟﺸﻠل‬
‫ﺍﻟﺸﺨﺹ ﺍﻟﺫﻱ ﺘﻤﺕ ﺯﻴﺎﺭﺘﻪ‬
‫‪...................................................................................................................................................‬‬
‫‪...................................................................................................................................................‬‬
‫‪...................................................................................................................................................‬‬
‫ﻫل ﺴﺒﻕ ﻭﺍﺘﺼل ﺍﻟﻤﺭﻴﺽ ﺒﺄﺴﺭﺓ ﻓﻴﻬﺎ ﻁﻔل ﺴﺒﻕ ﺘﻠﻘﻴﺤﻪ ﺨﻼل ‪ ٧٥‬ﻴﻭﻡ ﻗﺒل ﻅﻬﻭﺭ ﺍﻟﺸﻠل‬
‫ﺘﺎﺭﻴﺦ ﺍﻟﺘﻠﻘﻴﺢ‬
‫‪...................................................................................................................................................‬‬
‫‪...................................................................................................................................................‬‬
‫‪...................................................................................................................................................‬‬
‫ﺍﻟﺘﺎﺭﻴﺦ‬ ‫ﺍﻟﻤﻜﺎﻥ‬
‫‪...................................................................................................................................................‬‬ ‫‪...................................................................................................................................................‬‬
‫‪-١‬‬
‫‪...................................................................................................................................................‬‬ ‫‪...................................................................................................................................................‬‬
‫‪-٢‬‬
‫‪...................................................................................................................................................‬‬ ‫‪...................................................................................................................................................‬‬
‫‪-٣‬‬
‫ﺍﻟﻌﻨﻭﺍﻥ‬ ‫ﺍﻻﺴﻡ‬
‫‪...................................................................................................................................................‬‬ ‫‪...................................................................................................................................................‬‬
‫‪-١‬‬
‫‪...................................................................................................................................................‬‬ ‫‪...................................................................................................................................................‬‬
‫‪-٢‬‬
‫‪...................................................................................................................................................‬‬ ‫‪...................................................................................................................................................‬‬
‫‪-٣‬‬

‫‪١٧١‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(١٧‬‬

‫ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﻤﺘﺎﺒﻌﺔ ﻟﺤﺎﻟﺔ ﺍﻟﺸﻠل ﺍﻟﺭﺨﻭ ﺍﻟﺤﺎﺩ‬

‫)ﺒﻌﺩ ‪ ٦٠‬ﻴﻭﻡ(‬
‫‪..................................................................................................‬‬ ‫ﺍﻟﻌﻤﺭ‪:‬‬ ‫‪...................................................................................................................................................................................................‬‬ ‫ﺍﻻﺴﻡ‪:‬‬ ‫‪......................................................................................................‬‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬
‫‪...................................................................................................‬‬ ‫ﺍﻟﺤﺎﻟﺔ‪:‬‬ ‫‪...........................................................................................................................................................................................‬‬ ‫ﺍﻟﺠﻨﺱ‪:‬‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺒﺘﺎﺭﻴﺦ‬ ‫‪.................................‬‬ ‫ﻻ‬ ‫‪.................................‬‬ ‫ﻨﻌﻡ‬ ‫‪ -‬ﻫل ﺘﻤﺕ ﻤﺘﺎﺒﻌﺔ ﺍﻟﺤﺎﻟﺔ ﺒﻌﺩ ‪ ٦٠‬ﻴﻭﻡ ﻤﻥ ﺒﺩﺍﻴﺔ ﺍﻟﺸﻠل‪:‬‬
‫‪ -‬ﺇﺫﺍ ﻟﻡ ﻴﺘﻡ ﻤﺘﺎﺒﻌﺔ ﺍﻟﺤﺎﻟﺔ‪ .‬ﻤﺎ ﻫﻭ ﺍﻟﺴﺒﺏ؟‬
‫‪.................................‬‬ ‫ﻻ‬ ‫‪.................................‬‬ ‫ﻨﻌﻡ‬ ‫‪ -‬ﻫل ﻴﻭﺠﺩ ﺸﻠل ﻤﺘﺒﻘﻲ ﺒﻌﺩ ‪ ٦٠‬ﻴﻭﻡ؟‬
‫‪........................................................................‬‬ ‫ﺍﻟﻁﺭﻑ ﺍﻟﻌﻠﻭﻱ ﺍﻷﻴﻤﻥ‪:‬‬ ‫‪........................................................................‬‬ ‫‪ -‬ﺇﺫﺍ ﻜﺎﻥ ﻨﻌﻡ ﺃﻴﻥ ﻴﺘﻭﻀﻊ ﺍﻟﺸﻠل‪ :‬ﺍﻟﻁﺭﻑ ﺍﻟﺴﻔﻠﻲ ﺍﻷﻴﻤﻥ‪:‬‬
‫‪.....................................................................‬‬ ‫ﺍﻟﻁﺭﻑ ﺍﻟﻌﻠﻭﻱ ﺍﻷﻴﺴﺭ‪:‬‬ ‫‪....................................................................‬‬ ‫ﺍﻟﻁﺭﻑ ﺍﻟﺴﻔﻠﻲ ﺍﻷﻴﺴﺭ‪:‬‬
‫‪.................................‬‬ ‫ﻻ‬ ‫‪.................................‬‬ ‫ﻨﻌﻡ‬ ‫‪ -‬ﻫل ﺤﺩﺙ ﺘﺤﺴﻥ ﺒﻌﺩ ﺍﻹﺼﺎﺒﺔ؟‬
‫‪ -‬ﺍﻟﻤﻨﻌﻜﺴﺎﺕ‪ ٠) :‬ﻏﺎﺌﺒﺔ‪ = ١ ،‬ﻀﻌﻴﻔﺔ‪ = ٢ ،‬ﻁﺒﻴﻌﻴﺔ‪ = ٣ ،‬ﻤﺸﺘﺩﺓ(‬
‫ﻓﻲ ﺍﻟﺠﺎﻨﺏ ﺍﻷﻴﺴﺭ‬ ‫ﻓﻲ ﺍﻟﺠﺎﻨﺏ ﺍﻷﻴﻤﻥ‬
‫‪.................................................................................................................................................................‬‬ ‫‪.................................................................................................................................................................‬‬
‫‪ - ١‬ﻤﻨﻌﻜﺱ ﺫﺍﺕ ﺍﻟﺭﺃﺴﻴﻥ‪:‬‬
‫‪.................................................................................................................................................................‬‬ ‫‪.................................................................................................................................................................‬‬
‫‪ - ٢‬ﻤﻨﻌﻜﺱ ﻤﺜﻠﺜﺔ ﺍﻟﺭﺅﻭﺱ‪:‬‬
‫‪.................................................................................................................................................................‬‬ ‫‪.................................................................................................................................................................‬‬
‫‪ - ٣‬ﺍﻟﺭﻜﺒﺔ‪:‬‬
‫‪.................................................................................................................................................................‬‬ ‫‪.................................................................................................................................................................‬‬
‫‪ - ٤‬ﺍﻟﻜﺎﺤل‬
‫‪.............................................................................................................‬‬ ‫ﻻ ﺤﺭﻜﺔ‬ ‫‪.............................................................................................................‬‬ ‫ﺍﻷﺴﻔل‬ ‫‪.............................................................................................................‬‬ ‫ﺒﺎﺒﻨﺴﻜﻲ‪ :‬ﻟﻸﻋﻠﻰ‬
‫‪...................................................................................................................................................................................................................................................................‬‬ ‫‪ - ١‬ﻻ ﻴﺴﺘﻁﻴﻊ ﺍﻟﻁﻔل ﺍﻟﻤﺸﻲ‬ ‫ﺘﻘﺩﻴﺭ ﺩﺭﺠﺔ ﺍﻟﻌﺠﺯ‪:‬‬
‫‪.....................................................................................................................................................................................................................................................................................‬‬ ‫‪ - ٢‬ﻴﻤﺸﻲ ﺒﻤﺴﺎﻋﺩﺓ ﺃﻫﻠﻪ‬
‫‪....................................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ - ٣‬ﻋﺭﺝ‬
‫‪......................................................................................................................................................................................................................................................................................‬‬ ‫‪ - ٤‬ﻴﻤﺸﻲ ﺒﺸﻜل ﻁﺒﻴﻌﻲ‬
‫‪.....................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ - ٥‬ﻏﻴﺭ ﺫﻟﻙ‬
‫‪.......................................................‬‬ ‫ﻻ‬ ‫‪/‬‬ ‫ﺒﺘﺎﺭﻴﺦ ‪/‬‬ ‫‪.......................................................‬‬ ‫ﻫل ﺘﻭﻓﻲ ﺍﻟﻁﻔل‪ :‬ﻨﻌﻡ‬
‫ﺒﺤﺎل ﻭﻓﺎﺓ ﺍﻟﻁﻔل ﺃﻋﻁ ﺒﻌﺽ ﺍﻟﺘﻔﺎﺼﻴل‬
‫‪........................................‬‬ ‫ﻻ‬ ‫‪........................................‬‬ ‫ﺍﻟﺘﻬﺎﺏ ﺃﻋﺼﺎﺏ ﺭﻀﻲ‪ :‬ﻨﻌﻡ‬ ‫‪........................................‬‬ ‫ﻻ‬ ‫‪........................................‬‬ ‫ﻨﻌﻡ‬ ‫ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻨﻬﺎﺌﻲ‪ :‬ﺸﻠل ﺃﻁﻔﺎل‪:‬‬
‫‪........................................‬‬ ‫ﻻ‬ ‫‪........................................‬‬ ‫ﻨﻌﻡ‬ ‫ﻏﻴﻼﻥ ﺒﺎﺭﻴﻪ‪:‬‬ ‫‪........................................‬‬ ‫ﻻ‬ ‫‪........................................‬‬ ‫ﻨﻌﻡ‬ ‫ﺍﻟﺘﻬﺎﺏ ﻨﺨﺎﻉ ﻤﻌﺘﺭﺽ‪:‬‬
‫‪.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﻏﻴﺭ ﺫﻟﻙ‪:‬‬

‫ﺍﻟﻁﺒﻴﺏ ﺭﺌﻴﺱ ﺸﻌﺒﺔ ﺼﺤﺔ ﺍﻟﻁﻔل ﻭﺍﻟﺘﻠﻘﻴﺢ‬ ‫ﺍﺴﻡ ﺍﻟﻁﺒﻴﺏ ﺍﻻﺨﺘﺼﺎﺼﻲ ﺒﺎﻷﻁﻔﺎل‬
‫ﺘﻭﻗﻴﻌﻪ‪:‬‬ ‫ﺘﻭﻗﻴﻌﻪ‪:‬‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‪:‬‬

‫‪١٧٢‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(١٨‬‬
‫ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻭﻁﻨﻲ‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬

‫ﺍﺴﺘﻤﺎﺭﺓ ﺘﻘﺼﻲ ﻟﻜل ﺤﺎﻟﺔ ﺤﺼﺒﺔ ‪ /‬ﺃﻭ ﺤﺼﺒﺔ ﺃﻟﻤﺎﻨﻴﺔ ﻤﺸﺘﺒﻬﺔ‬

‫ﺘﻌﺫﺭ ﺃﺨﺫ ﻋﻴﻨﺔ‪:‬‬ ‫ﻤﻠﺘﺒﺱ‪:‬‬ ‫ﺴﻠﺒﻲ‪:‬‬ ‫ﺤﺼﺒﺔ‪ :‬ﺇﻴﺠﺎﺒﻲ‪:‬‬
‫ﻨﺘﻴﺠﺔ ﺍﻟﻤﺨﺒﺭ‪:‬‬
‫ﻤﻠﺘﺒﺱ‪:‬‬ ‫ﺴﻠﺒﻲ‪:‬‬ ‫ﺃﻟﻤﺎﻨﻴﺔ‪ :‬ﺇﻴﺠﺎﺒﻲ‪:‬‬

‫ﺍﻟﺭﻗﻡ ﺍﻟﻤﺨﺒﺭﻱ‪:‬‬ ‫ﺭﻗﻡ ﺍﻷﺴﺒﻭﻉ‪:‬‬ ‫ﺍﻟﺭﻗﻡ ﺍﻟﻭﻁﻨﻲ‪:‬‬

‫ﺍﺴﻡ ﺍﻟﻤﻨﻁﻘﺔ‪:‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬
‫ﺃﻨﺜﻰ‬ ‫ﺍﻟﺠﻨﺱ‪ :‬ﺫﻜﺭ‬ ‫ﺍﻟﺭﻴﻑ‬ ‫ﻫل ﻫﻲ ﻤﻥ‪ :‬ﺍﻟﻤﺩﻴﻨﺔ‬
‫ﺍﺴﻡ ﺍﻷﺏ‪:‬‬ ‫ﺍﺴﻡ ﺍﻷﻡ‪:‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﺼﺎﺏ‪:‬‬
‫ﻻ‬ ‫ﻫل ﺍﻷﻡ ﺤﺎﻤل‪ :‬ﻨﻌﻡ‬
‫ﻋﻨﻭﺍﻥ ﺍﻟﺤﺎﻟﺔ ﺒﺸﻜل ﻤﻔﺼل‪:‬‬
‫ﻋﻤﺭ ﺍﻟﻤﺼﺎﺏ‪:‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻭﻻﺩﺓ‪:‬‬ ‫ﺭﻗﻡ ﺍﻟﻬﺎﺘﻑ‪:‬‬
‫ﻟﻡ ﻴﺤﻥ‪:‬‬ ‫ﺤﺴﺏ ﺃﻗﻭﺍل ﺍﻷﻡ‪:‬‬ ‫ﺤﺴﺏ ﺍﻟﺒﻁﺎﻗﺔ‪:‬‬ ‫)‪ (i‬ﺍﻟﺤﺎﻟﺔ ﺍﻟﺘﻠﻘﻴﺤﻴﺔ‪:‬‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺠﺭﻋﺔ‪:‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻤﻠﻘﺢ ‪:MMR1‬‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺠﺭﻋﺔ‪:‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻤﻠﻘﺢ ‪:MMR2‬‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻤﻠﻘﺢ ﺤﻤﻠﺔ ‪:٢٠٠٧‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻤﻠﻘﺢ ﺤﻤﻠﺔ ‪:١٩٩٨‬‬
‫‪.......................................................‬‬ ‫ﺃﺨﺭﻯ‪:‬‬ ‫ﻋﻴﺎﺩﺓ ﺨﺎﺼﺔ‪:‬‬ ‫ﻤﺸﻔﻰ‪:‬‬ ‫ﻤﺭﻜﺯ ﺼﺤﻲ‪:‬‬ ‫)‪ (i‬ﺍﻟﺠﻬﺔ ﺍﻟﻤﺒﻠﻐﺔ‪:‬‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻹﺒﻼﻍ‪:‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻟﻁﻔﺢ‪:‬‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺘﻘﺼﻲ‪:‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻤﺸﺎﻫﺩﺓ‪:‬‬
‫)‪ (i‬ﻤﻌﻠﻭﻤﺎﺕ ﺴﺭﻴﺭﻴﺔ‪:‬‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﻴﻭﺠﺩ ﺤﺭﺍﺭﺓ‪:‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺸﻜل ﺍﻟﻁﻔﺢ‪ :‬ﺤﻁﺎﻁﻲ‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺴﻴﻼﻥ ﺃﻨﻑ‪:‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺍﻟﺘﻬﺎﺏ ﻤﻠﺘﺤﻤﺔ‪:‬‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻀﺨﺎﻤﺔ ﻋﻘﺩ ﻟﻤﻔﺎﻭﻴﺔ‪:‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺴﻌﺎل‪:‬‬
‫ﺨﻠﻑ ﺍﻷﺫﻥ‬ ‫ﺘﺤﺕ ﺍﻟﻘﺫﺍﻟﻲ‬ ‫ﻤﻜﺎﻨﻬﺎ‪ :‬ﺭﻗﺒﻴﺔ‬
‫‪.............................................................................................................................................................................................................‬‬ ‫ﺃﻋﺭﺍﺽ ﺃﺨﺭﻯ‪:‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺃﻟﻡ ﻤﻔﺼل ‪ /‬ﺍﻟﺘﻬﺎﺏ ﻤﻔﺼل‪:‬‬
‫‪............................................................................................................................................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﺸﻔﻰ‪:‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺩﺨل ﺍﻟﻤﺸﻔﻰ‪:‬‬
‫)‪ (i‬ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﺴﺭﻴﺭﻱ ﺍﻟﻤﺒﺩﺌﻲ‪:‬‬
‫‪........................................................................................................................‬‬ ‫‪-٣‬‬ ‫‪........................................................................................................................‬‬ ‫‪-٢‬‬ ‫‪........................................................................................................................‬‬ ‫‪-١‬‬
‫)‪ (i‬ﻤﻌﻠﻭﻤﺎﺕ ﻭﺒﺎﺌﻴﺔ‪:‬‬
‫ﻻ‬ ‫‪ -‬ﻫل ﺍﺨﺘﻠﻁ ﺍﻟﻤﺼﺎﺏ ﻤﻊ ﺤﺎﻟﺔ ﺤﺼﺒﺔ ﺃﻭ ﺤﺎﻟﺔ ﺤﺼﺒﺔ ﺃﻟﻤﺎﻨﻴﺔ ﻤﺸﺘﺒﻬﺔ ﻗﺒل ﺸﻬﺭ ﻤﻥ ﺒﺩﺀ ﺍﻹﺼﺎﺒﺔ؟ ﻨﻌﻡ‬
‫‪.......................................................................................................................................................................................................................‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ‪:‬‬ ‫‪..................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﺼﺎﺏ ﺍﻟﺫﻱ ﺍﺨﺘﻠﻁ ﻤﻌﻪ‪:‬‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫‪ -‬ﻫل ﻴﻭﺠﺩ ﺤﺎﻟﺔ ﺤﺼﺒﺔ ﺃﻭ ﺤﺼﺒﺔ ﺃﻟﻤﺎﻨﻴﺔ ﻤﺜﺒﺘﺔ ﻓﻲ ﺍﻟﻤﻨﻁﻘﺔ ﻗﺒل ﺸﻬﺭ ﻤﻥ ﺒﺩﺀ ﺍﻹﺼﺎﺒﺔ؟‬

‫‪١٧٣‬‬
 ‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫‪ -‬ﻫل ﺴﺎﻓﺭ ﺍﻟﻁﻔل ﺨﻼل ﺸﻬﺭ ﻤﻥ ﺒﺩﺀ ﺍﻹﺼﺎﺒﺔ؟‬
‫‪..................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺃﻴﻥ ﻭﻤﺘﻰ‪:‬‬
‫ﻏﻴﺭ ﻤﻌﺭﻭﻑ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫‪ -‬ﻫل ﺍﺨﺘﻠﻁ ﺍﻟﻁﻔل ﺒﺎﻤﺭﺃﺓ ﺤﺎﻤل ﻤﻨﺫ ﺘﻁﻭﺭ ﺍﻷﻋﺭﺍﺽ؟‬
‫)‪ (i‬ﺠﻤﻊ ﺍﻟﻌﻴﻨﺎﺕ‪:‬‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻹﺭﺴﺎل ﺇﻟﻰ ﺍﻟﻤﺨﺒﺭ‪:‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﻋﻴﻨﺔ ﺍﻟﺩﻡ ﺍﻷﻭﻟﻰ‪ :‬ﺘﺎﺭﻴﺦ ﺍﻷﺨﺫ‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻹﺭﺴﺎل ﺇﻟﻰ ﺍﻟﻤﺨﺒﺭ‪:‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﻋﻴﻨﺔ ﺍﻟﺩﻡ ﺍﻟﺜﺎﻨﻴﺔ‪ :‬ﺘﺎﺭﻴﺦ ﺍﻷﺨﺫ‬
‫ﺴﺒﺏ ﺃﺨﺫ ﻋﻴﻨﺔ ﺍﻟﺩﻡ ﺍﻟﺜﺎﻨﻴﺔ‪:‬‬
‫ﻟﻡ ﺘﺠ ‪‬ﺭ‬ ‫ﻤﻌﻠﻘﺔ‬ ‫ﺴﻠﺒﻲ‬ ‫ﺇﻴﺠﺎﺒﻲ‬ ‫ﺤﺼﺒﺔ ‪ / IGM‬ﺍﻟﻨﺘﻴﺠﺔ‬
‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬
‫ﻋﻴﻨﺔ ﺍﻟﺩﻡ ﺍﻷﻭﻟﻰ‪:‬‬
‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬
‫ﻋﻴﻨﺔ ﺍﻟﺩﻡ ﺍﻟﺜﺎﻨﻴﺔ‪:‬‬
‫ﻟﻡ ﺘﺠ ‪‬ﺭ‬ ‫ﻤﻌﻠﻘﺔ‬ ‫ﺴﻠﺒﻲ‬ ‫ﺇﻴﺠﺎﺒﻲ‬ ‫ﺤﺼﺒﺔ ﺃﻟﻤﺎﻨﻴﺔ ‪ /‬ﺍﻟﻨﺘﻴﺠﺔ‬
‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬
‫ﻋﻴﻨﺔ ﺍﻟﺩﻡ ﺍﻷﻭﻟﻰ‪:‬‬
‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬
‫ﻋﻴﻨﺔ ﺍﻟﺩﻡ ﺍﻟﺜﺎﻨﻴﺔ‪:‬‬

‫‪/‬‬ ‫‪/‬‬ ‫)‪ (i‬ﺘﺎﺭﻴﺦ ﺍﺴﺘﻼﻡ ﺍﻟﻨﺘﻴﺠﺔ‪:‬‬

‫)‪ (i‬ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻨﻬﺎﺌﻲ‪:‬‬

‫ﻤﺜﺒﺘﺔ ﻭﺒﺎﺌﻴﹰﺎ‬ ‫ﻤﺜﺒﺘﺔ ﻤﺨﺒﺭﻴﹰﺎ‬ ‫ﻤﺜﺒﺘﺔ ﺴﺭﻴﺭﻴﹰﺎ‬ ‫ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻨﻬﺎﺌﻲ‪:‬‬
‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬
‫ﺤﺼﺒﺔ‪:‬‬
‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬ ‫‪.....................................................................................‬‬
‫ﺤﺼﺒﺔ ﺃﻟﻤﺎﻨﻴﺔ‪:‬‬
‫‪.........................................................................................................................................................................................................................................................‬‬ ‫‪ ،‬ﺇﺫﺍ ﻤﺴﺘﺒﻌﺩﺓ ـ ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬ ‫‪.....................................................................................‬‬ ‫ﻤﺴﺘﺒﻌﺩﺓ‪:‬‬

‫)‪ (i‬ﺍﻟﻘﺎﺌﻡ ﺒﺎﻟﺘﻘﺼﻲ‪:‬‬

‫‪..........................................................................................................................................................................‬‬ ‫ﺭﻗﻡ ﺍﻟﻬﺎﺘﻑ‪:‬‬ ‫‪..........................................................................................................................................................................‬‬ ‫ﺍﻻﺴﻡ‪:‬‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﻤلﺀ ﺍﻻﺴﺘﻤﺎﺭﺓ ﺒﺎﻟﻜﺎﻤل‪:‬‬ ‫‪..........................................................................................................................................................................‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ‪:‬‬

‫‪..........................................................................................................................................................................‬‬ ‫ﺍﻟﺘﻭﻗﻴﻊ‪:‬‬ ‫ﻤﺼﺩﻕ ﺭﺌﻴﺱ ﺸﻌﺒﺔ ﺼﺤﺔ ﺍﻟﻁﻔل ﻭﺍﻟﺘﻠﻘﻴﺢ‬

‫‪١٧٤‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(١٩‬‬
‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ‬
‫ﺒﺭﻨﺎﻤﺞ ﺍﻟﺘﻠﻘﻴﺢ ﺍﻟﻭﻁﻨﻲ‬

‫ﺍﺴﺘﻤﺎﺭﺓ ﺘﻘﺼﻲ ﻤﺘﻼﺯﻤﺔ ﺍﻟﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ ﺍﻟﺨﻠﻘﻴﺔ )‪(CRS‬‬

‫ﺘﻌﺭﻴﻑ ﺍﻟﻁﻔل‪:‬‬
‫ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻭﻻﺩﺓ‪:‬‬ ‫‪............................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻷﻡ‪:‬‬ ‫‪...................................................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﻁﻔل‪:‬‬
‫ﺃﻨﺜﻰ‬ ‫ﺍﻟﺠﻨﺱ‪ :‬ﺫﻜﺭ‬
‫‪......................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ ﺒﺎﻟﺘﻔﺼﻴل‪:‬‬

‫ﺍﻹﺒﻼﻍ‪:‬‬
‫ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻹﺒﻼﻍ‪:‬‬ ‫‪...................................................................................................................................‬‬ ‫ﺍﻟﻤﺼﺩﺭ‪:‬‬
‫‪...................................................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﻘﺎﺌﻡ ﺒﺎﻹﺒﻼﻍ )ﺍﻹﺤﺎﻟﺔ(‪:‬‬
‫‪..................................................................................................................................................‬‬ ‫ﺭﻗﻡ ﺍﻟﻬﺎﺘﻑ‪:‬‬ ‫‪..........................................................................................................................................................‬‬ ‫ﻋﻨﻭﺍﻥ ﺍﻟﺸﺨﺹ ﺍﻟﻤﺒﻠﻎ‪:‬‬

‫ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺘﻘﺼﻲ‪:‬‬

‫ﺍﻟﻌﻼﻤﺎﺕ ﻭﺍﻷﻋﺭﺍﺽ ﺍﻟﺴﺭﻴﺭﻴﺔ‪:‬‬

‫ﻫل ﻴﻭﺠﺩ‪:‬‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺇﺼﺎﺒﺔ ﻗﻠﺒﻴﺔ ﺨﻠﻘﻴﺔ‪:‬‬
‫ﺇﺫﺍ ﻜﺎﻥ ﻨﻌﻡ )ﻗﻡ ﺒﻭﺼﻔﻬﺎ(‪:‬‬
‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫ﻫل ﻴﻭﺠﺩ‪:‬‬
‫ﻻ‬ ‫ﺍﻋﺘﻼل ﺍﻟﺸﺒﻜﻴﺔ ﺍﻟﺼﺒﺎﻏﻲ‪ :‬ﻨﻌﻡ‬ ‫ﻻ‬ ‫ﺍﻟﺯﺭﻕ‪ :‬ﻨﻌﻡ‬ ‫ﻻ‬ ‫ﺍﻟﺴﺎﺩ‪ :‬ﻨﻌﻡ‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻀﻌﻑ ﺍﻟﺴﻤﻊ‪:‬‬
‫ﻻ‬ ‫ﺍﻟﻴﺭﻗﺎﻥ‪ :‬ﻨﻌﻡ‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺃﻤﺭﺍﺽ ﺘﺭﻗﻕ ﺍﻟﻌﻅﺎﻡ‪:‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺍﻟﻔﺭﻓﺭﻴﺔ‪:‬‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺃﻋﺭﺍﺽ ﺃﺨﺭﻯ ﻏﻴﺭ ﻁﺒﻴﻌﻴﺔ‪:‬‬
‫‪.....................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺇﺫﺍ ﻜﺎﻥ ﻨﻌﻡ )ﻗﻡ ﺒﻭﺼﻔﻬﺎ(‪:‬‬

‫‪١٧٥‬‬
 ‫ﻤﺎ ﻴﺘﻌﻠﻕ ﺒﺎﻷﻡ‪:‬‬
‫‪........................................................................................................................................................................‬‬ ‫ﻋﺩﺩ ﺍﻟﺤﻤﻭﻻﺕ ﺍﻟﺴﺎﺒﻘﺔ‪:‬‬ ‫‪........................................................................................................................................................................‬‬ ‫ﻋﻤﺭ ﺍﻷﻡ‪:‬‬
‫ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺇﺫﺍ ﻜﺎﻥ ﻨﻌﻡ‪ ،‬ﺘﺎﺭﻴﺦ ﺃﺨﺫ ﺍﻟﻠﻘﺎﺡ‪:‬‬ ‫ﻻ‬ ‫ﻫل ﻟﻘﺤﺕ ﻀﺩ ﺍﻟﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ‪ :‬ﻨﻌﻡ‬
‫‪............................................................‬‬ ‫ﺇﺫﺍ ﻜﺎﻥ ﻨﻌﻡ ﺃﻱ ﺸﻬﺭ ﻤﻥ ﺍﻟﺤﻤل‪:‬‬ ‫ﻻ‬ ‫ﻫل ﻜﺎﻥ ﻫﻨﺎ ﻁﻔﺢ ﺤﻁﺎﻁﻲ ‪ +‬ﺤﺭﺍﺭﺓ ﺨﻼل ﺍﻟﺤﻤل‪ :‬ﻨﻌﻡ‬
‫‪........................................................................................................................‬‬ ‫ﺇﺫﺍ ﻜﺎﻥ ﻨﻌﻡ ﻓﻲ ﺃﻱ ﺸﻬﺭ ﻤﻥ ﺍﻟﺤﻤل‪:‬‬ ‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﻫل ﺘﻡ ﺍﻟﺴﻔﺭ ﺨﻼل ﺍﻟﺤﻤل؟‪:‬‬
‫‪.........................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺇﺫﺍ ﻜﺎﻥ ﻨﻌﻡ ﺃﻴﻥ ﻤﻜﺎﻥ ﺍﻟﺴﻔﺭ‪:‬‬

‫ﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺨﺒﺭﻴﺔ‪:‬‬
‫ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺠﻤﻊ ﻋﻴﻨﺔ ﺍﻟﺩﻡ‪:‬‬
‫ﻡ ﺇﺫﺍ ﻜﺎﻥ ﺍﻟﻤﺨﺒﺭ ﺨﺎﺹ‪:‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺇﺭﺴﺎل ﺍﻟﻌﻴﻨﺔ ﺇﻟﻰ ﺍﻟﻤﺨﺒﺭ‪:‬‬
‫‪...............................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﺨﺒﺭ‪:‬‬
‫‪.................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ‪:‬‬
‫‪....................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﻬﺎﺘﻑ‪:‬‬
‫ﺇﻴﺠﺎﺒﻲ‪:‬‬ ‫ﻨﺘﻴﺠﺔ ﺍﻟﻌﻴﻨﺔ‪ :‬ﺴﻠﺒﻲ‪:‬‬
‫ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﺴﺘﻼﻡ ﺍﻟﻨﺘﻴﺠﺔ‪:‬‬
‫ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺇﻋﻼﻡ ﺍﻷﻫل ﺒﺎﻟﻨﺘﻴﺠﺔ‪:‬‬

‫ﺍﻟﺘﺼﻨﻴﻑ ﺍﻟﻨﻬﺎﺌﻲ ﻟﻠﺤﺎﻟﺔ‪:‬‬

‫ﻻ ﻴﻭﺠﺩ ﻓﺤﺹ ﻤﺨﺒﺭﻱ ‪ /‬ﻟﻜﻥ ﺃﺜﺒﺘﺕ ﺴﺭﻴﺭﻴﹰﺎ‪.‬‬
‫ﺇﻴﺠﺎﺒﻲ ‪ + IGM‬ﺇﺜﺒﺎﺕ ﺴﺭﻴﺭﻱ = ﺇﺜﺒﺎﺕ ﻤﺨﺒﺭﻱ‪.‬‬
‫ﺇﻴﺠﺎﺒﻲ ‪ + IGM‬ﻋﺩﻡ ﻭﺠﻭﺩ ﺃﻋﺭﺍﺽ ﻟـ ‪ :CRS‬ﺇﻨﺘﺎﻥ ﺒﺎﻟﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ ﺨﻠﻘﻲ‪:‬‬

‫ﺍﻟﻘﺎﺌﻡ ﺒﺎﻟﺘﻘﺼﻲ‪:‬‬
‫‪.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻻﺴﻡ‪:‬‬
‫‪.................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ‪:‬‬
‫‪....................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﻬﺎﺘﻑ‪:‬‬
‫ﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺇﻜﻤﺎل ﺍﻟﺘﻘﺼﻲ‪:‬‬

‫‪..........................................................................................................................................................‬‬ ‫ﺍﻟﺘﻭﻗﻴﻊ‪:‬‬ ‫ﺭﺌﻴﺱ ﺸﻌﺒﺔ ﺍﻟﻁﻔل ﻭﺍﻟﺘﻠﻘﻴﺢ‬

‫‪١٧٦‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٢٠‬‬
‫‪....................................................................................................................................‬‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﺍﻟﻤﻨﻁﻘﺔ‪:‬‬
‫‪.........................................................................................................................................‬‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫‪..............................................................................................................................................‬‬ ‫ﺍﻟﻤﺩﻴﻨﺔ‪:‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫‪...........................................................................................................................................‬‬ ‫ﺍﻟﻨﺎﺤﻴﺔ‪:‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ‬
‫‪..................................................................................................................................................‬‬‫ﺍﻟﺒﻠﺩﺓ‪:‬‬

‫ﺍﺴﺘﻤﺎﺭﺓ ﺘﻘﺼﻲ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻹﻨﺘﺎﻨﻲ ‪E - A‬‬

‫ﺍﻟﻬﻭﻴﺔ ﺍﻟﺸﺨﺼﻴﺔ‪:‬‬
‫‪.........................................................................................................‬‬ ‫ﺍﻟﻤﻬﻨﺔ‪:‬‬ ‫‪...............................................‬‬ ‫ﺍﻟﺠﻨﺱ‪:‬‬ ‫‪.................................................‬‬ ‫ﺍﻟﻌﻤﺭ‪:‬‬ ‫‪..............................................................................................................................................................‬‬ ‫ﺍﻻﺴﻡ‪:‬‬
‫‪...........................................................................................................................................................................................‬‬ ‫ﻋﻨﻭﺍﻥ ﺍﻹﻗﺎﻤﺔ‪:‬‬ ‫‪.......................................................................................................................................................................................‬‬ ‫ﻋﻨﻭﺍﻥ ﺍﻟﻌﻤل‪:‬‬
‫‪................................................................................................................................................................................................‬‬ ‫ﻋﺩﺩ ﺍﻷﻁﻔﺎل‪:‬‬ ‫‪................................................................................................................................................................................‬‬ ‫ﺍﻟﻭﻀﻊ ﺍﻟﻌﺎﺌﻠﻲ‪:‬‬
‫‪....................................................................‬‬ ‫ﺇﻗﻴﺎﺀ‬ ‫‪...................................................................‬‬ ‫ﻏﺜﻴﺎﻥ‬ ‫‪....................................................................‬‬ ‫ﺁﻻﻡ ﺒﻁﻨﻴﺔ‬ ‫‪....................................................................‬‬ ‫ﺍﻟﺸﻜﺎﻴﺔ ﺍﻟﻤﺭﻀﻴﺔ‪ :‬ﻓﻘﺩ ﺸﻬﻴﺔ‬
‫‪.............................................................................‬‬ ‫ﺃﻋﺭﺍﺽ ﺃﺨﺭﻯ‬ ‫‪.............................................................................‬‬ ‫ﻴﺭﻗﺎﻥ‬ ‫‪.............................................................................‬‬ ‫ﺁﻻﻡ ﻤﻔﺼﻠﻴﺔ‬ ‫‪.............................................................................‬‬ ‫ﻁﻔﺢ‬
‫‪..............................................................................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ‬
‫‪........................................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺘﺸﺨﻴﺹ‬ ‫‪.............................................................................‬‬ ‫ﻤﺨﺒﺭﻱ‬ ‫‪.............................................................................‬‬ ‫ﺍﻟﺘﺸﺨﻴﺹ‪ :‬ﺴﺭﻴﺭﻱ‬
‫‪.........................................................................................................................................................................................‬‬ ‫ﻫل ﺘﻭﺠﺩ ﺤﺎﻟﺔ ﺃﻭ ﺤﺎﻻﺕ ﻤﺭﻀﻴﺔ ﻤﺘﺸﺎﺒﻬﺔ ﻓﻲ ﻨﻔﺱ ﺍﻟﻤﻨﺯل ﻭﻤﺎ ﻫﻭ ﻋﺩﺩﻫﺎ‬
‫ﺍﻷﻭﻀﺎﻉ ﺍﻟﺼﺤﻴﺔ ﻓﻲ ﺍﻟﻤﻨﺯل‪:‬‬
‫‪.............................................................................‬‬ ‫ﺃﻱ ﻤﺼﺩﺭ ﺁﺨﺭ‬ ‫‪.............................................................................‬‬ ‫ﺒﺌﺭ‬ ‫‪.............................................................................‬‬ ‫ﻤﺼﺩﺭ ﻤﻴﺎﻩ ﺍﻟﺸﺭﺏ‪ :‬ﻤﻴﺎﻩ ﺸﺒﻜﺔ‬
‫‪...........................‬‬ ‫ﻻ‬ ‫‪...........................‬‬ ‫ﻫل ﺍﻟﻤﻴﺎﻩ ﻤﻌﺎﻟﺠﺔ‪ :‬ﻨﻌﻡ‬
‫‪............................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﺼﺭﻑ ﺍﻟﺼﺤﻲ ﻭﻨﻭﻋﻪ‬
‫ﻤﻌﻠﻭﻤﺎﺕ ﻭﺒﺎﺌﻴﺔ ﻫﺎﻤﺔ‪:‬‬
‫‪..................................................................................................................................................................................................................................‬‬ ‫ﺍﺨﺘﻼﻁﻪ ﺒﺤﺎﻟﺔ ﻤﺸﺎﺒﻬﺔ ﺨﻼل ﺍﻷﺴﺎﺒﻴﻊ ﺍﻟﺜﻼﺜﺔ ﻤﻥ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ‪:‬‬
‫‪.....................................................................................................................................................................................................................................................................‬‬ ‫ﺘﻨﻘﻼﺘﻪ ﺨﻼل ﺍﻷﺴﺎﺒﻴﻊ ﺍﻟﺜﻼﺜﺔ ﺍﻟﺘﻲ ﺴﺒﻘﺕ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ‪:‬‬
‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪...........................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﺘﺨﺫﺓ ﺘﺠﺎﻩ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ‪:‬‬

‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪........................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﻤﻼﺤﻅﺎﺕ ﺃﺨﺭﻯ‪:‬‬

‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪................................................................................................................................................................................................................‬‬ ‫ﺍﻻﺴﻡ ﻭﺍﻟﺘﻭﻗﻴﻊ‪:‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‬

‫‪١٧٧‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٢١‬‬
‫‪....................................................................................................................................‬‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﺍﻟﻤﻨﻁﻘﺔ‪:‬‬
‫‪.........................................................................................................................................‬‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫‪..............................................................................................................................................‬‬ ‫ﺍﻟﻤﺩﻴﻨﺔ‪:‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫‪...........................................................................................................................................‬‬ ‫ﺍﻟﻨﺎﺤﻴﺔ‪:‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ‬
‫‪..................................................................................................................................................‬‬‫ﺍﻟﺒﻠﺩﺓ‪:‬‬

‫ﺍﺴﺘﻤﺎﺭﺓ ﺘﻘﺼﻲ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻹﻨﺘﺎﻨﻲ ‪D – C - B‬‬

‫ﺍﻟﻬﻭﻴﺔ ﺍﻟﺸﺨﺼﻴﺔ‪:‬‬
‫‪.........................................................................................................‬‬ ‫ﺍﻟﻤﻬﻨﺔ‪:‬‬ ‫‪...............................................‬‬ ‫ﺍﻟﺠﻨﺱ‪:‬‬ ‫‪.................................................‬‬ ‫ﺍﻟﻌﻤﺭ‪:‬‬ ‫‪..............................................................................................................................................................‬‬ ‫ﺍﻻﺴﻡ‪:‬‬
‫‪...........................................................................................................................................................................................‬‬ ‫ﻋﻨﻭﺍﻥ ﺍﻹﻗﺎﻤﺔ‪:‬‬ ‫‪.......................................................................................................................................................................................‬‬ ‫ﻋﻨﻭﺍﻥ ﺍﻟﻌﻤل‪:‬‬
‫‪................................................................................................................................................................................................‬‬ ‫ﻋﺩﺩ ﺍﻷﻁﻔﺎل‪:‬‬ ‫‪................................................................................................................................................................................‬‬ ‫ﺍﻟﻭﻀﻊ ﺍﻟﻌﺎﺌﻠﻲ‪:‬‬
‫‪....................................................................‬‬ ‫ﺇﻗﻴﺎﺀ‬ ‫‪...................................................................‬‬ ‫ﻏﺜﻴﺎﻥ‬ ‫‪....................................................................‬‬ ‫ﺁﻻﻡ ﺒﻁﻨﻴﺔ‬ ‫‪....................................................................‬‬ ‫ﺍﻟﺸﻜﺎﻴﺔ ﺍﻟﻤﺭﻀﻴﺔ‪ :‬ﻓﻘﺩ ﺸﻬﻴﺔ‬
‫‪.............................................................................‬‬ ‫ﺃﻋﺭﺍﺽ ﺃﺨﺭﻯ‬ ‫‪.............................................................................‬‬ ‫ﻴﺭﻗﺎﻥ‬ ‫‪.............................................................................‬‬ ‫ﺁﻻﻡ ﻤﻔﺼﻠﻴﺔ‬ ‫‪.............................................................................‬‬ ‫ﻁﻔﺢ‬
‫‪..............................................................................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ‬
‫ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫‪................................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬ ‫‪.................................................................................................‬‬ ‫ﻤﺨﺒﺭﻱ‪:‬‬ ‫‪.............................................................................................‬‬ ‫ﺴﺭﻴﺭﻱ‪:‬‬
‫ﺍﻟﺴﻭﺍﺒﻕ ﺍﻟﺸﺨﺼﻴﺔ‪:‬‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‪:‬‬ ‫‪..............................‬‬ ‫ﻻ‬ ‫‪..............................‬‬ ‫ﻨﻌﻡ‬ ‫‪ - ١‬ﻫل ﺃﺠﺭﻱ ﻟﻪ ﻨﻘل ﺩﻡ‪:‬‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‪:‬‬ ‫‪..............................‬‬ ‫ﻻ‬ ‫‪..............................‬‬ ‫ﻨﻌﻡ‬ ‫‪ - ٢‬ﻫل ﺘﺒﺭﻉ ﺒﺎﻟﺩﻡ‪:‬‬
‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺁﺨﺭ ﺤﻘﻨﺔ‪:‬‬ ‫‪..............................‬‬ ‫ﻻ‬ ‫‪..............................‬‬ ‫ﻨﻌﻡ‬ ‫‪ - ٣‬ﻫل ﻴﺘﻌﺎﻁﻰ ﺃﺩﻭﻴﺔ ﺤﻘﻨﹰﺎ‪:‬‬
‫‪..............................‬‬ ‫ﻻ‬ ‫‪..............................‬‬ ‫ﻨﻌﻡ‬ ‫‪ - ٤‬ﻫل ﺃﺠﺭﻱ ﻗﻠﻊ ﺃﺴﻨﺎﻥ‪:‬‬
‫‪.................................................................................................‬‬ ‫ﺁﺨﺭ )ﻴﺫﻜﺭ(‬ ‫‪.................................................................................................‬‬ ‫ﺍﻟﺸﺨﺹ ﺍﻟﺫﻱ ﺃﺠﺭﻯ ﻋﻨﺩﻩ ﻗﻠﻊ ﺍﻷﺴﻨﺎﻥ‪ :‬ﻁﺒﻴﺏ‬
‫‪..............................‬‬ ‫ﻻ‬ ‫‪..............................‬‬ ‫‪ - ٥‬ﻫل ﺃﺠﺭﻱ ﻟﻪ ﻋﻤل ﺠﺭﺍﺤﻲ‪ :‬ﻨﻌﻡ‬
‫‪..............................................................................................................................................................................................................................‬‬ ‫ﺃﻴﻥ‬ ‫‪..............................‬‬ ‫ﻻ‬ ‫‪..............................‬‬ ‫ﻨﻌﻡ‬ ‫‪ - ٦‬ﻫل ﻴﺠﺭﻱ ﻏﺴﻴل ﻜﻠﻴﺔ‪:‬‬
‫‪ - ٧‬ﻫل ﻴﺴﺘﻌﻤل ﺤﻭﺍﺌﺞ ﺍﻵﺨﺭﻴﻥ‪:‬‬
‫‪..............................‬‬ ‫ﻻ‬ ‫‪..............................‬‬ ‫ﻨﻌﻡ‬ ‫ﻓﺭﺸﺎﺓ ﺃﺴﻨﺎﻥ‬ ‫‪..............................‬‬ ‫ﻻ‬ ‫‪..............................‬‬ ‫ﻨﻌﻡ‬ ‫ﻤﻭﺱ ﺤﻼﻗﺔ‪:‬‬
‫‪........................................................................................................................‬‬ ‫ﻋﺩﺩ ﺍﻟﺯﺭﻗﺎﺕ‪:‬‬ ‫‪..............................‬‬ ‫ﻻ‬ ‫‪..............................‬‬ ‫‪ - ٨‬ﻫل ﺴﺒﻕ ﺃﻥ ﻟﻘﺢ ﻀﺩ ﺍﻟﻤﺭﺽ ﻨﻌﻡ‬
‫‪............................................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ - ٩‬ﺍﻷﺩﻭﻴﺔ ﺍﻟﺘﻲ ﺘﻨﺎﻭﻟﻬﺎ ﺍﻟﻤﺭﻴﺽ‪:‬‬
‫‪..........................................................................................................................................................................................................................‬‬ ‫ﺍﺨﺘﻼﻁﺎﺕ ﺇﻥ ﻭﺠﺩﺕ‬ ‫‪..............................‬‬ ‫ﻭﻓﺎﺓ‬ ‫‪..............................‬‬ ‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﺭﺍﻫﻨﺔ‪ :‬ﺸﻔﺎﺀ‬
‫‪......................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺃﻴﺔ ﻤﻼﺤﻅﺎﺕ‪:‬‬
‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪................................................................................................................................................................................................................‬‬ ‫ﺍﻻﺴﻡ ﻭﺍﻟﺘﻭﻗﻴﻊ‪:‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‬

‫‪١٧٨‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٢٢‬‬
‫‪....................................................................................................................................‬‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﺍﻟﻤﻨﻁﻘﺔ‪:‬‬
‫‪.........................................................................................................................................‬‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫‪..............................................................................................................................................‬‬ ‫ﺍﻟﻤﺩﻴﻨﺔ‪:‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫‪...........................................................................................................................................‬‬ ‫ﺍﻟﻨﺎﺤﻴﺔ‪:‬‬ ‫ﺩﺍﺌﺭﺓ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻭﺒﺎﺌﻴﺔ‬
‫‪..................................................................................................................................................‬‬‫ﺍﻟﺒﻠﺩﺓ‪:‬‬

‫ﺍﺴﺘﻤﺎﺭﺓ ﺘﻘﺼﻲ ﻭﺒﺎﺌﻲ ﺍﻟﺤﻤﻰ ﺍﻟﺘﻴﻔﻴﺔ‬

‫ﺍﻟﻬﻭﻴﺔ ﺍﻟﺸﺨﺼﻴﺔ‪:‬‬
‫‪.........................................................................................................‬‬ ‫ﺍﻟﻤﻬﻨﺔ‪:‬‬ ‫‪...............................................‬‬ ‫ﺍﻟﺠﻨﺱ‪:‬‬ ‫‪.................................................‬‬ ‫ﺍﻟﻌﻤﺭ‪:‬‬ ‫‪..............................................................................................................................................................‬‬ ‫ﺍﻻﺴﻡ‪:‬‬
‫‪...........................................................................................................................................................................................‬‬ ‫ﻋﻨﻭﺍﻥ ﺍﻹﻗﺎﻤﺔ‪:‬‬ ‫‪.......................................................................................................................................................................................‬‬ ‫ﻋﻨﻭﺍﻥ ﺍﻟﻌﻤل‪:‬‬
‫‪................................................................................................................................................................................................‬‬ ‫ﻋﺩﺩ ﺍﻷﻁﻔﺎل‪:‬‬ ‫‪................................................................................................................................................................................‬‬ ‫ﺍﻟﻭﻀﻊ ﺍﻟﻌﺎﺌﻠﻲ‪:‬‬
‫ﺍﻟﺸﻜﺎﻴﺔ ﺍﻟﻤﺭﻀﻴﺔ‪:‬‬
‫‪...........................‬‬ ‫ﺃﻡ ﻤﺨﺒﺭﻴﹰﺎ‬ ‫‪............................‬‬ ‫ﻫل ﺘﻡ ﺍﻟﺘﺸﺨﻴﺹ ﺴﺭﻴﺭﻴﹰﺎ‬ ‫‪..............................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺘﺸﺨﻴﺹ‬ ‫‪..............................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻟﻤﺭﺽ‬
‫‪.............................................................................‬‬ ‫ﻫل ﺘﻭﺠﺩ ﺤﺎﻟﺔ ﺃﻭ ﺤﺎﻻﺕ ﻤﺘﺸﺎﺒﻬﺔ ﻓﻲ ﻨﻔﺱ ﺍﻟﻤﻨﺯل ﻭﻤﺎ ﻫﻭ ﻋﺩﺩﻫﺎ‬ ‫‪.............................................................................‬‬ ‫ﻨﺴﺒﺔ ﺍﻷﻀﺩﺍﺩ‬
‫‪.........................‬‬ ‫ﻨﻜﺱ‬ ‫‪.........................‬‬ ‫ﻭﻓﺎﺓ‬ ‫‪.........................‬‬ ‫ﺍﻟﻨﺘﻴﺠﺔ‪ :‬ﺸﻔﺎﺀ‬ ‫‪.........................‬‬ ‫ﻻ‬ ‫‪.........................‬‬ ‫ﻫل ﺃﺩﺨل ﺍﻟﻤﺭﻴﺽ ﺍﻟﻤﺴﺘﺸﻔﻰ؟ ﻨﻌﻡ‬
‫ﺍﻷﻭﻀﺎﻉ ﺍﻟﺼﺤﻴﺔ ﻓﻲ ﺍﻟﻤﻨﺯل‪:‬‬
‫‪.............................................................................‬‬ ‫ﺃﻱ ﻤﺼﺩﺭ ﺁﺨﺭ‬ ‫‪.............................................................................‬‬ ‫ﺒﺌﺭ‬ ‫‪.............................................................................‬‬ ‫ﻤﺼﺩﺭ ﻤﻴﺎﻩ ﺍﻟﺸﺭﺏ‪ :‬ﻤﻴﺎﻩ ﺸﺒﻜﺔ‬
‫‪...........................‬‬ ‫ﻻ‬ ‫‪...........................‬‬ ‫ﻫل ﻴﻭﺠﺩ ﻤﺭﺤﺎﺽ؟ ﻨﻌﻡ‬ ‫‪......................................................................................‬‬ ‫ﻨﻭﻉ ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫‪...........................‬‬ ‫ﻻ‬ ‫‪...........................‬‬ ‫ﻫل ﺍﻟﻤﻴﺎﻩ ﻤﻌﺎﻟﺠﺔ‪ :‬ﻨﻌﻡ‬
‫‪.......................................................................................................................................................................................................................................................................................‬‬ ‫ﺇﺫﺍ ﻟﻡ ﻴﺘﻭﻓﺭ ﻤﺭﺤﺎﺽ‪ ،‬ﻤﺎ ﻫﻭ ﻨﻭﻉ ﺍﻟﺼﺭﻑ ﺍﻟﺼﺤﻲ‬
‫ﺍﻷﻏﺫﻴﺔ ﺍﻟﺘﻲ ﺘﻨﺎﻭﻟﻬﺎ ﺍﻟﻤﺭﻴﺽ ﺨﻼل ﺍﻷﻴﺎﻡ ﺍﻟﻌﺸﺭﺓ ﺍﻟﺘﻲ ﺴﺒﻘﺕ ﺍﻹﺼﺎﺒﺔ‪:‬‬
‫‪...........................‬‬ ‫ﻟﺒﻥ‬ ‫‪...........................‬‬ ‫ﻗﺸﺩﺓ‬ ‫‪...........................‬‬ ‫ﺯﺒﺩﺓ‬ ‫‪...........................‬‬ ‫ﻤﺸﺘﻘﺎﺕ ﺍﻟﺤﻠﻴﺏ‪ :‬ﺠﺒﻨﺔ ﻨﻴﺌﺔ‬ ‫‪...........................‬‬ ‫ﺤﻠﻴﺏ‬
‫‪.................................................................................................................................................................‬‬ ‫ﻨﻭﻋﻬﺎ‬ ‫‪....................................................................................................‬‬ ‫ﺨﻀﺎﺭ ﻨﻴﺌﺔ‬ ‫‪..........................................................................................‬‬ ‫ﻓﻭﺍﻜﻪ ﻁﺎﺯﺠﺔ‬
‫‪...........................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﺘﺨﺫﺓ ﺘﺠﺎﻩ ﺍﻟﻤﺨﺎﻟﻁﻴﻥ‪:‬‬
‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪........................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﻤﻼﺤﻅﺎﺕ ﺃﺨﺭﻯ‪:‬‬

‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪....................................................................................................................................................‬‬ ‫ﺍﺴﻡ ﻤﻨﻅﻡ ﺍﻻﺴﺘﻤﺎﺭﺓ ﻭﺘﻭﻗﻴﻌﻪ‪:‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‬

‫‪١٧٩‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٢٣‬‬
‫ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‬
‫‪..................................................................................‬‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺍﺭﺩ ﺇﻟﻰ ﺩﺍﺌﺭﺓ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﺸﺘﺭﻜﺔ‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻭﻁﻨﻲ ﻟﺘﺭﺼﺩ ﺍﻟﺤﻤﻰ ﺍﻟﻤﺎﻟﻁﻴﺔ‬

‫ﺍﺴﺘﻤﺎﺭﺓ ﻤﺭﻴﺽ ﺤﻤﻰ ﻤﺎﻟﻁﻴﺔ‬

‫‪.................................................................................................................‬‬ ‫ﺭﻗﻡ ﺍﻟﺘﺴﺠﻴل‬ ‫‪..........................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﺘﺴﺠﻴل‬ ‫‪....................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﺭﻜﺯ‬
‫ﻤﻌﻠﻭﻤﺎﺕ ﺍﻟﻤﺭﻴﺽ‪:‬‬
‫‪....................................................................‬‬ ‫ﺍﻟﻭﺯﻥ‪:‬‬ ‫‪.............................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻷﺏ‪:‬‬ ‫‪.............................................................................................‬‬ ‫ﺍﻟﻜﻨﻴﺔ‪:‬‬ ‫‪.............................................................................................‬‬ ‫ﺍﻻﺴﻡ‪:‬‬
‫ﺃﻨﺜﻰ‬ ‫ﺫﻜﺭ‬ ‫‪.............................................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻤﻴﻼﺩ‪:‬‬ ‫‪...........................................................................................................................‬‬ ‫ﺭﻗﻡ ﺍﻟﻬﻭﻴﺔ‪:‬‬
‫‪..............................................................................................................................‬‬ ‫ﻫﺎﺘﻑ‪:‬‬ ‫‪................................................................................................................................‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ‪:‬‬ ‫‪.........................................................................................................................................‬‬ ‫ﺍﻟﻤﻬﻨﺔ‪:‬‬
‫‪................................................................................‬‬ ‫ﺍﻟﻘﺭﻴﺔ‪:‬‬ ‫‪.......................................................................................‬‬ ‫ﺍﻟﻨﺎﺤﻴﺔ‪:‬‬ ‫‪.................................................................................‬‬ ‫ﺍﻟﻤﻨﻁﻘﺔ‪:‬‬ ‫‪.......................................................................................‬‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬

‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻟﻤﺭﺽ‬ ‫ﻤﻌﻠﻭﻤﺎﺕ ﻋﻥ ﺍﻟﺤﺎﻟﺔ‪:‬‬

‫ﻤﺜﺒﺘﺔ‬ ‫ﻤﺤﺘﻤﻠﺔ‬ ‫ﻨﺎﻜﺴﺔ‬ ‫ﺤﺎﻟﺔ ﺠﺩﻴﺩﺓ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ‬
‫ﻨﻭﻉ ﺍﻟﻤﻨﺘﺞ‬ ‫ﻨﻭﻉ ﺍﻟﺤﻴﻭﺍﻥ‬ ‫ﻤﺼﺩﺭ ﺍﻹﺼﺎﺒﺔ‬ ‫ﺍﻷﻋﺭﺍﺽ‬
‫‪.....................................................................................................................‬‬ ‫‪.....................................................................................................................‬‬
‫ﺘﻤﺎﺱ ﻤﻊ ﺍﻟﺤﻴﻭﺍﻥ‬ ‫‪.....................................................................................................................‬‬

‫‪.....................................................................................................................‬‬ ‫‪.....................................................................................................................‬‬ ‫‪.....................................................................................................................‬‬

‫‪.....................................................................................................................‬‬ ‫‪.....................................................................................................................‬‬
‫ﺘﻤﺎﺱ ﻤﻊ ﻤﻨﺘﺠﺎﺕ ﺤﻴﻭﺍﻨﻴﺔ‬ ‫‪.....................................................................................................................‬‬

‫‪.....................................................................................................................‬‬ ‫‪.....................................................................................................................‬‬ ‫‪.....................................................................................................................‬‬

‫‪.....................................................................................................................‬‬ ‫‪.....................................................................................................................‬‬
‫ﺍﺴﺘﻬﻼﻙ ﻤﻨﺘﺠﺎﺕ ﺍﻟﺤﻠﻴﺏ‬ ‫‪.....................................................................................................................‬‬

‫‪.....................................................................................................................‬‬ ‫‪.....................................................................................................................‬‬
‫ﻁﺭﻕ ﺃﺨﺭﻯ ﻟﻠﻌﺩﻭﻯ‬ ‫‪.....................................................................................................................‬‬

‫ﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺨﺒﺭﻴﺔ‬
‫‪...............................................‬‬ ‫ﺍﻟﻌﻴﺎﺭ‬ ‫‪................................................................................‬‬ ‫ﺍﻻﺨﺘﺒﺎﺭ ﺍﻟﻤﺴﺘﺨﺩﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻤﺨﺒﺭﻱ ﺍﻟﺘﺎﺭﻴﺦ‬
‫‪...............................................‬‬ ‫ﺍﻟﻌﻴﺎﺭ‬ ‫‪................................................................................‬‬ ‫ﺍﻻﺨﺘﺒﺎﺭ ﺍﻟﻤﺴﺘﺨﺩﻡ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‬ ‫ﺍﺨﺘﺒﺎﺭﺍﺕ ﺃﺨﺭﻯ‬
‫ﺍﻻﺨﺘﺒﺎﺭ ﺍﻟﺠﺭﺜﻭﻤﻲ‬
‫‪................................................‬‬ ‫ﺍﻟﻌﺘﺭﺓ‬ ‫‪....................................................‬‬ ‫ﺍﻟﻨﺘﻴﺠﺔ‬ ‫‪.....................................................................................‬‬ ‫ﻤﺩﺓ ﺍﻟﺘﺤﻀﻴﻥ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‬

‫‪/‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬

‫ﺍﻟﻤﺩﺓ‬ ‫ﺍﻟﺠﺭﻋﺔ‪/‬ﺍﻟﻴﻭﻡ‬ ‫ﺍﻟﻌﻴﺎﺭ‬ ‫ﻁﺭﻴﻕ ﺍﻹﻋﻁﺎﺀ‬ ‫ﺍﻟﺩﻭﺍﺀ‬
‫‪...........................................................................................‬‬ ‫‪...........................................................................................‬‬ ‫‪...........................................................................................‬‬ ‫‪...........................................................................................‬‬ ‫‪...........................................................................................‬‬

‫‪...........................................................................................‬‬ ‫‪...........................................................................................‬‬ ‫‪...........................................................................................‬‬ ‫‪...........................................................................................‬‬ ‫‪...........................................................................................‬‬

‫‪ -‬ﺘﺭﺴل ﺍﻟﻨﺴﺨﺔ ﺍﻷﻭﻟﻰ ﺇﻟﻰ ﺸﻌﺒﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﺸﺘﺭﻜﺔ ﻓﻲ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺼﺤﺔ‪.‬‬

‫‪ -‬ﺘﺒﻘﻰ ﺍﻟﻨﺴﺨﺔ ﺍﻟﺜﺎﻨﻴﺔ ﻭﺍﻟﺜﺎﻟﺜﺔ ﻓﻲ ﻤﺭﻜﺯ ﺍﻟﻤﻨﻁﻘﺔ‪.‬‬

‫‪١٨٠‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٢٤‬‬
‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬

‫‪...........................................................................................‬‬ ‫ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻋﻥ ﺃﻋﻤﺎل ﻤﺭﻜﺯ ﻤﻜﺎﻓﺤﺔ ﺩﺍﺀ ﺍﻟﻜﻠﺏ ﻓﻲ ﻤﺤﺎﻓﻅﺔ‬

‫‪...........................................................................................‬‬ ‫ﺨﻼل ﺸﻬﺭ‬
‫‪...................................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﻋﺩﺩ ﺍﻟﻤﺭﺍﺠﻌﻴﻥ ﻓﻲ ﺍﻟﺸﻬﺭ ﺍﻟﻤﺎﻀﻲ‬
‫‪.............................................................................................................................................................................................................................‬‬ ‫‪ -‬ﻋﺩﺩ ﺍﻟﻤﺭﺍﺠﻌﻴﻥ ﻓﻲ ﺍﻟﺸﻬﺭ ﺍﻟﻤﺎﻀﻲ ﺍﻟﺫﻴﻥ ﺃﺘﻤﻭﺍ ﺍﻟﻌﻼﺝ‬
‫‪................................................................................................................................................................................................................‬‬ ‫‪ -‬ﻋﺩﺩ ﺍﻟﻤﺭﺍﺠﻌﻴﻥ ﻓﻲ ﺍﻟﺸﻬﺭ ﺍﻟﻤﺎﻀﻲ ﺍﻟﺫﻴﻥ ﻟﻡ ﻴﺘﻤﻭﺍ ﺍﻟﻌﻼﺝ‬
‫‪................................................................................................................................................................................................................................................................................................‬‬ ‫‪ - ١‬ﺒﺴﺒﺏ ﺍﻹﻫﻤﺎل )ﺍﻟﻤﺘﺨﻠﻔﻴﻥ(‬
‫‪.................................................................................................‬‬ ‫‪ - ٢‬ﺒﺴﺒﺏ ﻋﺩﻡ ﺍﻟﺤﺎﺠﺔ ﻻﺴﺘﻜﻤﺎل ﺍﻟﻌﻼﺝ ﻟﺴﻼﻤﺔ ﺍﻟﺤﻴﻭﺍﻥ ﺍﻟﻌﺎﺽ ﺒﻌﺩ ﺃﺴﺒﻭﻉ‬
‫‪............................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﻋﺩﺩ ﺍﻟﻤﺭﺍﺠﻌﻴﻥ ﺍﻟﺠﺩﺩ )ﺨﻼل ﺍﻟﺸﻬﺭ ﺍﻟﺤﺎﻟﻲ(‬
‫‪...........................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﻋﺩﺩ ﺍﻟﻤﻌﺎﻟﺠﻴﻥ ﻤﻨﻬﻡ ﺒﺎﻟﻠﻘﺎﺡ ﻓﻘﻁ‬
‫‪.......................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﻋﺩﺩ ﺍﻟﻤﻌﺎﻟﺠﻴﻥ ﻤﻨﻬﻡ ﺒﺎﻟﻠﻘﺎﺡ ﻭﺍﻟﻤﺼل‬

‫ﺠﺭﺍﺡ ﺭﻀﻴﺔ‬ ‫ﺠﺭﺍﺡ ﻭﺍﺨﺯﺓ‬ ‫ﺴﺤﺠﺎﺕ ﻭﺨﺩﻭﺵ‬ ‫ﺘﻤﺎﺱ ﻤﻊ ﺍﻟﺤﻴﻭﺍﻥ‬ ‫ﻭﺼﻑ ﺇﺼﺎﺒﺘﻬﻡ‬
‫ﺃﻭ ﻟﻌﺎﺒﻪ‬
‫ﺍﻟﻌﺩﺩ‬
‫ﺍﻷﻁﺭﺍﻑ ﺍﻟﺴﻔﻠﻴﺔ‬ ‫ﺍﻷﻁﺭﺍﻑ ﺍﻟﻌﻠﻭﻴﺔ‬ ‫ﺍﻟﺠﺫﻉ‬ ‫ﺍﻟﺭﺃﺱ ﻭﺍﻟﻌﻨﻕ‬ ‫ﻤﻜﺎﻥ ﺇﺼﺎﺒﺘﻬﻡ‬
‫ﺍﻟﻌﺩﺩ‬
‫ﺤﻴﻭﺍﻥ ﺁﺨﺭ‬ ‫ﺍﺒﻥ ﺁﻭﻯ‬ ‫ﺜﻌﻠﺏ‬ ‫ﺫﺌﺏ‬ ‫ﺤﺼﺎﻥ‬ ‫ﺤﻤﺎﺭ‬ ‫ﻗﻁ‬ ‫ﻜﻠﺏ‬ ‫ﻨﻭﻉ ﺍﻟﺤﻴﻭﺍﻥ ﺍﻟﻤﻌﺘﺩﻱ‬
‫ﺍﻟﻌﺩﺩ‬
‫ﺒﻌﺩ ﺃﻜﺜﺭ ﻤﻥ ‪ ١٠‬ﺃﻴﺎﻡ‬ ‫ﺨﻼل ‪ ١٠‬ﺃﻴﺎﻡ‬ ‫ﺨﻼل ‪ ٧‬ﺃﻴﺎﻡ‬ ‫ﺨﻼل ‪٣‬‬ ‫ﻤﺒﺎﺸﺭﺓ‬ ‫ﺒﻌﺩ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺒﺩﺀ‬
‫ﺃﻴﺎﻡ‬ ‫ﺤﺎﺩﺜﺔ ﺍﻟﻌﺽ‬
‫ﺍﻟﻌﺩﺩ‬

‫‪.................................................................................................................................................................‬‬ ‫‪ -‬ﻋﺩﺩ ﺍﻟﻤﺭﺍﺠﻌﻭﻥ ﺍﻟﺠﺩﺩ ﺍﻟﻤﻭﺍﻅﺒﻭﻥ ﻋﻠﻰ ﻤﺭﺍﺠﻌﺔ ﺍﻟﻤﺭﻜﺯ ﻓﻲ ﺍﻟﻤﻭﺍﻋﻴﺩ ﺍﻟﻤﺤﺩﺩﺓ‬
‫‪............................................................................................................................................‬‬ ‫‪ -‬ﻋﺩﺩ ﺍﻟﻤﺭﺍﺠﻌﻭﻥ ﺍﻟﺠﺩﺩ ﻏﻴﺭ ﺍﻟﻤﻭﺍﻅﺒﻭﻥ ﻋﻠﻰ ﻤﺭﺍﺠﻌﺔ ﺍﻟﻤﺭﻜﺯ ﻓﻲ ﺍﻟﻤﻭﺍﻋﻴﺩ ﺍﻟﻤﺤﺩﺩﺓ‬
‫‪..................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﻜﻤﻴﺔ ﺍﻟﻠﻘﺎﺡ ﺍﻟﻤﺴﺘﻬﻠﻜﺔ ﺨﻼل ﻫﺫﺍ ﺍﻟﺸﻬﺭ‬
‫‪..............................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﻜﻤﻴﺔ ﺍﻟﻠﻘﺎﺡ ﺍﻟﻤﺘﺒﻘﻴﺔ ﻓﻲ ﻨﻬﺎﻴﺔ ﻫﺫﺍ ﺍﻟﺸﻬﺭ‬
‫‪...........................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﻜﻤﻴﺔ ﺍﻟﻤﺼل ﺍﻟﻤﺴﺘﻬﻠﻜﺔ ﺨﻼل ﻫﺫﺍ ﺍﻟﺸﻬﺭ‬
‫‪........................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﻜﻤﻴﺔ ﺍﻟﻤﺼل ﺍﻟﻤﺘﺒﻘﻴﺔ ﻓﻲ ﻨﻬﺎﻴﺔ ﻫﺫﺍ ﺍﻟﺸﻬﺭ‬
‫(ﻻ‬ ‫)‬ ‫( ﻨﻌﻡ‬ ‫‪ -‬ﻫل ﺤﺼﻠﺕ ﻭﻓﻴﺎﺕ ﻨﺎﺘﺠﺔ ﻋﻥ ﺩﺍﺀ ﺍﻟﻜﻠﺏ‪) :‬‬

‫‪١٨١‬‬
‫ﻓﻲ ﺤﺎل ﺍﻹﻴﺠﺎﺏ ﻴﺭﺠﻰ ﺫﻜﺭ ﺍﺴﻡ ﻜل ﺸﺨﺹ ﺘﻭﻓﻲ ﻭﻋﻤﺭﻩ ﻭﻋﻨﻭﺍﻨﻪ ﻭﻨﻭﻉ ﺍﻟﺤﻴﻭﺍﻥ ﺍﻟﻌﺎﺽ ﻭﺍﻟﻤﻜﺎﻥ ﺍﻟﺫﻱ ﺠﺭﻯ ﻓﻴﻪ‬
‫ﺍﻟﺤﺎﺩﺙ ﻭﻭﺼﻑ ﺸﻜل ﺍﻟﻌﻀﺔ ﻭﻤﻜﺎﻨﻬﺎ ﻭﺘﺎﺭﻴﺦ ﺤﺩﻭﺜﻬﺎ ﻭﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻭﺴﻴﺭﻫﺎ ﺇﻥ ﻜﺎﻨﺕ ﻤﻨﻅﻤﺔ ﺃﻡ ﻻ ﻭﺘﺎﺭﻴﺦ ﺒﺩﺀ‬
‫ﺍﻷﻋﺭﺍﺽ ﻭﺘﺎﺭﻴﺦ ﻤﺭﺍﺠﻌﺔ ﺍﻟﻤﺭﻴﺽ ﻟﻠﻤﺭﻜﺯ ﻭﺘﺎﺭﻴﺦ ﺍﻟﻭﻓﺎﺓ‪.‬‬
‫ﻭﻓﻲ ﺤﺎل ﻤﺭﺍﺠﻌﺘﻪ ﻁﺒﻴﺏ ﺨﺎﺹ ﺍﺴﻡ ﺍﻟﻁﺒﻴﺏ ﻭﻋﻨﻭﺍﻨﻪ ﻭﻜﻴﻔﻴﺔ ﻤﻌﺎﻟﺠﺔ ﺍﻟﻤﻌﻀﻭﺽ ـ ﻭﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﺘﺨﺫﺓ ﻤﻥ ﻗﺒل‬
‫‪.............................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﻁﺒﻴﺏ ﺃﻭ ﺍﻷﻫل‬
‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫(ﻻ‬ ‫)‬ ‫( ﻨﻌﻡ‬ ‫‪ -‬ﻫل ﺤﺼﻠﺕ ﺃﻴﺔ ﺍﺨﺘﻼﻁﺎﺕ ﻋﻨﺩ ﺍﻟﺸﺨﺹ ﺍﻟﻤﻌﻀﻭﺽ ﻨﺘﻴﺠﺔ ﺇﻋﻁﺎﺀ ﺍﻟﻠﻘﺎﺡ ﻀﺩ ﺩﺍﺀ ﺍﻟﻜﻠﺏ‪) :‬‬
‫ﻓﻲ ﺤﺎل ﺍﻹﻴﺠﺎﺏ ﻴﺭﺠﻰ ﺫﻜﺭ ﺍﺴﻡ ﺍﻟﺸﺨﺹ ﺃﻭ ﺍﻷﺸﺨﺎﺹ ﺍﻟﺫﻴﻥ ﻅﻬﺭﺕ ﻟﺩﻴﻬﻡ ﺍﻻﺨﺘﻼﻁﺎﺕ ﻭﻨﻭﻉ ﻫﺫﻩ ﺍﻻﺨﺘﻼﻁﺎﺕ‬
‫‪...............................................................................................................................................................................‬‬ ‫ﻭﺸﺩﺘﻬﺎ ﻭﻋﺩﺩ ﺍﻟﺯﺭﻗﺎﺕ ﺍﻟﻤﻌﻁﺎﺓ ﻋﻨﺩ ﻅﻬﻭﺭ ﺍﻻﺨﺘﻼﻁﺎﺕ ﻭﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﺘﺨﺫﺓ‬
‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫ﺍﺴﻡ ﺍﻟﻤﻤﺭﺽ ﻭﺘﻭﻗﻴﻌﻪ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‬

‫ﺍﻟﺨﺎﺘﻡ ﺍﻟﺭﺴﻤﻲ ﻟﻠﻤﺭﻜﺯ‬ ‫ﺍﺴﻡ ﺍﻟﻁﺒﻴﺏ ﺍﻟﻤﺸﺭﻑ ﻋﻠﻰ ﺍﻟﻤﺭﻜﺯ ﻭﺘﻭﻗﻴﻌﻪ‬

‫‪١٨٢‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٢٥‬‬
‫ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‪:‬‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﺘﻭﺯﻉ ﺇﺼﺎﺒﺎﺕ ﺍﻟﻼﻴﺸﻤﺎﻨﻴﺎ ﺍﻟﺠﻠﺩﻴﺔ‬
‫ﺸﻬﺭ ‪:‬‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﻋﺎﻡ‪:‬‬ ‫ﺤﺴﺏ ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﺼﺤﻴﺔ ﻭﺍﻟﻘﺭﻯ‬ ‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ‬
‫ﻤﺼﺩﺭ‬
‫ﺭﺵ ﺍﻟﻘﺭﻴﺔ‬ ‫ﺍﻟﺤﺎﻻﺕ‬
‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻟﻭﻀﻊ ﺍﻟﺒﻴﺌﻲ‬ ‫ﺍﻹﺼﺎﺒﺔ‬ ‫ﺘﻭﺯﻉ ﺍﻹﺼﺎﺒﺎﺕ ﻋﻠﻰ‬

‫ﻋﺩﺩ ﺍﻹﺼﺎﺒﺎﺕ ﻓﻲ ﺍﻟﻘﺭﻴﺔ ﺃﻭ ﺍﻟﺤﻲ‬

‫ﺃﻭ ﺍﻟﺤﻲ‬ ‫ﺍﻟﻤﺸﺨﺼﺔ‬
‫ﺍﻟﻤﺘﻭﻗﻊ‬

‫ﻋﺩﺩ ﺴﻜﺎﻥ ﺍﻟﻘﺭﻴﺔ ﺃﻭ ﺍﻟﺤﻲ‬

‫ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﺼﺤﻴﺔ‬
‫ﺍﻟﻘﺭﻴﺔ ﺃﻭ ﺍﻟﺤﻲ‬
‫ﺫﺒﺎﺏ ﺭﻤﻠﻲ‬
‫ﺼﺤﻲ ﺴﻲﺀ‬

‫ﺴﺭﻴﺭﻴﺎﹰ ﺃﻭ‬
‫ﻤﺭﺸﻭﺵ‬

‫ﺍﻹﻴﺠﺎﺒﻴﺔ‬
‫ﻗﻭﺍﺭﺽ‬
‫ﻤﻼﺤﻅﺎﺕ‬

‫ﺍﻟﻨﺎﻜﺴﺔ‬

‫ﻤﺨﺒﺭﻴ ﹰﺎ‬
‫ﺼﺭﻑ‬

‫ﻨﻔﺎﻴﺎﺕ‬
‫ﺁﺯﻭﺕ‬

‫ﺒﻨﺘﻭﺴﺘﺎﻡ‬ ‫ﻏﻠﻭﻜﺎﻨﺘﻴﻡ‬ ‫ﺍﻟﺠﻨﺱ‬

‫ﻤﺤﻠﻴﺔ‬
‫ﺍﻟﺭﺵ‬
‫ﺘﺎﺭﻴﺦ‬

‫ﻭﺍﻓﺩﺓ‬
‫ﻏﻴﺭ‬

‫ﺃﻗل ﻤﻥ ‪٥‬‬
‫‪١٥ - ٥‬‬
‫ﻤﻭﻀﻌﻲ‬

‫ﻤﻭﻀﻌﻲ‬

‫‪ ١٦‬ﺴﻨﺔ‬
‫ﻋﻀﻠﻲ‬

‫ﻋﻀﻠﻲ‬

‫ﻓﺄﻜﺜﺭ‬

‫ﺃﻨﺜﻰ‬

‫ﺫﻜﺭ‬
‫ﺴﻨﺔ‬
‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﺭﺌﻴﺱ ﺍﻟﻤﺭﻜﺯ‬ ‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﻤﻨﻅﻡ ﺍﻟﺘﻘﺭﻴﺭ‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٢٦‬‬
‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﺍﻟﻤﻨﻁﻘﺔ‪:‬‬
‫ﺍﺴﺘﻤﺎﺭﺓ ﻤﺭﻴﺽ‬
‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫ﺍﻟﻘﺭﻴﺔ ﺃﻭ ﺍﻟﺤﻲ ‪:‬‬ ‫ﻻﻴﺸﻤﺎﻨﻴﺎ ﺠﻠﺩﻴﺔ‬ ‫ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ‬

‫ﺍﻟﻤﻌﻠﻭﻤﺎﺕ ﺍﻟﺸﺨﺼﻴﺔ‪:‬‬
‫ﺍﻻﺴﻡ ﺍﻟﺜﻼﺜﻲ‪:‬‬
‫ﺍﻟﻤﻬﻨﺔ‪:‬‬ ‫ﺍﻟﻌﻤﺭ‪:‬‬ ‫ﺍﻟﺠﻨﺱ‪:‬‬
‫ﺍﻟﻌﻨﻭﺍﻥ ﺒﺎﻟﺘﻔﺼﻴل ﻭﺍﻟﻬﺎﺘﻑ‪:‬‬

‫ﺴﺭﻴﺭﻴﹰﺎ‪:‬‬
‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻹﺼﺎﺒﺔ‬ ‫ﻤﻜﺎﻥ ﺍﻻﻨﺩﻓﺎﻋﺎﺕ‬
‫ﺃﺸﻜﺎل ﺍﻻﻨﺩﻓﺎﻋﺎﺕ‬ ‫ﻋﺩﺩ ﺍﻻﻨﺩﻓﺎﻋﺎﺕ‬
‫ﺃﻋﺭﺍﺽ ﻤﺭﺍﻓﻘﺔ )ﺘﺫﻜﺭ(‬ ‫ﻋﻤﺭ ﺍﻻﻨﺩﻓﺎﻋﺎﺕ‬
‫ﻭﺒﺎﺌﻴﹰﺎ‪:‬‬
‫ﻨﻭﻉ ﺍﻹﺼﺎﺒﺔ ﻭﺒﺎﺌﻴﹰﺎ‬
‫ﺍﻷﻤﺎﻜﻥ ﺍﻟﻤﻭﺒﻭﺀﺓ ﺍﻟﻤﺯﺍﺭﺓ ﺃﻭ ﻤﺼﺩﺭ ﺍﻹﺼﺎﺒﺔ ﺍﻟﻤﺘﻭﻗﻊ‬
‫ﻭﺠﻭﺩ ﺇﺼﺎﺒﺎﺕ ﺠﻠﺩﻴﺔ ﻓﻲ ﺍﻟﺠﻭﺍﺭ‬ ‫ﻭﺠﻭﺩ ﺇﺼﺎﺒﺎﺕ ﺠﻠﺩﻴﺔ ﻓﻲ ﺍﻟﻤﻨﺯل‬
‫ﻭﺠﻭﺩ ﺤﻴﻭﺍﻨﺎﺕ ﺨﺎﺯﻨﺔ )ﻗﻭﺍﺭﺽ(‬ ‫ﻭﺠﻭﺩ ﻟﺩﻍ ﺤﺸﺭﻱ )ﺫﺒﺎﺒﺔ ﺭﻤل(‬
‫ﻨﻔﺎﻴﺎﺕ ﻭﺼﺭﻑ ﺼﺤﻲ ﺴﻲﺀ‬ ‫ﺘﺎﺭﻴﺦ ﺭﺵ ﺍﻟﻤﻨﺯل‬
‫ﻤﺨﺒﺭﻴﹰﺎ‪:‬‬
‫ﻨﺘﻴﺠﺔ ﻓﺤﺹ ﺍﻟﺸﺭﻴﺤﺔ‬ ‫ﻤﺭﻜﺯ ﻓﺤﺹ ﺍﻟﺸﺭﻴﺤﺔ‬ ‫ﺘﺎﺭﻴﺦ ﺘﺸﺨﻴﺹ ﺍﻟﺸﺭﻴﺤﺔ‬
‫ﻋﻼﺠﻴﹰﺎ‪:‬‬
‫ﺇﻋﻁﺎﺀ‬ ‫ﻁﺭﻴﻘﺔ‬ ‫ﺠﻠﺴﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻁﺒﻕ‬ ‫ﺇﻋﻁﺎﺀ ﺘﺎﺭﻴﺦ‬ ‫ﻁﺭﻴﻘﺔ‬ ‫ﺠﻠﺴﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻁﺒﻕ‬ ‫ﺘﺎﺭﻴﺦ‬
‫ﺍﻟﻌﻼﺝ‬ ‫ﺍﻟﻌﻼﺝ‬ ‫ﺍﻟﻌﻼﺝ‬ ‫ﺍﻟﻌﻼﺝ‬
‫‪-٥‬‬ ‫‪-١‬‬
‫‪-٦‬‬ ‫‪-٢‬‬
‫‪-٧‬‬ ‫‪-٣‬‬
‫‪-٨‬‬ ‫‪-٤‬‬
‫ﺍﻟﺘﻘﻴﻴﻡ ﻭﺍﻟﻤﺘﺎﺒﻌﺔ‪:‬‬
‫ﻭﻓﺎﺓ‬ ‫ﻨﻜﺱ‬ ‫ﺘﺤﺴﻥ‬ ‫ﺸﻔﺎﺀ‬ ‫ﺍﻟﻔﺘﺭﺓ ﺍﻟﺯﻤﻨﻴﺔ‬
‫ﺒﻌﺩ ﺸﻬﺭ‬
‫ﺒﻌﺩ ﺸﻬﺭﻴﻥ‬
‫ﺒﻌﺩ ﺜﻼﺜﺔ ﺃﺸﻬﺭ‬
‫ﺒﻌﺩ ﺴﺘﺔ ﺃﺸﻬﺭ‬
‫ﺒﻌﺩ ﺴﻨﺔ‬
‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﺭﺌﻴﺱ ﺍﻟﻤﺭﻜﺯ‬ ‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﻤﻨﻅﻡ ﺍﻻﺴﺘﻤﺎﺭﺓ‬

‫‪١٨٤‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٢٧‬‬
‫ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‪:‬‬ ‫‪-١‬‬ ‫ﺃﺴﻤﺎﺀ‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﺸﻬﺭ ‪:‬‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫‪-٢‬‬ ‫ﺍﻟﻔﺭﻴﻕ‬
‫ﻋﺎﻡ‪:‬‬
‫ﺍﻟﺤﺸﺭﻱ ‪- ٣‬‬
‫ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻟﺘﻘﺼﻲ ﺍﻟﺫﺒﺎﺏ ﺍﻟﺭﻤﻠﻲ‬ ‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫‪-٤‬‬ ‫ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ‬
‫ﺘﺎﺭﻴﺦ ﺭﺵ ﺍﻟﻘﺭﻴﺔ ﺃﻭ ﺍﻟﺤﻲ‬
‫ﻋﺩﺩ ﺍﻟﺫﺒﺎﺏ ﻤﺘﻭﺴﻁ ﺍﻟﻜﺜﺎﻓﺔ‬ ‫ﻋﺩﺩ ﺍﻟﻐﺭﻑ‬ ‫ﺤﺎﻟﺔ ﺭﺵ ﺍﻟﻘﺭﻴﺔ‬ ‫ﻋﺩﺩ ﺴﻜﺎﻥ‬
‫ﻨﻭﻉ ﺍﻟﺫﺒﺎﺏ‬ ‫ﻋﺩﺩ ﺇﺼﺎﺒﺎﺕ‬ ‫ﻨﻭﻉ‬ ‫ﺍﻟﻘﺭﻴﺔ ﺃﻭ‬ ‫ﺍﻟﻤﻨﻁﻘﺔ‬
‫ﻤﻼﺤﻅﺎﺕ‬ ‫ﺍﻟﺤﺸﺭﻴﺔ‬ ‫ﺍﻟﺭﻤﻠﻲ‬ ‫ﻏﻴﺭ‬ ‫ﺘﺎﺭﻴﺦ‬ ‫ﺍﻟﻘﺭﻴﺔ ﺃﻭ‬
‫ﺍﻟﺭﻤﻠﻲ‬ ‫ﺍﻟﻤﺯﺍﺭﺓ ﺍﻹﻴﺠﺎﺒﻴﺔ‬ ‫ﺍﻟﺸﻬﺭ ﺍﻟﺴﺎﺒﻕ‬ ‫ﺍﻟﻤﺤﻁﺔ‬ ‫ﺍﻟﺤﻲ‬ ‫ﺍﻟﺼﺤﻴﺔ‬
‫ﺍﻟﻤﺠﻤﻭﻉ ﺒﺎﻟﻐﺭﻓﺔ ﺍﻟﻭﺍﺤﺩﺓ‬ ‫ﻤﺭﺸﻭﺸﺔ‬ ‫ﺍﻟﺭﺵ‬ ‫ﺍﻟﺤﻲ‬
‫ﻤﺘﻭﺴﻁ ﺍﻟﻜﺜﺎﻓﺔ ﺍﻟﺤﺸﺭﻴﺔ ﻓﻲ ﺍﻟﻐﺭﻓﺔ ﺍﻟﻭﺍﺤﺩﺓ = ﻋﺩﺩ ﺍﻟﺫﺒﺎﺏ ﺍﻟﺭﻤﻠﻲ ﺍﻟﻤﺠﻤﻭﻉ ‪ /‬ﻋﺩﺩ ﺍﻟﻐﺭﻑ ﺍﻟﻤﺯﺍﺭﺓ‬
‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﺭﺌﻴﺱ ﺍﻟﻤﺭﻜﺯ‬ ‫ﻤﺸﺭﻑ ﺍﻟﻔﺭﻴﻕ ﺍﻟﺤﺸﺭﻱ‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٢٨‬‬
‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﺍﻟﻤﻨﻁﻘﺔ‪:‬‬
‫ﺍﺴﺘﻤﺎﺭﺓ ﻤﺭﻴﺽ‬
‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫ﺍﻟﻘﺭﻴﺔ ﺃﻭ ﺍﻟﺤﻲ ‪:‬‬ ‫ﻤﻼﺭﻴﺎ‬ ‫ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ‬

‫ﺍﻟﻤﻌﻠﻭﻤﺎﺕ ﺍﻟﺸﺨﺼﻴﺔ‪:‬‬
‫ﺍﻻﺴﻡ ﺍﻟﺜﻼﺜﻲ‪:‬‬
‫ﺍﻟﻤﻬﻨﺔ‪:‬‬ ‫ﺍﻟﻌﻤﺭ‪:‬‬ ‫ﺍﻟﺠﻨﺱ‪:‬‬
‫ﻋﺩﺩ ﺴﻜﺎﻥ ﺍﻟﻘﺭﻴﺔ ﺃﻭ ﺍﻟﺤﻲ‬ ‫ﺍﻟﻌﻨﻭﺍﻥ ﺒﺎﻟﺘﻔﺼﻴل ﻭﺍﻟﻬﺎﺘﻑ‪:‬‬

‫ﺴﺭﻴﺭﻴﹰﺎ‪:‬‬
‫ﺸﺤﻭﺏ ﻭﻓﻘﺭ ﺩﻡ‬ ‫ﺘﺭﻓﻊ ﺤﺭﻭﺭﻱ‬ ‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ‬
‫ﺁﻻﻡ ﻤﻔﺼﻠﻴﺔ‬ ‫ﺼﺩﺍﻉ‬ ‫ﻋﺭﻭﺍﺀ ﻤﻊ ﺘﻌﺭﻕ‬
‫ﻭﺒﺎﺌﻴﹰﺎ‬
‫ﺍﻷﻤﺎﻜﻥ ﺍﻟﻤﻭﺒﻭﺀﺓ ﺍﻟﻤﺯﺍﺭﺓ ﺨﻼل ﺍﻟﺴﺘﺔ ﺃﺸﻬﺭ ﺍﻟﺴﺎﺒﻘﺔ‬
‫ﺇﺼﺎﺒﺔ ﻤﻤﺎﺜﻠﺔ ﻓﻲ ﺍﻟﺠﻭﺍﺭ‬ ‫ﻏﻴﺭ ﻤﺭﺸﻭﺵ‬ ‫ﺘﺎﺭﻴﺦ ﺭﺵ ﺍﻟﻤﻨﺯل‬
‫ﻭﺠﻭﺩ ﻜﺜﺎﻓﺔ ﻴﺭﻗﺎﺕ ﺒﻌﻭﺽ‬ ‫ﻭﺠﻭﺩ ﻤﺴﺘﻨﻘﻌﺎﺕ‬ ‫ﻭﺠﻭﺩ ﻜﺜﺎﻓﺔ ﺒﻌﻭﺽ ﻨﺎﻗل‬
‫ﻤﺨﺒﺭﻴﹰﺎ‬
‫ﻤﻜﺎﻥ ﻓﺤﺹ ﺍﻟﺸﺭﻴﺤﺔ‬ ‫ﺘﺎﺭﻴﺦ ﻓﺤﺹ ﺍﻟﺸﺭﻴﺤﺔ‬ ‫ﺘﺎﺭﻴﺦ ﺃﺨﺫ ﺍﻟﺸﺭﻴﺤﺔ‬
‫ﺍﻟﺨﻀﺎﺏ ﻭﺍﻟﻬﻴﻤﺎﺘﻭﻜﺭﻴﺕ‬ ‫ﺘﻌﺩﺩ ﺍﻟﻜﺭﻴﺎﺕ ﺍﻟﺤﻤﺭ‬ ‫ﻨﻭﻉ ﺍﻟﻁﻔﻴﻠﻲ‬
‫ﻋﻼﺠﻴﹰﺎ‬
‫ﻨﻜﺱ‬ ‫ﺘﺤﺴﻥ‬ ‫ﺸﻔﺎﺀ‬ ‫ﺘﺎﺭﻴﺦ ﺍﻨﺘﻬﺎﺀ ﺍﻟﻌﻼﺝ‬ ‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻟﻌﻼﺝ‬ ‫ﺍﻟﺠﺭﻋﺔ ﺍﻟﻤﻁﺒﻘﺔ‬ ‫ﺍﻟﻌﻼﺝ ﺍﻟﻤﻁﺒﻕ ﻭﻋﻴﺎﺭﻩ‬

‫ﺍﻟﻤﺘﺎﺒﻌﺔ ﻭﺍﻟﺘﻘﻴﻴﻡ‬
‫ﻭﻓﺎﺓ‬ ‫ﻨﻜﺱ‬ ‫ﺘﺤﺴﻥ‬ ‫ﺸﻔﺎﺀ‬ ‫ﻨﺘﻴﺠﺔ ﻓﺤﺹ ﺍﻟﺸﺭﻴﺤﺔ‬ ‫ﺍﻟﻔﺘﺭﺓ ﺍﻟﺯﻤﻨﻴﺔ‬
‫ﺒﻌﺩ ﺃﺴﺒﻭﻉ ﻤﻥ ﺍﻨﺘﻬﺎﺀ ﺍﻟﻌﻼﺝ‬
‫ﺒﻌﺩ ﺃﺴﺒﻭﻋﻴﻥ ﻤﻥ ﺍﻨﺘﻬﺎﺀ ﺍﻟﻌﻼﺝ‬
‫ﺒﻌﺩ ﺸﻬﺭ ﻤﻥ ﺍﻨﺘﻬﺎﺀ ﺍﻟﻌﻼﺝ‬
‫ﺒﻌﺩ ﺴﻨﺔ ﻤﻥ ﺍﻨﺘﻬﺎﺀ ﺍﻟﻌﻼﺝ‬
‫ﻤﻼﺤﻅﺔ‪ :‬ﻴﺠﺏ ﺍﻹﺒﻼﻍ ﻋﻥ ﺃﻴﺔ ﺇﺼﺎﺒﺔ ﻤﻼﺭﻴﺎ ﺤﺩﻴﺜﺔ ﻷﺨﺫ ﺍﻟﺭﻗﻡ ﺍﻟﻌﺎﻡ‪ ،‬ﻤﻊ ﺇﺭﺴﺎل ﻨﺴﺨﺔ ﻤﻥ ﺍﻻﺴﺘﻤﺎﺭﺓ ﻤﻊ ﺍﻟﺸﺭﻴﺤﺔ ﺍﻟﺩﻤﻭﻴﺔ‬
‫ﻟﻺﺼﺎﺒﺔ ﺇﻟﻰ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ‪ -‬ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ‪.‬‬
‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﺭﺌﻴﺱ ﺍﻟﻤﺭﻜﺯ‬ ‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﻤﻨﻅﻡ ﺍﻻﺴﺘﻤﺎﺭﺓ‬

‫‪١٨٦‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪) (٢٩‬ﺃ(‬
‫ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‪:‬‬ ‫‪-١‬‬ ‫ﺃﺴﻤﺎﺀ‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﺸﻬﺭ ‪:‬‬
‫‪-٢‬‬ ‫ﺍﻟﻔﺭﻴﻕ‬ ‫ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﺤﻭل ﺘﻘﺼﻲ ﺒﻌﻭﺽ ﺍﻟﻤﻼﺭﻴﺎ ﺍﻟﺒﺎﻟﻎ ﻓﻲ ﻤﺭﻜﺯ ﺒﺭﺩﺍﺀ‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﻋﺎﻡ‪:‬‬
‫ﺍﻟﺤﺸﺭﻱ ‪- ٣‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫‪٢٠٠ /‬‬ ‫‪/‬‬ ‫‪ ٢٠٠ /‬ﺇﻟﻰ‬ ‫‪/‬‬ ‫ﺍﺒﺘﺩﺍﺀ ﻤﻥ‬
‫‪-٤‬‬ ‫ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ‬
‫ﻋﺩﺩ ﺇﺼﺎﺒﺎﺕ‬
‫ﻤﻼﺤﻅﺎﺕ‬ ‫ﺤﺎﻟﺔ ﺍﻟﺒﻁﻥ‬ ‫ﻋﺩﺩ ﻭﻨﻭﻉ ﺍﻟﺒﻌﻭﺽ ﺍﻟﻤﺠﻤﻭﻉ‬ ‫ﻁﺭﻴﻘﺔ ﺍﻟﺠﻤﻊ‬ ‫ﺍﻷﻤﻜﻨﺔ ﺍﻟﻤﺯﺍﺭﺓ ﻭﻋﺩﺩﻫﺎ‬ ‫ﺤﺎﻟﺔ ﺍﻟﺭﺵ‬ ‫ﺍﻟﻤﻼﺭﻴﺎ ﻓﻲ‬ ‫ﻨﻭﻉ ﺍﻟﻤﺤﻁﺔ‬

‫ﻋﺩﺩ ﺴﻜﺎﻥ ﺍﻟﻘﺭﻴﺔ‬

‫ﺍﻟﻘﺭﻴﺔ‬ ‫ﺍﻟﻘﺭﻴﺔ‬
‫ﺘﺎﺭﻴﺦ‬ ‫ﺍﻟﻤﻨﻁﻘﺔ‬
‫ﺃﻭ‬
‫ﺍﻟﺯﻴﺎﺭﺓ‬ ‫ﺍﻟﺼﺤﻴﺔ‬

‫ﻏﻴﺭ ﻤﺭﺸﻭﺵ‬

‫ﺍﻟﺴﻨﺔ ﺍﻟﺴﺎﺒﻘﺔ‬
‫ﺴﻭﺒﺭ ﺒﻜﺘﻭﺱ‬
‫ﻨﺼﻑ ﺒﻴﻭﻀﺔ‬

‫ﺍﻟﺴﻨﺔ ﺍﻟﺤﺎﻟﻴﺔ‬
‫ﺃﺨﺭﻯ )ﺘﺫﻜﺭ(‬

‫ﺘﺎﺭﻴﺦ ﺍﻟﺭﺵ‬
‫ﺃﻨﻭﺍﻉ ﺃﺨﺭﻯ‬
‫ﺒﻴﻭﻀﺔ ﺃﻭ‬

‫ﺍﻟﺤﻲ‬
‫ﺴﻜﺎﺭﻭﻓﻲ‬

‫ﻋﺭﻀﻴﺔ‬
‫ﻜﻼﻓﻴﺠﺭ‬
‫ﻤﺘﻐﺫﻴﺔ‬

‫ﺇﺴﻁﺒل‬
‫)ﺘﺫﻜﺭ(‬
‫ﻓﺎﺭﻏﺔ‬

‫ﻤﻁﺒﺦ‬
‫ﺸﻔﺎﻁ‬

‫ﺜﺎﺒﺘﺔ‬
‫ﻓﻠﻴﺕ‬

‫ﻨﻭﻡ‬
‫ﻤﻼﺤﻅﺔ‪ :‬ﻴﻭﻀﻊ ﺍﻟﺒﻌﻭﺽ ﺍﻟﻤﺠﻤﻭﻉ ﻓﻲ ﻋﻠﺏ ﻜﺒﺭﻴﺕ ﻭﺘﺭﺴل ﺇﻟﻰ ﺍﻹﺩﺍﺭﺓ ﺍﻟﻤﺭﻜﺯﻴﺔ ﻤﻊ ﻜﺘﺎﺒﺔ ﻤﻜﺎﻥ ﻭﺘﺎﺭﻴﺦ ﺍﻟﺠﻤﻊ‪.‬‬
‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﺭﺌﻴﺱ ﺍﻟﻤﺭﻜﺯ‬ ‫ﻤﺸﺭﻑ ﺍﻟﻔﺭﻴﻕ ﺍﻟﺤﺸﺭﻱ‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪) (٢٩‬ﺏ(‬
‫ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‪:‬‬ ‫‪-١‬‬ ‫ﺃﺴﻤﺎﺀ‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﺸﻬﺭ ‪:‬‬
‫‪-٢‬‬ ‫ﺍﻟﻔﺭﻴﻕ‬ ‫ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﺤﻭل ﺘﻘﺼﻲ ﺒﻌﻭﺽ ﺍﻟﻤﻼﺭﻴﺎ ﺍﻟﺒﺎﻟﻎ ﻓﻲ ﻤﺭﻜﺯ ﺒﺭﺩﺍﺀ‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﻋﺎﻡ‪:‬‬
‫ﺍﻟﺤﺸﺭﻱ ‪- ٣‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫‪٢٠٠ /‬‬ ‫‪/‬‬ ‫‪ ٢٠٠ /‬ﺇﻟﻰ‬ ‫‪/‬‬ ‫ﺍﺒﺘﺩﺍﺀ ﻤﻥ‬
‫‪-٤‬‬ ‫ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ‬
‫ﻤﻼﺤﻅﺎﺕ‬ ‫ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﻴﺭﻗﻲ‬ ‫ﺍﻟﻁﻭﺭ ﺍﻟﻴﺭﻗﻲ‬ ‫ﻨﻭﻉ ﺍﻟﻴﺭﻗﺎﺕ‬ ‫ﺤﺎﻟﺔ ﺍﻟﺭﺵ‬ ‫ﻨﻭﻉ ﺍﻟﻤﻴﺎﻩ‬ ‫ﺇﺼﺎﺒﺎﺕ ﺍﻟﻤﻼﺭﻴﺎ‬

‫ﺃﻭ ﺍﻟﻤﻜﺎﻥ ﺍﻟﻤﺯﺍﺭ‬

‫ﺍﻟﻤﺼﺩﺭ ﺍﻟﻤﺎﺌﻲ‬
‫ﻭﺠﻭﺩ‬ ‫ﺍﻟﻘﺭﻴﺔ‬
‫ﻜﺜﺎﻓﺔ ﺍﻟﻴﺭﻗﺎﺕ‪/‬ﻡ‪) ٢‬ﻜل‬ ‫ﺘﺎﺭﻴﺦ‬ ‫ﺍﻟﻤﻨﻁﻘﺔ‬
‫ﺴﻤﻙ‬ ‫ﺃﻭ‬
‫ﺴﻜﺎﺭﻭﻓﻲ‬

‫ﻜﻴﻭﻟﻴﻜﺱ‬

‫ﻤﺭﺸﻭﺵ‬
‫‪ ٥‬ﻏﺭﺍﻤﺎﺕ ﺘﻌﺎﺩل ﻡ‪(٢‬‬ ‫ﺍﻟﺯﻴﺎﺭﺓ‬ ‫ﺍﻟﺼﺤﻴﺔ‬

‫ﺍﻟﺴﺎﺒﻘﺔ‬
‫ﺒﻜﺘﻭﺱ‬

‫ﺍﻟﺤﺎﻟﻴﺔ‬
‫)ﺘﺫﻜﺭ(‬

‫ﺃﻨﻭﻓﻴل‬
‫ﺃﺨﺭﻯ‬

‫ﻤﺎﻟﺤﺔ‬
‫ﺍﻟﺭﺵ‬
‫ﺘﺎﺭﻴﺦ‬
‫ﺴﻭﺒﺭ‬

‫ﺍﻟﺴﻨﺔ‬

‫ﺍﻟﺴﻨﺔ‬
‫ﻋﺫﺒﺔ‬
‫ﺭﺍﺒﻊ‬

‫ﺜﺎﻟﺙ‬

‫ﺜﺎﻨﻲ‬

‫ﻏﻴﺭ‬
‫ﺃﻭل‬

‫ﺍﻟﻜﻤﺒﻭﺯﻴﺎ‬ ‫ﺍﻟﺤﻲ‬
‫ﻤﻼﺤﻅﺔ‪ :‬ﺘﻭﻀﻊ ﺍﻟﻴﺭﻗﺎﺕ ﺍﻟﻤﺠﻤﻭﻋﺔ ﻓﻲ ﻜﺤﻭل ‪ %٧٠‬ﻭﺘﺭﺴل ﺇﻟﻰ ﺍﻹﺩﺍﺭﺓ ﺍﻟﻤﺭﻜﺯﻴﺔ‪.‬‬
‫ﺍﺴﻡ ﻭﺘﻭﻗﻴﻊ ﺭﺌﻴﺱ ﺍﻟﻤﺭﻜﺯ‬ ‫ﻤﺸﺭﻑ ﺍﻟﻔﺭﻴﻕ ﺍﻟﺤﺸﺭﻱ‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٣٠‬‬
‫‪....................................................................................................................................‬‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﺍﻟﻤﻨﻁﻘﺔ‪:‬‬
‫‪.........................................................................................................................................‬‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫‪..............................................................................................................................................‬‬ ‫ﺍﻟﻤﺩﻴﻨﺔ‪:‬‬ ‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬
‫‪...........................................................................................................................................‬‬ ‫ﺍﻟﻨﺎﺤﻴﺔ‪:‬‬ ‫ﺩﺍﺌﺭﺓ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺒﺭﺩﺍﺀ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﻔﻴﻠﻴﺔ‬
‫‪..................................................................................................................................................‬‬‫ﺍﻟﺒﻠﺩﺓ‪:‬‬

‫ﺍﺴﺘﻤﺎﺭﺓ ﺘﻘﺼﻲ ﻋﻥ ﺇﺼﺎﺒﺎﺕ ﺍﻟﺒﻠﻬﺎﺭﺴﻴﺎ ﺍﻟﺒﻭﻟﻴﺔ‬

‫‪ - ١‬ﻤﻌﻠﻭﻤﺎﺕ ﻋﻥ ﺍﻟﻤﺭﻴﺽ‪:‬‬
‫ﺍﻟﺠﻨﺱ‪:‬‬ ‫‪..............................................................................................................................................................................‬‬ ‫ﺍﻟﻌﻤﺭ‪:‬‬ ‫‪..............................................................................................................................................................................‬‬ ‫ﺍﻻﺴﻡ‪:‬‬
‫‪..............................................................................................................................................................................‬‬ ‫ﺍﻟﻭﻀﻊ ﺍﻟﻌﺎﺌﻠﻲ‪:‬‬ ‫‪..............................................................................................................................................................................‬‬

‫‪..............................................................................................................................................................................‬‬ ‫ﺍﻟﻌﻤل‪:‬‬ ‫‪..............................................................................................................................................................................‬‬ ‫ﻤﻜﺎﻥ ﺍﻹﻗﺎﻤﺔ‪:‬‬

‫‪ - ٢‬ﺍﻟﻘﺼﺔ ﺍﻟﻤﺭﻀﻴﺔ‪:‬‬
‫‪..............................................................................................................................................................................‬‬ ‫ﺃ( ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ‪:‬‬
‫‪...................................‬‬ ‫ﺇﻗﻴﺎﺀ‬ ‫‪...................................‬‬ ‫ﺩﻡ ﻓﻲ ﺍﻟﺒﻭل‬ ‫‪...................................‬‬ ‫ﺏ( ﺍﻟﺸﻜﺎﻴﺔ ﺍﻟﺤﺎﻟﻴﺔ‪ :‬ﺃﻟﻡ‬
‫‪...................................................................................................................................‬‬ ‫ﻜﻭﻟﻨﺞ ﻜﻠﻭﻱ‬ ‫‪...................................................................................................................................‬‬ ‫ﻓﻘﺭ ﺩﻡ‬
‫‪...................................................................................................................................‬‬ ‫ﺤﺭﺍﺭﺓ‬ ‫‪...................................................................................................................................‬‬ ‫ﻋﺴﺭﺓ ﺘﺒﻭل‬
‫‪...................................‬‬ ‫ﻜﻼ‬ ‫‪...................................................................................................................................‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‬ ‫‪...................................‬‬ ‫ﺝ( ﻫل ﺴﺒﻕ ﺃﻥ ﺸﻜﻰ ﻤﻥ ﻨﻔﺱ ﺍﻷﻋﺭﺍﺽ‪ :‬ﻨﻌﻡ‬
‫‪..............................................................................................................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﺩﻭﺍﺀ ﺍﻟﻤﺴﺘﻌﻤل‬ ‫‪...................................‬‬ ‫ﺩ( ﻫل ﺴﺒﻕ ﺃﻥ ﻋﻭﻟﺞ ﻀﺩ ﺍﻟﺒﻠﻬﺎﺭﺴﻴﺎ‪ :‬ﻨﻌﻡ‬
‫‪........................................................................................................................................................................................................................................................................................‬‬ ‫ﻜﻤﻴﺘﻪ‬
‫‪.........................................................‬‬ ‫ﻤﺨﺒﺭﻱ‬ ‫‪.........................................................‬‬ ‫ﺴﺭﻴﺭﻱ‬ ‫‪ - ٣‬ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫‪ - ٤‬ﺍﻟﻤﻌﺎﻟﺠﺔ‪:‬‬
‫ﺃ( ﺍﻟﻌﻼﺝ ﺍﻟﻤﺴﺘﻌﻤل‪:‬‬
‫‪.........................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﺒﻠﺘﺭﻴﺴﻴﺩ‪ :‬ﻜﻤﻴﺘﻪ‬
‫‪.........................................................................................................................................................................................................................................................................................................................‬‬ ‫ﻜﻤﻴﺘﻪ‬ ‫‪......................................................................‬‬ ‫‪ -‬ﺃﻱ ﻋﻼﺝ ﺁﺨﺭ‬
‫ﺏ( ﻨﺘﻴﺠﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ‪:‬‬
‫‪.........................................................‬‬ ‫ﻏﻴﺭ ﺸﺎﻑ‬ ‫‪.........................................................‬‬ ‫ﺸﺎﻑ‬
‫‪...................................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﻌﻼﺝ ﺍﻟﻤﻁﺒﻕ‬ ‫‪.............................................................................................................‬‬ ‫ﺝ( ﺇﻋﺎﺩﺓ ﺍﻟﻤﻌﺎﻟﺠﺔ‬
‫‪ - ٥‬ﺍﻟﻤﺭﺍﻗﺒﺔ‪:‬‬
‫‪.........................................................‬‬ ‫ﺇﻴﺠﺎﺒﻴﺔ‬ ‫‪.........................................................‬‬ ‫ﺇﻋﺎﺩﺓ ﺍﻟﻔﺤﺹ ﺍﻟﻤﺨﺒﺭﻱ ﺒﻌﺩ ﺸﻬﺭﻴﻥ‪ :‬ﺴﻠﺒﻴﺔ‬
‫‪............................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ - ٦‬ﻤﻼﺤﻅﺎﺕ‪:‬‬
‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫ﺍﻻﺴﻡ ﻭﺍﻟﺘﻭﻗﻴﻊ‪:‬‬ ‫‪/‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ ‪/‬‬

‫‪١٨٩‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٣١‬‬
‫ﻤﺭﻜﺯ ﺍﻟﺴل ﻤﺩﻴﺭﻴﺔ ﺼﺤﺔ‪:‬‬
‫‪........................................................................‬‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺍﺭﺩ ﺇﻟﻰ ﺇﺩﺍﺭﺓ ﺒﺭﻨﺎﻤﺞ ﺍﻟﺴل‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻭﻁﻨﻲ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﺴل‬

‫ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺸﻬﺭﻱ ﻋﻥ ﺍﻷﻨﺸﻁﺔ ﺍﻟﺨﺩﻤﻴﺔ ﻟﻠﺘﺩﺭﻥ‬

‫‪............................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺸﻬﺭ‬
‫‪................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﻋﺎﻡ‬
‫‪.................................................................‬‬ ‫ﺸﻌﺎﻋﻲ‬ ‫‪.................................................................‬‬ ‫ﻨﻭﻉ ﺍﻟﻤﺭﻜﺯ‪ :‬ﺘﺨﺼﺼﻲ‬ ‫‪........................................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﺭﻜﺯ‬
‫‪.................................................................‬‬ ‫ﻋﺎﺩﻱ‬ ‫‪.................................................................‬‬ ‫ﻤﺨﺒﺭﻱ‬
‫‪ ١٢‬ﺴﻨﺔ ﻭﻤﺎ ﺩﻭﻥ‬ ‫ﺃﻜﺜﺭ ﻤﻥ ‪ ١٢‬ﺴﻨﺔ‬ ‫ﺍﻟﺠﺯﺀ ﺍﻷﻭل‪ :‬ﻤﻌﻠﻭﻤﺎﺕ ﻋﺎﻤﺔ ﻋﻥ ﻨﺸﺎﻁ ﻜﺸﻑ ﺍﻟﺤﺎﻻﺕ‪:‬‬
‫‪...................................................................................................‬‬ ‫‪...................................................................................................‬‬
‫ﻋﺩﺩ ﺍﻟﻤﺭﺍﺠﻌﻴﻥ ﺍﻟﻜﻠﻲ‬
‫‪...................................................................................................‬‬ ‫‪...................................................................................................‬‬
‫ﺍﻟﻌﺩﺩ ﺍﻟﻜﻠﻲ ﻟﻠﻤﺭﺍﺠﻌﻴﻥ ﺫﻭﻱ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺼﺩﺭﻴﺔ‬
‫‪...................................................................................................‬‬ ‫‪...................................................................................................‬‬
‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺸﺨﺼﺔ ﺍﻹﻴﺠﺎﺒﻴﺔ ﻟﻠﻘﺸﻊ ﺠﺩﻴﺩﺓ‬
‫ﻗﻴﺩ ﺍﻟﻌﻼﺝ )ﻕ(‬ ‫ﺍﻟﺘﺸﺨﻴﺹ )ﺝ(‬
‫‪...................................................................................................‬‬ ‫‪...................................................................................................‬‬
‫ﻋﺩﺩ ﺍﻟﺼﻭﺭ ﺍﻟﺸﻌﺎﻋﻴﺔ‬
‫‪...................................................................................................‬‬ ‫‪...................................................................................................‬‬
‫ﻋﺩﺩ ﺍﻟﻤﻔﺤﻭﺼﻴﻥ ﺸﻌﺎﻋﻴﹰﺎ‬
‫‪...................................................................................................‬‬ ‫‪...................................................................................................‬‬
‫ﻋﺩﺩ ﺍﻟﻤﺸﺨﺼﻴﻥ ﺸﻌﺎﻋﻴﹰﺎ )ﻗﺸﻊ ﺴﻠﺒﻲ(‬
‫‪...................................................................................................‬‬ ‫‪...................................................................................................‬‬
‫ﻋﺩﺩ ﻓﺤﻭﺹ ﺍﻟﻘﺸﻊ‬
‫‪...................................................................................................‬‬ ‫‪...................................................................................................‬‬
‫ﻋﺩﺩ ﺍﻟﻤﻔﺤﻭﺼﻴﻥ ﻤﺨﺒﺭﻴﹰﺎ‬
‫‪...................................................................................................‬‬ ‫‪...................................................................................................‬‬
‫ﻋﺩﺩ ﺍﻟﻤﺸﺨﺼﻴﻥ ﻤﺨﺒﺭﻴﹰﺎ )ﻗﺸﻊ ﺇﻴﺠﺎﺒﻲ(‬
‫‪...................................................................................................‬‬ ‫‪...................................................................................................‬‬
‫ﻋﺩﺩ ﺤﺎﻻﺕ ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﺩﺭﻨﻲ )ﺃﻗل ﻤﻥ ‪ ٥‬ﺴﻨﻭﺍﺕ(‬
‫‪...................................................................................................‬‬ ‫‪...................................................................................................‬‬
‫ﻋﺩﺩ ﺤﺎﻻﺕ ﺩﺍﺀ ﺍﻟﺩﺨﻥ )ﺃﻗل ﻤﻥ ﺨﻤﺱ ﺴﻨﻭﺍﺕ(‬
‫‪...................................................................................................‬‬ ‫‪...................................................................................................‬‬
‫ﻋﺩﺩ ﺤﺎﻻﺕ ﺍﻟﺘﺩﺭﻥ ﺨﺎﺭﺝ ﺍﻟﺭﺌﺔ‬
‫ﺍﻟﺠﺯﺀ ﺍﻟﺜﺎﻨﻲ‪:‬‬
‫ﻴﻤﻸ ﻤﻥ ﻗﺒل ﺭﺌﻴﺱ ﺍﻟﻤﺭﻜﺯ‬
‫ﻤﻼﺤﻅﺎﺕ‪) :‬ﺃﺩﻭﻴﺔ‪ ،‬ﻤﻭﺍﺩ‪ ،‬ﻟﻭﺍﺯﻡ ﻤﺨﺒﺭﻴﺔ‪ ،‬ﺼﻴﺎﻨﺔ‪ ...‬ﺇﻟﺦ(‪.‬‬
‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪٢٠٠‬‬ ‫‪/‬‬ ‫ﺘﺎﺭﻴﺦ ﺇﻋﺩﺍﺩ ﺍﻟﺘﻘﺭﻴﺭ ‪/‬‬ ‫‪......................................................................................................................................................................................................................................................................................................................................‬‬

‫ﺘﻭﻗﻴﻊ ﻁﺒﻴﺏ ﺍﻟﻤﺭﻜﺯ‬

‫‪١٩٠‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٣٢‬‬
‫ﺼﺎﺩﺭ ﻋﻥ ﻤﺭﻜﺯ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺴل ﻓﻲ ﻤﺤﺎﻓﻅﺔ ‪:‬‬
‫‪........................................................................‬‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺍﺭﺩ ﺇﻟﻰ ﺒﺭﻨﺎﻤﺞ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺴل‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻭﻁﻨﻲ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﺴل‬

‫‪..............................................................‬‬ ‫ﺸﻬﺭ‬ ‫‪..............................................................‬‬ ‫ﺘﻘﺭﻴﺭ ﺍﺴﻤﻲ ﺸﻬﺭﻱ ﻟﻠﻤﺭﻀﻰ ﺍﻟﻤﺴﺠﻠﻴﻥ ﻓﻲ ﻤﺭﻜﺯ ﺍﻟﺴل ﻓﻲ ﻤﺤﺎﻓﻅﺔ‬
‫‪...................................................................‬‬ ‫ﻋﺎﻡ‬

‫ﺍﻟﻌﻨﻭﺍﻥ )ﺍﻟﻤﻨﻁﻘﺔ ‪ -‬ﺍﻟﺒﻠﺩﺓ ‪-‬‬

‫ﺤﺎﻟﺔ ﺍﻟﻤﺭﻴﺽ ﻋﻨﺩ ﺍﻟﺘﺴﺠﻴل‬

‫ﺍﻟﺒﺭﻨﺎﻤﺞ‬
‫؟؟؟؟ ﺍﻟﻠﻁﺎﺨﺔ ﺍﻟﻨﺘﻴﺠﺔ‬

‫ﺭﻗﻡ ﺍﻟﻤﻴﻜﺭ ﻭﺍﻟﻨﺘﻴﺠﺔ‬

‫ﺍﻟﻌﻼﺠﻲ‬

‫ﺍﺴﻡ ﺍﻟﻤﺭﻴﺽ‬

‫ﺭﻗﻡ ﺍﻟﻔﻬﺭﺱ‬
‫ﺠﻬﺔ ﺍﻹﺤﺎﻟﺔ‬

‫ﺍﻟﺸﺎﺭﻉ(‬
‫ﺍﻟﺠﻨﺴﻴﺔ‬

‫ﺍﻟﺘﺎﺭﻴﺦ‬
‫ﺍﻟﺠﻨﺱ‬

‫ﺍﻟﻌﻤﺭ‬

‫ﺍﻷﺏ‬
‫ﺘﺎﺭﻴﺦ‬
‫ﺒﺩﺀ‬
‫ﺍﻟﻌﻼﺝ‬

‫ﻤﺠﻤﻭﻉ‬ ‫ﺤﺎﻻﺕ‬ ‫ﻋﻼﺝ‬

‫ﺍﻹﺠﻤﺎﻟﻲ‬ ‫‪E‬‬ ‫‪X‬‬ ‫ﻓﺸل ‪B‬‬ ‫ﻨﻜﺱ ‪B‬‬ ‫ﻀﻴﺎﻉ ‪B‬‬ ‫ﺠﺩﻴﺩ‬
‫‪B‬‬ ‫ﺃﺨﺭﻯ ‪B‬‬ ‫ﺒﻌﺩ‬

‫‪١٩١‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٣٣‬‬
‫ﺼﺎﺩﺭ ﻋﻥ ﻤﺭﻜﺯ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺴل ﻓﻲ ﻤﺤﺎﻓﻅﺔ ‪:‬‬
‫‪........................................................................‬‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺍﺭﺩ ﺇﻟﻰ ﺒﺭﻨﺎﻤﺞ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺴل‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻭﻁﻨﻲ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﺴل‬
‫‪...................................................................‬‬ ‫ﻋﺎﻡ‬ ‫‪..........................................................‬‬ ‫ﺸﻬﺭ‬ ‫‪..............................................................‬‬ ‫ﺘﻘﺭﻴﺭ ﺍﺴﻤﻲ ﺸﻬﺭﻱ ﻟﻨﺘﺎﺌﺞ ﺍﻟﻌﻼﺝ ﻟﻠﻤﺭﻀﻰ ﺍﻟﻤﺴﺠﻠﻴﻥ ﻓﻲ ﻤﺤﺎﻓﻅﺔ‬
‫‪......................................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺇﻋﺩﺍﺩ ﺍﻟﺘﻘﺭﻴﺭ‬
‫ﻓﺤﺹ‬ ‫ﻓﺤﺹ‬ ‫ﻓﺤﺹ‬ ‫ﻓﺤﺹ‬
‫ﻋﺩﺩ‬ ‫ﻨﺘﻴﺠﺔ‬
‫ﺍﻟﻤﺘﺎﺒﻌﺔ‬ ‫ﺍﻟﻤﺘﺎﺒﻌﺔ‬ ‫ﺍﻟﻤﺘﺎﺒﻌﺔ‬ ‫ﺍﻟﻤﺘﺎﺒﻌﺔ‬ ‫ﺤﺎﻟﺔ‬
‫ﺍﻷﻴﺎﻡ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺘﺎﺭﻴﺦ‬ ‫ﺭﻤﺯ‬ ‫ﺍﺴﻡ‬
‫ﺵ‪٩/٧‬‬ ‫ﺵ‪٥‬‬ ‫ﺵ‪٣‬‬ ‫ﺵ‪٢‬‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﺭﻗﻡ‬
‫‪Dot‬‬ ‫ﺒﺩﺀ‬ ‫ﺍﻟﺒﺭﻨﺎﻤﺞ‬ ‫ﺍﻟﻤﺭﻴﺽ‬
‫ﺍﻟﻔﻌﻠﻲ‬ ‫ﺘﺎﺭﻴﺦ‬ ‫ﺭﻗﻡ ‪-‬‬ ‫ﺭﻗﻡ ‪-‬‬ ‫ﺭﻗﻡ ‪-‬‬ ‫ﺭﻗﻡ ‪-‬‬ ‫ﻋﻨﺩ‬ ‫ﺍﻟﻔﻬﺭﺱ‬
‫ﺍﻟﻌﻼﺝ‬ ‫ﺍﻟﻌﻼﺠﻲ‬ ‫ﺍﻟﺜﻼﺜﻲ‬
‫)ﻤﻜﺜﻑ(‬ ‫ﺇﻏﻼﻕ‬ ‫ﺘﺎﺭﻴﺦ‬ ‫ﺘﺎﺭﻴﺦ‬ ‫ﺘﺎﺭﻴﺦ‬ ‫ﺘﺎﺭﻴﺦ‬ ‫ﺍﻟﺘﺴﺠﻴل‬
‫ﺍﻟﺒﻁﺎﻗﺔ‬ ‫ﻨﺘﻴﺠﺔ‬ ‫ﻨﺘﻴﺠﺔ‬ ‫ﻨﺘﻴﺠﺔ‬ ‫ﻨﺘﻴﺠﺔ‬

‫‪١٩٢‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٣٤‬‬
‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﺒﺭﻨﺎﻤﺞ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺘﺩﺭﻥ‬

‫ﻨﻤﻭﺫﺝ ﺇﺒﻼﻍ ﻋﻥ ﺤﺎﻟﺔ ﺩﺭﻨﻴﺔ‬

‫‪...........................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﺍﺴﻡ ﺍﻟﻤﺭﻴﺽ‪:‬‬
‫‪....................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﺠﻨﺱ‪:‬‬ ‫‪..............................................................................................................................................................................................‬‬ ‫‪ -‬ﺍﻟﻌﻤﺭ‪:‬‬
‫‪...................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﺍﻹﻗﺎﻤﺔ‪ :‬ﺃﺼﻠﻴﺔ‪:‬‬
‫‪............................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫( ﻓﻲ‬ ‫ﻤﺅﻗﺘﺔ )ﻟﻤﺩﺓ‬
‫‪............................................................................................................................................................‬‬ ‫ﺹ‪ .‬ﺏ‪:‬‬ ‫‪............................................................................................................................................................‬‬ ‫‪ -‬ﻫﺎﺘﻑ‪:‬‬
‫‪............................................................................................................................................................‬‬ ‫ﻤﻌﺭﻭﻑ ﻤﻥ ﻗﺒل‪:‬‬ ‫‪......................................................................................................................................................................................................‬‬ ‫‪ -‬ﻨﻘﻁﺔ ﻋﻼﻡ‪:‬‬
‫‪........................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﺍﻷﻋﺭﺍﺽ‪:‬‬
‫‪..........................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ‪:‬‬
‫‪............................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﺘﺎﺭﻴﺦ ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫‪ -‬ﻨﺘﺎﺌﺞ ﺍﻟﻔﺤﻭﺹ‪:‬‬
‫‪..................................................................................................................‬‬ ‫‪-٣‬‬ ‫‪..................................................................................................................‬‬ ‫‪-٢‬‬ ‫‪..................................................................................................................‬‬ ‫‪-١‬‬ ‫‪ -‬ﺍﻟﻘﺸﻊ‪:‬‬
‫‪..................................................................................................................‬‬ ‫‪ -‬ﻤﺠﺭﻯ ﻓﻲ ﻤﺨﺒﺭ‪:‬‬
‫‪.....................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﺼﻭﺭﺓ ﺍﻟﺼﺩﺭ‪:‬‬
‫‪...................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺒﺯل ﺍﻟﺠﻨﺏ ـ ﺨﺯﻋﺔ‬
‫‪......................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺒﺯل ﺍﻟﺤﺒﻥ ـ ﺨﺯﻋﺔ‬
‫‪.........................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﻭﺜﺎﺌﻕ ﺃﺨﺭﻯ‪:‬‬
‫)ﻴﻔﻀل ﺇﺭﻓﺎﻕ ﺍﻟﻭﺜﺎﺌﻕ ﻤﻊ ﺍﻹﺒﻼﻍ ﺃﻭ ﺼﻭﺭﺓ ﻋﻨﻬﺎ ﺃﻭ ﻜﺘﺎﺒﺘﻬﺎ ﻤﻔﺼﻠﺔ(‬
‫‪....................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻌﻼﺠﻲ ﺍﻟﻤﻘﺘﺭﺡ‪:‬‬
‫‪.....................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻟﻌﻼﺝ‪:‬‬
‫‪..............................................................................................................................................................................‬‬ ‫‪ -‬ﻫل ﺘﻤﺕ ﺇﺤﺎﻟﺔ ﺍﻟﻤﺭﻴﺽ ﺇﻟﻰ ﺃﺤﺩ ﻤﺭﺍﻜﺯ ﺍﻟﺴل‪:‬‬
‫‪......................................................................................‬‬ ‫ﺍﺴﺘﺸﺎﺭﺓ‬ ‫‪.......................................................................................‬‬ ‫ﺇﻋﻁﺎﺀ ﺍﻟﻌﻼﺝ‬ ‫‪.......................................................................................‬‬ ‫‪ -‬ﺴﺒﺏ ﺍﻹﺤﺎﻟﺔ‪ :‬ﺇﺠﺭﺍﺀ ﻓﺤﺹ‬
‫‪.................................................................................................................................................‬‬ ‫‪ -‬ﻫل ﻴﻭﺍﻓﻕ ﺍﻟﻤﺭﻴﺽ ﻋﻠﻰ ﺇﺠﺭﺍﺀ ﺘﻘﺼﻲ ﻟﻠﻤﺨﺎﻟﻁﻴﻥ ﻓﻲ ﻤﺭﻜﺯ ﺍﻟﺴل ﻓﻲ ﺍﻟﻤﺤﺎﻓﻅﺔ‪:‬‬
‫)ﺴﻴﺘﻡ ﺇﺠﺭﺍﺀ ﺍﻟﻔﺤﻭﺹ ﻟﻠﻤﺨﺎﻟﻁﻴﻥ ﻓﻲ ﻤﺭﻜﺯ ﺍﻟﺴل(‬
‫‪..........................................................................................................................‬‬ ‫‪ -‬ﻫل ﻴﻭﺍﻓﻕ ﺍﻟﻤﺭﻴﺽ ﻋﻠﻰ ﺇﺠﺭﺍﺀ ﺯﻴﺎﺭﺓ ﻟﻪ ﻤﻥ ﻗﺒل ﺍﻟﻌﺎﻤﻠﻴﻥ ﻓﻲ ﺒﺭﻨﺎﻤﺞ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺘﺩﺭﻥ‪:‬‬
‫‪....................................................................................................................................................................................................................................................................................................................................................‬‬ ‫‪ -‬ﻋﻨﻭﺍﻥ ﺍﻟﻁﺒﻴﺏ ﻟﻼﺘﺼﺎل ﻭﺍﻟﻤﺘﺎﺒﻌﺔ‪:‬‬
‫‪.................................................................................................................................................................................................................‬‬ ‫‪ -‬ﻫﺎﺘﻑ‪:‬‬
‫‪...........................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﻁﺒﻴﺏ ﻭﺘﻭﻗﻴﻌﻪ‪:‬‬

‫‪١٩٣‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٣٥‬‬
‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻭﻁﻨﻲ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻟﺴل‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬

‫ﺍﺴﺘﻤﺎﺭﺓ ﺘﻘﺼﻲ ﻟﻤﺨﺎﻟﻁﻲ ﻤﺭﻴﺽ ﺴل‬

‫‪ - ١‬ﺍﻟﻬﻭﻴﺔ‪:‬‬
‫‪...........................................................................................................................‬‬ ‫ﺍﻟﻌﻤﺭ‪:‬‬ ‫‪.........................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻻﺴﻡ‪:‬‬
‫‪............................................................................................................‬‬ ‫ﺍﻟﺠﻨﺱ‪:‬‬
‫‪............................................................................................................‬‬ ‫ﻋﺩﺩ ﺍﻷﻭﻻﺩ‪:‬‬ ‫‪...............................................................................................................‬‬ ‫ﺍﻟﻭﻀﻊ ﺍﻟﻌﺎﺌﻠﻲ‪:‬‬ ‫‪...................................................................................................................‬‬ ‫ﺍﻟﻤﻬﻨﺔ‪:‬‬
‫‪......................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ ﺒﺎﻟﺘﻔﺼﻴل‪:‬‬
‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪ - ٢‬ﺍﻷﻋﺭﺍﺽ‪:‬‬
‫‪.................................................................................‬‬ ‫ﺃﻟﻡ ﺼﺩﺭﻱ‬ ‫‪.................................................................................‬‬ ‫ﻨﻔﺙ ﺩﻤﻭﻱ‬ ‫‪.................................................................................‬‬ ‫ﻗﺸﻊ‬ ‫‪.................................................................................‬‬ ‫ﺴﻌﺎل‬
‫‪.................................................................................‬‬ ‫ﺤﺭﺍﺭﺓ ﻟﻴﻠﻴﺔ ﺃﻭ ﺘﻌﺭﻕ ﻟﻴﻠﻲ‬
‫‪ - ٣‬ﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺸﺨﺼﺔ‪:‬‬
‫‪ - ٢‬ﺍﻷﺸﻌﺔ‪:‬‬ ‫‪ - ١‬ﺍﺨﺘﺒﺎﺭ ﺍﻟﺴﻠﻴﻥ‪:‬‬
‫‪ - ٤‬ﻓﺤﻭﺹ ﺇﻀﺎﻓﻴﺔ‪:‬‬ ‫‪ - ٣‬ﻓﺤﺹ ﺍﻟﻘﺸﻊ‪:‬‬
‫ﺭﻗﻡ ﺍﻟﻔﻬﺭﺱ‬ ‫‪ - ٤‬ﺍﻟﺘﺸﺨﻴﺹ‪:‬‬
‫‪ - ٥‬ﺍﻟﺒﺭﻨﺎﻤﺞ ﺍﻟﻌﻼﺠﻲ‪:‬‬

‫ﺍﻟﻤﺨﺎﻟﻁﻴﻥ‪:‬‬

‫ﺍﻟﻨﺘﻴﺠﺔ‬ ‫ﺍﻹﺠﺭﺍﺀ ﺍﻟﻤﻨﻔﺫ‬ ‫ﺩﺭﺠﺔ‬ ‫ﺍﻟﺭﻗﻡ‬

‫ﺍﻟﻌﻤﺭ‬ ‫ﺍﻻﺴﻡ‬
‫ﻗﺸﻊ‬ ‫ﺃﺸﻌﺔ‬ ‫ﺴﻠﻴﻥ‬ ‫ﻗﺸﻊ‬ ‫ﺃﺸﻌﺔ‬ ‫ﺴﻠﻴﻥ‬ ‫ﺍﻟﻘﺭﺍﺒﺔ‬ ‫ﺍﻟﻤﺘﺴﻠﺴل‬

‫‪١٩٤‬‬
 ‫ﺍﻟﻤﻠﺤﻕ ﺭﻗﻡ )‪(٣٦‬‬
‫ﻤﺩﻴﺭﻴﺔ ﻤﺨﺎﺒﺭ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴﺔ ﺍﻟﻌﺭﺒﻴﺔ ﺍﻟﺴﻭﺭﻴﺔ‬
‫ﻤﺨﺒﺭ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﺎﺭﺌﺔ‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬
‫ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‬

‫ﺍﻻﺴﺘﻤﺎﺭﺓ ﺍﻟﺨﺎﺼﺔ ﺒﻤﺭﻴﺽ ﺍﻹﻨﻔﻠﻭﻨﺯﺍ )‪A (H1N1‬‬

‫‪......................................................................‬‬ ‫ﺍﻟﻔﺎﻜﺱ‬ ‫‪......................................................................‬‬ ‫ﺍﻟﻬﺎﺘﻑ‬ ‫‪.....................................................................‬‬ ‫ﺍﻟﻤﺸﻔﻰ‪/‬ﺍﻟﻤﺭﻜﺯ ﺍﻟﺼﺤﻲ‬ ‫‪.....................................................................‬‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‬
‫‪.....................................................................‬‬ ‫ﺍﻟﻬﺎﺘﻑ‬ ‫‪.....................................................................‬‬ ‫ﺍﻟﻌﻨﻭﺍﻥ‬ ‫‪.....................................................................‬‬ ‫ﺍﻟﻌﻤﺭ‬ ‫‪.....................................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﻤﺭﻴﺽ‬
‫‪......................................................................................................................‬‬ ‫ﻤﺨﺎﻟﻁ‬ ‫‪......................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻌﻭﺩﺓ‬ ‫‪............................................................................................‬‬ ‫ﺍﻟﻘﺎﺩﻡ ﻤﻥ ﺍﻟﺴﻔﺭ‬
‫‪..........................................................................................................................................................................................................‬‬ ‫ﺍﺴﻡ ﺍﻟﻁﺒﻴﺏ ﺍﻟﺫﻱ ﺃﺨﺫ ﺍﻟﻌﻴﻨﺔ‬ ‫‪............................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺃﺨﺫ ﺍﻟﻌﻴﻨﺔ‬
‫‪.................................................................................................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻤﺸﺎﻫﺩﺓ‬ ‫‪.....................................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ‬
‫‪...........................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺒﺩﺀ ﺍﻟﻌﻼﺝ ﺒﺎﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﻔﻴﺭﻭﺴﻴﺔ‬
‫ﻋﻭﺍﻤل ﺍﻟﺨﻁﻭﺭﺓ‬ ‫ﺍﻟﻌﻼﻤﺎﺕ‬
‫‪...............................................................‬‬ ‫ﻗﻠﺒﻴﺔ‬ ‫‪...............................................................‬‬ ‫ﺴﻴﻼﻥ ﺃﻨﻔﻲ‬ ‫‪...............................................................‬‬ ‫ﺍﻟﺤﺭﺍﺭﺓ‬
‫‪...............................................................‬‬ ‫ﺭﺌﻭﻴﺔ‬ ‫‪...............................................................‬‬ ‫ﺇﻗﻴﺎﺀ‬ ‫‪...............................................................‬‬ ‫ﺴﻌﺎل ﺠﺎﻑ‬
‫‪...............................................................‬‬ ‫ﺴﻜﺭﻱ‬ ‫‪...............................................................‬‬ ‫ﺇﺴﻬﺎل‬ ‫‪...............................................................‬‬ ‫ﺃﻟﻡ ﺒﻠﻌﻭﻡ‬
‫‪...............................................................‬‬ ‫ﺃﻭﺭﺍﻡ‬ ‫‪...............................................................‬‬ ‫ﺃﻟﻡ ﻤﻔﺎﺼل‬ ‫‪...............................................................‬‬ ‫ﺴﻌﺎل ﻤﻊ ﻗﺸﻊ‬
‫‪...............................................................‬‬ ‫ﻜﻠﻭﻴﺔ‬ ‫‪...............................................................‬‬ ‫ﺃﻟﻡ ﻋﻀﻼﺕ‬ ‫‪...............................................................‬‬ ‫ﺃﻟﻡ ﺼﺩﺭﻱ‬
‫‪..............................................‬‬ ‫)ﺍﻟﺸﻬﺭ(‬ ‫‪.......................‬‬ ‫ﺤﺎﻤل‬ ‫‪...............................................................‬‬ ‫ﺘﻐﻴﻡ ﻭﻋﻲ‬ ‫‪...............................................................‬‬ ‫ﺯﻟﺔ ﺘﻨﻔﺴﻴﺔ‬
‫‪...............................................................‬‬ ‫ﺒﺩﺍﻨﺔ‬ ‫‪.....................................................................................................................................................................................................................................................................‬‬ ‫ﻋﻼﻤﺎﺕ ﺃﺨﺭﻯ‬
‫‪.....................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺃﻤﺭﺍﺽ ﺃﺨﺭﻯ‬
‫‪......................................................................................................................................................................................................‬‬ ‫ﺍﻷﺴﺒﺎﺏ ﺍﻟﺘﻲ ﺃﺩﺕ ﻟﻘﺒﻭﻟﻪ ﺒﺎﻟﻌﻨﺎﻴﺔ‬ ‫‪...............................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻘﺒﻭل ﺒﺎﻟﻤﺸﻔﻰ‬
‫‪..............................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﻭﺃﺴﺒﺎﺏ ﻭﻀﻌﻪ ﻋﻠﻰ ﺍﻟﻤﻨﻔﺴﺔ‬
‫‪.............................................................................................‬‬ ‫ﻨﻭﻉ ﺍﻟﻤﺴﺤﺔ‬ ‫‪.............................................................................................‬‬ ‫( ﻤﺴﺤﺔ‪ ،‬ﻋﺩﺩ ﺍﻟﻨﻤﺎﺫﺝ ﺍﻟﻤﺄﺨﻭﺫﺓ‪:‬‬ ‫)‬ ‫ﻨﻭﻉ ﺍﻟﻌﻴﻨﺔ‪:‬‬
‫‪.............................................................................................‬‬ ‫ﻨﻭﻉ ﺍﻟﺭﺸﺎﻗﺔ‬ ‫‪.............................................................................................‬‬ ‫( ﺭﺸﺎﻗﺔ‪ ،‬ﻋﺩﺩ ﺍﻟﻨﻤﺎﺫﺝ ﺍﻟﻤﺄﺨﻭﺫﺓ‪:‬‬ ‫)‬
‫‪...........................................................................................................................................................................................................................................................‬‬ ‫( ﻤﺼل‪ ،‬ﻋﺩﺩ ﺍﻟﻨﻤﺎﺫﺝ ﺍﻟﻤﺄﺨﻭﺫﺓ‪:‬‬ ‫)‬
‫‪.............................................................................................................‬‬ ‫ﻭﺍﺴﻁﺔ ﺍﻟﻨﻘل‪:‬‬ ‫‪.............................................................................................................‬‬ ‫ﻁﺭﻴﻘﺔ ﺍﻟﻨﻘل‪:‬‬ ‫‪...............................................................‬‬ ‫ﺩﺭﺠﺔ ﺤﺭﺍﺭﺓ ﺍﻟﺤﻔﻅ‪:‬‬
‫‪...........................................................................................‬‬ ‫ﺘﻡ ﺘﺩﻭﻴﻥ ﺍﻟﻤﻌﻠﻭﻤﺎﺕ ﻤﻥ ﻗﺒل‪:‬‬ ‫‪................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻹﺭﺴﺎل ﺇﻟﻰ ﻤﺨﺒﺭ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻁﺎﺭﺌﺔ‪:‬‬
‫‪.....................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﻤﻼﺤﻅﺎﺕ‪:‬‬
‫‪.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................‬‬

‫‪.................................................................................................................................................................................................................................................................................................................................................................................................‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻻﺴﺘﻼﻡ ﻓﻲ ﺍﻟﻤﺨﺒﺭ‪:‬‬

‫‪..............................................................................................................‬‬ ‫ﺍﻟﺘﺎﺭﻴﺦ‬ ‫‪................................................................................................‬‬ ‫ﺍﻟﻨﺘﻴﺠﺔ‬ ‫‪.........................................................................................................................................‬‬ ‫ﺍﻻﺨﺘﺒﺎﺭﺍﺕ ﺍﻟﻤﺠﺭﺍﺓ‬
‫‪..............................................................................................................................................‬‬ ‫ﺍﻟﺘﻭﻗﻴﻊ‬ ‫‪.......................................................................................................................................................................................................................................................‬‬ ‫ﻤﺴﺅﻭل ﺍﻻﺨﺘﺒﺎﺭ‬

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 ‫‪‬‬
‫א‪‬א‪ ‬‬
‫‪Surveillance of communicable diseases‬‬ ‫‪WHO‬‬ ‫‪1998‬‬
‫‪Control of communicable diseases manual‬‬ ‫‪APHA‬‬ ‫‪1995‬‬
‫‪Communicable diseases surveillance kits‬‬ ‫‪WHO‬‬ ‫‪1997‬‬
‫‪Guideline for cholera control‬‬ ‫‪WHO‬‬ ‫‪1993‬‬
‫‪Detection and control of epidemic meningococcal diseases‬‬ ‫‪CDC‬‬ ‫‪1996‬‬
‫‪curent issues in the management of Viral hepatitis. Lavanchy and gavnio. A‬‬ ‫‪August‬‬ ‫‪2000‬‬
‫‪Guidelines for the treatment of Malaria 2nd edition‬‬ ‫‪WHO‬‬ ‫‪2010‬‬
‫‪Management of servere Malaria 2nd edition‬‬ ‫‪WHO‬‬ ‫‪2000‬‬
‫‪Brucellosis in humans and animals‬‬ ‫‪WHO, FAO, OIE‬‬ ‫‪2006‬‬

‫‪ -‬ﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪ :‬ﺠﻤﻌﻴﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻤﺔ ﺍﻷﻤﺭﻴﻜﻴﺔ ‪.٢٠٠٦ -‬‬

‫‪ -‬ﺩﻟﻴل ﺘﺭﺼﺩ ﻭﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪ .‬ﻤﻨﺸﻭﺭﺍﺕ ﻤﺩﻴﺭﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺒﻴﺌﻴﺔ ﻭﺍﻟﻤﺯﻤﻨﺔ ‪.٢٠٠٥ -‬‬
‫‪ -‬ﺩﻟﻴل ﺘﺭﺼﺩ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ‪ .‬ﻤﻨﺸﻭﺭﺍﺕ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ ﺍﻷﻭﻟﻴﺔ ‪.١٩٩٣ -‬‬
‫‪ -‬ﺘﺩﺒﻴﺭ ﺒﻌﺽ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻟﻤﺴﺘﻭﻁﻨﺔ ﻓﻲ ﺴﻭﺭﻴﺔ ﻭﺍﻟﺨﻁﻁ ﺍﻟﻌﻼﺠﻴﺔ‪ .‬ﻤﻨﺸﻭﺭﺍﺕ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ‬
‫ﺍﻟﺼﺤﻴﺔ ﺍﻷﻭﻟﻴﺔ ‪١٩٩٣ -‬‬
‫‪ -‬ﺩﻟﻴل ﺍﻟﻌﻤل ﻓﻲ ﺒﺭﻨﺎﻤﺞ ﻤﻜﺎﻓﺤﺔ ﺍﻟﺘﺩﺭﻥ‪ .‬ﻤﻨﺸﻭﺭﺍﺕ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ‪.٢٠١٠ - ١٩٩٢ -‬‬
‫‪ -‬ﺸﻠل ﺍﻷﻁﻔﺎل ‪ -‬ﺩﻟﻴل ﺘﺩﺭﻴﺒﻲ ﻟﻸﻁﺒﺎﺀ ﺍﻟﺴﺭﻴﺭﻴﻴﻥ‪ .‬ﻤﻨﻅﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ ‪.١٩٩٥ -‬‬
‫‪ -‬ﺴﻠﺴﻠﺔ ﺍﻟﺘﻘﺎﺭﻴﺭ ﺍﻟﻔﻨﻴﺔ ﻟﻤﻨﻅﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ‪.‬‬
‫‪ -‬ﺍﻟﻤﻼﺭﻴﺎ ﺩﻟﻴل ﺍﻟﻌﺎﻤﻠﻴﻥ ﻓﻲ ﺼﺤﺔ ﺍﻟﻤﺠﺘﻤﻊ‪ .‬ﻤﻨﻅﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ ‪.١٩٩٨ -‬‬
‫‪ -‬ﺍﻟﺨﻁﻁ ﺍﻟﻭﻁﻨﻴﺔ ﻟﻤﻜﺎﻓﺤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺎﺭﻴﺔ ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﻤﺸﻤﻭﻟﺔ ﺒﺎﻟﻠﻘﺎﺡ‪ .‬ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ‪.٢٠١٠‬‬
‫‪ -‬ﺍﻟﺘﻌﻠﻴﻤﺎﺕ ﺍﻟﻨﺎﻅﻤﺔ ﻟﺘﺩﺒﻴﺭ ﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩ ﺍﻟﻔﻴﺭﻭﺴﻲ )‪ (B/C‬ﻋﻠﻰ ﺍﻟﻤﺴﺘﻭﻯ ﺍﻟﻭﻁﻨﻲ ‪.٢٠٠٩‬‬
‫‪ -‬ﺩﻟﻴل ﺍﻟﺘﺄﺜﻴﺭﺍﺕ ﺍﻟﺠﺎﻨﺒﻴﺔ ﻟﻠﻘﺎﺡ ‪ -‬ﻤﻨﺸﻭﺭﺍﺕ ﻤﺩﻴﺭﻴﺔ ﺍﻟﺭﻋﺎﻴﺔ ﺍﻟﺼﺤﻴﺔ ﺍﻷﻭﻟﻴﺔ ‪.٢٠٠٧‬‬
‫‪ -‬ﺍﻟﺴل ﻓﻲ ﺍﻟﻤﻤﺎﺭﺴﺔ ﺍﻟﺴﺭﻴﺭﻴﺔ ‪ -‬ﻤﻨﻅﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ ‪.٢٠٠٦ -‬‬

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