白秀華 國立高雄大學 運動健康與休閒學系 環境健康研究室

Presentation on theme: "白秀華 國立高雄大學 運動健康與休閒學系 環境健康研究室"— Presentation transcript:

1 白秀華 國立高雄大學 運動健康與休閒學系 環境健康研究室
登革熱病媒蚊綜合治理 白秀華 國立高雄大學 運動健康與休閒學系 環境健康研究室

2 登革熱的流行 世衛組織公佈全世界每年有5千萬人罹患登革熱. 據估計每年有50萬人須住院治療，約有2.5%病患死亡
如缺少適當的醫療，登革出血熱可能造成29%的死亡率，由於現代的輔助醫療技術進步，死亡率已降低至1%。

3 媒介生物可持续控制国际论坛　International Forum for Sustainnable Management of Disease Vectors
鄰近國家登革熱之流行情形

4 歷年台灣登革熱之病例數

5

6 台灣為什麼特別重視登革熱防治 過去曾經大流行 人口密度高 高度都市化 亞熱帶氣候 國際貿易、旅客來往、流動人口多。 鄰近國家登革熱大流行。

7 為什麼臺灣登革熱難根治 由於進出臺灣的旅客很多，很難防範登革熱病患進入 臺灣病媒蚊密度高，登革熱防治難度特高

8 Aedes aegypti Aedes albopictus Tropical cancer 北回歸線 1981 1987

9 斑蚊生活史 成蚊 吸血 產卵 孳生源 孑孓 蛹

10 登革熱病媒蚊非藥劑防治— 物理防治

11 成蚊防治 成蚊不趨光。 網捕困難。

12 物理防治 成蟲:誘捕法(產卵、氣味、光線)、電蚊拍

13 誘卵器 平時可做病媒監測用。 可做誘殺器，捕成蚊、卵。 (但需妥善管理) 環境孳生源多時，則沒有意義。

14 如何阻斷登革熱的流行 只要有確定病例，立即執行病患住家周圍50公尺的噴灑殺蟲劑，以消滅帶病毒的病媒蚊(埃及斑蚊或白線斑蚊)阻斷登熱的蔓延。

15 緊急防治-化學防治 ULV spray

16 殺蟲劑抗藥性的嚴重性 埃及伊蚊幼蟲對氯菊酯(permethrin)的抗藥性是100-300倍，成蟲的抗藥性>300倍。
對氯氰菊酯(cypermethrin)有交互抗性，幼蟲抗藥性為30-40倍，成蟲達 倍。 對苯醚菊酯(phenothrin)的幼蟲抗藥達 倍，對成蟲 50-60倍。 醚菊酯(etofenprox),完全無防治效果。

17 比抗藥性更麻煩的事 —居民抗拒噴藥 味道難聞 油污染傢俱 植栽、寵物(魚、蝦、烏龜、鳥、鼠 、兔、犬 、貓等)受害。
孳生源完全清除永遠做不到。 無公害藥物的需求。

18 民眾使用一次按壓式自動噴霧罐殺蟲劑之意願
戶數 百分率(%) 配合使用 300 50 訪視未遇 213 35.5 拒訪 87 14.5 合計 600 100.0

19 平常使用哪些預防登革熱的方法 預防登革熱的方法 人數 % 裝紗門紗窗 222 74.0 噴殺蟲劑 210 70.0 清除積水容器 161
53.7 使用電蚊拍 86 28.7 噴防蚊液 84 28.0 使用捕蚊燈 83 27.7 使用蚊香 74 23.3 使用電蚊香 45 15.0 水池內養魚 25 8.3 穿長袖衣褲 23 7.7 使用蚊帳 11 3.7 沒有預防方法 7 2.3

20 使用一次按壓式自動噴霧罐殺蟲劑民眾 ----是否曾有政府派員噴藥
戶數 百分率(%) 有,室內外 84 28.0 有,僅室外 171 57.0 沒有 45 15.0 合計 300 100.0

21 政府派員噴藥後是否覺得蚊子減少 戶數 百分率(%) 有,室內外 98 38.4 有,僅室外 93 36.5 沒有 64 25.1 合計
255 100.0

22 使用一次按壓式自動噴霧罐殺蟲劑之調查結果 ----- 過去45戶接受政府派員噴藥後造成之影響
使用一次按壓式自動噴霧罐殺蟲劑之調查結果 過去45戶接受政府派員噴藥後造成之影響 造成之影響 戶數 % 氣味無法接受 45 100.0 清理不易 44 97.8 須在家等候 34 75.6 地面潮濕 33 73.3 魚缸養殖魚類死亡 4 8.8 寵物死亡 2 4.4 地板受損 家具受損 1 2.2 身體不適

23 使用一次按壓式自動噴霧罐殺蟲劑民眾 ----過去是否聽過一次按壓式自動噴霧罐殺蟲劑
使用一次按壓式自動噴霧罐殺蟲劑民眾 ----過去是否聽過一次按壓式自動噴霧罐殺蟲劑 戶數 百分率(%) 有聽過 42 14.0 沒有聽過 258 86.0 合計 300 100.0

24 使用一次按壓式自動噴霧罐殺蟲劑民眾之調查結果 ----- 發放數
使用一次按壓式自動噴霧罐殺蟲劑民眾之調查結果 發放數 發放罐數 戶數 % 1 48 16 2 144 3 84 28 4 9 5 0.3 6 13 4.3 8 合計 300 100.0

25 一次按壓式自動噴霧罐殺蟲劑之調查結果--- 空罐回收率
回收數 回收百分率(%) 289 96.3 11 3.7 合計 300 100.0

26 一次按壓式自動噴霧罐殺蟲劑之調查結果-- 噴藥方式喜好之比較
喜好之方式 戶數 百分率(%) 自行使用一次按壓式自動噴霧罐殺蟲劑 281 93.7 政府派員噴藥 19 6.3 合計 300 100.0

27 一次按壓式自動噴霧罐殺蟲劑斑蚊成蟲殺滅效果評估結果:半數擊昏時間(KT50)(單位:分)
蚊籠位子 半數擊昏時間(KT50分) 感性品系 白線斑蚊 埃及斑蚊 上 1.18±0.71 1.35±0.47 3.53±1.11 中 0.97±0.65 1.09±0.47 2.79±1.25 下 0.85±0.50 0.87±0.36 2.92±1.32 註:17個家戶實驗結果,每個蚊籠各含20隻斑蚊.

28 一次按壓式自動噴霧罐殺蟲劑斑蚊成蟲之殺滅效果評估結果: 24小時死亡率(%)
蚊籠位子 24小時死亡率(%) 感性品系 白線斑蚊 埃及斑蚊 上 100.0 中 下 註:17個家戶實驗結果,每個蚊籠各含20隻斑蚊.

29 圖 2. 化學防治前後室內病媒蚊密度之變化 誘蚊產卵指數陽性率(%) 10 30 40 50 60 70 防治前 防治後1週 防治後2週
10 20 30 40 50 60 70 防治前 防治後1週 防治後2週 防治後3週 圖 2. 化學防治前後室內病媒蚊密度之變化 誘蚊產卵指數陽性率(%) 實驗組II 實驗組III 對照組II 對照組III

30 登革熱病煤蚊幼蟲防治 環境防治: 進行孳生源清除(翻瓶倒罐) 生物防治: 魚、劍水蚤、蜻蜓、巨蚊等 防治幼蟲殺蟲劑之應用

31 環境防治法: 製造孳生源的行為? 種花、種菜、養水生植物。 儲水。 休閒觀賞: 社區公園、 居家綠美化。 堆放物品於戶外。 廢棄物。
天然容器。 空屋、空地。 地下室積水。

32 病例與非病例家戶登革熱孳生源清除之比較 Pai HH, et al. 2005
病例與非病例家戶登革熱孳生源清除之比較 Pai HH, et al Int J Environ Health R 15: 病例家戶（n=207） 非病例家戶（n=236） 戶數 % 每週定期清除 戶外積水容器 40 19.3 66 28.0* 四周水溝 22 10.6 44 18.6* *p<0.05

33 「環境清潔週」對登革熱病媒蚊密度之影響 Pai HH,et al. 2006. J Environ Health 68: 35-39.
誘蚊產卵桶 個數 陽性數 陽性率% 前 30 20 66.7 清潔週 17 56.7 一星期後 91 33 36.3 兩星期後 35 38.5 一個月 52 11 21.2 兩個月 18 34.6 三個月 112 44 39.3

34 登革熱病媒蚊非藥劑防治— 生物防治

35 生物防治 植物:捕蟲植物，驅蟲植物。 人類:養成看到蚊子就打，發生積水就處理。 捕食性動物:
吃成蟲者:鳥(燕子 ……..、) 、蝙蝠、蛤蟆、青蛙、蜥蝪、蜻蜓、螞蟻、 吃幼蟲者:魚、劍水蚤、蜻蜓幼蟲、肉食性甲蟲、巨蚊幼蟲 微生物:真菌、細菌、病毒、原蟲 (microsporidia, Wolbachia)

36 植株會不會引來蚊子棲息? 成蚊常棲息於植物枝葉上，因為隱蔽又有植物分泌物可供取食。

37 何種植物會驅蚊? 薰衣草、天竺葵、七里香、薄荷、芸香、小茴香、香茅草、九層塔、萬壽菊、檸檬桉等，驅蚊樹、樟樹。
精油並不會自動逸出，沒有科學研究證明可以有效驅蚊。 肉眼觀察可以發現成蚊可以安靜棲息於上述植物上。

38 Mesocyclops, which feeds on the larvae of Aedes aegypti
Mesocyclops撓足類 This has been achieved through the integration of the biological agent Mesocyclops, which feeds on the larvae of Aedes aegypti, combined with social mobilisation and educational activities, providing communities with the knowledge and resources needed to effectively control dengue fever Vietnam Australia NGO Cooperation Agreement (VANGOCA) The project is to improve health through increased access to safe water.  It will reduce the numbers of dengue mosquitoes; thereby reduce morbidity and mortality of dengue.  The design focuses on ensuring that the human resource base in expanded so that health and water professionals and future leaders from the southern provinces of Viet Nam will be trained in critical technologies in order to promote sustainability.  This tiny crustacean kills virtually all the mosquito larvae whenever it is in water-filled containers where mosquitoes breed. Vietnam has mounted a campaign to distribute Mesocyclops throughout the country. The mosquito and the disease have disappeared from every village that uses Mesocyclops, the key to success being strong community organization to ensure that everyone uses the copepods. The use of the new measure of low-cost, easy application with high, sustainable effectiveness such as Mesocyclops, a biological agent to control Aedes aegypti larvae, is encouraging for high-risk areas of dengue fever(4,5). In Viet Nam, with the support of the Medical Committee Nederland-Vietnam, such a model has been applied and discussed

39 Wolbachia Scientists have made a major breakthrough in understanding the genetics of the insect parasite that is being targeted by researchers as a way of preventing the spread of malaria. Gene breakthrough heralds better prospect for malaria solution Wolbachia bacteria are parasites that infect as many as 80 per cent of the world’s insects and manipulate reproduction in their hosts in order to improve their own transmission. In species including the fruit fly and mosquito, they do this by altering the sperm of infected males to prevent them from successfully reproducing with uninfected females. Females infected with Wolbachia produce, on average, more offspring than uninfected females. This is because they can successfully mate with any male in the population, whereas uninfected females are restricted to uninfected males. As Wolbachia is maternally transmitted, this has the effect of spreading the infection through the insect population. Researchers around the world have secured millions in research funding to help develop malaria control strategies that use genetically modified Wolbachia that would spread through mosquito populations and carry genes that make their mosquito hosts unable to transmit the plasmodium parasite that cause malaria. For the first time, in new research published in the journal Genetics, scientists from the University of Bath (UK) and the University of Chicago (USA) have identified two of the genes that Wolbachia manipulates when it infects the fruit fly Drosophila simulans. “This is a major breakthrough in our understanding of the genetic basis of Wolbachia infection,” said Dr Ben Heath, from the Department of Biology & Biochemistry at the University of Bath. “In recent years there has been great interest in using transgenic Wolbachia as a way of modifying natural populations of insects such as mosquitoes which transmit malaria. “However this would always be difficult to achieve without a full understanding of the genetics of how Wolbachia interacts with its host insect. “Our discovery of two of the fruit fly genes manipulated by Wolbachia sheds light on this process, and we should now be able to develop a clearer picture of exactly how Wolbachia manipulate the reproductive process in a variety of its hosts. “Part of the problem in studying Wolbachia is that it lives inside the cells of its host insect and cannot effectively be studied on its own because it needs the cellular machinery and materials it gets from its host to survive. “Another difficulty is that the changes it makes in the development of sperm are so subtle that they can be difficult to trace.” In their research the scientists compared the genes that were being expressed – switched on - in infected and uninfected male fruit flies. By subtracting one from the other, they were left with the genes that were being expressed as a result of the Wolbachia infection. One of the genes they identified, called zipper, is well known to scientists but has never been associated with Wolbachia infection before. “Infected males have increased expression of their zipper gene compared to those that are uninfected,” said Dr Tim Karr, also from the University of Bath, who led the research. “We were then able to work with transgenic flies which express the zipper gene more when warmed up slightly for periods of one hour during their development. “This doesn’t harm the flies and provides an opportunity to mimic the effect of Wolbachia in fruit flies that don’t carry the bacteria. “The zipper gene identified by the scientists also interacts with a second gene called lgl which is responsible for polarity within the cell and this becomes important when a cell divides into two different cells, such as when stem cells develop into sperm. “By affecting the balance between these genes, it appears Wolbachia can promote cytoplasmic incompatibility by modifying the sperm of infected males. “This prevents the sperm from being compatible with any egg from a female not infected with Wolbachia and results in sterility. “However when infected males mate with infected females, the Wolbachia in the egg finds a way of correcting the modification to sperm and allows fertilization and normal development to continue.” The researchers are now looking at the mechanisms present in other insect species with different levels of cytoplasmic incompatibility In other insects Wolbachia infection has diverse and often dramatic results which all cause an increase in Wolbachia transmission for the simple reason that these bacteria are only transmitted through the maternal line, from mother to daughter. In two–spot ladybirds Wolbachia kill male offspring leaving the surviving sisters to eat the bodies of their dead brothers, in woodlice, infected males are turned into females, and infected parasitic wasps give birth without reproducing. These reproductive effects are what made Wolbachia so fascinating to biologists in the first place and now they may also provide new ways of tackling insect-bourne diseases such as malaria. The research was funded by the Biotechnology and Biological Sciences Research Council (UK), the Royal Society (UK) and the National Science Foundation (USA). The University of Bath is one of the UK's leading universities, with an international reputation for quality research and teaching. In 16 subject areas the University of Bath is rated in the top ten in the country. View a full list of the University's press releases:

40 具實用性的生物防治 魚類:世界性。 劍水蚤:越南、澳洲 巨蚊、Wochachia:研究性 蘇力菌以色列品系:世界性

41 臺灣常用的登革熱病媒蚊之生物防治 生物種類 捕食對象 來源 大肚魚 (Gambusia affinis) 幼蟲、不常捕食蛹
野外、水族群、養殖業 孔雀魚 (Poecilia reticulata) 蓋斑鬥魚 (Macropodus opercularis) 幼蟲、蛹 水族群、養殖業 劍水蚤 (Mesocyclops) 一齡幼蟲 研究室

42 生物防治: 孔雀魚 條鰭魚剛class Actinopterygii 新鰭亞鋼subclass Neopterygii 鯉齒目order Cyprinodontiformes 鯉齒亞目suborder Cyprinodontoidei 花鱂科266 Family Poeciliidae 花鱂屬Genus Poecilia 孔雀花鱂（紅鱂、孔雀魚） Poecilia reticuata Peters, 1859

43 孔雀魚捕食蚊幼蟲數 (隻/日) 雌 雄 平均值 標準差 39.33 13.61 25.33 9.45

44 問卷訪視居民對積水地下室進行食蚊魚放養之態度
個數(位) 百分比(%) 我同意衛生單位於住家 積水地下室進行食蚊魚放養　 非常同意 37 31.09 同意 61 51.26 沒意見 21 17.65 食蚊魚放養後，我會定期 觀察食蚊魚是否存活及維護 5 4.20 42 35.29 68 57.14 不同意 4 3.36

45 幼蟲防治藥劑 除直接噴灑藥劑外，亦有以含有藥劑之長效性配方（乳膏塊、粒劑）放於水中，使藥劑慢慢溶出，達到長期防蚊之效果。
常用的滅幼蚊劑包括生物製劑(蘇力菌)、生長調節(二福隆、美賜平及百利普芬劑)及有機磷劑(陶斯松、亞培松)。 生物製劑則有蘇力菌，一般粒劑有效時間為1週。昆蟲生長調節劑為利用蚊蟲之青春荷爾蒙可干擾幼蟲之發育，使其無法順利化蛹或羽化。有二福隆、美賜平及百利普芬。有機磷劑則有陶斯松、亞培松等藥劑。世界衛生組織建議用滅蚊幼蟲劑及其劑量如表四。台中霧峰地區三斑家蚊的幼蟲對亞培松抗藥性嚴重（Teng et al. 2005）。

46 防治用藥的特性 有效的滅蚊幼蟲劑必須對哺乳類動物具低毒性，對環境的衝擊性小。
廣效性，對所有的標的蚊蟲都有效，有相當之殘效期 ，減少頻頻施用，浪費人力。

47 世界衛生組織推薦防治幼蟲之殺蟲劑 殺蟲劑有效成分 分類 劑型 WHO危險分類** Fuel oil --- 蘇力菌 Bti 生物製劑 粒劑
二福隆 Duflubenzuron 昆蟲生長調節劑 可濕性粉劑 U 美賜平 Methoprene 乳劑 諾伐隆 Novaluron NA 百列普芬Pyriproxyfen 陶斯松 Chlorpyrifos 有機磷 II 芬殺松 Fenthion 乳劑、粒劑 亞特松 Pirimiphos-methyl III 亞培松 Temephos 表四、世界衛生組織推薦防治幼蟲之殺蟲劑（WHO 2006）。 *防治積水容器的蚊蟲劑量為1-5 毫克/公升 ** II=中度危險; III=輕度危險; U=正常使用下無立即危險; NA=不適用

48 蘇力菌以色列品系(bti) 1976年Goldberg and Margalit從以色列河床之Culex pipiens分離出得到Bacillus thuringiensis。1977, de Barjac定為Btstrain H14,並發現對蚊及蚋幼蟲具有毒性，近年來發現更多品種，主要商品化的品種為SA3A及FM65-52。

49 Bti 幼蟲之蛋白分解酵素 分解活化之毒蛋白 轉變成多胜肽 多胜肽黏結於中腸細胞 使之形成孔洞 中腸細胞溶解
幼蟲食入Bti 毒蛋白(Bti 內含物) Bti  Bti 毒蛋白於鹼性環境下活化 (pH > 7) 幼蟲之蛋白分解酵素 分解活化之毒蛋白 轉變成多胜肽   多胜肽黏結於中腸細胞 使之形成孔洞 中腸  中腸細胞溶解  幼蟲死亡

50 粒劑及塊劑都有效 Bti粒劑灑佈可以維持7-14天效果。 Mosquito Bits 塊劑可以維持30天效果。 Mosquito Dunks

51 VectoBac WG VectoBac WG 可以用水稀釋，以一般噴霧劑噴灑向高處噴，也可以廣範圍噴灑，涵蓋全面目標區。
地下室、植物葉腋、防火巷或屋簷排水處、屋頂隔熱磚、高處樹洞。

52 塊劑及粒劑使用:只能針對小面積可見積水處灑佈。
大面積(地下室)或狹窄(植物葉腋、防火巷)或不易及達之處(屋簷排水處、屋頂隔熱磚、樹洞)等處施用不易。

53 個人防蚊措施（個人防護） 個人防護措施避免被蚊蟲叮咬包括以下方法: 因為蚊蟲會被深色吸引，所以應盡量穿著淺色的長袖、長褲、襪子及包鞋。
於裸露處及衣服噴灑防蚊液（忌避劑）。請依照產品標示說明使用。 使用蚊香等驅除蚊蟲。因蚊香含殺蟲劑，所以也請依照產品標示說明使用。 睡覺時，請使用蚊帳。 common sense rules to follow when using repellents-1 Wear long sleeve shirts and pants outdoors during peak mosquito activity time periods. Apply repellent sparingly only to exposed skin or clothing. Keep repellents away from eyes, nostrils and lips:  do not inhale or ingest repellents or get them into the eyes. common sense rules to follow when using repellents-2 Avoid applying high-concentration (>30% DEET) products to the skin, particularly of children. Avoid applying repellents to portions of children's hands that are likely to have contact with eyes or mouth. Pregnant and nursing women should minimize use of repellents. common sense rules to follow when using repellents-3 Using Insect Repellents Safely -1 Repellents should be applied only to exposed skin and/or clothing (as directed on the product label). Do not use under clothing. Never use repellents over cuts, wounds, or irritated skin. Don't apply to eyes and mouth, and apply sparingly around ears. When using sprays do not spray directly onto face; spray on hands first and then apply to face. Do not allow children to handle this products, and do not apply to children's hands. When using on children, apply to your own hands and then put it on the child Using Insect Repellents Safely -2 Do not spray in enclosed areas. Avoid breathing a repellent spray, and do not use it near food. Use just enough repellent to cover exposed skin and/or clothing. Heavy application and saturation is unnecessary for effectiveness; if biting insects do not respond to a thin film of repellent, apply a bit more. After returning indoors, wash treated skin with soap and water or bathe. This is particularly important when repellents are used repeatedly in a day or on consecutive days. Also, wash treated clothing before wearing it again. Using Insect Repellents Safely -3 If you suspect that you or your child are reacting to an insect repellent, discontinue use, wash treated skin and then call your local poison control center. If/when you go to a doctor, take the repellent with you. You and your doctor can get specific medical information about the active ingredients in repellents and other pesticides by calling the National Pesticide Telecommunications Network (NPTN) at NPTN operates from 6:30 a.m. to 4:30 p.m. (Pacific Time) 9:30 a.m. to 7:30 p.m. (Eastern Time) seven days a week

54 法規防治 以立法來協助蚊蟲之防治工作。 在1930年代，巴西曾制定嚴格的法律，禁止家庭用任何容器隨意儲水以防治埃及斑蚊。
1969年新加坡曾制定病媒管制法案，授權政府公職人員得以在白日進入任何房屋或交通工具內檢查及防治。

55 我國傳染病防治法 （參考疾病管制局網站 http://cdc.gov.tw）
民國87年新增病媒防治條款，要求地管主管機關應督導撲滅蚊蟲等病媒，而公、私場所之所有人、管理人或使用人應依公告主動清除，明訂「疫情發生或發生之虞時，民眾若未配合主管機關之病媒清除工作，則依規定處新台幣三千元以上一萬五千元以下罰鍰，得連續處罰」，以利病媒性傳染病防治工作之進行。 民國92年新增防疫工作人員強制進入公、私場所與運輸工具條款，明訂「疫情發生時，民眾若拒絕、規避或妨礙防疫工作，則依規定，除逕行強制處分外，並得處以新台幣六萬元以上三十萬元以下罰鍰。」，以利傳染病防治工作之進行。

56 重點工作-落實公權力 疫情流行期將加強稽查，疫情發生地區查獲違規事實，無寬限 期，立即開單告發！ 615 92 32 傳染病防治法第25條
資料時間： ~ 改善單 舉發單 裁處 615 92 32 中國時報 2017/3/21 全國至生藥械29屆學術交流會議 高雄市政府

57 綜合防治 因目前沒有單一有效的滅蚊方法，所以綜合防治為現階段所推廣建議採行的蚊蟲防治。例如登革熱病媒蚊（埃及斑蚊與白線斑蚊）的防治方法結合環境防治（孳生源清除）、生物防治（食蚊魚）、物理防治（細網密封水溝及住家紗門紗窗）與化學防治（有登革熱病例時實施殺蟲劑空間噴灑）。 Integrated Mosquito Management (IMM) concept based on ecological economic and social criteria integrates multidisciplinary methodologies into pest management strategies that are practical and effective to protect public health and the environment and improve the quality of life. Insecticide source reduction physical control (digging ditches and ponds in the target marsh) biological control [placing live mosquito fish (Gambusia) in the ditches and ponds to eat mosquito larvae], invertebrate predators, parasites and diseases to control mosquito larvae. Adult mosquito biological control by means of birds, bats, dragonflies and frogs has been employed by various agencies. However, supportive data is anecdotal and there is no documented study to show that bats, purple martins, or other predators consume enough adult mosquitoes to be effective control agents. Pesticides may be applied to control larvae (larvicides) or adults (adulticides).

58 衛生教育與社區参與 登革熱病媒蚊之防治，清除孳生源是最有效的方法，但大部分的孳生源為民眾製造出來的，所以若製造孳生源的行為不改變，孳生源清除完畢後，又會不斷的產生。 唯有透過衛生教育宣導來教導民眾不要製造孳生源便成了重要的工作。 為了有效防治病媒蚊，鼓勵社區自行組織參與防治監督工作，建立一個無蚊社區家園，也是一個重要且可行的辦法。。

59 衛生教育 蚊蟲生態習性 防治對象確認 有效防治方法的認識

60 推動部門間之合作 政府行政部門主管 衛生單位 環保單位 民政單位 警政單位 民間單位 社區組織

61 登革熱防治需要大家的參與 沒有積水容器，就沒有病媒蚊孳生源 沒有孳生源，就沒有登革熱病媒蚊 沒有病媒蚊，就沒有典型登革熱
沒有典型登革熱，就沒有登革出血熱 2017/3/21 全國至生藥械29屆學術交流會議

62 參考資料 周欽賢、連日清、王正雄。1988。醫學昆蟲學。南山出版社。
陳錦生。2007。第七章、蚊類之種類、生態與防治實務。環境保護署病媒防治業者96年度講義。39-70頁。 鄧華真。2008 。蚊類之種類、生態與防治實務。環境保護署病媒防治業者96年度講義。 Pai HH, Lu YL, Hong YJ and Hsu EL The differences of dengue vectors and human behavior between families with and without members having dengue fever/dengue hemorrhagic fever. Int J Environ Health R 15: Pai HH, Hong YJ and Hsu EL Impact of a short-term community-based cleanliness campaign on the sources of dengue vectors: an entomological and human behavior study. J Environ Health 68: Pai HH, Lu YL Seasonal Abundance of Vectors at Outdoor Environments in Endemic and Non-Endemic Districts of Dengue in Kaohsiung, South Taiwan. J Environ Health 71: Pai HH, Hsu EL Effectiveness and acceptance of total release insecticidal aerosol cans as a control measure in reducing dengue vectors. J Environ Health 76:

63 謝謝聆聽