Você está na página 1de 8

OPEN ACCESS Asian Journal of Epidemiology

ISSN 1992-1462
DOI: 10.3923/aje.2018.

Research Article
Estimating the Complication Risk of Epidemic Situation with
Diphtheria in Ukraine
Podavalenko Alla Pavlivna

Department of Hygiene, Kharkiv Medical Academy of Postgraduate Education, Epidemiology and Occupational Diseases,
street Amosova, 58, 61176, Kharkiv, Ukraine

"CTUSBDU
#BDLHSPVOE BOE 0CKFDUJWF *O UIF FSB PG HMPCBMJ[BUJPO UIF JOUFOTJUZ PG UIF FQJEFNJD QSPDFTT PG EJQIUIFSJB DBO DIBOHF TJHOJGJDBOUMZ BT
B SFTVMU PG UIF JNQBDU PG TPDJBM FOWJSPONFOUBM FDPOPNJD BOE PUIFS GBDUPST 5IFSFGPSF UIF JEFOUJGJDBUJPO PG UIF DBVTFT BOE DPOEJUJPOT GPS
UIF JOUFOTJGJDBUJPO PG UIF FQJEFNJD QSPDFTT PG EJQIUIFSJB JT UIF NBJO UBTL PG NPEFSO FQJEFNJPMPHZ 5IFSFGPSF UIF BJN PG UIF TUVEZ XBT
UP BTTFTT UIF DPNQMJDBUJPO SJTL PG UIF FQJEFNJD EJQIUIFSJB UBLJOH JOUP BDDPVOU UIF JOGMVFODF PG UIF FOWJSPONFOUBM GBDUPST PO UIF DPVSTF
PG UIF FQJEFNJD QSPDFTT PG UIJT JOGFDUJPO .BUFSJBMT BOE .FUIPET 5IF NPSCJEJUZ BOE QSFWBMFODF PG EJQIUIFSJB JO TJY PCMBTUT BOE JO HFOFSBM
JO 6LSBJOF EVSJOH XFSF TUVEJFE "CPVU QSFEJDUPST TPDJBM BOE FDPMPHJDBM GBDUPST JOEJDFT PG IVNBO EFWFMPQNFOU FUD XFSF
VTFE UP DPOTUSVDU B NBUIFNBUJDBM NPEFM VTJOH CJOBSZ MPHJTUJD SFHSFTTJPO " DPSSFMBUJPO BOBMZTJT CFUXFFO UIF NPSCJEJUZ PG EJQIUIFSJB BOE
UIF GBDUPST PG UIF MJGF FOWJSPONFOU XBT DPOEVDUFE 3FTVMUT *U XBT FTUBCMJTIFE UIBU UIF JOEFYFT PG EJQIUIFSJB JODJEFODF XFSF UJNFT
IJHIFS JO UIF QFSJPE EVSJOH UIF NBSLFE QSPDFTTFT PG NPEFSOJ[BUJPO PG QPMJUJDBM TPDJBM BOE FDPOPNJD TQIFSFT JO 6LSBJOF JO DPNQBSJTPO
XJUI UIF QFSJPE PG UIFJS TUBCJMJ[BUJPO *U XBT EFUFSNJOFE UIBU UIF QSPCBCJMJUZ PG JOUFOTJGJDBUJPO PG UIF EJQIUIFSJB FQJEFNJD QSPDFTT DBO CF
BTTPDJBUFE XJUI B EFDSFBTF JO PG UIF QVCMJD JNNVOJ[BUJPO XJUI BO JODSFBTF JO PG FNJTTJPOT PG IBSNGVM TVCTUBODFT JOUP UIF BJS
XJUI BO JODSFBTF JO PG OBUVSBM QPQVMBUJPO HSPXUI BOE B QPQVMBUJPO EFOTJUZ JO *O NPEFSO DPOEJUJPOT UIFSF JT B SJTL PG
JOUFOTJGZJOH UIF FQJEFNJD QSPDFTT PG EJQIUIFSJB EVF UP UIF MPX MFWFM PG WBDDJOBUJPO BHBJOTU EJQIUIFSJB CVU EFDSFBTJOH UIF
QPQVMBUJPO BOE SFEVDJOH UIF FNJTTJPOT PG IBSNGVM TVCTUBODFT JOUP UIF BUNPTQIFSF JT B SFTUSBJOJOH GBDUPS UP UIF QSFWBMFODF PG EJQIUIFSJB
$PODMVTJPO 5IFSF JT B TUSPOH EPXOXBSE USFOE PG EJQIUIFSJB JODJEFODF JO UFSNT PG QPQVMBUJPO EFDMJOF BOE FNJTTJPOT PG IBSNGVM TVCTUBODFT
JOUP UIF BUNPTQIFSF CVU UIF MPX MFWFM PG WBDDJOBUJPO BHBJOTU EJQIUIFSJB EFNPOTUSBUFET BO VOTUBCMF FQJEFNJD TJUVBUJPO XJUI UIJT JOGFDUJPO
BOE SFRVJSFT NBLJOH BEFRVBUF NBOBHFSJBM EFDJTJPOT JNNFEJBUFMZ

,FZ XPSET %JQIUIFSJB NPSCJEJUZ FQJEFNJD TJUVBUJPO TPDJBM BOE FDPMPHJDBM GBDUPST

$JUBUJPO 1PEBWBMFOLP "MMB 1BWMJWOB &TUJNBUJOH UIF DPNQMJDBUJPO SJTL PG FQJEFNJD TJUVBUJPO XJUI EJQIUIFSJB JO 6LSBJOF "TJBO + &QJEFNJPM $$ $$ $$

$PSSFTQPOEJOH "VUIPS 1PEBWBMFOLP "MMB 1BWMJWOB %FQBSUNFOU PG )ZHJFOF &QJEFNJPMPHZ BOE 0DDVQBUJPOBM %JTFBTFT ,IBSLJW .FEJDBM "DBEFNZ PG
1PTUHSBEVBUF &EVDBUJPO 4USFFU "NPTPWB ,IBSLJW 6LSBJOF

$PQZSJHIU ˜ "MMB 1PEBWBMFOLP 5IJT JT BO PQFO BDDFTT BSUJDMF EJTUSJCVUFE VOEFS UIF UFSNT PG UIF DSFBUJWF DPNNPOT BUUSJCVUJPO -JDFOTF XIJDI QFSNJUT
VOSFTUSJDUFE VTF EJTUSJCVUJPO BOE SFQSPEVDUJPO JO BOZ NFEJVN QSPWJEFE UIF PSJHJOBM BVUIPS BOE TPVSDF BSF DSFEJUFE

$PNQFUJOH *OUFSFTU 5IF BVUIPS IBT EFDMBSFE UIBU OP DPNQFUJOH JOUFSFTU FYJTUT

%BUB "WBJMBCJMJUZ "MM SFMFWBOU EBUB BSF XJUIJO UIF QBQFS BOE JUT TVQQPSUJOH JOGPSNBUJPO GJMFT
"TJBO + &QJEFNJPM

*/530%6$5*0/ EJQIUIFSJB FQJEFNJD TJUVBUJPOT XBT NBEF 'PS UIF DPOTUSVDUJPO


PG B NBUIFNBUJDBM NPEFM PG QSPHOPTUJDBUJPO XF DBMDVMBUFE
%JQIUIFSJB JT BO JOGFDUJPVT EJTFBTF UIBU JT DPOUSPMMFE CZ UIF NFEJBO PG NPSCJEJUZ JO UIF TJY BSFBT PG 6LSBJOF UIBU
GBDJMJUJFT PG TQFDJGJD QSPQIZMBYJT BOE JT QSFEFGJOFE CZ UIF BDUJPO EJGGFSFE GSPN TUBUF TPDJBM BOE FDPMPHJDBM GBDUPST 5IF TUVEJFE
PG FYPUPYJO PG $PSZOFCBDUFSJVN EJQIUIFSJBF $ EJQIUIFSJBF BSFBT XFSF EJWJEFE JOUP HSPVQT "SFBT UIBU IBE JOEFYFT PG
*O B QSF WBDDJOBUJPO QFSJPE EJQIUIFSJB XBT POF PG UIF MFBEJOH NPSCJEJUZ IJHIFS UIBO NFEJBO XBT B QBSU PG UIF TU HSPVQ BOE
SFBTPOT PG EFBUI JO DIJMESFO *O UIF XPSME MFWFMT PG NPSCJEJUZ BSFBT UIBU IBE JOEFYFT PG NPSCJEJUZ CFMPX UIF NFEJBO XFSF B
BOE EJQIUIFSJB EFBUI SBUF IBWF EFDSFBTFE DPOTJEFSBCMZ QBSU PG UIF TFDPOE HSPVQ 5IFTF EBUB JODMVEFE B CJOBSZ MPHJTUJD
BDDPSEJOH UP UIF 8PSME )FBMUI 0SHBOJ[BUJPO #VU UIF SFHSFTTJPO
UPYJDBOUT PG $ EJQIUIFSJB DPOTUBOUMZ DJSDVMBUF FWFSZXIFSF 'PS NFBTVSJOH MPHJTUJD FRVBUJPOT JOEFYFT XFSF VTFE
5IFSFGPSF DBTFT PG EJQIUIFSJB BSF QSBDUJDBMMZ SFHJTUFSFE JO BMM 5BCMF
DPOUJOFOUT BOE UIFSF JT BO FQJEFNJD SJTF JO TPNF
DPVOUSJFT 5IFSF XBT BO FQJEFNJD PG EJQIUIFSJB JO UIF .FUIPET "QQMZJOH UIF NFUIPE PG CJOBSZ MPHJTUJD SFHSFTTJPO
T JO 6LSBJOF BOE PUIFS DPVOUSJFT PG UIF 4PWJFU 6OJPO 0WFS UIF QBSBNFUFST PG UIF SFHSFTTJPO FRVBUJPO XFSF EFUFSNJOFE
QFPQMF IBE EJQIUIFSJB BOE NPSF UIBO QBUJFOUT EJFE UIF QSPHOPTJT PG UIF QSPCBCJMJUZ PG JOGMVFODF PG B TQFDJGJD
EVSJOH B QFSJPE PG FQJEFNJD JO 6LSBJOF *U JT DPOTJEFSFE UIBU GBDUPS PO UIF NPSCJEJUZ MFWFM PG EJQIUIFSJB XBT EFUFSNJOFE
UIF FQJEFNJD NPSCJEJUZ SJTF PG EJQIUIFSJB JT DPOOFDUFE UP UIF 5IF TUBUF PG UIF PCKFDU JODJEFODF SBUF XBT EFTDSJCFE CZ B
MPX MFWFM PG JNNVOJ[BUJPO DPWFSBHF BHBJOTU UIJT JOGFDUJPO EJTDSFUF RVBMJUBUJWF TJHO JO PVS DBTF B SBOL 5IF SPMF PG
*U JT BMTP JNQPTTJCMF UP FYDMVEF UIF JOGMVFODF PG TPDJBM QSFEJDUPST IBSCJOHFST QSFDPOEJUJPOT BOE JOEJDFT PG IVNBO
FDPMPHJDBM BOE PUIFS GBDUPST PO UIF NPWFNFOU PG EJQIUIFSJB EFWFMPQNFOU XBT RVBOUJUBUJWF
FQJEFNJD QSPDFTT BOE DIBSBDUFSJTUJD PG $ EJQIUIFSJBF JO UIF 5IF QSPCBCJMJUZ UIBU BO FWFOU XJMM PDDVS XJMM DPVOU PO TVDI
FQPDI PG HMPCBMJ[BUJPO %FUFDUJPO PG UIF DBVTFT BOE B GPSNVMB
DPOEJUJPOT PG UIF JOUFOTJGJDBUJPO PG UIF EJQIUIFSJB FQJEFNJD
QSPDFTT BOE NBLJOH BENJOJTUSBUJWF EFDJTJPOT JO UJNF UP XBSO 1
p
1  e z
UIF FQJEFNJDT JT UIF NBJO UBTL PG NPEFSO FQJEFNJPMPHZ
"DDPSEJOH UP UIF BCPWF NFOUJPOFE UBLJOH JOUP BDDPVOU
8IFSF
UIF JOGMVFODF PG FOWJSPONFOUBM GBDUPST PO UIF FQJEFNJD
QSPDFTT PG UIJT JOGFDUJPO UIF BTTFTTNFOU PG UIF DPNQMJDBUJPO
z = В1*X1+В2*Х2+…+Вn*Xn+a
SJTL PG UIF FQJEFNJD TJUVBUJPO CFDBNF UIF HPBM PG UIF TUVEZ

9 .FBOJOH PG JOEFQFOEFOU WBSJBCMFT


."5&3*"-4 "/% .&5)0%4 # $PFGGJDJFOUT UIFJS DBMDVMBUJPO JT UIF UBTL PG CJOBSZ
MPHJTUJD SFHSFTTJPO
.BUFSJBMT 5IF NPSCJEJUZ BOE QSFWBMFODF PG EJQIUIFSJB B $POTUBOU
JODMVEJOH JO BHF SFMBUFE HSPVQT BT XFMM BT TPDJBM BOE
FDPMPHJDBM GBDUPST EVSJOH XFSF TUVEJFE BDDPSEJOH 5IF DPSF NFTTBHF PG UIJT TUVEZ JT UIBU UIF JODJEFODF PG
UP EBUB PG UIF .JOJTUSZ PG )FBMUI BOE 4UBUJTUJDT TFSWJDFT PG EJQIUIFSJB XBT DPOTJEFSFE BT BO PCKFDU OPTPMPHJDBM GPSN BOE
6LSBJOF 5BLJOH JOUP BDDPVOU UIF QFSNBOFOU DIBOHFBCJMJUZ PG BT B RVBMJUBUJWF TJHO XJUI UXP HSBEBUJPOT .PEFSBUF BOE
TPDJBM FDPOPNJD BOE FOWJSPONFOUBM GBDUPST JO 6LSBJOF 4FWFSF NPSCJEJUZ " TJHO 1SPOPVODFE NPSCJEJUZ XBT
UISPVHI GPSNBM MPHJD SFDFQUJPOT UXP QFSJPET XJUI EJGGFSFOU QSFEJDUFE XJUI IFMQ PG UIF NFUIPE PG DPOTUSVDUJOH MPHJTUJD
MFWFM PG JOGMVFODF PG UIFTF GBDUPST XFSF EFUFDUFE 5IF GJSTU NVMUJGBDUPS NPEFMT PG SFHSFTTJPO
QFSJPE XBT DIBSBDUFSJ[FE CZ UIF FYQSFTTFE 5IF SFMBUJWF DPOUSJCVUJPO PG GPSFDBTUFST BOE IBSCJOHFST PG
QSPDFTTFT PG NPEFSOJ[BUJPO PG TPDJBM EFQPQVMBUJPO QSPDFTTFT SJTL TPDJBM BOE FOWJSPONFOUBM XBT FYQSFTTFE CZ UIF WBMVF
JODSFBTFT PG VSCBOJ[BUJPO BDUJWBUJPO PG NJHSBUPSZ QSPDFTTFT PG 8BME T TUBUJTUJDT P 8BME DIJ TRVBSF BT XFMM BT UIF
FDPOPNJD GJOBODJBM DSJTJT VOFNQMPZNFOU QPWFSUZ JODSFBTF TUBOEBSEJ[FE SFHSFTTJPO DPFGGJDJFOU 4UBOEBSEJ[FE &TUJNBUF
BOE QPMJUJDBM DIBOHF PG QPMJUJDBM TZTUFN TQIFSFT JO 6LSBJOF "T B DSJUFSJPO GPS UIF DPPSEJOBUJPO PG UIF SFBM EJTUSJCVUJPO PG
BOE UIF TFDPOE QFSJPE XBT DIBSBDUFSJ[FE CZ PCTFSWBUJPOT GPS JOEJWJEVBM HSBEBUJPOT BOE HSPVQT BOE
TUBCJMJ[JOH PG UIFTF QSPDFTTFT 5BLJOH JOUP BDDPVOU UIF TPDJBM UIF GPSFDBTU CBTFE PO UIF FRVBMJ[BUJPO PG MPHJTUJD SFHSFTTJPO
BOE FDPMPHJDBM GBDUPST UIF GPSFDBTU PG SJTL DPNQMJDBUJPO JO UIF QFSDFOUBHF PG JOEJDBUPST DPSSFDUMZ DMBTTJGJFE 5IF PWFSBMM
"TJBO + &QJEFNJPM

5BCMF *OEFYFT UIBU DIBSBDUFSJ[F UIF FQJEFNJD QSPDFTT PG EJQIUIFSJB BOE DBO JOGMVFODF PO UIF MFWFM PG NPSCJEJUZ
(SPVQT *OEFYFT 6OJUT PG NFBTVSFNFOU
)BSCJOHFST PG SJTL *ODJEFODF BNPOH DIJMESFO 1FS UIPVTBOE PG UIF BHF HSPVQ
"EVMU NPSCJEJUZ 1FS UIPVTBOE PG UIF BHF HSPVQ
.PSCJEJUZ PG UIF WJMMBHFST 1FS UIPVTBOE JOIBCJUBOUT PG UIF WJMMBHF
.PSCJEJUZ PG UIF JOIBCJUBOUT PG UIF DJUZ 1FS UIPVTBOE JOIBCJUBOUT PG UIF DJUZ
1SFSFRVJTJUFT SJTL
4PDJBM GBDUPST *NNVOJ[BUJPO DPWFSBHF
%FHSFF PG VSCBOJ[BUJPO
1PQVMBUJPO EFOTJUZ 1FSTPOT QFS TR LN
.PSUBMJUZ 1FS QPQVMBUJPO
/BUVSBM JODSFBTF 1FS QPQVMBUJPO
0WFSBMM JODSFBTF 1FS QPQVMBUJPO
.JHSBUJPO CBMBODF 1FS QPQVMBUJPO
&DPMPHJDBM GBDUPST &NJTTJPOT JOUP UIF BUNPTQIFSF GSPN TUBUJPOBSZ TPVSDFT 5IPVTBOE UPOT QFS ZFBS
&NJTTJPOT JOUP UIF BJS GSPN NPCJMF TPVSDFT 5IPVTBOE UPOT QFS ZFBS
&NJTTJPOT JOUP UIF BJS GSPN TUBUJPOBSZ BOE NPCJMF TPVSDFT 5IPVTBOE UPOT QFS ZFBS
"NPVOU PG BJS JO UIF EVTU 5IPVTBOE UPOT QFS ZFBS
"NPVOU PG TVMGVS EJPYJEF JO UIF BJS 5IPVTBOE UPOT QFS ZFBS
"NPVOU PG OJUSPHFO EJPYJEF JO UIF BJS 5IPVTBOE UPOT QFS ZFBS
5IF BNPVOU PG DBSCPO NPOPYJEF JO UIF BUNPTQIFSF 5IPVTBOE UPOT QFS ZFBS
)VNBO EFWFMPQNFOU JOEFY *OUFHSBM JOEFY PG IVNBO EFWFMPQNFOU $PFGGJDJFOUT
%FNPHSBQIJD EFWFMPQNFOU $PFGGJDJFOUT
.BUFSJBM XFMM CFJOH PG UIF QPQVMBUJPO $PFGGJDJFOUT
-JWJOH DPOEJUJPOT PG UIF QPQVMBUJPO $PFGGJDJFOUT
%FWFMPQNFOU PG SFHJPOBM MBCPS NBSLFUT $PFGGJDJFOUT
&EVDBUJPO MFWFM PG UIF QPQVMBUJPO $PFGGJDJFOUT
4UBUF BOE IFBMUI DBSF $PFGGJDJFOUT
4PDJBM FOWJSPONFOU $PFGGJDJFOUT
&DPMPHJDBM TJUVBUJPO $PFGGJDJFOUT
'JOEJOH PG IVNBO EFWFMPQNFOU $PFGGJDJFOUT
$POUSJCVUJPO PG FBDI PG UIF GBDUPST JO UIF EFWFMPQNFOU BOE TQSFBE PG EJQIUIFSJB XFSF TUVEJFE
BTTFTTNFOU PG DPPSEJOBUJPO CFUXFFO UIF NPEFM BOE UIF SFBM UIF SFMBUJPOTIJQ CFUXFFO QSFDVSTPST SJTL QSFSFRVJTJUFT BOE
EBUB XBT FTUJNBUFE VTJOH UIF )PTUFS BOE -FNFTIPX IVNBO EFWFMPQNFOU JOEJDFT UIF PEET SBUJP 03 BOE JUT
)PTUFS BOE -FNFTIPX (PPEOFTT PG 'JU 5FTU UFTU 5IF QBSU QSPCBCJMJUZ JOUFSWBM 1*
PG UIF BHHSFHBUF NPEFM EFTDSJCFE CZ UIF DPOTUSVDUFE NPEFM 5IFSF IBT CFFO B DIBOHF JO UIF QSPDFTTFT PG
XBT DPOTJEFSFE TVGGJDJFOU JG 3 /BHFMLFSLB FYDFFEFE NPEFSOJ[BUJPO JO TPDJBM BOE FDPOPNJD TQIFSFT EVSJOH UIF MBTU
'PS FTUJNBUJOH UIF SFHSFTTJPO FRVBUJPO UIF NFUIPE PG ZFBST JO 6LSBJOF $VSSFOUMZ UIFSF BSF EFNPHSBQIJD DIBOHFT
TUFQ CZ TUFQ JODPSQPSBUJPO PG QSFEJDUPST JOEJDBUPST UIBU UIF BDUJWBUJPO PG FYUFSOBM NJHSBUJPO QSPDFTTFT UIF GJOBODJBM
SBOLFE TJHOT JO BDDPSEBODF XJUI UIFJS DPOUSJCVUJPO UP UIF DSJTJT JO TPDJFUZ *O WJFX PG UIJT BO BTTFTTNFOU PG UIF
NPEFM XBT VTFE 5IF MFWFM PG TJHOJGJDBODF GPS JODMVEJOH PG SJTL FQJEFNJPMPHJDBM TJUVBUJPO XBT NBEF XJUI EJQIUIFSJB GPS
GBDUPST JO UIF SFHSFTTJPO FRVBUJPO XBT TFU JO TVDI B XBZ JO UBLJOH JOUP BDDPVOU UIF JEFOUJGJFE NBJO SJTL PG
PSEFS UP BDIJFWF B TJHOJGJDBODFMFWFM P 1S DIJ TRVBSF GPS FBDI GPSFDBTUJOH
QSFEJDUPS BU UIF FOE PG UIF TUFQ QSPDFEVSF OP NPSF UIBO #Z BOBMZ[JOH UIF JODJEFODF BOE QSFWBMFODF PG EJQIUIFSJB
*O PSEFS UP BTTFTT UIF RVBMJUZ PG UIF NPEFM JOEJDBUPST PG JUT UIF GPMMPXJOH SBOEPN QBSBNFUFST XFSF TUVEJFE . JT UIF
TFOTJUJWJUZ TQFDJGJDJUZ BOE BDDVSBDZ XFSF DBMDVMBUFE 4FOTJUJWJUZ BSJUINFUJD NFBO .F JT NFEJBO BU JOUFSRVBSUJMF MBUJUVEF
XBT EFGJOFE BT UIF QFSDFOUBHF PG JOEJDBUPST UIBU SFBMMZ BOE UIF NBHOJUVEF PG UIF PTDJMMBUJPOT UIF EJGGFSFODF
CFMPOHFE UP UIF HSPVQ XJUI QSPOPVODFE JOUFOTJUZ PG UIF CFUXFFO UIF NJOJNVN BOE NBYJNVN NPSCJEJUZ SBUFT
FQJEFNJD QSPDFTT UIBU JT USVF BOE DPSSFDU 4QFDJGJDJUZ BT B 5IF MPOH UFSN EZOBNJDT PG EJQIUIFSJB NPSCJEJUZ XBT
QFSDFOUBHF PG JOEJDBUPST UIBU SFBMMZ CFMPOHFE UP UIF HSPVQ FTUJNBUFE VTJOH B TUSBJHIU MJOF USFOE 5IF HSPXUI SBUF (3 XBT
XJUI NPEFSBUF JOUFOTJUZ PG UIF FQJEFNJD QSPDFTT UIBU JT USVF DBMDVMBUFE VTJOH UIF NFUIPE PG MFBTU TRVBSFT XIJMF UIF
USVUIGVMMZ OFHBUJWF "DDVSBDZ QPJOUT UP UIF QFSDFOUBHF PG EFDSFBTF PS HSPXUI XBT FTUJNBUFE BDDPSEJOH UP UIF
DPSSFDU QFSGPSNBODF PG UIF JOEJDBUPST JO UIF NPEFM GPS BMM GPMMPXJOH DSJUFSJB 'SPN UP ʶ DPOTJEFSFE UIF USFOE UP CF
GBDUPST BOE JU JT UIF BHHSFHBUF JOEJDBUPS PG UIF JOGPSNBUJWFOFTT NPEFSBUF GSPN ʶ UP JT TUBCMF BOE NPSF ʶ
PG UIF TFMFDUFE JOEJDBUPST *O PSEFS UP BTTFTT UIF EFHSFF PG FYQSFTTFE
"TJBO + &QJEFNJPM

5IF DPSSFMBUJPO PG EJQIUIFSJB NPSCJEJUZ XBT NBEF XJUI EFWFMPQNFOU JOEFYFT BOE SJTL QSFEJDUPST UIF
UIF BNPVOU PG IBSNGVM TVCTUBODFT SFMFBTFE JOUP UIF DPSSFMBUJPO PG UIFTF GBDUPST XJUI UIF JOUFOTJUZ PG UIF
BUNPTQIFSF GSPN GJYFE BOE NPCJMF TPVSDFT UIPVTBOE UPOT QFS EJQIUIFSJB FQJEFNJD QSPDFTT XBT QSFEJDUFE 5BCMF
ZFBS UIF OVNCFS PG NPTU DPNNPO TVCTUBODFT JO UIF 5IF DPOTUSVDUFE NPEFM NBEF JU QPTTJCMF UP DMBTTJGZ
BUNPTQIFSF UIPVTBOE UPOFT QFS ZFBS TVDI BT DBSCPO DPSSFDUMZ PG FOWJSPONFOUBM GBDUPST PG TPDJBM
NPOPYJEF EVTU TVMGVS EJPYJEF BOE OJUSPHFO EJPYJEF JOEJDBUPST GBDUPST PG IVNBO EFWFMPQNFOU JOEFY BOE
PG QPQVMBUJPO EFOTJUZ QFPQMF QFS TR LN BOE JNNVOJ[BUJPO IBSCJOHFST PG SJTL JOUSPEVDFE JOUP UIF NPEFM 4P BO JODSFBTF
BOE UPUBM QPQVMBUJPO BCT O $PSSFMBUJPO BOBMZTJT XBT JO UIF DPOUFOU PG TVMGVS EJPYJEF JO UIF BUNPTQIFSF JODSFBTFT
QFSGPSNFE VTJOH UIF 4QFBSNBO SBOL DPFGGJDJFOU ST 5IF WBMVF UIF DIBODFT PG JOUFOTJGZJOH UIF FQJEFNJD QSPDFTT PG EJQIUIFSJB
ST UP JOEJDBUFE B XFBL MJOL BCPVU UIF BWFSBHF CZ NFBOXIJMF TQFDJGJDJUZ PG UIF NPEFM XBT
DPOOFDUJPO BCPVU B TUSPOH DPOOFDUJPO TFOTJUJWJUZ BDDVSBDZ
4UBUJTUJDBM QSPDFTTJOH PG UIF SFTVMUT XBT DBSSJFE PVU VTJOH 5IF EFDSFBTF JO UIF MFWFM PG WBDDJOBUJPO BHBJOTU EJQIUIFSJB
UIF GPMMPXJOH DPNQVUFS QSPHSBNT &YDFM BOE 4144 JODSFBTFT UIF DIBODFT PG JOUFOTJGZJOH UIF FQJEFNJD QSPDFTT PG
UIJT JOGFDUJPO CZ XIJMF UIF OBUVSBM QPQVMBUJPO HSPXUI CZ
3&46-54 NFBOXIJMF UIF TQFDJGJDJUZ PG UIF NPEFM XBT
TFOTJUJWJUZ BDDVSBDZ
%VSJOH UIF GJSTU QFSJPE QFPQMF EJFE PG 5IF SJTF JO UIF EJQIUIFSJB JODJEFODF JO UIF DJUZ JODSFBTFT
EJQIUIFSJB UIF NFEJBO JODJEFODF XBT QFS UIPVTBOE UIF DIBODFT PG BO JOUFOTJGJDBUJPO PG UIF FQJEFNJD QSPDFTT CZ
QPQVMBUJPO BOE UIF SBUF PG GMVDUVBUJPOT XBT QFS BMNPTU BOE DBO CF B QSFEJDUPS PG UIF DPNQMJDBUFE
UIPVTBOE QPQVMBUJPO %VSJOH TFDPOE QFSJPE FQJEFNJD TJUVBUJPO XJUI UIJT JOGFDUJPO JO B DFSUBJO UFSSJUPSZ
QFPQMF EJFE PG EJQIUIFSJB UIF NFEJBO JODJEFODF XBT NFBOXIJMF UIF TQFDJGJDJUZ PG UIF NPEFM XBT TFOTJUJWJUZ
QFS UIPVTBOE QPQVMBUJPO BOE UIF SBUF PG GMVDUVBUJPO BDDVSBDZ
XBT QFS UIPVTBOE QPQVMBUJPO *NQSPWJOH MJWJOH DPOEJUJPOT JODMVEJOH JODSFBTJOH
" DPSSFMBUJPO BOBMZTJT CFUXFFO UIF EJQIUIFSJB JODJEFODF QPQVMBUJPO EFOTJUZ JODSFBTFT UIF DIBODFT PG JOUFOTJGZJOH UIF
BOE UIF FOWJSPONFOUBM GBDUPST SFWFBMFE PG UIF EJQ FQJEFNJD QSPDFTT PG EJQIUIFSJB CZ NFBOXIJMF UIF
DPSSFMBUJPO QBJST JODMVEJOH PG UIF QBJST PG TUSPOH GPSDFT TQFDJGJDJUZ PG UIF NPEFM XBT TFOTJUJWJUZ BDDVSBDZ
*O NPTU DBTFT EJSFDU DPSSFMBUJPOT ST Q ST Q
ST Q XFSF FTUBCMJTIFE CFUXFFO UIF JOEJDBUPST 'PS UIF QFSJPE UIF NFEJBO PG UIF JODJEFODF
PG UIF EJQIUIFSJB JODJEFODF BOE UIF QPQVMBUJPO EFOTJUZ BOE QSFWBMFODF PG EJQIUIFSJB XBT SFTQFDUJWFMZ BOE
6TJOH B CJOBSZ MPHJTUJD SFHSFTTJPO B NBUIFNBUJDBM NPEFM QFS UIPVTBOE QPQVMBUJPO BOE UIF SBUF PG
GPS EFUFDUJOH SJTL GBDUPST XJUI B WJFX UP UBLJOH FBSMZ TUFQT UP GMVDUVBUJPOT SFTQFDUJWFMZ BOE QFS UIPVTBOE
EFBM XJUI DPNQMJDBUJPOT PG UIF FQJEFNJD TJUVBUJPO XJUI QPQVMBUJPO
EJQIUIFSJB XBT DPOTUSVDUFE 5IVT CBTFE PO UIF DPFGGJDJFOU PG "U QSFTFOU UIF MPOH UFSN EZOBNJDT PG NPSCJEJUZ BOE
SFHSFTTJPO GVODUJPO # JODMVEJOH UIF DPOTUBOU GPS QSFWBMFODF PG EJQIUIFSJB JOGFDUJPO JO 6LSBJOF JT
FOWJSPONFOUBM GBDUPST TPDJBM GBDUPST IVNBO DIBSBDUFSJ[FE CZ TUBCJMJ[BUJPO PG UIFTF JOEJDBUPST 'PS UIF
MBTU ZFBST QBUJFOUT XJUI EJQIUIFSJB XFSF QFPQMF

5BCMF 3FTVMUT PG UIF QSPHOPTJT SJTL GBDUPST PG UIF DPNQMJDBUFE FQJEFNJD TJUVBUJPO XJUI EJQIUIFSJB EFQFOEJOH PO UIF FOWJSPONFOUBM GBDUPST
3FHSFTTJPO "DIJFWFE MFWFM 3FMBUJPO 1* GPS
/BNF PG GBDUPST DPFGGJDJFOU # 4UBOEBSE FSSPS χ XBMEB TJHOJGJDBODF DIBODFT PEET SBUJP
&OWJSPONFOUBM GBDUPST
4VMGVS EJPYJEF
4PDJBM GBDUPST
7BDDJOBUJPO
/BUVSBM JODSFBTF
(FOFSBMJ[FE FOWJSPONFOUBM GBDUPST JOEJDFT PG IVNBO EFWFMPQNFOU
-JWJOH DPOEJUJPOT JODMVEJOH
QPQVMBUJPO EFOTJUZ
&YQFEJUPST PG SJTL
.PSCJEJUZ SBUF PG DJUZ SFTJEFOUT
"TJBO + &QJEFNJPM

2.0 Morbidity

An int. ind per 100 thousands


Prevalence
1.5 Line forecast morbidity
Line forecast prevalence
1.0

people
0.5 2
2
R = 0.7486 R = 0.9239
0.0

2000 2002 2004 2006 2008 2010 2012 2014 2016 2018

-0.5 Years

'JH %ZOBNJDT PG NPSCJEJUZ BOE QSFWBMFODF PG EJQIUIFSJB EVSJOH JO 6LSBJOF


12000000 Number of children 0.8
Morbidity of children
An int. ind per 100 thousands children

0.7
10000000
0.6
8000000
0.5

Morbidity
6000000 0.4

0.3
4000000
0.2
2000000 0.1

0 0.0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Years

'JH %ZOBNJDT PG UIF NPSCJEJUZ PG EJQIUIFSJB JO DIJMESFO BOE UIF OVNCFS PG DIJMESFO JO 6LSBJOF EVSJOH
38500000 Number of adults 0.6
38000000 Morbidity of adults
An int. ind per 100 thousands adults

37500000 0.5

37000000
0.4
36500000
Morbidity
36000000 0.3
35500000
35000000 0.2

34500000
0.1
34000000
33500000
0.0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Years

'JH %ZOBNJDT PG BEVMU EJQIUIFSJB NPSCJEJUZ BOE UIF OVNCFS PG BEVMU QPQVMBUJPO JO 6LSBJOF EVSJOH
5IFSF JT B QSPOPVODFE UFOEFODZ UP EFDSFBTF UIF JODJEFODF " TUSPOH DPSSFMBUJPO CFUXFFO UIF JODJEFODF PG EJQIUIFSJB
(3 BOE UIF QSFWBMFODF (3 EJQIUIFSJB BNPOH DIJMESFO BOE OVNCFS PG DIJMESFO QPQVMBUJPO ST Q
'JH IBT CFFO FTUBCMJTIFE 'JHVSF TIPXFE EFDMJOF JO UIF JODJEFODF
%VSJOH UIF MBTU ZFBST UIF JODJEFODF PG EJQIUIFSJB PG EJQIUIFSJB BNPOH DIJMESFO PO UIF CBDLHSPVOE PG
BNPOH DIJMESFO XBT TMJHIUMZ IJHIFS UIBO BNPOH BEVMUT SFEVDJOH UIF DIJME QPQVMBUJPO
BOE QFS UIPVTBOE SFTQFDUJWFMZ PG DFSUBJO BHF 5IFSF JT B TUSPOH DPSSFMBUJPO CFUXFFO UIF JODJEFODF PG
HSPVQ 5IFSF IBT CFFO B EFDSFBTF OVNCFS PG BEVMU EJQIUIFSJB JO BEVMUT BOE UIF OVNCFS PG BEVMUT ST Q
GSPN QFPQMF BOE DIJME QPQVMBUJPO 'JHVSF TIPXFE B SFEVDUJPO JO UIF JODJEFODF PG EJQIUIFSJB
BOE UIF DIJME QPQVMBUJPO GSPN QFPQMF BNPOH BEVMUT JO UIF DPOUFYU PG EFDMJOJOH JO BEVMU
QPQVMBUJPO XBT
"TJBO + &QJEFNJPM

%*4$644*0/ $IVNBDIFOLP JU JT OPUFE UIF OFHBUJWF JNQBDU PG


FOWJSPONFOUBM GBDUPST PO TQFDJGJD JNNVOJUZ UIBU DPOUSJCVUFT
5IF TUVEZ TIPXFE UIBU UIF EJQIUIFSJB NPSCJEJUZ BOE UIF UP UIF GPSNBUJPO PG TVTDFQUJCMF QPQVMBUJPO TFHNFOUT UP
FYUFOU PG GMVDUVBUJPOT EVSJOH UIF QFSJPE PG NBSLFE JOGFDUJPVT EJTFBTFT
NPEFSOJ[BUJPO PG QPMJUJDBM TPDJBM FDPOPNJD BOE PUIFS TQIFSFT $POTFRVFOUMZ UIF TDJFOUJGJD DPODFQUT CBTFE PO UIF
JO 6LSBJOF XFSF SFTQFDUJWFMZ BOE UJNFT BOBMZTJT PG SJTL GBDUPST UIF FWPMVUJPO PG UIF FQJEFNJD QSPDFTT
IJHIFS UIBO EVSJOH UIF QFSJPE PG TUBCJMJ[BUJPO PG UIFTF IBWF QSBDUJDBM DPOGJSNBUJPO JO UIF TUVEZ PG EJQIUIFSJB
QSPDFTTFT 5IF DPSSFMBUJPO BOBMZTJT BOE UIF 5IVT UIF EFDSFBTF JO UIF QFSDFOUBHF PG JNNVOJ[BUJPO UIF
DPOTUSVDUFE NBUIFNBUJDBM NPEFM IBWF DPOGJSNFE UIF DSJTJT JO TPDJBM FDPOPNJD BOE QPMJUJDBM TQIFSFT IBT MFE UP B
EFQFOEFODF PG UIF NPSCJEJUZ MFWFM PO UIF FOWJSPONFOUBM EFUFSJPSBUJPO PG UIF FQJEFNJD TJUVBUJPO XJUI EJQIUIFSJB 5IJT
GBDUPST 5IVT EJSFDU DPSSFMBUJPO CFUXFFO UIF JODJEFODF PG XBT FTUBCMJTIFE CZ DPNQBSJOH UIF JOEJDBUPST PG EJQIUIFSJB
EJQIUIFSJB BOE QPQVMBUJPO EFOTJUZ IBT CFFO FTUBCMJTIFE NPSCJEJUZ JO EJGGFSFOU QFSJPET PG NPEFSOJ[BUJPO PG TPDJBM
"DDPSEJOH UP UIF GPSFDBTU UIF SJTL PG DPNQMJDBUFE FQJEFNJD FDPOPNJD BOE QPMJUJDBM TQIFSFT JO 6LSBJOF BOE DPOGJSNFE CZ
TJUVBUJPO XJUI EJQIUIFSJB XJMM JODSFBTF CZ XJUI B FTUBCMJTIFE EJSFDU DPSSFMBUJPO SFMBUJPOT CFUXFFO UIF JOEJDBUPST
EFDSFBTF JO UIF WBDDJOBUJPO DPWFSBHF CZ XJUI BO PG UIF JODJEFODF BOE FOWJSPONFOUBM GBDUPST "TTFTTJOH UIF
JODSFBTF JO FNJTTJPOT PG IBSNGVM TVCTUBODFT JOUP UIF BJS CZ SFTVMUT PG QSFEJDUJPO VTJOH NBUIFNBUJDBM NPEFMJOH JU DBO CF
XJUI BO JODSFBTF JO QPQVMBUJPO HSPXUI BOE CZ BSHVFE UIBU UIF EJQIUIFSJB JODJEFODF EFQFOET PO UIF DPNQMFY
XJUI JODSFBTJOH QPQVMBUJPO EFOTJUZ *O UIF DBTF PG BO BDUJPO PG TPDJBM BOE FOWJSPONFOUBM GBDUPST " MPOH QFSJPE PG
JODSFBTF JO JODJEFODF BNPOH DJUZ SFTJEFOUT UIF SJTL PG EFDSFBTJOH JO UIF MFWFM PG JNNVOJ[BUJPO DBO OPU DPOUSJCVUF UP
JOUFOTJGJDBUJPO PG UIF EJQIUIFSJB FQJEFNJD QSPDFTT JT FYQFDUFE UIF DPNQMJDBUJPO PG UIF FQJEFNJD TJUVBUJPO XJUI UIJT JOGFDUJPO
UP JODSFBTF CZ 5IF SFTFBSDI DPOGJSNFE UIF IZQPUIFTJT XJUIPVU UIF DPNQMFY JOGMVFODF PG UIF FOWJSPONFOUBM GBDUPST
PG UIF JOGMVFODF PG UIF BTQFDUT PG HMPCBMJ[BUJPO FDPOPNJD 6OEFS DPOEJUJPO PG UIF HSPXUI JO QPQVMBUJPO TJ[F QPQVMBUJPO
FDPMPHJDBM QPMJUJDBM EFNPHSBQIJD PO UIF JOUFOTJUZ PG UIF EFOTJUZ BOE EFUFSJPSBUJPO PG FOWJSPONFOUBM GBDUPST JO MPX
FQJEFNJD QSPDFTT PG JOGFDUJPVT EJTFBTFT BT XFMM BT MFWFMT PG JNNVOJUJPO BO FQJEFNJD JODSFBTF JO UIF EJQIUIFSJB
EJQIUIFSJB JODJEFODF DBO CF FYQFDUFE )PXFWFS JO DPOEJUJPOT PG MPX
5IF SFTVMUT PG UIF GPSFDBTU XFSF VTFE UP BTTFTT UIF MFWFM PG JNNVOJ[BUJPO PG UIF QPQVMBUJPO BHBJOTU EJQIUIFSJB UIF
FQJEFNJD TJUVBUJPO XJUI EJQIUIFSJB JO NPEFSO DPOEJUJPOT " FQJEFNJD TJUVBUJPO XJUI UIJT JOGFDUJPO TIPVME CF BTTFTTFE BT
QPXFSGVM EFUFSSFOU UP UIF JOUFOTJGJDBUJPO PG UIF EJQIUIFSJB VOTVTUBJOBCMF BOE JNNFEJBUFMZ UBLJOH EFDJTJPOT PG
FQJEFNJD QSPDFTT JT B IJHI MFWFM PG WBDDJOBUJPO DPWFSBHF UIBU JODSFBTJOH UIF MFWFM PG BOUJ EJQIUIFSJB JNNVOJUZ BNPOH UIF
TIPVME CF BU MFBTU 5IF SBUF PG DIJME WBDDJOBUJPO BHBJOTU 6LSBJOJBO QPQVMBUJPO
EJQIUIFSJB BNPVOUFE UP PO BWFSBHF NFBOXIJMF BEVMUT
QSBDUJDBMMZ EJE OPU SFDFJWF BOZ EPTF EVSJOH UIF MBTU UFO ZFBST JO $0/$-64*0/
6LSBJOF
"U UIF TBNF UJNF UIF TUVEZ PG NBOZ JOEVTUSJBM FOUFSQSJTFT 5IF DPNQMJDBUJPO PG UIF EJQIUIFSJB FQJEFNJD TJUVBUJPO
IBT CFFO TVTQFOEFE JO UIF DPVOUSZ BOE UIF OVNCFS PG HBT PDDVSSFE EVSJOH UIF TPDJBM FDPOPNJD BOE QPMJUJDBM DSJTJT JO
ESJWFO WFIJDMFT IBT EFDSFBTFE UIBU MFE UP SFEVDJOH JO PG 6LSBJOF *U XBT PCTFSWFE UIBU JOEJDBUPST PG EJQIUIFSJB
IBSNGVM BUNPTQIFSJD FNJTTJPOT 5IF IJHI NPSUBMJUZ SBUF BOE JODJEFODF XFSF BMNPTU UJNFT IJHIFS BOE UJNFT IJHIFS
MPX CJSUI SBUF BNPOH DIJMESFO BT XFMM BT UIF BDUJWBUJPO PG UIF NBHOJUVEF PG UIFJS GMVDUVBUJPOT *OTUBMMFE UIF QSPCBCJMJUZ
FYUFSOBM NJHSBUJPO QSPDFTTFT DPOUSJCVUFE UP B EFDSFBTF PG PG JOUFOTJGJDBUJPO PG UIF FQJEFNJD QSPDFTT EFQFOEJOH PO
NJMMJPO UIPVTBOE QPQVMBUJPO QPQVMBUJPO EFOTJUZ QPQVMBUJPO HSPXUI UIF MFWFM PG
4P JU DBO BTTVNFE UIBU UIF TUBUF PG FOWJSPONFOUBM BOE WBDDJOBUJPO BOE UIF JODSFBTF PG IBSNGVM TVCTUBODFT JO
TPDJBM GBDUPST IBT QPTJUJWFMZ JOGMVFODFE UIF JOUFOTJUZ PG UIF BUNPTQIFSJD BJS BT XFMM BT UIF JODSFBTF JO PG EJQIUIFSJB
EJQIUIFSJB FQJEFNJD QSPDFTT 5IJT JT DPOGJSNFE CZ MPX JODJEFODF BNPOH UIF VSCBO QPQVMBUJPO XBT EFUFSNJOFE
NPSCJEJUZ SBUF BOE B QSPOPVODFE UFOEFODZ UP SFEVDF UIF 3FEVDJOH UIF QPQVMBUJPO BOE SFEVDJOH FNJTTJPOT PG IBSNGVM
JODJEFODF PG EJQIUIFSJB 'JH BT XFMM BT CZ TUSPOH EJSFDU TVCTUBODFT JOUP UIF BUNPTQIFSF IBT B QPTJUJWF FGGFDU PO UIF
DPSSFMBUJPO CFUXFFO UIF JODJEFODF SBUFT BNPOH DIJMESFO BOE JOUFOTJUZ PG UIF FQJEFNJD QSPDFTT PG EJQIUIFSJB CVU UIF MPX
BEVMUT BOE UIF OVNCFS PG UIFTF BHF HSPVQT 5IF JOGMVFODF PG MFWFM PG WBDDJOBUJPO BHBJOTU EJQIUIFSJB EFNPOTUSBUFT UIF
EFNPHSBQIJD QSPDFTTFT PO UIF JODJEFODF PG BOUISPQPHFOJD VOTUBCMF FQJEFNJD TJUVBUJPO PG UIJT JOGFDUJPO BOE SFRVJSFT UIF
JOGFDUJPOT BOE JO UIF TUVEZ PG 4BWZMPW BOE :MZOB BOE QSPNQU BEPQUJPO PG BEFRVBUF NBOBHFSJBM EFDJTJPOT
"TJBO + &QJEFNJPM

4*(/*'*$"/$& 45"5&.&/54 8)0 8)0 7BDDJOF 1SFWFOUBCMF %JTFBTFT .POJUPSJOH


4ZTUFN (MPCBM 4VNNBSZ *NNVOJ[BUJPO 7BDDJOFT BOE
5IJT TUVEZ EJTDPWFST UIF SJTL PG JOUFOTJGJDBUJPO JO UIF #JPMPHJDBMT 8PSME )FBMUI 0SHBOJ[BUJPO (FOFWB 4XJU[FSMBOE
EJQIUIFSJB FQJEFNJD QSPDFTT UBLJOH JOUP BDDPVOU NJHSBUJPO 1BHFT
BOE EFNPHSBQIJD QSPDFTTFT BJS QPMMVUJPO BT XFMM BT 3BTNVTTFO * 4 8BMMBDF " 5 .FOHTIPFM & " )PJCZ BOE
WBDDJOBUJPO SBUF UP EJQIUIFSJB BNPOH QPQVMBUJPO UIBU DBO CF 1 #SBOEU[‘ H %JQIUIFSJB PVUCSFBL JO /PSXBZ -FTTPOT
MFBSOFE 4DBOE + *OGFDU %JT
CFOFGJDJBM GPS QSFEJDU EJQIUIFSJB JO B DFSUBJO BSFB
4BJLJB - 3 /BUI / + 4BJLJB BOE ( $IPVEIVSZ "
5IJT TUVEZ XJMM IFMQ UIF SFTFBSDIFS UP VODPWFS UIF DSJUJDBM
EJQIUIFSJB PVU CSFBLJO "TTBN *OEJB 4PVUIFBTU "TJBO
BSFBT PG JNQBDU PG TQFDJGJD TPDJBM BOE FOWJSPONFOUBM GBDUPST PO
+ 5SPQ .FE 1VCMJD )FBMUI
UIF FQJEFNJD QSPDFTT PG EJQIUIFSJB UIBU NBOZ SFTFBSDIFST
.VSBLBNJ ) / . 1IVPOH ) 7 5IBOH / 7 $IBV 1 / (JBP
XFSF OPU BCMF UP FYQMPSF
BOE / % 5IP &OEFNJD EJQIUIFSJB JO )P $IJ .JOI $JUZ
5IVT B OFX UIFPSZ PG UIF FQJEFNJD TJUVBUJPO BTTFTTNFOU
7JFU /BN " NBUDIFE DBTF DPOUSPM TUVEZ UP JEFOUJGZ SJTL
PG EJQIUIFSJB BU UIF SFHJPOBM MFWFM NBZ BQQFBS XIJDI XJMM IFMQ
GBDUPST PG JODJEFODF 7BDDJOF
UP PQUJNJ[F UIF TZTUFN PG FQJEFNJPMPHJDBM TVSWFJMMBODF PG UIJT
#FTB / $ .& $PMEJSPO " #BLSJ " 3BKJ BOE
JOGFDUJPO
. + /TVBNJ FU BM %JQIUIFSJB PVUCSFBL XJUI IJHI
NPSUBMJUZ JO OPSUIFBTUFSO /JHFSJB &QJEFNJPM *OGFDU
3&'&3&/$&4
1FUSVTFWZDI 5 7 1SZDIZOZ [BLIWPSJVWBO OB EZGUFSJJV
;BLJLIBOZ , фOE " &GTUSBUJPV %JQIUIFSJB JO &VSPQF TIDIFQMFOZLI "WUPSFG %ZT /B [EPCVUUJB WDIFOPIP TUVQFOJB
DVSSFOU QSPCMFNT BOE OFX DIBMMFOHFT 'VUVSF .JDSPCJPM LBOE .FE /BVL TQFUT &QJEFNJPMPIJJB 1BHFT
4FJO $ 5 5JXBSJ " .BDOFJM , 8BOOFNVFIMFS BOE
8)0 %JQIUIFSJB WBDDJOF 8)0 QPTJUJPO QBQFS "VHVTU $ 4PVMBQIZ FU BM %JQIUIFSJB PVUCSFBL JO -BP 1FPQMF T
8FFLMZ &QJEFNJPM 3FDPSE
%FNPDSBUJD 3FQVCMJD 7BDDJOF
$MBSLF , & / 3FWJFX PG UIF FQJEFNJPMPHZ PG EJQIUIFSJB
(PMB[ " * 3 )BSEZ 1 4USFCFM , . #JTHBSE $ 7JUFL
64 $FOUFST GPS %JTFBTF $POUSPM BOE 3FWFOUJPO
5 1PQPWJD BOE . 8IBSUPO &QJEFNJD EJQIUIFSJB JO UIF
IUUQ XXX XIP JOU JNNVOJ[BUJPO TBHF NFFUJOHT B
OFXMZ *OEFQFOEFOU 4UBUFT PG UIF GPSNFS 4PWJFU 6OJPO
QSJM @'JOBM@SFQPSU@$MBSLF@BQSJM QEG
*NQMJDBUJPOT GPS EJQIUIFSJB DPOUSPM JO UIF 6OJUFE 4UBUFT
.BSTUPO $ , ' +BNJFTPO ' $BIPPO ( -FTJBL " (PMB[
+ *OGFDU %JT 4 4
. 3FFWFT BOE 5 1PQPWJD 1FSTJTUFODF PG B EJTUJODU
.BSLJOB 4 4 / . .BLTJNPWB $ 3 7JUFL & : #PHBUZSFWB BOE
$PSZOFCBDUFSJVN EJQIUIFSJBF DMPOBM HSPVQ XJUIJO UXP
" " .POJTPW %JQIUIFSJB JO UIF 3VTTJBO 'FEFSBUJPO JO
DPNNVOJUJFT JO UIF 6OJUFE 4UBUFT BOE $BOBEB XIFSF
UIF T + *OGFDU %JT
EJQIUIFSJB JT FOEFNJD + $MJO .JDSPCJPM
1PEBWBMFOLP "1 &QJEFNJPMPIJDIOJ PTPCMZWPTUJ
(BMB[LB " BOE 4 %JUUNBOO *NQMJDBUJPOT PG UIF
EZGUFSJJOPJ JOGFLUTJJ W PLSFNZLI PCMBTUJBLI 6LSBJOZ UB TIMJBLI
EJQIUIFSJB FQJEFNJD JO UIF GPSNFS 4PWJFU 6OJPO GPS
ZWEPTLPOBMFOOJB TZTUFNZ FQJEFNJPMPIJDIOPIP OBIMJBEV
JNNVOJ[BUJPO QSPHSBNT + *OGFDU %JT 4 4
'SFEMVOE ) 5 /PSFO 5 -FQQ & .PSGFMEU BOE # ) /PSNBSL "WUPSFG %ZT /B [EPCVUUJB WDIFOPIP TUVQFOJB LBOE .FE
" DBTF PG EJQIUIFSJB JO 4XFEFO 0DUPCFS &VSP /BVL TQFUT &QJEFNJPMPIJJB 1BHFT
4VSWFJMMBODF 7PM FTF FO $%$ %JQIUIFSJB *O &QJEFNJPMPHZ BOE 1SFWFOUJPO PG
%FXJOUFS - . , " #FSOBSE BOE . ( 3PNOFZ )VNBO 7BDDJOF 1SFWFOUBCMF %JTFBTFT UI &EJUJPO 1JOL #PPL
DMJOJDBM JTPMBUFT PG $PSZOFCBDUFSJVN EJQIUIFSJBF BOE ,SPHFS " + )BNCPSTLZ BOE $ 8PMGF &ET 1VCMJD )FBMUI
$PSZOFCBDUFSJVN VMDFSBOT DPMMFDUFE JO $BOBEB GSPN UP 'PVOEBUJPO *OEJB *4#/ QQ
CVU OPU GJUUJOH SFQPSUJOH DSJUFSJB GPS DBTFT PG EJQIUIFSJB 8BHOFS , 4 + . 8IJUF * -VDFOLP % .FSDFS
BOE
+ $MJO .JDSPCJPM
.PLIPSU ) " 1SPJBWZ FQJEFNJDIOPIP QSPUTFTV EZGUFSJJ W / 4 $SPXDSPGU FU BM %JQIUIFSJB JO UIF QPTUFQJEFNJD
TVDIBTOZLI VNPWBLI J TIMJBLIZ VEPTLPOBMFOOJB QFSJPE &VSPQF &NFSH *OGFDU %JT
FQJEFNJPMPIJDIOPIP OBIMJBEV "WUPSFG %ZT OB ;EPCVUUJB #FMPW " # BOE 1 * 0HBSLPW %JQIUIFSJB JO UIF
7DIFOPIP 4UVQFOJB ,BOE .FE /BVL TQFUT NJMJUBSZ GPSDFT -FTTPOT BOE DVSSFOU TUBUVT PG QSPQIZMBYJT
&QJEFNJPMPIJJB 1BHFT QSPTQFDUT PG FQJEFNJPMPHJDBM DPOUSPM QSPDFTT 7PFO .FE
3PVTTFBV $ & #FMDIJPS # #SPDIF & #BEFMM BOE ;I *O 3VTTJBO
/ (VJTP FU BM %JQIUIFSJB JO UIF 4PVUI PG 'SBODF .BSDI 1PQPWJD 5 * , .B[VSPWB " &GTUSBUJPV + 7VPQJP 7BSLJMB BOE
&VSP 4VSWFJMMBODF 7PM FTF FO . 8 3FFWFT FU BM .PMFDVMBS FQJEFNJPMPHZ PG
EJQIUIFSJB + *OGFDU %JT 4 4
"TJBO + &QJEFNJPM

,PNCBSPWB 4 * 0 * #PSZTPWB BOE 7 ) .FMOZLPW #SJLP / * BOE 7 * 1PLSPWTLJZ (MPCBMJ[BUTJZB J


1PMZNPSGZ[N IFOPW UPY Z EUY3 V UTZSLVMZSVJVTI DIZLI FQJEFNJDIFTLJZ QSPUTFTT &QJEFNJPMPHJZB J *OGFLUTJPOOZJF
TIUBNNPW $PSZOFCBDUFSJVN EJQIUIFSJBF ;IVSO .ZLSPCZPM #PMF[OJ
$IFSLBTTLJZ # - (MPCBMOBZB &QJEFNJPMPHJZB
,SBFWB - " ) * 5TFOFWB BOE 7 " )SBCZOB 7MZJBOZF 1SBLUJDIFTLBZB .FEJUTJOB .PTLWB 1BHFT
GBLUPSPW GZ[ZDIFTLPJ Z LIZNZDIFTLPJ QSZSPEј OB .JOEMJOB " : &QJEFNJPMPHJDIFTLJF PTPCFOOPTUJ
CZPMPIZDIFTLZF TWPJTUWB LPSZOFCBLUFSZJ 7FTUOZL 3PTTZJTLPJ BOUSPQPOP[OZJI JOGFLUTJZ SB[MJDIOPZ TUFQFOJ VQSBWMZBFNPTUJ J
7PFOOP .FEZUTZOTLPJ "LBEFNZZ OBVDIOPF PCPTOPWBOJF PQUJNJ[BUTJJ OBE[PSB OB
,IBSTFFWB ) ) / " 7PSPOZOBBOE BOE 5 % )BTSFUPWB TPWSFNFOOPN FUBQF "WUPSFG %JT /B 4PJTLBOJF 6DIFOPZ
1FSTZTUFOUOZF TWPJTUWB $PSZOFCBDUFSJVN OPO EJQIUIFSJBF 4UFQFOJ %PLU .FE /BVL 4QFUT &QJEFNJPMPHJZB
UTZSLVMZSVJVTIDIZLI W 3PTUPWF OB %POV Z 3PTUPWTLPJ PCMBTUZ 1BHFT
;IVSO .ZLSPCZPM (FSBTJNPW " / " : .JOEMJOB BOE 3 7 1PMJCJO
4BWZMPW & % BOE 4 7 :MZOB :OGFLUTZPOOBJB 1BUPMPIZJB %FNPHSBGJDIFTLBZB TUSVLUVSB OBTFMFOJZB J EJOBNJLB
W 6TMPWZJBLI 5FLIOPIFOOPIP ;BISJB[OFOZJB 0LSV[IBJVTIDIFJ [BCPMFWBFNPTUJ B OUSP Q P O P [O Z J NJ J O G F L U T J P OOZJNJ
4SFEZ ,MZOZLP &QZEFNZPMPIZDIFTLZF :TTMFEPWBOZJB CPMF[OZBNJ 7FTUOJL 3PTTJZTLPZ "LBEFNJJ .FEJUTJOTLJI /BVL
.POPISBGZJB /PWPTZCZSTL /BVLB 1BHFT
1PEBWBMFOLP " 1 7 * ;BEPSP[IOB 5 * 1FUSFOLP BOE $IVNBDIFOLP 50 *NVOPFQJEFNJPMPIJDIOZJ
07 1PEBWBMFOLP 4PUTJBMOP IJIJJFOJDIOZJ NPOJUPSZOI OBTFMFOOJB W TZTUFNJ FQJEFNJPMPIJDIOPIP
NPOJUPSZOI W TZTUFNJ FQJEFNJPMPIJDIOPIP OBIMJBEV [B OBIMJBEV [B JOGFLUTJJBNZ LPOUSPMPWBOZNZ [BTPCBNZ
QPWJUSJBOP LSBQFMOZNZ JOGFLUTJJBNZ 6LSBJOTLZ *NFEZDIOZJ JNVOPQSPGJMBLUZLZ "WUPSFG %ZT /B ;EPCVUUJB /BVL 4UVQFOJB
$IBTPQZT %PLU .FE /BVL 4QFUT &QJEFNJPMPIJJB 1BHFT