2016年国家传染病自动预警信息系统运行情况分析

目的 对国家传染病自动预警信息系统（预警系统）运行情况进行分析，为预警系统的改进与完善提供科学依据。方法 预警系统主要采用固定阈值法和时间模型方法进行异常探测，工作流程分为预警信号发送、预警信号初步核实和现场调查确认3个步骤。收集2016年预警系统在中国内地31个省（自治区、直辖市）产生的预警系统纳入全部预警病种的预警信号数量、响应情况和判断结果，分别从不同地区和不同疾病的维度分析预警信号的响应率和响应时间及疑似事件数和疑似事件率等指标。结果 2016年预警系统共发出325 208条预警信号，信号响应率、24 h内响应率、疑似事件率分别为99.40%、92.44%和4.91%。预警信号数居前3位的依次为山东省、河南省和广西壮族自治区，山东省疑似事件率最高，为22.33%。其中，固定阈值预警方法产生97 689条预警信号，预警信号响应率为98.83%，19省（自治区、直辖市）响应率达到100%。响应时间中位数为0.72 h（P25=0.16 h，P75=4.09 h），2 h内响应率为65.66%。时间模型预警方法共产生227 519条预警信号，疑似事件率、预警信号响应率和24 h内响应率分别为1.49%、99.65%和93.23%，响应时间中位数（P25~P75）为0.99（0.50~2.44）h。24 h内响应率居前3位的地区依次为贵州省、湖南省和上海市，疑似事件率最高的3种疾病为登革热、钩端螺旋体病和风疹。结论 2016年预警系统可稳定地对传染病报告数据进行自动运算并及时生成预警信号，信号响应率和响应及时性较好，但疑似信号比例较低，预警系统可通过区分疾病的不同发病水平地区和不同流行季节，探索新的预警数据源，缩小空间探测范围等方式，进一步提高预警系统的探测效果。

Performance of China infectious disease automated-alert and response system in 2016

Objective To analyze the performance of China Infectious Diseases Automated-alert and Response System (CIDARS)established in 2008 by China CDC,and provide reference for the improvement of CIDARS. Methods CIDARS used fixed-value detection method and temporal aberration detection method for aberrant detection,with the work flowchart of signals generating,preliminary verification and field investigation. The fixed-value detection method was for 15 diseases, and the temporal aberration detection method was for 33 diseases,including 3 types of sub-methods,such as moving percentile method,cumulative sum control chart algorithm and cluster early-warning method. Data analysis also included the concerned priority diseases which were added by province according to the actual disease control needs. All the signals generated by CIDARS in 31 provinces in 2016 were collected,the response status,such as response rate and response timeliness,and preliminary verification outcome,such as the signals related to suspected outbreaks and its proportion,were deeply analyzed from the dimension of province and disease,respectively. Results A total of 325 208 signals were generated nationwide by the system,in which 323 271(99.40%)were responded,300 614(92.44%)were responded within 24 hours. The proportion of signals of suspected outbreaks was 4.91%(15 964). The first 3 provinces with high number of signals were Shandong,Henan and Guangxi,and Shandong had highest proportion of signals of suspected outbreaks (22.33%). Among all the signals,97 689 were generated by the fixed-value detection method,the overall response rate of the signals was 98.83%,and in 19 provinces it was 100%. The median interval of the response was 0.72 h(P25=0.16 h,P75=4.09 h),the response rate within 2 hours was 65.66%. In addition,227 519 signals were generated by the temporal aberration detection method,in which 3 398(1.49%)were verified as suspected outbreaks. The response rate of signals was 99.65%(226 724),and the response rate within 24 hours was 93.23%. The median interval of signals was 0.99 h(P25=0.50 h, P75=2.44 h). The first 3 provinces with high response rates within 24 hours were Guizhou,Hunan and Shanghai,the first 3 diseases with highest proportion of signals of suspected outbreaks were dengue fever,leptospirosis and rubella. Conclusion In 2016,the performance of CIDARS was well,with response and timely response rates at high levels,but the proportion of signals of suspected outbreaks was low,so it is necessary to further improve CIDARS by identifying the areas and seasons with different disease incidence levels,exploring new data sources and narrowing the space detection coverage.