非处方药监测的基本原理与设计要点

近年来,非处方药(over-the-counter pharmaceutical sales,OTC)销量作为一种新兴的症状监测数据源,被越来越多的国家和地区用于开展传染病的强化监测,以提高传染病暴发与流行的早期探测能力。本文结合国外开展OTC监测的方法与实例,就OTC监测的基本原理及监测系统的设计要点进行综述。     

A three-state study of waterborne disease surveillance techniques.

For a two-year period, the states of Colorado, Vermont and Washington tested the effectiveness of ten surveillance methods for identifying waterborne disease. Nine were active surveillance methods, soliciting illness reports; one was passive, relying on voluntary disease reporting. One waterborne disease outbreak was identified through use of the nine active methods, while 14 were reported through the passive surveillance method. The presence of coliform bacteria during routine water testing was not related to illness in the community.     

Reported waterborne outbreaks of gastrointestinal disease in Australia are predominantly associated with recreational exposure

Objective: To examine the frequency and circumstances of reported waterborne outbreaks of gastroenteritis in Australia. Method: Examination of data reported to OzFoodNet between 2001 and 2007. Results: During these seven years, 6,515 gastroenteritis outbreaks were reported to OzFoodNet, most of which were classified as being transmitted person‐to‐person or from an unknown source. Fifty‐four (0.83%) outbreaks were classified as either ‘waterborne’ or ‘suspected waterborne’, of which 78% (42/54) were attributed to recreational water and 19% (10/54) to drinking water. Of the drinking water outbreaks, implicated pathogens were found on all but one occasion and included Salmonella sp. (five outbreaks), Campylobacter jejuni (three outbreaks) and Giardia (one outbreak). Conclusions: There have been few waterborne outbreaks detected in Australia, and most of those reported have been associated with recreational exposure. However, there are difficulties in identifying and categorising gastroenteritis outbreaks, as well as in obtaining microbiological and epidemiological evidence, which can result in misclassification or underestimation of water‐associated events. Implications: Gastroenteritis surveillance data show that, among reported water‐associated gastroenteritis outbreaks in Australia, recreational exposure is currently more common than a drinking water source. However, ongoing surveillance for waterborne outbreaks is important, especially as drought conditions may necessitate replacement of conventional drinking water supplies with alternative water sources, which could incur potential for new health risks.     

北京市石景山区药品销售监测系统研究

目的摸索建立石景山区药店监测系统的方法以及对传染病早期预警的意义。方法通过报表的方式收集监测药店每日药品销售情况,观察其变化趋势。结果退热药每日平均销量为84包装,止咳类药为2包装,止泻类药为2包装,抗菌素类药为11包装。药品销量随季节变化上下波动。结论药品销量监测可作为居民患病情况的指标,药品销量监测系统对传染病早期预警是有意义的。     

Syndromic surveillance of vaccine-associated adverse events in U.S. emergency departments

The Centers for Disease Control and Prevention explored use of emergency department (ED) visit data, during 2018–2020, from the National Syndromic Surveillance Program to monitor vaccine-associated adverse events (VAE) among all age groups. A combination of chief complaint terms and administrative diagnosis codes were used to detect VAE-related ED visits. Postvaccination fever was among the top 10 most frequently noted diagnoses. VAE annual trends demonstrated seasonality; visits trended upward starting in September of each year, coinciding with the administration of seasonal influenza vaccines. The 2020 VAE-related visit trend declined below the 2018 and 2019 baselines during March 22–September 5, 2020, before returning to the seasonal pattern. VAE-related visits declined in children aged 3–18 years in 2020 compared with 2018–2019, especially in the back-to-school months. These findings demonstrate that syndromic surveillance can complement traditional VAE reporting systems without an additional demand on data collection resources.     

The burden of acute gastrointestinal illness in Ontario, Canada, 2005-2006

A retrospective, cross-sectional telephone survey (n=2090) was conducted in Ontario, Canada, between May 2005 and April 2006, to determine the burden of acute gastrointestinal illness in the population. The 4-week prevalence was 8.56% (95% CI 7.36-9.76); in households with more than one resident, 35% of cases reported someone else in their household had similar symptoms at the same time. The annual adjusted incidence rate was 1.17 (95% CI 0.99-1.35) episodes per person-year, with higher rates in females, rural residents, and in the winter and spring. Health care was sought by 22% of cases, of which 33% were asked to provide a stool sample. Interestingly, 2.2% of cases who did not visit a health-care provider reported self-administering antibiotics. Overall, acute gastrointestinal illness appears to pose a significant burden in the Ontario population. Further research into the specific aetiologies and risk factors is now needed to better target intervention strategies.     

A retrospective study of the accuracy of cancer information in Ontario daily newspapers

CONTEXT: Studies suggest that the mass media is a common source of cancer information for the public. However, the quality of cancer information through various print outlets has not been extensively investigated. OBJECTIVES: To assess the accuracy of cancer information in a retrospective sample of Ontario daily newspapers as well as to determine the amount of mobilizing (enabling) information about community resources for cancer. METHODS AND RESULTS: Of 1,027 articles on cancer for 1991, drawn from the 5 highest and 5 lowest circulating newspapers, a random 30% sample (306 articles) was obtained. Only 40 articles had traceable citations (journal name, name of researcher, name of educational institution, or direct quotes from identifiable sources). Of these, 47.5% had misleading titles and 55% included erroneous information or omitted important study results. Only 13 (6.9%) included mobilizing information regarding prevention, diagnosis, treatment or support. INTERPRETATION: Cancer information in newspapers contain frequent inaccuracies and fail to provide mobilizing information. Inaccurate newspaper information about cancer is of concern if the public relies on this channel for at least part of their health knowledge.     

A prospective study of rural drinking water quality and acute gastrointestinal illness

Background  

This study examined the relationship between the bacteriological contamination of drinking water from private wells and acute gastrointestinal illness (AGII), using current government standards for safe drinking water.     

Syndromic surveillance models using Web data: the case of scarlet fever in the UK

Recent research has shown the potential of Web queries as a source for syndromic surveillance, and existing studies show that these queries can be used as a basis for estimation and prediction of the development of a syndromic disease, such as influenza, using log linear (logit) statistical models. Two alternative models are applied to the relationship between cases and Web queries in this paper. We examine the applicability of using statistical methods to relate search engine queries with scarlet fever cases in the UK, taking advantage of tools to acquire the appropriate data from Google, and using an alternative statistical method based on gamma distributions. The results show that using logit models, the Pearson correlation factor between Web queries and the data obtained from the official agencies must be over 0.90, otherwise the prediction of the peak and the spread of the distributions gives significant deviations. In this paper, we describe the gamma distribution model and show that we can obtain better results in all cases using gamma transformations, and especially in those with a smaller correlation factor.     

Burden of illness associated with Respiratory Syncytial Virus (RSV)-related hospitalizations among adults in Ontario,Canada: A retrospective population-based study

BackgroundGlobally, RSV is a common viral pathogen that causes 64 million acute respiratory infections annually. Our objective was to determine the incidence of hospitalization, healthcare resource use and associated costs of adults hospitalized with RSV in Ontario, Canada.MethodsTo describe the epidemiology of adults hospitalized with RSV, we used a validated algorithm applied to a population-based healthcare utilization administrative dataset in Ontario, Canada. We created a retrospective cohort of incident hospitalized adults with RSV between September 2010 and August 2017 and followed each person for up to two years. To determine the burden of illness associated with hospitalization and post-discharge healthcare encounters each RSV-admitted patient was matched to two unexposed controls based on demographics and risk factors. Patient demographics were described and mean attributable 6-month and 2-year healthcare costs (2019 Canadian dollars) were estimated.ResultsThere were 7,091 adults with RSV-associated hospitalizations between 2010 and 2019 with a mean age of 74.6 years; 60.4 % were female. RSV-coded hospitalization rates increased from 1.4 to 14.6 per 100,000 adults between 2010–2011 and 2018–2019. The mean difference in healthcare costs between RSV-admitted patients and matched controls was $28,260 (95 % CI: $27,728 - $28,793) in the first 6 months and $43,721 over 2 years (95 % CI: $40,383 – $47,059) post-hospitalization.ConclusionsRSV hospitalizations among adults increased in Ontario between 2010/11 to 2018/19 RSV seasons. RSV hospitalizations in adults were associated with increased attributable short-term and long-term healthcare costs compared to matched controls. Interventions that could prevent RSV in adults may reduce healthcare burden.     

Waterborne disease in Colorado: three years' surveillance and 18 outbreaks.

The Colorado Department of Health conducted intensive surveillance for waterborne diseases during the three-year period July 1, 1980-June 30, 1983. Eighteen outbreaks of waterborne illness were investigated. Outbreaks involved from 15 to 1,500 ill persons. Giardia lamblia was confirmed or suspected as the agent in nine outbreaks, rotavirus in one, and no agent could be identified in eight. Seventeen outbreaks occurred on surface-water systems; none of these had adequate chemical pretreatment and filtration. Investigation of water systems exhibiting positive coliform results during the first year detected no outbreaks. Activities important to effective surveillance included educational outreach programs to local health agencies, physicians and the public, and the designation of one individual to whom all water-related public complaints and health department inquiries were directed.     

珠海市2006-2008年流感症状监测分析及预测

目的 了解广东省珠海市2006-2008年流感流行趋势及其病毒株变化特点,预测2009年流行趋势,为本地区防控流感提供科学依据。方法 收集2006-2008年珠海市流感监测哨点流感样病例(ILI)监测和暴发疫情监测资料信息,医院门诊、暴发疫情的流感病毒病原学监测资料,进行综合分析。采用季节性自回归移动平均(ARIMA)构建模型预测2009年ILI的趋势。结果 2006-2008年珠海市流感流行大致呈3-4月和6-7月的双峰型,平均ILI%为4.1%;门诊报告ILI中<5岁儿童为主,占50.3%,构成比逐年上升。哨点医院流感病毒分离阳性率为10.0%,2006年流感季节类型为A(H1N1)型和B型混合型,2007年为A(H3N2)型占优势,2008年为A(H1N1)型和A(H3N2)型混合型。暴发疫情主要发生在3-6月,流行病毒株与医院哨点监测基本一致。结论 珠海市流感流行呈现春夏季双峰型,ILI的高峰较流感病毒早4周左右;H3型、H1型、B型流感病毒交替成为年分离优势株。预测2009年季节性流感流行趋势平稳。     

Involvement of pharmacy faculty in the development of policies for pharmaceutical sales representatives.

BACKGROUND. Few studies evaluating the impact of the pharmaceutical industry on postgraduate medical education have been done. Recently, position statements and professional guidelines have emerged to ensure the integrity of physician-industry relationships in the areas of clinical judgement, research, and medical education. METHODS. The present study surveyed directors of family practice residency programs in the United States to define the level of pharmacotherapy curriculum development and the existence of policies for pharmaceutical sales representatives. RESULTS. Of the 383 directors, 325 (85%) responded to a mailed survey. Nearly one third (32%) of the responding programs had pharmacist faculty, the majority of whom held a doctor of pharmacy degree. Approximately 30% of programs reported that they had printed guidelines for pharmaceutical sales representatives. CONCLUSIONS. Programs with pharmacist faculty are more likely to have a well-developed pharmacotherapy curriculum and printed guidelines for pharmaceutical sales representatives.