2004年全国克山病病情监测汇总分析

目的掌握2004年全国克山病患病及发病趋势。方法根据《克山病监测》标准(WS/T78-1996)及《克山病诊断标准》(GB17021-1997)对监测点区居民进行普查,随访2003年在册的克山病病例,对克山病发病相关因素进行调查。结果18个监测点区潜在型、慢型克山病检出率分别为3.5%和0.7%,估计全国有491万￣600万克山病病例,其中慢型克山病患者65万￣117万。潜在型、慢型克山病发病率分别为1.8‰和0.1‰,估计新发潜在型13万～39万例,新检出慢型病例最高可达4.3万例。人均发硒0.365mg/kg。粮硒平均0.020mg/kg。结论克山病仍然是一个严重的地方性公共卫生问题,工作重点应放在克山病监测、患者管理和硒预防等方面。     

Operationalisation of surveillance of communicable diseases in Chandigarh

Weekly reports of listed communicable diseases from various departments and centres of Government Medical College, Chandigarh, involved in clinical care and laboratory diagnosis, compiled and forwarded by Department of Community Medicine, sub-nodal centre under National Surveillance Programme for Communicable Diseases (NSPCD), to Anti- Malaria-cum-Nodal Officer, NSPCD were analysed for a period of one year Out of 14,082 cases of various communicable diseases 9166 (64.62%) were of Acute Respiratory Infections (ARI), 3586 (25.78%) of Acute Diarrhoeal Diseases (ADDs) and 576 (4.10%) of Pulmonary Tuberculosis. The proportion of ARI appeared higher among females while that of other diseases was higher among males. Most cases of ARI (76.5%) and Pneumonia (3.09%) reported in winter, ADDs (38.89%) and Pulmonary Tuberculosis (4.68%) in summer and Typhoid (1.57%) and Viral Hepatitis (1.23%) in monsoon season. No significant gender predilection was seen. Overall reporting of communicable diseases seen to be significantly more during winter and summer compared to monsoon season, with specific seasonal trends demonstrated by various morbidities.     

Efficient national surveillance for health-care-associated infections

BackgroundThe detection of novel health-care-associated infections as early as possible is an important public health priority. However, no evidence base exists to guide the design of efficient and reliable surveillance systems. Here we address this issue in the context of a novel pathogen spreading primarily between hospitals through the movement of patients.MethodsUsing hospital admission data from the year 2007, we modelled the spread of a pathogen among a network of hospitals connected by patient movements using a hospital-based susceptible-infectious model. We compared the existing surveillance system in Scotland with a gold standard (a putative optimal selection algorithm) to determine its efficiency and to see whether it is beneficial to alter the number and choice of hospitals in which to concentrate surveillance effort.FindingsWe validated our model by demonstrating that it accurately predicted the risk of meticillin-resistant cases of Staphylococcus aureus bacteraemia in hospitals in Scotland in 2007. Furthermore, the model predicted that relying solely on the 29 (out of 182) sentinel hospitals that currently contribute most of the national surveillance effort results in an average detection time (time until first appearance of the pathogen in a hospital) of 117 days. This detection time could be reduced to 87 days by optimal selection of the same number of hospitals. Alternatively, the same detection time (117 days) can be achieved with just 22 optimally selected hospitals. Increasing the number of sentinel hospitals to 38 (teaching and general hospitals) reduced detection time by 43 days; a decrease to seven sentinel hospitals (all teaching hospitals) increased detection time substantially to 268 days.InterpretationOur results show that the present surveillance system used in Scotland is not optimal in detecting novel pathogens compared with a gold standard. However, efficiency gains are possible by better choice of sentinel hospitals, or by increasing the number of hospitals involved in surveillance. Similar studies could be used elsewhere to inform the design and implementation of efficient national, hospital-based surveillance systems that achieve rapid detection of novel health-care-associated infections for minimum effort.FundingThis research received funding from the European Union Seventh Framework Programme (FP7-HEALTH-2011-single-stage): Evolution and Transfer of Antibiotic Resistance (EvoTAR).     

2004年全国大骨节病病情监测总结报告

目的掌握2004年全国大骨节病病情及时间与空间分布。方法在全国大骨节病病区省、自治区各选1～2个当前大骨节病最重病区作为本次监测点,每个点拍摄100名左右7￣12岁儿童右手X线片,按国家级诊断标准(GB),集体读片,确诊病例,确认患病水平。结果东部7省、市共11个监测点的儿童X线检出率均在6%以下。其中黑龙江2个点分别是4.55%和5.83%、吉林2个点分别是1.72%和0.85%、山西2个点分别是2.46%和2.5%、北京1个点是1.67%、山东是1.53%以及河南、河北均为0;西部6省、区(内蒙古、陕西、甘肃、青海、西藏、四川)14个监测点中8个检出率超过10%,其中有半数检出率超过20%,最高的达到27.78%(青海)。结论全国大骨节病病情(检出率)高点继续下移,平均检出率变化不大,西部病区病情严重而突出。西部病区要结合当地具体情况,强化大骨节病防治措施的落实。     

2006年全国克山病病情监测汇总分析

目的 掌握2006年全国克山病患病及发病情况.方法 根据2006年克山病监测方案及<克山病诊断标准>(GB 17021-1997),对27个监测点居民进行查体、描记心电图、疑似病例摄X线胸片等临床检查,同时对克山病发病相关因素进行检测.结果 27个监测点潜在型、慢型克山病检出率分别为2.25%(295/13 090)、0.60%(78/13 090).估计全国有3 370 000～4 110 000例克山病病人,其中慢型克山病患者600 000～940 000例.四川省报告发生6例亚急型克山病,另外新检出克山病潜在型5例,慢型1例.发硒平均水平为0.3282mg/kg,粮硒平均水平为0.0148 mg/kg.结论 历史重病区有新的亚急型克山病发生,克山病仍然是一个严重的地方性公共卫生问题;在进行克山病监测的同时,建议加强患者管理、治疗和重病区克山病的预防工作.     

2007年全国克山病病情监测汇总分析

目的 掌握2007年全国克山病患病及发病情况,为制订克山病防治策略提供科学依据.方法 根据2007年克山病监测方案及《克山病诊断标准》(GB 17021-1997),对15个病区省(区、市)的24个监测点居民进行查体、描记心电图、疑似病例摄X线胸片等临床检查.采集监测点居民主食粮样和发样,检测含硒量.结果 24个监测点居民潜在型、慢型克山病检出率分别为2.4%(465/19280)、0.6%(119/19 280).按检出率区间估计,全国病区有235万例(216万～254万例)克山病病人,其中慢型48万例(39万～57万例).本次监测新检出潜在型克山病85例,慢型克山病9例.15个省(区、市)的22个监测点心电图检查的异常率为14.3%(2554/17 801).14个省(区、市)22个监测点X线胸片检查有心胸比例增大者占38.8%(285/734).11个省(区、市)17个监测点共采集发样566份,发硒平均水平为0.3848 mg/kg;15个监测点采集小麦254份.平均硒水平为0.0428 mg/kg;采集玉米213份.平均硒水平为0.0250 mg/kg.结论 克山病仍然是严重的地方性公共卫生问题.要坚持做好克山病监测工作,改进抽样方法,增强监测的代表性;建议加大监测的投入.开展概率抽样,进行总体推断.以适应克山病新形势下的要求.     

2005年全国克山病病情监测汇总分析

目的掌握2005年全国克山病患病及发病情况。方法按统一监测方案并根据《克山病诊断标准》(GB 17021-1997)对22个克山病监测点区居民进行查体,描12导联心电图,疑似病人摄2 m后前位X线胸片及居民发硒、粮硒测定。结果22个监测点潜在型、慢型克山病检出率分别为3．5％和0．6％;新检出潜在型克山病7例,慢型克山病1例;人均发硒0．349 mg／kg,粮食硒0．025 mg／kg。结论监测点仍有潜在型和慢型克山病新发病例出现,说明克山病仍然是一个严重的地方性公共卫生问题;工作重点应放在克山病监测、硒预防、患者管理、治疗以及加强防治队伍培训等方面。     

Short communication: Strengthening sub-national communicable disease surveillance in a remote Pacific Island country by adapting a successful African outbreak surveillance model

Successful communicable disease surveillance depends on effective bidirectional information flow between clinicians at the periphery and communicable disease control units at regional, national and global levels. Resource-poor countries often struggle to establish and maintain the crucial link with the periphery. A simple syndrome-based outbreak surveillance system initially developed and evaluated in Mpumalanga Province, South Africa was adapted for the Pacific island nation of Tuvalu. Eight syndromes were identified for surveillance: acute flaccid paralysis (poliomyelitis), profuse watery diarrhoea (cholera), diarrhoea outbreak, dysentery outbreak, febrile disease with abdominal symptoms and headache (typhoid), febrile disease with generalized non-blistering rash (measles), febrile disease with intense headache and/or neck stiffness with or without haemorrhagic rash (meningococcal meningitis), and outbreaks of other febrile diseases of unknown origin. A user-oriented manual, the Tuvalu Outbreak Manual (http://www.wepi.org/books/tom/), was developed to support introduction of the surveillance system. Nurses working in seven outer island clinics and the hospital outpatient department on the main island rapidly report suspected outbreaks and submit weekly zero-reports to the central communicable disease control unit. An evaluation of the system after 12 months indicated that the Outbreak Manual was regarded as very useful by clinic nurses, and there was early evidence of improved surveillance and response to the disease syndromes under surveillance.     

2000-2007年全国大骨节病病情监测结果分析

目的 掌握全国大骨节病病情变化,为制订大骨节病防治策略提供科学依据.方法 采用资料回顾方法,收集2000-2007年全国大骨节病病情监测数据,分析2000-2007年我国大骨节病X线检出率变化,比较东、两部大骨节病病情.结果 2000-2007年全国14个省(区、市)共上报了189个监测点的监测数据,拍摄儿童右手X线片21 287张;2000-2007年全国大骨节病X线检出率呈明显下降趋势,西部病情重于东部,西部平均X线检出率水平由2000年的21.75%下降到了2007年的7.30%;除青海、西藏和内蒙古等个别省(区)外,其他省(区)病情已经基本得到控制,其他各省X线检出率均已在5%以下.结论 按X线诊断,已有90%的病区达到控制水平;按病区类型划分,以轻病区为主,中等病区为10%左右,重病区不到1%.