流感监测中儿童流感样病例定义探讨

目的探讨流感监测中儿童流感样病例的定义。方法对武汉地区1994～2004年的流感监测资料进行回顾性统计分析。结果在1003例研究对象中301例（30．01％）被证实存在流感病毒感染，两个年龄组的流感发病率差异有统计学意义（P=0．024），A型和B型流感病毒感染后“卡他症状”（P=0．0242）和“咽痛”（P=0．0091）的出现率差异有统计学意义；进入logistic回归模型的5个变量为：体温（OR=1．555）、发病天数（OR=0．591）、咳嗽（OR=2．369）、卡他症状（OR=1．873）、咽痛（OR=2．061）；用“咳嗽伴有卡他症状或咽痛”症状组合预测儿童流感感染的阳性预测值为41．3％，阴性预测值为78．4％，灵敏度为58．8％，特异度为64．1％。结论流感监测中儿童流感样病例较科学合理定义为：发热（体温≥38℃）、咳嗽并伴有卡他症状或咽痛之一者。     

353例流感样病例的强化监测结果与分析

[目的]分析禽流感监测期间353例流感样病例的临床特点和病毒学检测结果。[方法]回顾性分析2009年1月7～14日接诊的居住在宣武区符合流感样病例的353例(14岁以上)患者的临床特点,及咽拭子病毒学检测结果。[结果]该研究显示流感样病例占同类患者的52.6%,20～29岁患者组明显高于其他各组(40.5%)。T≥38.5℃者占71.3%(251/352)。伴有咳嗽者占64.2%,有咽痛者占48.5%。14%的患者除发热外无呼吸道症状。血白细胞计数多正常(占87.7%),X线胸片上表现为肺炎者占5%。流感快诊阳性者19例,占5.4%(19/353),其中52%(10/19)的患者为季节性流感H1型病毒。[结论]353例流感样病例的强化监测中,未发现禽流感。     

2009—2015年崇左市流感样病例监测结果分析

目的 了解崇左市流行性感冒(流感)流行特征及其变化的规律,为流感的预防控制提供科学依据.方法 对2009年8月至2015年12月崇左市流感监测哨点医院的流感样病例(influenza like illness,ILI)及其病原学监测结果进行分析.结果 2009年8月至2015年12月流感监测哨点医院共报告门急诊流感样病例15347例,占门急诊病例的2.51%.14岁以下的青少年儿童为主要发病人群,占57.67%.2009年、2011年、2013年以甲型H1N1为优势毒株分别占75.22%、78.19%、70.73%,其余4年以季节性H3N2和乙型为优势毒株,其中甲型H1N1、季节性H3N2型和乙型流感病毒其优势性呈现交替式变化.结论 崇左市流感流行具有明显的季节性,14岁以下的青少年儿童为主要发病人群,由不同亚型毒株交替流行所致.     

流感样病例定义对流感监测结果影响的比较分析

目的 比较不同临床症状的流感样病例流感检出情况的差异,探讨采用不同流感样病例定义对流感监测结果的影响。方法 根据2015年上海市2家国家级流感监测哨点医院的流感病原学监测数据和病例临床症状,计算不同临床症状（有咳嗽咽痛、仅咳嗽、仅咽痛）的流感样病例流感病毒检出情况,并通过多因素Logistic回归分析流感病毒检出情况的影响因素。结果 2 010例流感样病例中,有咳嗽咽痛者1 105例、仅有咳嗽者270例、仅有咽痛者635例,流感阳性率分别为36.2%、39.3%和15.9%,经分析,有咳嗽咽痛者、仅有咳嗽者的流感阳性检出率均高于仅有咽痛者（均有P<0.05）。对于发病3 d内采样的流感样病例,有咳嗽咽痛、仅有咳嗽者的流感阳性检出率均高于仅咽痛者（均有P<0.05）。多因素Logistic回归分析结果显示,流感病毒检出情况与病例体温（≥ 39℃）（OR=1.719,95%CI：1.389~2.127）、咳嗽（OR=3.046,95%CI：2.377~3.905）有关。结论 建议以"发热（体温≥ 38℃）伴咳嗽症状者"作为流感监测中的流感样病例定义。     

贵州省2012-2019年度流感样病例监测结果分析

目的 分析贵州省2012-2019年流感监测结果,为全省流感防控提供依据。方法 通过中国疾病预防控制信息系统收集哨点医院流感样病例（ILI）监测数据,运用描述性流行病学方法对贵州省2012-2019年度流感监测结果进行分析。结果 贵州省2012-2019 年度哨点医院共报告ILI 728970 例, ILI 占门急诊就诊病例比例为6.49%（4.34%~7.25%）。儿内科急诊ILI%最高,为65.52%,ILI主要集中在15岁以下的儿童,占90%。随着年龄的增长,ILI 比例逐渐递减,60岁以上年龄组人群所占比重最低,为2.69%。ILI%呈现冬春季和夏季2个流行高峰。完成核酸检测流感样病例标本90380份,核酸阳性12090份,阳性率为13.38%（10%~20%）。核酸阳性时间和地区分布呈现交替升降,黔东南和黔西南每个年度核酸阳性率都高。2014-2015年度和2016-2017年度以季节H3流感为主要优势毒株,2013-2014年度和2017-2018年度以甲型H1N1流感和B型流感共同流行,2015-2016年度以季节H3流感和B型流感为优势株,2018-2019年度以季节H3型流感和甲型H1N1流感为主。结论 儿童和学生是重点防控对象,流感病毒流行优势株交替出现,应加强流感防控工作,及时做好流感监测和预测预报。     

无锡市气温对流感样病例和实验室确证流感病例的影响

  目的  了解无锡市气温对流感样病例和实验室确证流感病例的影响。  方法  收集无锡市2012年12月31日至2017年12月31日期间流感样病例监测数据、实验室病原监测数据及同期气象数据资料。利用分布滞后非线性模型研究气温与流感样病例和实验室确证流感病例的关系。  结果  2012-2017年无锡市流感病例监测（influenza-like illness,ILI）总ILI%为4.96%,流感检测阳性率12.28%。无锡市气温对流感样病例的累积效应曲线呈近似"U"型,低温（10℃以下）和高温（20℃以上）均影响流感样病例的发生,低温效应滞后且效应较强,高温效应出现迅速且效应短暂。对实验室确证流感病例的累积效应呈近似"L"型,主要表现为较强的低温滞后效应,10℃以下实验室确证流感发病风险较高。  结论  气温影响流感样病例和实验室确证流感病例的发病,低温是危险因素且存在滞后效应。     

Heterogeneous case definitions used for the surveillance of influenza in Europe

We reviewed the case definitions used by 21 influenza sentinel-based surveillance networks in Western Europe. Two clinical syndromes were used with a wide range of case definitions that nevertheless shared common criteria. Although there is currently no international consensus, efforts are being undertaken to standardise influenza case definitions in Europe.     

The STRONGkids nutritional screening tool in hospitalized children: A validation study

ObjectiveThe STRONG_kids is a nutritional screening tool for hospitalized children, which was found to predict a negative weight for height (WFH) standard deviation score (SDS) and a prolonged hospital length of stay (LOS) in a Dutch population of hospitalized children. This study aimed to test the ease of use and reproducibility of the STRONG_kids, and to confirm its concurrent and prospective validity in a Belgian population of hospitalized children.MethodsReproducibility was tested in a cohort of 29 hospitalized children in a tertiary center and validity was tested in 368 children (105 hospitalized in a tertiary and 263 in three secondary hospitals) ages between 0.08 and 16.95 y (median 2.2 y).ResultsSubstantial intrarater (κ = 0.66) and interrater (κ = 0.61) reliabilities were found between observations. STRONG_kids scores correlated negatively with WFH SDS of the patients (ρ = –0.23; P < 0.01; odds ratio [OR], 2.47; 95% confidence interval [CI], 1.11–5.49; P < 0.05). It had a sensitivity and negative predictive value (NPV) of respectively 71.9% and 94.8% to identify acutely undernourished children. STRONG_kids did not correlate with weight loss during hospitalization, but correlated with LOS (ρ = 0.25; OR 1.96; 95% CI, 1.25–3.07; both P < 0.01) and the set-up of a nutritional intervention during hospitalization (OR, 18.93; 95% CI, 4.48–80.00; P < 0.01). The sensitivity and NPV to predict a LOS ≥ 4 d were respectively 62.6% and 72%, and respectively 94.6% and 98.9% to predict a nutritional intervention.ConclusionsSTRONG_kids is an easy-to-use screening tool. Children classified as “low risk” have a 5% probability of being acutely malnourished, with only a 1% probability of a nutritional intervention during hospitalization.     

Impact of influenza-like illness and effectiveness of influenza vaccination in oncohematological children who have completed cancer therapy

In order to evaluate the impact of influenza-like illness and the effectiveness of influenza vaccination in children with oncohematological disease who have completed cancer therapy, 182 children with a diagnosis of oncohematological disease were divided into two subgroups on the basis of the length of time off therapy (<6 months or 6–24 months) and randomised 1:1 to receive influenza vaccination or not. The controls were 91 otherwise healthy children unvaccinated against influenza. The results show that the clinical and socioeconomic impact of influenza-like illnesses and the effectiveness of influenza vaccination in oncohematological children who have completed cancer therapy are related to the length of the off therapy period, and seem to be significantly greater in those who have been off therapy for less than 6 months in comparison with healthy controls. This suggests that the administration of influenza vaccination should be strongly recommended only among oncohematological children who have been off therapy for less than 6 months.     

长沙市哨点医院流感样病例监测模式效果评价

目的 评估电子信息系统在哨点医院流感样病例监测中的运行效果,探讨流感样病例监测新模式.方法 在长沙市两家哨点医院中的一家医院(长沙市中心医院)中采用电子信息系统收集监测门诊信息和流感样病例(ILI)信息,在另一家医院(长沙市第一医院)中继续实行手工登记方式收集相关信息.从“中国流感监测信息系统”中导出2010年第6周-2015年第5周两家医院的ILI监测数据进行统计分析.结果 手工登记时期与HIS过渡时期两家哨点医院ILI％差值的差异没有统计学意义,手工报表时期与HIS正式运行时期两家哨点医院ILI％差值的差异有统计学意义,HIS过渡时期与HIS正式运行时期ILI％差值的差异有统计学意义.结论 HIS操作简单,数据客观,利用HIS收集和报告ILI信息的方式必将逐渐取代传统的手工报告方式,成为一种新的流感样病例监测模式.     

1999～2008年住院儿童死亡状况及相关因素分析

目的:了解近10年住院患儿死因变化情况及性别、年龄、季节分布情况。方法:统计近10年住院患儿死亡病例,根据国际疾病《ICD-10》分类原则进行分类,采用SPSS进行统计处理。结果:近10年住院儿童死亡率总体呈下降趋势;住院男女死亡之比为1.6∶1;住院女童死亡率略高于住院男童死亡率;极端的气候影响死亡率的高低;1岁以内婴儿死亡比例最高;近10年死因位于前5位的疾病分别为:先天异常(28.0%)、恶性肿瘤(22.5%)、新生儿疾病(9.9%)、呼吸系统疾病(9.4%)和传染性疾病(7.1%)。结论:对儿童疾病应以预防为主,加强孕前体检和孕育指导,降低新生儿出生缺陷,加强新生儿筛查工作,对早期疾病及时干预,关注女童健康,控制环境危害对儿童健康的影响。     

Internet-based monitoring of influenza-like illness in the general population: Experience of five influenza seasons in the Netherlands

Like in most other countries, influenza surveillance in The Netherlands is based upon influenza-like illness (ILI) consultations reported by sentinel general practitioners (GP). In addition, an internet-based monitoring of ILI in the general population started in 2003/2004 (Great Influenza Survey (GIS)). We compared GIS results over 5 influenza seasons with results from the GP system. Weekly ILI incidence from GIS correlated well with ILI incidence from the GP system the same week and even better 1 week later. This suggests that GIS is useful for early detection of trends in influenza activity. However, two important vulnerable groups, children and the elderly, are clearly underrepresented in the GIS. Furthermore, virological confirmation is lacking in the GIS. So, GIS can be a useful addition to the GP system, especially when representativeness can be improved and when participation remains at the current high level.