症状监测发展方向与问题思考

近十年来,症状监测(Syndromic surveillance)在理论与实践方面均取得很大进展,技术手段趋于成熟。症状监测系统的设计与运行,不但应遵从公共卫生监测基本准则,还应具备自身特色,体现其早期预警、方便快捷的优势。中国符合症状监测理念的疾病监测系统,包括脊髓灰质炎(AFP)监测、流感样病例监测,以及2004年为了传染性非典型肺炎(SARS)及禽流感预警而开展的“不明原因肺炎”监测等[1]。当前和今后一段时期,在中国发展症状监测,需对其在公共卫生领域的定位、今后的发展方向等问题进行认真思考。     

症状监测与监测数据源

1979年,俄罗斯发生一起炭疽杆菌事故性排放,在炭疽暴发事件被确认前,至少有6例炭疽患者被诊断为轻症疾病而未予收治;当实验室确认炭疽杆菌存在时,已有21人死亡。该起事件充分体现了疾病暴发早期预警的重要性。在全球生物恐怖威胁与传染病暴发形势日益严峻的今天,对传染病暴发流行及突发公共卫生事件预警的要求愈加迫切。因此,各种新的公共卫生监测系统应运而生,“症状监测”为目前各国在理论与实践中探索较多的一种疾病监测手段。     

医院感染性疾病症状监测体系的建立与应用尝试

目的 探讨构建医院感染性疾病症状监测体系的方法.方法 利用数据挖掘技术将医院信息系统(HIS)中的数据集成到医院感染性疾病症状监测体系内,并对数据进行分析整理.结果 医院感染性疾病症状监测体系具有快速、有效的特点,能充分利用资料.结论 医院感染性疾病症状监测体系提高了医院感染性疾病的管理水平,为综合性医院应对突发公共卫生事件奠定基础.     

浅谈应对突发公共卫生事件进行症状监测所面临的困难

目的：探讨在我国开展症状监测的困难。方法：本文通过分析症状监测的应用、优点和局限性，结合我国现状阐述。结果：症状监测是致力于早期发现突发公共卫生事件的主动监测系统，在我国受人力、物力、财力的限制。结论：症状监测系统必须和传统的公共卫生监测系统、先进的实验室网络体系有机结合，互相补充，并辅以相应的政策和技术支持，才能促进我国突发公共卫生事件预警应急体系的建立和发展。     

有效探查暴发的方法--症状监测

公共卫生监测是对描述和监控健康事件的数据进行持续、系统的收集、分析和解释,并快速地把数据资料分发给有关部门,使之用于规划、完善和评价公共卫生干预措施及方案的过程.     

传染病实验室监测实践——国家致病菌识别网

国家致病菌识别网作为我国传染病实验室监测实践,建立至今经历了起步、扩展和提升3个阶段。自2004年以来,通过病原菌鉴定和特征分析技术的更新换代、监测信息化系统的研发和完善、网络实验室成员覆盖范围和层级的逐步扩展,已经发展成为相对完善的细菌性传染病实验室监测网络,在我国细菌性传染病的监测预警和疫情处置中发挥了重要作用。     

护理人员开展医院传染病症状监测预警的可行性分析

传染病疫情防控形势日益严峻,护理人员在应对传染病疫情防控和开展救护工作中的作用十分重要。通过政策查阅和文献检索,结合医院传染病症状监测预警发展现况,分析我国护理人员在医院开展传染病症状监测预警的可行性,并对未来护理人员开展传染病症状监测预警在资源优化、岗位职责落实以及能力培训方面进行探讨,为护理人员开展传染病监测预警工作,提升医院传染病防控能力提供参考。     

新发传染病

新发传染病（emerging infectious diseases）是指新近30年来人们新认识到的或新发现的那些能造成地域性或国际公共卫生问题的新识别的和以往未知的传染病。     

发热症状监测的预警事例分析

目的为早期发现或检出疾病暴发,提供预警信号。方法对杭州市发热监测哨点数据进行时间趋势分析。结果对2004年2～3月发生的流感局部流行进行了成功预警。结论发热症状监测对于早期发现的以发热为主的呼吸道传染病疫情,采取及时有效的控制措施,降低患病率和减少经济损失具有至关重要的作用。     

新形势下新建传染病医院人力资源建设探讨

随着国家对公共卫生体系建设的重视，原有传染病医院的壮大发展与新建传染病医院的建设曾一度成为人们关注的焦点，一些被控制的传染病“死灰复燃”与新发传染病的频频问世，使传染病医院面临严峻的考验与挑战，尤其是新建传染病医院，如何在较短的时间内另辟蹊径，建立合理的人才梯队，使各项工作尽快步人良性运行轨道，在变革中寻求发展，成为当前新建传染病医院管理中需认真探讨的难点与热点问题。     

ED syndromic surveillance for novel H1N1 spring 2009

Purpose

The aim of this study is to demonstrate the use of emergency department (ED) syndromic surveillance in the setting of a novel and unexpected H1N1 influenza outbreak.

Basic Procedures

Data collection from ED electronic medical records was used to track initial chief complaint and discharge International Classification of Diseases, Ninth Revision, codes related to influenza-like illness (ILI). An alert threshold was generated using cumulative sum sequential analysis technique. The data were retrospectively analyzed to identify alerts that correlated with novel influenza H1N1 illness.

Main Findings

Our system alerted for ILI earlier than both the official national Centers for Disease Control and Prevention (CDC) press release for novel H1N1 and the first laboratory confirmed case in our county.

Principal Conclusions

Emergency department syndromic surveillance can be used to detect unexpected ILI before laboratory confirmation and serve as an adjunct to traditional laboratory-guided public health alerts. Early identification may allow for more efficient laboratory testing and early implementation of respiratory isolation precautions.     

A test of syndromic surveillance using a severe acute respiratory syndrome model

Objectives

We describe a field simulation that was conducted using volunteers to assess the ability of 3 hospitals in a network to manage a large influx of patients with a potentially communicable disease. This drill provided the opportunity to evaluate the ability of the New York City Department of Health and Mental Hygiene's (NYC-DOHMH) emergency department chief complaint syndromic surveillance system to detect a cluster of patients with febrile respiratory illness.

Methods

The evaluation was a prospective simulation. The clinical picture was modeled on severe acute respiratory syndrome symptoms. Forty-four volunteers participated in the drill as mock patients.

Results

Records from 42 patients (95%) were successfully transmitted to the NYC-DOHMH. The electronic chief complaint for 24 (57%) of these patients indicated febrile or respiratory illness. The drill did not generate a statistical signal in the NYC-DOHMH SaTScan analysis. The 42 drill patients were classified in 8 hierarchical categories based on chief complaints: sepsis (2), cold (3), diarrhea (2), respiratory (20), fever/flu (4), vomit (3), and other (8). The number of respiratory visits, while elevated on the day of the drill, did not appear particularly unusual when compared with the 14-day baseline period used for spatial analyses.

Conclusions

This drill with a cluster of patients with febrile respiratory illness failed to trigger a signal from the NYC-DOHMH emergency department chief complaint syndromic surveillance system. This highlighted several limitations and challenges to syndromic surveillance monitoring.     

上海市浦东新区幼托机构缺课缺勤症状监测系统预警效果评价

目的 评价上海市浦东新区幼托机构缺课缺勤症状监测系统对目标人群传染病发生流行的预警效果。方法 分析上海市浦东新区幼托机构缺课缺勤症状监测系统2013年9月1日至2014年6月30日和2014年9月1日至2015年6月30日两个学年的监测数据,并将其与同期浦东新区幼托儿童法定报告传染病数据比较,采用错位相关分析对两时间序列数据的相关性进行研究,探索利用幼托机构缺课缺勤数据及时预警幼托机构法定报告传染病的可行性及其效果。结果 幼托机构缺课缺勤系统中报告的发热症状、皮疹类症状与该人群发热、皮疹类相关法定报告传染病疫情具有显著相关性,其中发热症状、皮疹类症状均可提前1~3周发现相关目标疾病的波动。结论 发热症状和皮疹类症状在一定程度上可提示相关法定报告传染病的疫情波动,利用该监测数据的分析可起到传染病的预警及流行趋势预测作用。     

Practical solutions for injury surveillance at mass gatherings

INTRODUCTION: Public safety at mass gatherings is the responsibility of multiple agencies. Injury surveillance and inter-agency communication are pivotal to ensure continued public safety. OBJECTIVES: The principal objective of this pilot study was to improve the identification of trends and patterns of injury presentations at mass gatherings. This was achieved through an electronic process for data gathering to support timely reporting of injury data. In addition, what evolved was the development of an inter-agency communication model to support information transfer. METHODS: An Electronic Injury Surveillance System was created and piloted at two mass gatherings in South Australia. Live, real-time data were collected via customized software supported by electronic report generation. RESULTS: The Injury Surveillance System captured data on 181 injured patients and assisted in the identification of trends and patterns of presentations. The relevant injuries and patterns of injuries were reported to the appropriate organizations based on pre-defined communication models. CONCLUSIONS: The pilot study demonstrated that it was possible to perform "live", portable injury surveillance during patient presentations at two mass gatherings. The Injury Surveillance System ensured immediate data capture. Well-defined communication systems established for this pilot also enabled early action to rectify hazards. Further development of electronic injury surveillance should be considered as an essential tool for managing public safety at mass gatherings.     

Forecasting respiratory infectious outbreaks using ED-based syndromic surveillance for febrile ED visits in a Metropolitan City

Background

Monitoring and detecting sudden outbreaks of respiratory infectious disease is important. Emergency Department (ED)-based syndromic surveillance systems have been introduced for early detection of infectious outbreaks. The aim of this study was to develop and validate a forecasting model of respiratory infectious disease outbreaks based on a nationwide ED syndromic surveillance using daily number of emergency department visits with fever.

Under surveillance

This article outlines the importance of surveillance of healthcare-associated infections (HAIs), and argues for extension of mandatory surveillance.     

Screening and surveillance. OSHA's medical surveillance provisions.

The OSH Act requires OSHA to include provisions for medical examinations of employees in its standards. However, the specific test and examinations criteria are not outlined in the OSH Act. Instead, each standard has specific medical surveillance requirements. These are specific to the adverse health effects triggered by exposure to the hazardous substance. The OSHA uses the term medical surveillance to refer to its employee examination and testing provisions. Most occupational health professionals call this activity employee screening and reserve the term surveillance for aggregate analysis of population data. It is important to remember this distinction when referring to OSHA standards. Many standards are challenged in court resulting in changes to medical surveillance provisions of the standards. Some court decisions support OSHA's language. In either case, the court often sets precedents for future standards.