Improving surveillance of infectious diseases in New South Wales

OBJECTIVE: To determine the feasibility of laboratory reporting of infectious diseases and to compare the value of this system with the existing medical practitioner notification system. DESIGN: A sample of notifications was selected from medical practitioner notifications and was compared for both completeness and timeliness of notification with a sample of notifications obtained through the Laboratory Infectious Diseases Surveillance Project. SETTING: The New South Wales Health Department and the Public Health Unit of the Eastern Sydney Area Health Service. PARTICIPANTS: Medical practitioners forwarding notifications of infectious diseases to the New South Wales Health Department and laboratories participating in the Laboratory Infectious Diseases Surveillance Project. MAIN OUTCOME MEASURES: We counted the number of infectious diseases reported by medical practitioners and participating laboratories and estimated the proportion of these diseases which were common to both sources of data. We also estimated the time taken between the diagnosis of a notifiable infectious disease and the receipt of the notification by the Medical Officer of Health. RESULTS: There was substantial underreporting of notifiable infectious diseases by medical practitioners. During the study there were 461 cases of a notifiable disease reported by either medical practitioners or by participating laboratories. Of these cases, 75% were reported only by laboratory staff, 20.2% were reported by medical practitioners alone and 4.8% of cases were reported by both laboratory staff and medical practitioners. The Medical Officer of Health received the reports from the participating laboratories within a significantly shorter time than the notifications from medical practitioners. CONCLUSION: The use of infectious disease notifications by laboratories can substantially improve the surveillance of infectious diseases.     

深圳市2007～2008年传染病暴发疫情监测分析

目的对深圳市2007~2008年暴发疫情监测系统的运行结果进行流行病学分析,分析两年监测结果的异同。方法对法定传染病疫情及常见的非法定传染病疫情报告建立主动监测网络直报系统,应用描述性流行病学方法,从深圳市暴发疫情监测系统导出2007及2008年的监测数据Excel报表,利用SPSS 13.0进行统计分析。结果深圳市2008年聚集性病例及暴发疫情共报告197起,总病例数2 489例,分别较2007年下降3.4%和83%。2008年暴发疫情仍集中在流感、水痘、手足口病等为代表的呼吸道和肠道传染病;暴发疫情多集中发生在中小学和幼儿园等集体单位;2008年传染病暴发疫情的高峰分别发生在3-6月和12月,这与同年散发疫情分布有所区别。结论深圳市2008年传染病暴发疫情较2007年有所下降,但流行特征类似。依托各级疾控机构和医疗机构建立的暴发疫情网络直报系统是行之有效的,它能与国家疾病监测信息报告管理系统和突发公共卫生事件报告管理信息系统互为补充。     

深圳市福田区托幼机构传染病暴发疫情与管理调查

目的调查深圳市福田区托幼机构传染病暴发疫情,分析公立和私立托幼机构暴发疫情特征及相关影响因素,为托幼机构传染病防控提供参考依据。方法收集福田区2005~2013年所有上报的托幼机构暴发疫情数据进行流行病学分析。结果全区2005~2013年托幼机构共报告暴发疫情88起,其中公立托幼机构37起,罹患率8.05%,私立托幼机构51起,罹患率10.05%,两者差别有统计学意义(χ2=8.44,P0.05)。公立和私立托幼机构报告病种均以丙类传染病为主,疫情持续时间私立托幼机构明显长于公立托幼机构(t=-3.09,P0.05)。私立托幼机构在传染病管理方面也略逊于公立托幼机构,特别是在园医配置和发病班级单独加强消毒落实率等方面。结论私立托幼机构在传染病管理和疫情防控方面明显差于公立托幼机构,应加大政府补贴或社会投入,保障私立托幼机构传染病管理与防控经费,同时采取有效的管理措施,规范和完善私立托幼机构的传染病管理工作,确保儿童身心健康。     

Bound for Sydney town: health surveillance on international cruise vessels visiting the Port of Sydney

A program for routine health surveillance on international cruise ships visiting the Port of Sydney has been developed since 1998. Before introduction of this program, ships only reported quarantinable diseases and were not aware of the Australian requirement to report other infectious diseases. Voluntary routine reporting, developed in partnership with the cruise ship industry, provides timely information on all infectious diseases of public health interest during every cruise. During 1999-2003, the program resulted in detection of and response to 14 outbreaks of gastroenteritis or acute respiratory infection, affecting more than 1400 passengers and crew. The program has improved preventive action, and risk communication and management by cruise ship operators, and led to more timely investigation and support by public health authorities.     

2005-2012年金昌市法定传染病网络直报质量评价

目的：评价2005-2012年金昌市法定传染病网络直报质量,为进一步加强报告质量提供依据.方法：整理2005-2012年金昌市法定传染病个案数据库,应用各项质量评价指标完成评价.结果：2005-2012年金昌市法定传染病网络直报及时报告率和及时审核率均达100％;“填卡医生空缺率”、“工作单位空缺率”、“14岁以下家长空缺率”“学生和儿童工作单位空缺率”分别为：5.76％、78.92％、21.45％和61.36％;实际重卡率和错卡率分别为2.46％和0.19％.结论：金昌市传染病网络直报系统覆盖率、网络报告率较高;“疾病监测信息报告管理系统”报告质量结果不能很好评价传染病网络直报质量;卫生机构网报责任心的加强、疾控机构督导工作的规范化和卫生行政部门奖惩制度的完善也许对提高传染病网络直报质量大有裨益.     

Conceptual model for automatic early warning information system of infectious diseases based on internet reporting surveillance system

Objective To establish a conceptual model of automatic early warning of infectious diseases based on internet reporting surveillance system, with a view to realizing an automated warning system on a daily basis and timely identifying potential outbreaks of infectious diseases. Methods The statistic conceptual model was established using historic surveillance data with movable percentile method. Results Based on the infectious disease surveillance information platform, the conceptual model for early warning was established. The parameter, threshold, and revised sensitivity and specificity of early warning value were changed to realize dynamic alert of infectious diseases on a daily basis. Conclusion The instructive conceptual model of dynamic alert can be used as a validating tool in institutions of infectious disease surveillance in different districts.     

Mandatory reporting of infectious diseases by clinicians

Reporting of cases of communicable disease is important in the planning and evaluation of disease prevention and control programs, in the assurance of appropriate medical therapy, and in the detection of common-source outbreaks. In the United States, the authority to require notification of cases of disease resides in the respective state legislatures. We examined the laws and regulations of health departments of all US jurisdictions to ascertain diseases and conditions currently required to be reported in each state or territory. We present herein the state reporting requirements for infectious diseases and infectious disease-related conditions. To obtain additional information regarding time frames for reporting, agencies to which reports are required, persons required to report, and specific conditions under which reports are required, the reader is referred to the statutes and health department regulations of the respective states.     

Notification of infectious diseases by general practitioners: a quantitative and qualitative study

OBJECTIVE: To examine general practitioners' knowledge and practices concerning reporting of notifiable conditions, and to examine barriers to notification of infectious diseases by general practitioners and identify strategies for improving the notification process. DESIGN AND SETTING: Audit of the 100 most recent notifications received by the South Eastern Sydney Public Health Unit of cases of each of hepatitis A, pertussis and measles; and focus groups with GPs practising in Sydney's eastern and southern suburbs, some of whom were selected on the basis of their notification practices. RESULTS: Although these diseases are notifiable on clinical suspicion, only about 40% of the hepatitis A and pertussis cases and 80% of measles cases (54% overall) had been notified by GPs. Delays between doctor and laboratory notifications were an average of seven days for hepatitis A, 19 days for pertussis and seven days for measles. Focus groups showed that at least some GPs have poor understanding of the process of notification, most felt uncomfortable notifying an unconfirmed case, many preferred to leave notification to the laboratory because of concerns about damaging the doctor-patient relationship, and that there is need for financial or other incentives. CONCLUSIONS: There are deficiencies in the completeness and timeliness of notification by GPs which may adversely affect the timing of prophylaxis and outbreak control. Notification by GPs may be improved by such strategies as better notification forms and better feedback to doctors on the outcomes.     

海口市2008年医疗机构法定传染病报告质量分析

目的分析海口市2008年各级医疗机构法定传染病报告质量,以便进行规范管理。方法抽查61个医疗机构,通过访谈和随机查阅门诊日志、出入院登记、化验室登记、纸质传染病报告卡等有关资料,与传染病直报系统数据进行比较,分析不同级别医疗机构的传染病报告质量。结果被考核医疗机构传染病漏报率为11.38%,报告及时率为78.89%,报告卡准确率为87.30%;二级医疗机构报告质量高于其他级别医疗机构;化验室的漏报率为29.14%,是漏报的主要环节。结论海口市各级医疗机构法定传染病报告与管理工作均亟待提高,应针对不同级别的医疗机构进行分类指导,加强监管。     

The EpiCanvas infectious disease weather map: an interactive visual exploration of temporal and spatial correlations

Advances in surveillance science have supported public health agencies in tracking and responding to disease outbreaks. Increasingly, epidemiologists have been tasked with interpreting multiple streams of heterogeneous data arising from varied surveillance systems. As a result public health personnel have experienced an overload of plots and charts as information visualization techniques have not kept pace with the rapid expansion in data availability. This study sought to advance the science of public health surveillance data visualization by conceptualizing a visual paradigm that provides an 'epidemiological canvas' for detection, monitoring, exploration and discovery of regional infectious disease activity and developing a software prototype of an 'infectious disease weather map'. Design objectives were elucidated and the conceptual model was developed using cognitive task analysis with public health epidemiologists. The software prototype was pilot tested using retrospective data from a large, regional pediatric hospital, and gastrointestinal and respiratory disease outbreaks were re-created as a proof of concept.     

2009年唐山市法定传染病疫情及防控对策分析

目的了解我市1年来法定传染病流行态势,掌握传染病的流行特点和影响因素,为制订传染病防治对策提供科学依据。方法采用描述性流行病学方法对我市2009年各类法定报告传染病疫情资料进行分类统计分析。结果 2009年我市共报告乙丙类传染病23种35 010例,发病率479.59/10万,无甲类传染病疫情。传染病构成以肠道传染病、血液及性传播疾病、呼吸道传染病为主,其中感染性腹泻(30.33%)、病毒性肝炎(22.21%)、手足口病(21.37%)、肺结核(12.29%)和流行性腮腺炎(4.96%)等传染病发病率位居前5位。结论预防控制肠道传染病、血液及性传播疾病、呼吸道传染病是今后传染病防治工作的重点。     

某综合医院2010-2014年传染病疫情分析

目的了解近五年某地市级综合医院传染病病例疫情情况,分析其流行病学特征,为探索医院传染病预防控制工作提供科学依据。方法采用描述性流行病学方法和Excel 2007软件对传染病疫情报告资料进行分析。结果2010—2014年法定报告的传染病发病例数基本呈持续上升趋势。2010—2014年共报告传染病11673例次,发病数居前5位的传染病依次为手足口病、乙型肝炎、梅毒、生殖道沙眼衣原体感染、肺结核,分别占21.17％、12.44％、12.16％、8.51％和7.52％;总死亡数为21例,病死率为1.799‰。5年来,不同传染病发病数呈现出不同的变化趋势。结论及时掌握当地传染病的发病情况,加强对常见传染病的防控力度,提高病原检测力度,做好传染病的筛查工作,防止传染病在医院内传播。     

新农合政策下法定传染病住院经济负担及其影响因素

目的 通过分析新型农村合作医疗制度(以下称为“新农合”)下法定传染病在玉溪市农村居民造成的直接经济负担以及影响因素,为制定降低经济负担的措施提供科学依据. 方法 采集了2005～2012年新农合9 344例住院病例的住院费用、补偿情况等进行分析,采用多重线性回归进行影响因素分析. 结果 2005～2012年,玉溪市9 344例保销新农合的法定传染病住院直接经济负担为1 139.7元/例,维持在1 000元/例;补偿比为47.8％/例,中位实际补偿比逐年增加,由2005年的19.7％上升到2012年的72.6％.多因素分析显示:年度、年龄两个因素与实际补偿比呈正相关,就诊医疗机构级别、住院天数、住院费用与实际补偿比呈负相关(P均＜0.001). 结论 新农合在一定程度上起到了降低农村居民法定传染病经济负担的作用,探索适当提高重大、慢性传染病补偿比可成为减低负担有效途径之一.     

2012 年聊城市部分重点传染病流行状况分析及防控策略探讨

目的分析聊城市2012年部分重点传染病发病形势和特点,为制定防控措施提供科学依据。方法对2012年聊城市疫情网络直报数据进行分析,除传染病的发病概况外,着重分析重点传染病的时间、地区及人群分布特点。结果2012年聊城市共报告法定传染病23种21470例,报告发病率为365．87／10万,比2011年上升33．75％。其中无甲类传染病报告;乙类传染病报告17种8329例,发病率为141．93／10万,死亡17例,病死率为0．20％;丙类传染病报告6种13141例,发病率为223．93／10万,无死亡病例。2012年发病前5位的病种分别是手足口病（7357例）、乙型肝炎（3822例）、其它感染性腹泻（2983例）、肺结核（2973例）、流行性腮腺炎（2224例）,合计占全年发病总数的90．27％。结论2012年聊城市传染病发病形势整体平稳,仍以乙型肝炎、肺结核等慢性传染病发病为主,艾滋病、流行性腮腺炎、手足口病发病呈上升趋势,今后仍需进一步加大传染病监测力度,保证各项防控措施的落实。     

法定传染病疫情报告卡填写质量分析与监管措施改进探讨

目的评价近期我院法定传染病疫情报告卡填写质量,提出改进措施。方法对773份传染病疫情报告卡填写质量进行分析、评价。结果 773份传染病疫情报告卡中不合格148份,其中最主要的有患者地址不详细(58份,占39.19%),字迹潦草(33份,占22.3%),错别字(29份,占19.59%)。结论法定传染病疫情报告卡填写质量不佳,存在问题及原因较多,医院相关部门应时时提醒、常检查、勤督导,确保对传染病早发现、早上报、早治疗,发现问题及时提出有效的整改措施,可有效控制传染病。     

宜州市2002—2011年法定报告传染病流行趋势分析

目的分析宜州市2002—2011年法定报告传染病流行趋势及特征,为制定控制策略提供科学依据。方法采用描述流行病学方法对宜州市2002—2011年法定报告传染病发病情况进行分析。结果宜州市2002—2011年共报告传染病24种33230例,死亡181例,年平均发病率和死亡率分别为529．82／10万和2．82／10万。自然疫源性及虫媒传染病、肠道传染病发病率呈逐年下降趋势,呼吸道传染病保持平稳,血液及性传播疾病发病率呈上升趋势。结论宜州市2002—2011年传染病发病率总体呈上升趋势。应加强对肺结核、流感、手足口病等重点传染病和血液及性传播传染病的监测和防控工作。     

Challenges for communicable disease surveillance and control in southern Iraq,April-June 2003

The recent war in Iraq presents significant challenges for the surveillance and control of communicable diseases. In early April 2003, the World Health Organization (WHO) sent a team of public health experts to Kuwait and a base was established in the southern Iraqi governorate of Basrah on May 3. We present the lessons learned from the communicable disease surveillance and control program implemented in the Basrah governorate in Iraq (population of 1.9 million) in April and May 2003, and we report communicable disease surveillance data through June 2003. Following the war, communicable disease control programs were disrupted, access to safe water was reduced, and public health facilities were looted. Rapid health assessments were carried out in health centers and hospitals to identify priorities for action. A Health Sector Coordination Group was organized with local and international health partners, and an early warning surveillance system for communicable disease was set up. In the first week of May 2003, physicians in hospitals in Basrah suspected cholera cases and WHO formed a cholera control committee. As of June 29, 2003, Iraqi hospital laboratories have confirmed 94 cases of cholera from 7 of the 8 districts of the Basrah governorate. To prevent the transmission of major communicable diseases, restoring basic public health and water/sanitation services is currently a top priority in Iraq. Lack of security continues to be a barrier for effective public health surveillance and response in Iraq.     

Electronic Support for Public Health: Validated Case Finding and Reporting for Notifiable Diseases Using Electronic Medical Data

Health care providers are legally obliged to report cases of specified diseases to public health authorities, but existing manual, provider-initiated reporting systems generally result in incomplete, error-prone, and tardy information flow. Automated laboratory-based reports are more likely accurate and timely, but lack clinical information and treatment details. Here, we describe the Electronic Support for Public Health (ESP) application, a robust, automated, secure, portable public health detection and messaging system for cases of notifiable diseases. The ESP application applies disease specific logic to any complete source of electronic medical data in a fully automated process, and supports an optional case management workflow system for case notification control. All relevant clinical, laboratory and demographic details are securely transferred to the local health authority as an HL7 message. The ESP application has operated continuously in production mode since January 2007, applying rigorously validated case identification logic to ambulatory EMR data from more than 600,000 patients. Source code for this highly interoperable application is freely available under an approved open-source license at http://esphealth.org.