构建起强大的公共卫生体系 为维护人民健康提供有力保障

  目的   明确目前我国传染病监测体系存在的主要问题,初步构建“全哨点”“多症候”传染病监测体系,以满足日益增长的传染病监测防控需求,真正发挥岗哨前沿特异性、及时性、灵敏性的作用。  方法  系统全面检索收集2000 — 2021年有关新发（重大）传染病监测预警的文献,最终筛选出78篇文献并进行评阅,明确传染病监测哨点并利用文献内容分析法进一步归纳提炼。  结果  构建出“五纵四横一中心”的传染病监测网络,通过横到边、纵到底的全方位网格化监测网络,监测新发（重大）传染病早期的“临床症状”和“社会症状”,真正发挥各哨点灵敏的关口预警作用。  结论  新发（重大）传染病监测体系的构建遵循统一规划、纵横联网、资源共享、平战结合等原则,能够做到全方位、多症候监测,较为科学完善。     

学校食源性疾病暴发事件监测体系及预警系统研究进展

食源性疾病是当今世界最广泛的公共卫生问题之一,其对人类健康的危害已受到高度关注。学校食源性疾病的防控重在预防,监测预警是关键,本研究对学校食源性疾病进行了概述,将发达国家监测预警系统与国内进展进行比较,借鉴其宝贵经验。结合我国学校食源性疾病监测预警技术的研究现状,为学校食源性疾病预防控制提供科学依据和实践指南。     

牡蛎养殖区人群诺如病毒感染监测对暴发的预警作用

目的了解牡蛎养殖区人群诺如病毒感染病例的流行特征,研究病例监测对暴发的预警作用。方法 2014年1—12月,采用多阶段抽样方法从牡蛎养殖区选取部分社区人群进行入户调查,回顾其过去4周内急性胃肠炎的发病情况。采用实时RT-PCR与半巢式PCR相结合的方法检测诺如病毒,测序并绘制系统发育树。结果调查共发现75例急性胃肠炎病例,年发病率为0.10次/人年;诺如病毒阳性率为20.0%(15/75);系统发育分析显示,诺如病毒优势流行株为GII.4 Sydney 2012;发现新型GII.17变异株,检出时间为2014年3月。结论 GII.4 Sydney 2012仍是引起当地诺如病毒感染急性胃肠炎的主要流行株,在牡蛎养殖区哨点医院诺如病毒感染病例监测中发现的GII.17变异株对2014年冬季的暴发流行具有早期预警作用。     

Pacific-wide simplified syndromic surveillance for early warning of outbreaks

The International Health Regulations require timely detection and response to outbreaks. Many attempts to set up an outbreak early warning system in Pacific island countries and territories (PICTs) have failed. Most were modelled on systems from large countries; large amounts of data often overwhelmed small public health teams. Many conditions required overseas laboratory confirmation, further reducing timeliness and completeness. To improve timeliness and reduce the data burden, simplified surveillance was proposed, with case definitions based on clinical signs and symptoms without the need for laboratory confirmation or information on symptoms, location, sex and age. After trials in three PICTs, this system was implemented throughout the Pacific. Enthusiastic adoption by public health staff resulted in 20 of 22 PICTs reporting weekly to the World Health Organization within 12 months of starting to use the system. In the first year, the system has detected many infectious disease outbreaks and facilitated timely implementation of control measures. For several Pacific countries and territories, this is the first functional and timely infectious disease surveillance system. When outbreak detection is the principal objective, simplification of surveillance should be a priority in countries with a limited public health system capacity.     

传染病暴发或流行的探测、监测和预警

传染病继续成为全球发病死亡主要原因之一,影响公众健康生命、社会经济发展甚至国家安全。早期探测重点是及时、敏感地发现传染病暴发流行异常信息,并进行现场调查和核实,也是有效监测、预警系统的前期;有效监测、预警系统能够全面准确地认识特定传染病暴发流行可能发生的事实条件、驱动因素和传播链,并提出科学有效预防控制策略措施;因衡量...     

A method for evaluating systems of epidemiological surveillance

Epidemiological surveillance is the systematic collection, analysis and dissemination of health data for the planning, implementation and evaluation of public health programmes. Established surveillance systems should be regularly reviewed on the basis of explicit criteria of usefulness, cost and quality; systems should be modified as a result of such review. Attributes of quality include: (i) sensitivity, (ii) specificity, (iii) representativeness, (iv) timeliness, (v) simplicity, (vi) flexibility and (vii) acceptability. To date, evaluation of surveillance systems has been limited in scope and content. The evaluation method proposed in this article offers an organized approach to the evaluation of epidemiological surveillance systems. The usefulness of a surveillance system is measured by whether it leads to prevention or control or a better understanding of adverse health events. The measure can be qualitative, in terms of the subjective views of those using the system, or quantitative in terms of the impact of surveillance data on policies, interventions or the occurrence of a health event. The cost of a system includes indirect as well as direct costs, and should be measured in relation to the benefits obtained, such as reduction of medical-care expenses and of time lost from work. All elements of the system should be included in the cost: data collection, analysis and dissemination. The sensitivity of a surveillance system is its ability to detect health events (completeness of reporting). Its specificity is inversely proportional to the number of false positives it reports. Reports of a disease that do not meet the case definition are false positives, and may result in resources being wasted in investigating them.(ABSTRACT TRUNCATED AT 250 WORDS)     

Gram-positive rod surveillance for early anthrax detection

Connecticut established telephone-based gram-positive rod (GPR) reporting primarily to detect inhalational anthrax cases more quickly. From March to December 2003, annualized incidence of blood isolates was 21.3/100,000 persons; reports included 293 Corynebacterium spp., 193 Bacillus spp., 73 Clostridium spp., 26 Lactobacillus spp., and 49 other genera. Around-the-clock GPR reporting has described GPR epidemiology and enhanced rapid communication with clinical laboratories.     

The development of an evaluation framework for injury surveillance systems

Background  

Access to good quality information from injury surveillance is essential to develop and monitor injury prevention activities. To determine if information obtained from surveillance is of high quality, the limitations and strengths of a surveillance system are often examined. Guidelines have been developed to assist in evaluating certain types of surveillance systems. However, to date, no standard guidelines have been developed to specifically evaluate an injury surveillance system. The aim of this research is to develop a framework to guide the evaluation of injury surveillance systems.     

Evaluating spatial surveillance: detection of known outbreaks in real data

Since the anthrax attacks of October 2001 and the SARS outbreaks of recent years, there has been an increasing interest in developing surveillance systems to aid in the early detection of such illness. Systems have been established which do this is by monitoring primary health-care visits, pharmacy sales, absenteeism records, and other non-traditional sources of data. While many resources have been invested in establishing such systems, relatively little effort has as yet been expended in evaluating their performance.One way to evaluate a given surveillance system is to compare the signals it generates with known outbreaks identified in other systems. In public health practice, for example, public health departments investigate reports of illness and sometimes track hospital admissions. Comparison of new systems with extant systems cannot generate estimates of test characteristics such as sensitivity and specificity, since the actual number of positives and negatives cannot be known. However, the comparison can reveal whether a new or proposed system's signals match outbreaks detected by the existing system. This could help support or reject the new system as an alternative or complement to the extant system.We propose three methods to test the null hypothesis that the new system does not signal true outbreaks more often than would be expected by chance. The methods differ in the restrictiveness of the assumptions required. Each test may detect weaknesses in the new system, depending on the distribution of outbreaks and can be used to construct confidence limits on the agreement between the new system's signals and the outbreaks, given the distribution of the signals. They can be used to assess whether the new system works in that it detects the outbreaks better than chance would suggest and can also determine if the new systems' signals are generated earlier than an extant system.     

Investigation of disease outbreaks detected by “syndromic” surveillance systems

Syndromic surveillance systems can detect potential disease outbreaks quickly and can provide useful tools to assist in outbreak investigation. The steps used to investigate diseases detected through these newer methods are not that different from traditional investigative measures, but the differences and limitations of the systems must be understood. With syndromic surveillance systems, there is often readily available electronic demographic information that can help define the epidemic and direct disease control measures. The diagnosis needs to be confirmed as quickly as possible, however, as specific diagnostic information will be missing with early detection from nonspecific data. It is also important not to disregard smaller, nonsevere rises in disease incidence as they might be a harbinger of a worsening outbreak. The rapidity of most syndromic surveillance systems also requires an equally rapid response, and planning must be done to prioritize alert categories and the response sequence to best utilize the information available in these new systems.     

Innovative surveillance methods for rapid detection of disease outbreaks and bioterrorism: results of an interagency workshop on health indicator surveillance

A system designed to rapidly identify an infectious disease outbreak or bioterrorism attack and provide important demographic and geographic information is lacking in most health departments nationwide. The Department of Defense Global Emerging Infections System sponsored a meeting and workshop in May 2000 in which participants discussed prototype systems and developed recommendations for new surveillance systems. The authors provide a summary of the group's findings, including expectations and recommendations for new surveillance systems. The consensus of the group was that a nationally led effort in developing health indicator surveillance methods is needed to promote effective, innovative systems.     

A general framework for evaluating the reliability of medical measurement systems

Measurements of physical and social phenomena are often used in the decision-making process despite the error introduced by human and context variation. It would be advantageous to a decision maker to know the sources and magnitudes of such errors in using a measurement system or in choosing among alternative measurement systems. This paper describes an approach to determining the reliability of a measurement procedure called generalizability (G) theory. G theory uses the results of a random-effects analysis of variance to estimate the magnitude of error variability associated with each of several potential sources. These estimates can then be used to calculate a number of indices which typify the amount of precision provided by a measurement system in a particular context of usage. The major concepts of G theory are described and illustrated in the context of evaluating a radiologic total lung capacity measurement system.     

Sentinel surveillance system for early outbreak detection in Madagascar

Background  

Following the outbreak of chikungunya in the Indian Ocean, the Ministry of Health directed the necessary development of an early outbreak detection system. A disease surveillance team including the Institut Pasteur in Madagascar (IPM) was organized to establish a sentinel syndromic-based surveillance system. The system, which was set up in March 2007, transmits patient data on a daily basis from the various voluntary general practitioners throughout the six provinces of the country to the IPM. We describe the challenges and steps involved in developing a sentinel surveillance system and the well-timed information it provides for improving public health decision-making.     

捕获-标记-再捕获法在出生缺陷监测系统评估中的应用

目的 了解和评估现行的医院出生缺陷监测系统和人群出生缺陷监测系统的监测效率.方法 以湖南省某县2006年10月1日至12月31日人群出生缺陷监测数据作为第一来源资料,以同时期当地医院出生缺陷监测数据作为第二来源资料,利用捕获-标记-再捕获法(CMR)进行评价.结果 人群监测系统发现缺陷儿49例,医院监测系统发现缺陷儿28例,重复病例为20例;根据CMR法的计算公式,该县2006年10月1日至12月31日出生缺陷总体估计值为68例(N=68),95%CI:56～70;人群监测系统和医院监测系统的符合率分别为72.1%和41.2%,总符合率为83.8%,两种监测系统来源相互之间的符合率为57.1%;漏报率分别为27.9%与58.8%.结论 人群出生缺陷监测系统和医院出生缺陷监测系统均存在一定的漏报情况,可应用CMR法尽可能的校正.