病例定义改变对流感监测系统的影响

目的评价新修订的流感样病例定义在流感监测中的适用性和灵敏性，为科学制定流感样病例定义提供参考依据。方法通过对深圳市四区2005～2007年流感样病例暴发疫情中的流感样病例个案进行回顾性分析，重点比较各种流感样症状的频率、病例定义的范围和疫情规模，使用SPSS（11．0）和EPIINFO进行统计分析。结果深圳市流感样病例暴发疫情资料真实可靠，1529例（83．6％）符合流感样病例定义，68例（3．7％）未符合流感样病例定义，未有详细流行病学调查个案232例（12．7％）。流感样病例症状前3位顺位分别为咳嗽（70．2％），头痛（46．6％）、咽痛（41．9％）。新修订的流感样病例定义与原病例定义对流感样病例的一致率为83．4％，增加“头痛”（OR=0．37，adjOR=0．29～0．48）或“流涕”（OR=0．48，adjOR=0．38～0．60）症状，能有效扩大流感样病例定义的涵盖范围。另新修订的流感样病例定义，0-4人组段的疫情规模起数明显上升（Χ^2=10．6，P〈0．01），整体上降低了流感样病例暴发疫情规模的判断。结论我国新修订的流感样病例定义清晰明确，易于操作，但涵盖范围缩小，降低对流感样病例暴发疫情规模的判断。在新修订的病例定义基础上增加“头痛”或“流涕”一项或两项症状，均能较大程度扩大病例定义的适用范围，提高代表性和灵敏性。

Analysis of effect of variation of case definition on the Influenza monitoring system in Shenzhen

Objective To evaluate effect of variation of case definition of influenza - like cases on the Influenza monitoring system in SHENZHEN. Methods Retrospective analysis was conducted on the data of outbreak of inluenza - like disease in four districts of Shenzhen City from 2005 to 2007. Results The monitoring data were reliable and 1 529 eases （83. 6% ） met the definition of inluenza- like disease, only 68 cases （3.7%） not met the inluenza- like ease definition. Out of 1 529 inluenza - like eases 1074 eases （70.2%） had cough, 713 （46.6%） had headache and 640 （41.9%） had sore throat. 1 275 （83.4%） ease met the previous and the new inluenza -like ease definition. The newly added ＂headache （OR =0.37,adjOR =0.29-0. 48, P 〈 0.001） or ＂running nose＂ symptoms （OR=0. 48,adjOR=0.38 -0.60, P 〈 0.001） were significandy increased the coverage of new inluenza - like case definition. Conclusion The new influenza - like eases definition is clear and correct, hut the addition of headache and running nose （with temperature of ≥38℃ ） in the inluenza - like case definition can expand the coverage and suitable for use in Shenzhen.