本文選題：腹瀉病 + 監(jiān)測模式　； 參考：《中國公共衛(wèi)生》2017年10期

【摘要】：目的探索臨床診療與公共衛(wèi)生充分結(jié)合的腹瀉病監(jiān)測新模式,動態(tài)掌握上海市腹瀉病病原譜與流行病學變化特征。方法 2013年7月—2015年6月,按照現(xiàn)況研究樣本量公式和概率比例規(guī)模(PPS)方法進行樣本量計算和分配。通過醫(yī)生問詢收集監(jiān)測病例臨床特征和流行病學信息并錄入開發(fā)的信息化系統(tǒng)。監(jiān)測系統(tǒng)共登記初診腹瀉病例58 336例,采樣病例共6 543例。進行11種細菌分離和5種病毒核酸檢測,對陽性細菌株進一步進行藥敏檢測。結(jié)果成功構(gòu)建"市級疾病預防控制中心-區(qū)級疾病預防控制中心-監(jiān)測醫(yī)院"三位一體的監(jiān)測網(wǎng)絡(luò),內(nèi)容覆蓋腹瀉病例的臨床、流行學和病原學特征,并進行網(wǎng)絡(luò)信息化系統(tǒng)管理。從6 543例病例糞便標本中檢出至少1種病原體陽性者3 059例,陽性率為46.75%。共檢出7種細菌、5種病毒。細菌陽性率為12.07%(790/6 543),主要為副溶血性弧菌(256例)、致瀉性大腸埃希菌239例、沙門氏菌(209例)。病毒陽性率為30.46%,主要為諾如病毒(1 172例)、輪狀病毒(546例)。病毒陽性數(shù)呈較明顯的夏季高峰和秋冬季高峰,秋冬季病毒陽性率(52.54%,1 295/2 465)高于細菌(3.57%,88/2 465),夏季細菌陽性率(21.31%,541/2 539)高于病毒(10.05%,255/2 539),差異均有統(tǒng)計學意義(P0.05)。結(jié)論上海探索性構(gòu)建了"一份標本、多種監(jiān)測"的腹瀉病綜合監(jiān)測的新模式,通過網(wǎng)絡(luò)平臺實現(xiàn)臨床和公共衛(wèi)生的信息化聯(lián)接,基本掌握本市腹瀉的病原譜和流行病學特征。該模式適用于特大型城市的腹瀉病動態(tài)監(jiān)測。
[Abstract]:Objective to explore a new surveillance model of diarrhoeal diseases combined with clinical diagnosis and treatment and public health, and to dynamically understand the spectrum and epidemiological characteristics of diarrhoeal diseases in Shanghai. Methods from July 2013 to June 2015, sample size formula and probabilistic proportional scale (PPS) method were studied to calculate and distribute the sample size. The information of clinical features and epidemiology of monitored cases was collected and recorded in the information system developed by doctor inquiry. A total of 58,336 cases of newly diagnosed diarrhea and 6,543 cases of sampled diarrhea were registered by the surveillance system. Eleven kinds of bacteria were isolated and 5 kinds of viral nucleic acid were detected. Results A trinity surveillance network was successfully constructed, which covers the clinical, epidemiological and etiological characteristics of diarrhea cases, including the city level disease prevention and control center, the district disease prevention and control center and the surveillance hospital. And carries on the network information system management. 3 059 of 6 543 fecal specimens were positive for at least one pathogen, and the positive rate was 46. 75%. A total of 7 kinds of bacteria and 5 kinds of viruses were detected. The positive rate of bacteria was 12.070.The positive rate was 790% 6543%, including 256 cases of Vibrio parahaemolyticus, 239 cases of cathartic Escherichia coli and 209 cases of salmonella. The positive rate of virus was 30.46%, mainly 1 172 cases of norovirus and 546 cases of rotavirus. The positive rate of virus in autumn and winter was significantly higher than that in summer and autumn and winter. The positive rate of virus in autumn and winter was higher than that in bacteria 3.5788 / 2 465). The positive rate of bacteria in summer was 21.31% 541% 2 539) higher than that of virus 10.05% 2555% 2 539 (P 0.05). Conclusion A new model of comprehensive surveillance of diarrhoeal diseases based on "one specimen, multiple surveillance" has been constructed in Shanghai. The information connection between clinical and public health can be realized through the network platform, and the pathogeny spectrum and epidemiological characteristics of diarrhea in this city can be basically grasped. The model is suitable for dynamic surveillance of diarrhoeal diseases in large cities.
【作者單位】： 上海市疾病預防控制中心;
【基金】：上海市第四輪公共衛(wèi)生三年行動計劃重點學科“傳染病與衛(wèi)生微生物學”(15GWZK0101) 上海市第四輪公共衛(wèi)生三年行動計劃高端海外研修團隊培養(yǎng)計劃(GWTD2015S02)
【分類號】：R181.3

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