传染病信息实时采集与应急处置系统研究
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摘要
1.研究背景和目的
进入新世纪以来，新发传染病不断出现，2003年的SARS疫情，2009年的甲型H1N1流感疫情，以及2013年2月中国出现的H7N9禽流感疫情等不断威胁人类健康。地震、飓风、洪水、干旱等自然灾害频发，在一些经济欠发达地区，由于医疗卫生条件有限，通讯手段落后，对传染病突发疫情不能及时监测，获取现场疫情信息困难且滞后，这些极易造成传染病的大面积流行，严重威胁人类健康。在一些偏远地区，由于专业设备欠缺，疾病预防控制人员对突发传染病疫情处置能力相对不足，容易造成疫情的扩散。对突发传染病疫情的有效控制有赖于传染病现场信息的快速获取和采取及时有效的干预措施，对传染病疫情暴发地点自然情况和历史传染病发病情况以及传染病防控专业信息的掌握，有助于传染病防控人员根据现场情况制定合理的防控措施，及时控制传染病突发疫情。因此，建立一套方便易操作、灵活多用的传染病防治及应急处置决策支持系统非常必要。本研究立足中国发展实际，依托先进的计算机硬件技术和软件技术，为应对突发传染病疫情和及时获取传染病现场信息和标本提供方便廉价的工具，建立一套软硬件结合的、完善的传染病防治和应急处置决策支持系统平台，系统平台的有效应用可以增强传染病现场调查和疫情应急处置的效率，为突发传染病疫情和其它公共卫生事件的处置提供有效的工具。
2.研究内容
本研究综合应用无线通讯技术、网络技术、WebGIS技术、计算机硬件集成技术建立基于网络、电脑、手机的传染病防治及应急处置决策支持系统，包括硬件和软件两个部分。
软件主要为基于WebGIS的传染病防治及应急处置决策支持系统，采用浏览器/服务器架构（B/S结构），建立基于PC和PDA两个版本，满足传染病现场调查需求。本研究综合应用无线通讯技术、网络技术、WebGIS技术建立基于网络和手机的传染病防治及应急处置决策支持系统。该系统是集传染病现场调查与信息采集、卫生流行病学信息支持、卫生流行病学统计分析、传染病疫情处置指南、流行病学调查表定制、流行病学专业知识查询等功能于一体的传染病防治及应急处置决策支持系统平台。系统平台的有效应用可以快速有效地获取现场流行病学调查信息并进行统计分析，可以为流行病学相关从业人员提供专业指导，提高突发传染病疫情处置效率，避免传染病疫情的快速扩散。本系统应用方便廉价，通过用户名和密码访问网站（PC用户访问www.geoepi.com；手机用户访问m.geoepi.com）即可获得相应服务，适用于经济条件相对落后的国家和地区。本系统分为PC端和移动便携端两个入口，PC端可以通过台式机、笔记本电脑进行访问，移动便携端可以通过PDA或手机进行访问，系统操作简单，用户通过GPS定位或系统快速定位功能可以快速确定疫情的地理位置并对疫情当地的自然情况和历史传染病发病情况进行侦察。信息采集功能可以实现传染病现场调查数据实时上报与分析，并可以通过站内消息实现前方流调人员与后方专家或决策人员实时交流，后方专家可以实时指导现场流行病调查工作，提高传染病疫情的处理效率。本系统可以为传染病相关人员提供有效服务，为传染病现场调查和传染病疫情应急处置提供有效的工具和平台。
硬件主要为便携式传染病现场应急作业箱，包括电子模块和医学模块两个箱体。主要应用于突发传染病疫情以及其他突发公共卫生事件的现场调查以及标本的采集、储存运输等。电子模块由自制加固计算机、风速风向仪、PDA、照相机、录音笔、内置无线网卡等一系列电子设备构成，可实现对传染病现场相关信息实时采集、分析和传输，可采集音频、视频、图片、调查表等现场资料，通过电子模块还可以实现流行病学调查前后方交互，后方专家和决策者可以实时指导现场工作，为现场工作人员提供技术支持。医学模块包括酒精灯、试剂瓶、不锈钢消毒盒、各种标本采集管、止血钳以及防护服护目镜等个人防护用品等。可用于采集动物脏器标本、昆虫、人和动物各种体液、大小便等标本，可以进行简单的试验操作并对采集的信息进行标准化处理。医学模块箱体内部结构采用模块化设计，可根据每次现场调查任务进行组合以携带不同的物品，应用方便快捷。
3.方法
系统中历史传染病数据资料来源于中国CDC传染病监测系统数据，包括中国各县（市）多年的传染病发病种类以及发病人数等信息，主要用于流行病学侦察，让用户了解不同地区的传染病发病情况。搜集中国所有县（市）的宿主动物数据，用于了解当地的宿主动物分布信息。搜集中国所有县（市）的气象信息，包括年/月平均温度、最高温度、最低温度、平均湿度、平均气压、降雨量等信息，为传染病的防控提供决策支持信息。搜集所有县（市）内的道路交通、地形地貌、人口特征和人口构成等信息数据。所有这些数据都应用于流行病学信息支持系统。提供传染病病原体经气溶胶施放危害评估、现场流行病学调查表定制、现场信息采集上报、疾病智能判断等功能。
系统通过PC和手机两个入口进行访问，与地理信息相关信息查询以Google Map为地理显示平台、用户通过关键字查询、GPS定位等功能确定地理位置，根据地理位置查询相关地区的卫生流行病学信息、气候气象情况、宿主动物及地形地貌等基础信息，并可以通过文本、图片、调查表等方式上报当地的流行病学调查信息，并对上报的调查表信息进行实时统计分析，通过站内消息后方专家可以及时了解现场流调人员的情况，并可以对现场工作进行指导。
便携式传染病现场应急作业箱可分为电子模块和医学模块两个箱体。电子模块由自制加固便携计算机、随机附件、防水安全箱3部分。流调箱绝大部分功能集成在加固计算机上，无法集成的功能设备作为随机附件，加固计算机和随机附件全部放置在定制防水安全箱中。医学模块主体也为防水安全箱，内部采用模块化设计，包括采血模块、不锈钢消毒盒、排泄物采集管、昆虫盒、动物器官标本采集管、防护模块、储运模块等。用户可以根据每次调查和采集标本任务的不同合理携带不同的物品。
便携式传染病现场应急作业箱采取自主设计，现场测试定型，专业工厂代为生产的方式进行。
4.结果
建立了能够通过PC和PDA两个入口进行访问的传染病防治及应急处置决策支持系统，并申请域名进行了部署，PC用户通过访问http://www.geoepi.com获得服务，手机用户通过访问http://m.geoepi.com获得相关服务。
4.1传染病调查现场信息实时采集上报和分析
用户可以通过电脑、PDA或手机等采集传染病调查现场的调查表信息、文本信息、图片信息以及音视频信息等，这些信息可以通过无线网络实时发送至数据库。后方专家和决策者可以对现场上报的数据进行实时的统计分析，通过分析了解突发传染病疫情的发展动态、现场病人的时空分布、受影响的人群以及可能的危险因素等。
系统中集成200多种传染病个案调查表和疫情调查表，当现有调查表不能满足需求时，系统提供调查表定制功能，满足现场流行病学调查人员实际需求。在现场调查中，调查者的位置信息是非常重要的，本研究中位置信息通过GPS定位模块和快速定位关键字查询获得，经纬度信息会集成在调查者上报的数据中。用户通过对上报的信息进行统计分析，可以实时绘制现场调查病例空间分布地图、流行曲线，年龄性别职业分布等也可以快速通过饼图、条图等进行展示。当系统内置分析功能满足需求时，用户可以将调查数据导出为Excel格式，而后利用STATA、SPSS等专业软件进行进一步分析。
4.2以Google Map为地理信息显示平台的全国卫生流行病学信息支持
了解传染病疫情当地的相关信息可以为传染病疫情处置提供有效的信息支持，提高疫情处置效率。用户通过GPS定位和系统提供的快速定位功能可以快速确定自己所处的地理位置，现场疫情处置人员可以通过系统了解传染病疫情现场的基本情况，用户位置信息以及当地流行病学信息会在Google Maps平台上进行展示。这些信息包括传染病既往流行情况、地形地貌特征、宿主动物分布、气候信息、交通状况、医疗卫生机构分布等。
根据传染病疫情现场处置需求，搜集并整合了传染病相关专业知识并建立了数据库，传染病相关从业人员及传染病疫情处置人员可以通过电脑手机随时检索查阅，可以丰富传染病相关从业人员专业知识、为传染病疫情应急处置人员和卫生部门决策者提供信息支持。包括专业信息、应急预案、经典案例、防护防疫保障、文书指南、专业技能信息、法律法规、卫生资源等信息。可以为疾病预防控制相关从业者提供专业的技术支持。
4.3基于Google Maps API可视化方法的传染病病原体经气溶胶施放危害评估
利用Google Map API (谷歌地图应用程序开发接口)提供的绘图和空间分析功能，结合现有的传染病病原体经气溶胶施放扩散模型和全国人口密度数据，实现对病原微生物通过气溶胶施放所造成的危害范围、受影响人数的快速评估，并在地图上进行动态的可视化模拟与展示。该方法可以在发生通过气溶胶施放生物危害事件时对不同种类病原微生物危害的范围、人数等进行快速评估，为快速制定防控措施、减少生物危害后果提供决策支持依据。
4.4传染病突发疫情处置指南
本研究集成突发传染病疫情和突发公共卫生事件应急处置流程图，包括重大传染病处置流程、新发传染病应急处置流程、食物中毒、核化生危害应急处置以及其它公共卫生事件应急处置流程。现场处置人员和决策者可以获得多种突发公共卫生事件的处置流程，也可以获得不同应急事件的相关专业信息，包括相关传染病预防控制信息、传染病实验室诊断信息、相关法律法规、相关卫生服务信息以及消毒、杀虫、灭菌等信息。4.5流行病学调查表定制功能
本研究实现了流行病学调查表现场定制功能，系统管理员用户可以管理现有的调查表，可以对现有调查表进行优化，也可以定制新的调查表。普通用户具有输入、浏览、修改、查询、以及对调查表数据进行分析以及导出为Excel文件的权限。现场调查处置人员可以根据现场需要快速定制新的调查表。定制调查表的表项在系统中容易获得而且容易填写，主要包括单选项、多选项、文本、表格、时间等类型。用户可以根据填写调查表的设备（PC或PDA）合理设置所定制调查表的格式，使得用户易于在线填写、发送及浏览。用户上报的调查表信息直接写入数据库，具有相应权限的用户可以对这些信息进行实时统计分析并将结果反馈给现场调查人员，有助于现场调查和疫情处置的有效开展。
4.6便携式传染病现场应急作业箱
本研究根据现场流行病学调查的需要，研制出新一代的便携式传染病现场应急作业箱，调查箱包含电子模块和医学模块两个箱体，能够实现现场流行病学调查作业的集成化、信息化和模块化，实现调查现场到指挥中心的快速沟通，进一步提高现场流行病学调查工作的实时性和科学性。
5.结论
传染病防治及应急处置决策支持系统和新一代流行病学现场调查作业箱构成一套完整的流行病学现场调查作业平台，平台集现场信息采集与传输、现场标本采集与储运、数据分析、流行病学调查表定制等功能于一体。携带方便、使用灵活、成本低廉，适合多种级别的用户进行流行病学调查和标本采集。系统平台的有效应用可以提高我国现场流行病学调查的信息化水平和效率，为传染病防控和突发公共卫生事件处置提供强有力的工具。
1. Background and objectives
Since the beginning of the new century, emerging infectious diseasesappeared frequently and threatened human health, i.e., the SARS epidemic in2003, influenza A (H1N1) in2009and human infections with avian influenzaA (H7N9) virus in2013.. There have also been frequent natural disasters, i.e.,the Wenchuan earthquake in2008and the Yushu earthquake and Zhouqumudslides in2010. In some underdeveloped areas, information of infectiousdisease emergencies in fields was diffecult to be collected timely due tolimited medical, health, and communication conditions. All these above arelikely to cause pandemic outbreaks of infectious diseases.. In addition, it isalso likely to cause diffusion of infectious diseases in some remote areas dueto lack of professional equipment and experiences for response to infectiousdisease emergences. Effective control of outbreaks of infectious diseasesdepends on obtains of information quickly in fields and targeted interventions.To understand the epidemiological knowledge, the environment of thelocation of outbreaks and historical incidence of infectious diseases is helpfulfor the staff of prevention and control to develop reasonable prevention andcontrol measures in fields. According to the reasons above, it’s necessary toestablish a flexible decision support system for infectious emergency. Thisstudy, based on the development of China, combined the software andhardware technology to build a perfect platform used for decision supportsystem for infectious disease emergency based on WebGIS and mobile service.The effective application of the system platform could enhance the efficiencyof the infectious disease field investigation and outbreak emergency responseand provide an effective tool for the disposal of unexpected infectious diseasesoutbreaks and public health events.
2. Research contents
This study integrated wireless communication, network technique, andWebGIS technique build an infectious disease prevention, emergency disposal and decision support system, it’s include software and hardware.
Software is a decision support platform for infectious disease emergencybased on WebGIS and mobile service. Include the functions of fieldinvestigation and data collection, epidemiology detection, epidemiologicalstatistical analysis, guide of emergency disposal of infectious disease,epidemiological questionnaire custom-tailor, epidemiology expertise enquiryand so on. It’s a platform for prevention and emergency disposal of infectiousdisease. The utility of this system can obtain information in the field andstatistical the data in real time. The system can provide professionalinstruction for the people who engaged in the work of infectious diseaseprevention, enhanced the efficiency of disposal, to avoid epidemicwide-bound. This system apply to low-income and middle-income countriesand districts, it’s used convenient and cheaply. The system has two accessinterfaces, computer and Personal Data Assistant (PDA and mobile phone).Users can access the system by computer, PDA and Mobile Phone, it’soperated easily. Through global position system (GPS) and fast positionfunction, the users determine the location of the epidemic and detected thenatural condition and historic infectious diseases in the field. Through thefunction of information acquisition, we can collect the data of the fieldimmediately, reporting and analysis them real time. Through the site messagefunction, the workers in the field and decision makers in the office cancommunicated with each other, the officer instruct the work of the field, raiseefficiency of the field investigation.
Hardware is portable infectious disease emergency operation box,include electronic module and medical module. Hardware is used forspecimen collection, storage and transportation in sudden outbreaks ofinfectious diseases and other public health emergencies. Electronic moduleinclude rugged computer, dogvane, PDA, camera, voice recorder, built-inwireless card and other electronic equipments. Field investigation workers useelectronic module can collect the information and can analyse andtransmission in real time. The collected data include audio, video, picture andquestionnaire. Using electronic module, the field workers and rear expertscould communicate with each other in real time, the experts and decisionmakers can guide the field work in real time and provide technical support. Medical module include alcohol lamp, reagent bottles, stainless steeldisinfection box, specimen collection tubes, hemostatic clamp, protectiveclothing and other protective equipments. Medical module can be used tocollect animal organ specimens, insects, animal body fluids, urine and otherspecimens, and can standardize the collected data and do simple test operation.Medical module case using modular design, users can combination and carrydifferent investigation items according every scene investigation task, it’s veryconvenient.
3. Methods
Collected the historic infectious disease data Chinese CDC, include allcategories of infectious disease and incident number in different countries allover China. Collected host animals of all countries in China. Collected themeteorology data of all countries in China, include average temperature,maximum temperature, minimum temperature, medial humidity, average airpressure, and rainfall, all these data provide decision support information forprevention and emergency disposal of infectious disease. Collected the pathand traffic data, landform data, population structure data, and hospitalsinformation in China, integrated the information in the system, and providesupport for infectious disease workers. All the data were used in epidemiologyinformation support system. The system also provides hazard assessment forinfectious disease pathogens by aerosol release, epidemiological questionnairecustomization and diseases intelligent judgment.
Users access the system by PC and mobile phone, Google Maps is thedisplaying platform of geographic relevant information. The users obtainedthe geographic locations by keyword polling and GPS, according the locationinformation users acquire the epidemic information, climate condition, hostanimal information, and landform of these areas. Users report the epidemicinformation by text, pictures, and questionnaires in the investigation field, theexperts and decision makers in the office analyze the data real-time and thenguide the work in the field by station message according to the results ofanalysis results.
Portable infectious disease emergency operation box include two cases,named electronic module and medical module. Electronic module iscomposed by reinforce computer, attachments and waterproof safety box. Most functions of the portable infectious disease emergency operation boxintegrated in the reinforce computer, and some other functions were realizedby attachments, reinforce computer and attachments were placed inwaterproof safety box. The main body of medical module is also a waterproofsafety box, include blood collection module, stainless steel box, excretacollection tube, insect box, animal organ specimen collection tubes, protectionmodule, storage and transport module and so on. Users can take differentitems according to the task in the field.
Portable infectious disease emergency operation box designed byourselves, through field testing to determine the model and produced byspecialized factory.
4. Results
This study created a decision support system for infectious diseaseemergencies based on WebGIS and mobile service, users can access thesystem by PC and PDA. PC users access http://www.geoepi.com to acquireservice, PDA and mobile user access http://m.geoepi.com to acquire service.
4.1Field infectious disease information collection and analysis inreal-time
Information including questionnaire results, text, pictures, voice recordingsand video recorded in the field can be collected and sent to the database viawireless internet services from PCs, PDAs and mobile phones in real time bydifferent users. Experts and officials can analyze the data to understand thedynamics of the infectious disease emergency, the temporal and spatialdistributions of patients, the population at risk, the susceptible population, andprobable influencing factors.
More than200types of questionnaires including individual casesquestionnaires and epidemic-case questionnaires are provided by the system.The system also provides epidemiological questionnaires customized accordingto users’ actual demands in the field. In addition, the geographic location isimportant for field investigations. In this study, location information is collectedby a GPS unit or keyword enquiry, and the information of longitude and latitudeis then integrated into the report data. The spatial distribution maps, figures ofthe epidemic curve, and patterns of gender, age and occupation can be createdquickly, and epidemiologic analyses are conducted in real time. Additionally, users can export these additional data to an Excel spreadsheet for furtherepidemiology analysis in professional software, such as SPSS or STATA.
4.2Epidemiological information support function based on GoogleMaps
To understand the historic information related with infectious disease inthe locality, can raise efficiency of emergency disposal of epidemic situation.In this system, users searched the location by GPS and keyword enquiry, andthen review the information about this district, their location information andepidemiological information can displaying on Google Maps. Theepidemiological information include distribution of historical infectiousdisease in different countries in China, landform types, distribution of hostanimals, historical climate information, traffic information, distribution ofsanitary institution and so on, understand these information support the fieldinvestigation and emergency disposal.
According to the demanding of field investigation and emergencydisposal of epidemic situation, the system integrated the infectious diseaseknowledge and created a database, when infectious disease outbreak, theinfectious disease workers search the repository through PC or mobile phone,this function increased the specialty knowledge and provide informationsupport for emergency disposal workers and decision makers. Infectiousdisease repository include infectious disease expertise, emergency scheme forepidemic situation, classic cases, defend and epidemic prevention, guide ofinfectious disease documents, profession skills, laws about infectious diseaseand sanitation resources.
4.3Hazard assessment via aerosol dissemination based on GoogleMaps API visualization methods
Google Maps API (Google Maps application programming interface)provides mapping and spatial analysis capabilities, we use these functions andcombined with the aerosol diffusion model and population density data toaccess the scope of harm and the number of persons affected by pathogenicmicroorganisms through aerosol release. The assessment process and results candynamic visualizing simulation and displaying on the map. This method canprovide decision support information for the prevention and control anddecision-makers when the pathogenic microbiological hazard occurred. Theinformation include the scope of impact, impacted persons and districts, it’suseful for rapid developing prevention and control measures and reducing harmful of the biological hazards.
4.4Guides to Handling an Infectious Disease Emergency
This study integrates flow diagrams for the handling of an emergency,including handling cases of severe infectious diseases, emerging infectiousdiseases, food poisoning, nuclear, chemical and biologic hazards and otherpublic health emergencies. Disposal workers and decision makers can beassisted by the flow diagrams in different emergencies, and can also be providedwith information relating to the emergency, information for the prevention andcontrol of infectious diseases, information relating to laboratory diagnosis,information relating to law, and information relating to medical services,disinfection, insecticides and sterilization, and case analyses.
4.5Epidemiological questionnaire custom-tailor
The system provides the function that novel questionnaires can becustomized in the field by users. Administrative users have the permission tomanage questionnaires, including new questionnaires that are customized andoptimized versions of existing questionnaires. Common users have thepermission to put in, browse, modify, enquire about, and analyze questionnairedata and to export the information in a table format. Investigation and disposalworkers can use the existing questionnaires or create novel questionnaires usingthe custom-tailor according to their needs in the field. Options for filling outquestionnaires are readily provided by the system, and include uni-selections,multiple-selections, text, tables, and times. Users can choose the format of thequestionnaire according to whether they are using a PC or PDA, and they areable to fill out, send, or review questionnaires online. The data of reportedquestionnaires are written to the database directly. Permitted users can analyzethe data and transmit the results to the investigation worker in real time; it’shelpful for the field investigation and handling an infectious disease emergency.
4.6Portable infectious disease emergency operation box
According to the need of field epidemiological investigation, this studydeveloped a new generation of portable infectious disease emergency operationbox, include electronic module and medical module. Using this equipmentallow the field investigation workers quickly communicated withdecision-makers in the office, enhance the real-time and scientific of the fieldepidemiological investigation.
5. Conclusion
Decision support system for the infectious disease emergency and newportable infectious disease emergency operation box composed a completedplatform for field epidemiological investigation. The platform integrated thefunctions include field information collection and transmission, field specimencollection and transportation, data analysis, epidemiological questionnairecustom-tailor and so on. The operation box portable, flexible and low-cost, it’sapplicable to different-level users do epidemiological investigation andspecimen collection in the field. The effective application of the systemplatform can improve the level of information and efficiency of fieldepidemiological investigation and provide a powerful tool for handinginfectious disease and public health emergencies.
进入新世纪以来，新发传染病不断出现，2003年的SARS疫情，2009年的甲型H1N1流感疫情，以及2013年2月中国出现的H7N9禽流感疫情等不断威胁人类健康。地震、飓风、洪水、干旱等自然灾害频发，在一些经济欠发达地区，由于医疗卫生条件有限，通讯手段落后，对传染病突发疫情不能及时监测，获取现场疫情信息困难且滞后，这些极易造成传染病的大面积流行，严重威胁人类健康。在一些偏远地区，由于专业设备欠缺，疾病预防控制人员对突发传染病疫情处置能力相对不足，容易造成疫情的扩散。对突发传染病疫情的有效控制有赖于传染病现场信息的快速获取和采取及时有效的干预措施，对传染病疫情暴发地点自然情况和历史传染病发病情况以及传染病防控专业信息的掌握，有助于传染病防控人员根据现场情况制定合理的防控措施，及时控制传染病突发疫情。因此，建立一套方便易操作、灵活多用的传染病防治及应急处置决策支持系统非常必要。本研究立足中国发展实际，依托先进的计算机硬件技术和软件技术，为应对突发传染病疫情和及时获取传染病现场信息和标本提供方便廉价的工具，建立一套软硬件结合的、完善的传染病防治和应急处置决策支持系统平台，系统平台的有效应用可以增强传染病现场调查和疫情应急处置的效率，为突发传染病疫情和其它公共卫生事件的处置提供有效的工具。
2.研究内容
本研究综合应用无线通讯技术、网络技术、WebGIS技术、计算机硬件集成技术建立基于网络、电脑、手机的传染病防治及应急处置决策支持系统，包括硬件和软件两个部分。
软件主要为基于WebGIS的传染病防治及应急处置决策支持系统，采用浏览器/服务器架构（B/S结构），建立基于PC和PDA两个版本，满足传染病现场调查需求。本研究综合应用无线通讯技术、网络技术、WebGIS技术建立基于网络和手机的传染病防治及应急处置决策支持系统。该系统是集传染病现场调查与信息采集、卫生流行病学信息支持、卫生流行病学统计分析、传染病疫情处置指南、流行病学调查表定制、流行病学专业知识查询等功能于一体的传染病防治及应急处置决策支持系统平台。系统平台的有效应用可以快速有效地获取现场流行病学调查信息并进行统计分析，可以为流行病学相关从业人员提供专业指导，提高突发传染病疫情处置效率，避免传染病疫情的快速扩散。本系统应用方便廉价，通过用户名和密码访问网站（PC用户访问www.geoepi.com；手机用户访问m.geoepi.com）即可获得相应服务，适用于经济条件相对落后的国家和地区。本系统分为PC端和移动便携端两个入口，PC端可以通过台式机、笔记本电脑进行访问，移动便携端可以通过PDA或手机进行访问，系统操作简单，用户通过GPS定位或系统快速定位功能可以快速确定疫情的地理位置并对疫情当地的自然情况和历史传染病发病情况进行侦察。信息采集功能可以实现传染病现场调查数据实时上报与分析，并可以通过站内消息实现前方流调人员与后方专家或决策人员实时交流，后方专家可以实时指导现场流行病调查工作，提高传染病疫情的处理效率。本系统可以为传染病相关人员提供有效服务，为传染病现场调查和传染病疫情应急处置提供有效的工具和平台。
硬件主要为便携式传染病现场应急作业箱，包括电子模块和医学模块两个箱体。主要应用于突发传染病疫情以及其他突发公共卫生事件的现场调查以及标本的采集、储存运输等。电子模块由自制加固计算机、风速风向仪、PDA、照相机、录音笔、内置无线网卡等一系列电子设备构成，可实现对传染病现场相关信息实时采集、分析和传输，可采集音频、视频、图片、调查表等现场资料，通过电子模块还可以实现流行病学调查前后方交互，后方专家和决策者可以实时指导现场工作，为现场工作人员提供技术支持。医学模块包括酒精灯、试剂瓶、不锈钢消毒盒、各种标本采集管、止血钳以及防护服护目镜等个人防护用品等。可用于采集动物脏器标本、昆虫、人和动物各种体液、大小便等标本，可以进行简单的试验操作并对采集的信息进行标准化处理。医学模块箱体内部结构采用模块化设计，可根据每次现场调查任务进行组合以携带不同的物品，应用方便快捷。
3.方法
系统中历史传染病数据资料来源于中国CDC传染病监测系统数据，包括中国各县（市）多年的传染病发病种类以及发病人数等信息，主要用于流行病学侦察，让用户了解不同地区的传染病发病情况。搜集中国所有县（市）的宿主动物数据，用于了解当地的宿主动物分布信息。搜集中国所有县（市）的气象信息，包括年/月平均温度、最高温度、最低温度、平均湿度、平均气压、降雨量等信息，为传染病的防控提供决策支持信息。搜集所有县（市）内的道路交通、地形地貌、人口特征和人口构成等信息数据。所有这些数据都应用于流行病学信息支持系统。提供传染病病原体经气溶胶施放危害评估、现场流行病学调查表定制、现场信息采集上报、疾病智能判断等功能。
系统通过PC和手机两个入口进行访问，与地理信息相关信息查询以Google Map为地理显示平台、用户通过关键字查询、GPS定位等功能确定地理位置，根据地理位置查询相关地区的卫生流行病学信息、气候气象情况、宿主动物及地形地貌等基础信息，并可以通过文本、图片、调查表等方式上报当地的流行病学调查信息，并对上报的调查表信息进行实时统计分析，通过站内消息后方专家可以及时了解现场流调人员的情况，并可以对现场工作进行指导。
便携式传染病现场应急作业箱可分为电子模块和医学模块两个箱体。电子模块由自制加固便携计算机、随机附件、防水安全箱3部分。流调箱绝大部分功能集成在加固计算机上，无法集成的功能设备作为随机附件，加固计算机和随机附件全部放置在定制防水安全箱中。医学模块主体也为防水安全箱，内部采用模块化设计，包括采血模块、不锈钢消毒盒、排泄物采集管、昆虫盒、动物器官标本采集管、防护模块、储运模块等。用户可以根据每次调查和采集标本任务的不同合理携带不同的物品。
便携式传染病现场应急作业箱采取自主设计，现场测试定型，专业工厂代为生产的方式进行。
4.结果
建立了能够通过PC和PDA两个入口进行访问的传染病防治及应急处置决策支持系统，并申请域名进行了部署，PC用户通过访问http://www.geoepi.com获得服务，手机用户通过访问http://m.geoepi.com获得相关服务。
4.1传染病调查现场信息实时采集上报和分析
用户可以通过电脑、PDA或手机等采集传染病调查现场的调查表信息、文本信息、图片信息以及音视频信息等，这些信息可以通过无线网络实时发送至数据库。后方专家和决策者可以对现场上报的数据进行实时的统计分析，通过分析了解突发传染病疫情的发展动态、现场病人的时空分布、受影响的人群以及可能的危险因素等。
系统中集成200多种传染病个案调查表和疫情调查表，当现有调查表不能满足需求时，系统提供调查表定制功能，满足现场流行病学调查人员实际需求。在现场调查中，调查者的位置信息是非常重要的，本研究中位置信息通过GPS定位模块和快速定位关键字查询获得，经纬度信息会集成在调查者上报的数据中。用户通过对上报的信息进行统计分析，可以实时绘制现场调查病例空间分布地图、流行曲线，年龄性别职业分布等也可以快速通过饼图、条图等进行展示。当系统内置分析功能满足需求时，用户可以将调查数据导出为Excel格式，而后利用STATA、SPSS等专业软件进行进一步分析。
4.2以Google Map为地理信息显示平台的全国卫生流行病学信息支持
了解传染病疫情当地的相关信息可以为传染病疫情处置提供有效的信息支持，提高疫情处置效率。用户通过GPS定位和系统提供的快速定位功能可以快速确定自己所处的地理位置，现场疫情处置人员可以通过系统了解传染病疫情现场的基本情况，用户位置信息以及当地流行病学信息会在Google Maps平台上进行展示。这些信息包括传染病既往流行情况、地形地貌特征、宿主动物分布、气候信息、交通状况、医疗卫生机构分布等。
根据传染病疫情现场处置需求，搜集并整合了传染病相关专业知识并建立了数据库，传染病相关从业人员及传染病疫情处置人员可以通过电脑手机随时检索查阅，可以丰富传染病相关从业人员专业知识、为传染病疫情应急处置人员和卫生部门决策者提供信息支持。包括专业信息、应急预案、经典案例、防护防疫保障、文书指南、专业技能信息、法律法规、卫生资源等信息。可以为疾病预防控制相关从业者提供专业的技术支持。
4.3基于Google Maps API可视化方法的传染病病原体经气溶胶施放危害评估
利用Google Map API (谷歌地图应用程序开发接口)提供的绘图和空间分析功能，结合现有的传染病病原体经气溶胶施放扩散模型和全国人口密度数据，实现对病原微生物通过气溶胶施放所造成的危害范围、受影响人数的快速评估，并在地图上进行动态的可视化模拟与展示。该方法可以在发生通过气溶胶施放生物危害事件时对不同种类病原微生物危害的范围、人数等进行快速评估，为快速制定防控措施、减少生物危害后果提供决策支持依据。
4.4传染病突发疫情处置指南
本研究集成突发传染病疫情和突发公共卫生事件应急处置流程图，包括重大传染病处置流程、新发传染病应急处置流程、食物中毒、核化生危害应急处置以及其它公共卫生事件应急处置流程。现场处置人员和决策者可以获得多种突发公共卫生事件的处置流程，也可以获得不同应急事件的相关专业信息，包括相关传染病预防控制信息、传染病实验室诊断信息、相关法律法规、相关卫生服务信息以及消毒、杀虫、灭菌等信息。4.5流行病学调查表定制功能
本研究实现了流行病学调查表现场定制功能，系统管理员用户可以管理现有的调查表，可以对现有调查表进行优化，也可以定制新的调查表。普通用户具有输入、浏览、修改、查询、以及对调查表数据进行分析以及导出为Excel文件的权限。现场调查处置人员可以根据现场需要快速定制新的调查表。定制调查表的表项在系统中容易获得而且容易填写，主要包括单选项、多选项、文本、表格、时间等类型。用户可以根据填写调查表的设备（PC或PDA）合理设置所定制调查表的格式，使得用户易于在线填写、发送及浏览。用户上报的调查表信息直接写入数据库，具有相应权限的用户可以对这些信息进行实时统计分析并将结果反馈给现场调查人员，有助于现场调查和疫情处置的有效开展。
4.6便携式传染病现场应急作业箱
本研究根据现场流行病学调查的需要，研制出新一代的便携式传染病现场应急作业箱，调查箱包含电子模块和医学模块两个箱体，能够实现现场流行病学调查作业的集成化、信息化和模块化，实现调查现场到指挥中心的快速沟通，进一步提高现场流行病学调查工作的实时性和科学性。
5.结论
传染病防治及应急处置决策支持系统和新一代流行病学现场调查作业箱构成一套完整的流行病学现场调查作业平台，平台集现场信息采集与传输、现场标本采集与储运、数据分析、流行病学调查表定制等功能于一体。携带方便、使用灵活、成本低廉，适合多种级别的用户进行流行病学调查和标本采集。系统平台的有效应用可以提高我国现场流行病学调查的信息化水平和效率，为传染病防控和突发公共卫生事件处置提供强有力的工具。
1. Background and objectives
Since the beginning of the new century, emerging infectious diseasesappeared frequently and threatened human health, i.e., the SARS epidemic in2003, influenza A (H1N1) in2009and human infections with avian influenzaA (H7N9) virus in2013.. There have also been frequent natural disasters, i.e.,the Wenchuan earthquake in2008and the Yushu earthquake and Zhouqumudslides in2010. In some underdeveloped areas, information of infectiousdisease emergencies in fields was diffecult to be collected timely due tolimited medical, health, and communication conditions. All these above arelikely to cause pandemic outbreaks of infectious diseases.. In addition, it isalso likely to cause diffusion of infectious diseases in some remote areas dueto lack of professional equipment and experiences for response to infectiousdisease emergences. Effective control of outbreaks of infectious diseasesdepends on obtains of information quickly in fields and targeted interventions.To understand the epidemiological knowledge, the environment of thelocation of outbreaks and historical incidence of infectious diseases is helpfulfor the staff of prevention and control to develop reasonable prevention andcontrol measures in fields. According to the reasons above, it’s necessary toestablish a flexible decision support system for infectious emergency. Thisstudy, based on the development of China, combined the software andhardware technology to build a perfect platform used for decision supportsystem for infectious disease emergency based on WebGIS and mobile service.The effective application of the system platform could enhance the efficiencyof the infectious disease field investigation and outbreak emergency responseand provide an effective tool for the disposal of unexpected infectious diseasesoutbreaks and public health events.
2. Research contents
This study integrated wireless communication, network technique, andWebGIS technique build an infectious disease prevention, emergency disposal and decision support system, it’s include software and hardware.
Software is a decision support platform for infectious disease emergencybased on WebGIS and mobile service. Include the functions of fieldinvestigation and data collection, epidemiology detection, epidemiologicalstatistical analysis, guide of emergency disposal of infectious disease,epidemiological questionnaire custom-tailor, epidemiology expertise enquiryand so on. It’s a platform for prevention and emergency disposal of infectiousdisease. The utility of this system can obtain information in the field andstatistical the data in real time. The system can provide professionalinstruction for the people who engaged in the work of infectious diseaseprevention, enhanced the efficiency of disposal, to avoid epidemicwide-bound. This system apply to low-income and middle-income countriesand districts, it’s used convenient and cheaply. The system has two accessinterfaces, computer and Personal Data Assistant (PDA and mobile phone).Users can access the system by computer, PDA and Mobile Phone, it’soperated easily. Through global position system (GPS) and fast positionfunction, the users determine the location of the epidemic and detected thenatural condition and historic infectious diseases in the field. Through thefunction of information acquisition, we can collect the data of the fieldimmediately, reporting and analysis them real time. Through the site messagefunction, the workers in the field and decision makers in the office cancommunicated with each other, the officer instruct the work of the field, raiseefficiency of the field investigation.
Hardware is portable infectious disease emergency operation box,include electronic module and medical module. Hardware is used forspecimen collection, storage and transportation in sudden outbreaks ofinfectious diseases and other public health emergencies. Electronic moduleinclude rugged computer, dogvane, PDA, camera, voice recorder, built-inwireless card and other electronic equipments. Field investigation workers useelectronic module can collect the information and can analyse andtransmission in real time. The collected data include audio, video, picture andquestionnaire. Using electronic module, the field workers and rear expertscould communicate with each other in real time, the experts and decisionmakers can guide the field work in real time and provide technical support. Medical module include alcohol lamp, reagent bottles, stainless steeldisinfection box, specimen collection tubes, hemostatic clamp, protectiveclothing and other protective equipments. Medical module can be used tocollect animal organ specimens, insects, animal body fluids, urine and otherspecimens, and can standardize the collected data and do simple test operation.Medical module case using modular design, users can combination and carrydifferent investigation items according every scene investigation task, it’s veryconvenient.
3. Methods
Collected the historic infectious disease data Chinese CDC, include allcategories of infectious disease and incident number in different countries allover China. Collected host animals of all countries in China. Collected themeteorology data of all countries in China, include average temperature,maximum temperature, minimum temperature, medial humidity, average airpressure, and rainfall, all these data provide decision support information forprevention and emergency disposal of infectious disease. Collected the pathand traffic data, landform data, population structure data, and hospitalsinformation in China, integrated the information in the system, and providesupport for infectious disease workers. All the data were used in epidemiologyinformation support system. The system also provides hazard assessment forinfectious disease pathogens by aerosol release, epidemiological questionnairecustomization and diseases intelligent judgment.
Users access the system by PC and mobile phone, Google Maps is thedisplaying platform of geographic relevant information. The users obtainedthe geographic locations by keyword polling and GPS, according the locationinformation users acquire the epidemic information, climate condition, hostanimal information, and landform of these areas. Users report the epidemicinformation by text, pictures, and questionnaires in the investigation field, theexperts and decision makers in the office analyze the data real-time and thenguide the work in the field by station message according to the results ofanalysis results.
Portable infectious disease emergency operation box include two cases,named electronic module and medical module. Electronic module iscomposed by reinforce computer, attachments and waterproof safety box. Most functions of the portable infectious disease emergency operation boxintegrated in the reinforce computer, and some other functions were realizedby attachments, reinforce computer and attachments were placed inwaterproof safety box. The main body of medical module is also a waterproofsafety box, include blood collection module, stainless steel box, excretacollection tube, insect box, animal organ specimen collection tubes, protectionmodule, storage and transport module and so on. Users can take differentitems according to the task in the field.
Portable infectious disease emergency operation box designed byourselves, through field testing to determine the model and produced byspecialized factory.
4. Results
This study created a decision support system for infectious diseaseemergencies based on WebGIS and mobile service, users can access thesystem by PC and PDA. PC users access http://www.geoepi.com to acquireservice, PDA and mobile user access http://m.geoepi.com to acquire service.
4.1Field infectious disease information collection and analysis inreal-time
Information including questionnaire results, text, pictures, voice recordingsand video recorded in the field can be collected and sent to the database viawireless internet services from PCs, PDAs and mobile phones in real time bydifferent users. Experts and officials can analyze the data to understand thedynamics of the infectious disease emergency, the temporal and spatialdistributions of patients, the population at risk, the susceptible population, andprobable influencing factors.
More than200types of questionnaires including individual casesquestionnaires and epidemic-case questionnaires are provided by the system.The system also provides epidemiological questionnaires customized accordingto users’ actual demands in the field. In addition, the geographic location isimportant for field investigations. In this study, location information is collectedby a GPS unit or keyword enquiry, and the information of longitude and latitudeis then integrated into the report data. The spatial distribution maps, figures ofthe epidemic curve, and patterns of gender, age and occupation can be createdquickly, and epidemiologic analyses are conducted in real time. Additionally, users can export these additional data to an Excel spreadsheet for furtherepidemiology analysis in professional software, such as SPSS or STATA.
4.2Epidemiological information support function based on GoogleMaps
To understand the historic information related with infectious disease inthe locality, can raise efficiency of emergency disposal of epidemic situation.In this system, users searched the location by GPS and keyword enquiry, andthen review the information about this district, their location information andepidemiological information can displaying on Google Maps. Theepidemiological information include distribution of historical infectiousdisease in different countries in China, landform types, distribution of hostanimals, historical climate information, traffic information, distribution ofsanitary institution and so on, understand these information support the fieldinvestigation and emergency disposal.
According to the demanding of field investigation and emergencydisposal of epidemic situation, the system integrated the infectious diseaseknowledge and created a database, when infectious disease outbreak, theinfectious disease workers search the repository through PC or mobile phone,this function increased the specialty knowledge and provide informationsupport for emergency disposal workers and decision makers. Infectiousdisease repository include infectious disease expertise, emergency scheme forepidemic situation, classic cases, defend and epidemic prevention, guide ofinfectious disease documents, profession skills, laws about infectious diseaseand sanitation resources.
4.3Hazard assessment via aerosol dissemination based on GoogleMaps API visualization methods
Google Maps API (Google Maps application programming interface)provides mapping and spatial analysis capabilities, we use these functions andcombined with the aerosol diffusion model and population density data toaccess the scope of harm and the number of persons affected by pathogenicmicroorganisms through aerosol release. The assessment process and results candynamic visualizing simulation and displaying on the map. This method canprovide decision support information for the prevention and control anddecision-makers when the pathogenic microbiological hazard occurred. Theinformation include the scope of impact, impacted persons and districts, it’suseful for rapid developing prevention and control measures and reducing harmful of the biological hazards.
4.4Guides to Handling an Infectious Disease Emergency
This study integrates flow diagrams for the handling of an emergency,including handling cases of severe infectious diseases, emerging infectiousdiseases, food poisoning, nuclear, chemical and biologic hazards and otherpublic health emergencies. Disposal workers and decision makers can beassisted by the flow diagrams in different emergencies, and can also be providedwith information relating to the emergency, information for the prevention andcontrol of infectious diseases, information relating to laboratory diagnosis,information relating to law, and information relating to medical services,disinfection, insecticides and sterilization, and case analyses.
4.5Epidemiological questionnaire custom-tailor
The system provides the function that novel questionnaires can becustomized in the field by users. Administrative users have the permission tomanage questionnaires, including new questionnaires that are customized andoptimized versions of existing questionnaires. Common users have thepermission to put in, browse, modify, enquire about, and analyze questionnairedata and to export the information in a table format. Investigation and disposalworkers can use the existing questionnaires or create novel questionnaires usingthe custom-tailor according to their needs in the field. Options for filling outquestionnaires are readily provided by the system, and include uni-selections,multiple-selections, text, tables, and times. Users can choose the format of thequestionnaire according to whether they are using a PC or PDA, and they areable to fill out, send, or review questionnaires online. The data of reportedquestionnaires are written to the database directly. Permitted users can analyzethe data and transmit the results to the investigation worker in real time; it’shelpful for the field investigation and handling an infectious disease emergency.
4.6Portable infectious disease emergency operation box
According to the need of field epidemiological investigation, this studydeveloped a new generation of portable infectious disease emergency operationbox, include electronic module and medical module. Using this equipmentallow the field investigation workers quickly communicated withdecision-makers in the office, enhance the real-time and scientific of the fieldepidemiological investigation.
5. Conclusion
Decision support system for the infectious disease emergency and newportable infectious disease emergency operation box composed a completedplatform for field epidemiological investigation. The platform integrated thefunctions include field information collection and transmission, field specimencollection and transportation, data analysis, epidemiological questionnairecustom-tailor and so on. The operation box portable, flexible and low-cost, it’sapplicable to different-level users do epidemiological investigation andspecimen collection in the field. The effective application of the systemplatform can improve the level of information and efficiency of fieldepidemiological investigation and provide a powerful tool for handinginfectious disease and public health emergencies.
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