天津市流行性感冒社区监测新模式研究
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摘要
目的：探索以社区为基础的全人群流感监测方法,建立新型的流感监测模式。
方法：2009年10月至2011年2月,在天津市汉沽区汉沽街、大田镇开展全人群流感监测,包括流感样病例(influenza like illness, ILI)监测、在流感病毒快速检测的基础上开展病原学监测、感冒相关药物销售监测以及疾病负担研究。开展社区居民患流感样症状就诊意向调查,用社区居民患流感样症状后的就诊率校正ILI和流感发病率。应用EARS软件的累计和方法进行暴发预警,应用SaTScan软件对各社区的ILI进行时空扫描分析。采用自回归求和移动平均模型(Autoregressive integrated moving average, ARIMA)对ILI进行预测分析。
结果：社区居民因流感样症状就诊率为20.9%。2009年10月至2011年2月,共报告ILI700例,ILI占就诊病例总数的百分比(ILI%)为1.19%。2010年ILI发病率为2397.60/10万,流感发病率为94.64/10万。2009年10月至2010年3月流感季,社区流感监测ILI数与国家级哨点监测当日ILI数(延迟=0)有相关性(Spearman等级相关系数rs=0.675,P=0.000)。ILI数与前一周(延迟=-1)的感冒药销售人次相关程度最强(rs=0.620,P=0.000)。社区流感流行毒株与哨点医院监测流行毒株相似。与哨点医院监测相比,城镇和农村社区流感流行毒株出现晚于哨点医院流行株高峰后3-4周。ARIMA(0,1,1)(0,1,1)7模型能够很好的拟合社区ILI的发病情况。经累计和以及SaTScan时空扫描分析,发现10个聚集性区域,经确认证实两起暴发疫情。住院病例人均花费为1692.86元,门诊就诊人均花费为263.43元。
结论：社区流感监测新模式弥补了现有基于二级以上医院的流感监测网络,两者互为补充,对流感疫情做到早期预警和预测,为公共卫生决策提供理论依据。
Objective:To explore a new method of influenza surveillance in community.
Methods:Influenza surveillance,including influenza like illness(ILI),pharmacy on sale,pathogen based on rapid test and disease burden,was carried out on Hangu street,Datian town,Hangu district between Oct,2009 to Feb,2011. Visting rate of rural residents was used to adjust the incidence rate of ILI and influenza.Cumulative sum control chart (CUSUM) was used to give alert signal by using EARS software. Space-time scan statistics was used to identify clusters of village by using SaTScan software. Autoregressive integrated moving average (ARIMA) model was used to predict the ILI.
Results:The visiting rate of ILI case on community was 20.9%. From Oct,2009 to Feb,2011,700 ILI cases were found,ILI% was 1.19%.The incidence of ILI and influenza was 2397.6 and 94.64 per 100,000. The influenza season from Oct,2009 to March.2010,IIL of community surveillance was most related(lag=0) to ILI of national sentinel surveillance (Spearman rank r=0.675,P=0.000).ILI was most related to person time of sale of influenza pharmacy ahead one week(Spearman rank r=0.620,P=0.000). The popular viruses were late 3 or 4 weeks when compared with national sentinel surveillance. ARIMA(0,1,1)(0,1,1)7 Model could be as a good model for predicting influenza-like illness. Ten cluster areas were founded by CUSUM and space-time permutation analysis.Two outbreaks were confirmed.The average fees for inpatient was￥1692.86 and outpatient was￥263.43.
Conclusion:The new surveillance mode of influenza in community can complement the sentinel surveillance based on over second-class hospitals,give early alert and prediction,and provide theoretical for public health measures.
方法：2009年10月至2011年2月,在天津市汉沽区汉沽街、大田镇开展全人群流感监测,包括流感样病例(influenza like illness, ILI)监测、在流感病毒快速检测的基础上开展病原学监测、感冒相关药物销售监测以及疾病负担研究。开展社区居民患流感样症状就诊意向调查,用社区居民患流感样症状后的就诊率校正ILI和流感发病率。应用EARS软件的累计和方法进行暴发预警,应用SaTScan软件对各社区的ILI进行时空扫描分析。采用自回归求和移动平均模型(Autoregressive integrated moving average, ARIMA)对ILI进行预测分析。
结果：社区居民因流感样症状就诊率为20.9%。2009年10月至2011年2月,共报告ILI700例,ILI占就诊病例总数的百分比(ILI%)为1.19%。2010年ILI发病率为2397.60/10万,流感发病率为94.64/10万。2009年10月至2010年3月流感季,社区流感监测ILI数与国家级哨点监测当日ILI数(延迟=0)有相关性(Spearman等级相关系数rs=0.675,P=0.000)。ILI数与前一周(延迟=-1)的感冒药销售人次相关程度最强(rs=0.620,P=0.000)。社区流感流行毒株与哨点医院监测流行毒株相似。与哨点医院监测相比,城镇和农村社区流感流行毒株出现晚于哨点医院流行株高峰后3-4周。ARIMA(0,1,1)(0,1,1)7模型能够很好的拟合社区ILI的发病情况。经累计和以及SaTScan时空扫描分析,发现10个聚集性区域,经确认证实两起暴发疫情。住院病例人均花费为1692.86元,门诊就诊人均花费为263.43元。
结论：社区流感监测新模式弥补了现有基于二级以上医院的流感监测网络,两者互为补充,对流感疫情做到早期预警和预测,为公共卫生决策提供理论依据。
Objective:To explore a new method of influenza surveillance in community.
Methods:Influenza surveillance,including influenza like illness(ILI),pharmacy on sale,pathogen based on rapid test and disease burden,was carried out on Hangu street,Datian town,Hangu district between Oct,2009 to Feb,2011. Visting rate of rural residents was used to adjust the incidence rate of ILI and influenza.Cumulative sum control chart (CUSUM) was used to give alert signal by using EARS software. Space-time scan statistics was used to identify clusters of village by using SaTScan software. Autoregressive integrated moving average (ARIMA) model was used to predict the ILI.
Results:The visiting rate of ILI case on community was 20.9%. From Oct,2009 to Feb,2011,700 ILI cases were found,ILI% was 1.19%.The incidence of ILI and influenza was 2397.6 and 94.64 per 100,000. The influenza season from Oct,2009 to March.2010,IIL of community surveillance was most related(lag=0) to ILI of national sentinel surveillance (Spearman rank r=0.675,P=0.000).ILI was most related to person time of sale of influenza pharmacy ahead one week(Spearman rank r=0.620,P=0.000). The popular viruses were late 3 or 4 weeks when compared with national sentinel surveillance. ARIMA(0,1,1)(0,1,1)7 Model could be as a good model for predicting influenza-like illness. Ten cluster areas were founded by CUSUM and space-time permutation analysis.Two outbreaks were confirmed.The average fees for inpatient was￥1692.86 and outpatient was￥263.43.
Conclusion:The new surveillance mode of influenza in community can complement the sentinel surveillance based on over second-class hospitals,give early alert and prediction,and provide theoretical for public health measures.
引文
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