郑州市2014—2016年急性弛缓性麻痹病例监测结果分析

目的分析郑州市2014—2016年报告的15岁以下儿童急性弛缓性麻痹(acute flaccid paralysis,AFP)病例和AFP监测系统运行情况,为AFP防控策略提供科学依据。方法对郑州市2014—2016年报告的15岁以下儿童AFP病例的监测数据进行流行病学特征分析,并对AFP监测系统进行评价。结果郑州市2014—2016年AFP监测系统共报告406例,其中AFP病例378例,非AFP病例28例;发病时间以夏秋季为主;报告病例居首位的地区是二七区,报告病例157例;378例AFP病例中,完成脊髓灰质炎疫苗全程免疫史有351例;AFP病例各项监测指标除2016年合格便采集率较低外,其他均符合"全国AFP病例监测方案"的要求;AFP病例监测敏感性指标显示:378例AFP病例中,283例为外地病例。结论郑州市AFP监测系统灵敏度较高,应继续关注AFP监测重点地区、发病集中季节和重点人群的情况。     

沭阳县2006-2009年急性弛缓性麻痹病例流行病学分析

为了进一步掌握沭阳县急性弛缓性麻痹(AFP)病例流行特征,从而提高AFP病例的监测工作质量。根据AFP病例个案调查表进行统计分析。结果显示,沭阳县2006-2009年AFP病例监测系统共报告AFP患者28例,15岁以下儿童AFP病例年平均报告发病率为2.31/10万,其中0~4岁发病占67.86%,全程免疫占89.29%,地级医院报告病例占32.14%,AFP患者粪便标本采集率为100%。沭阳县AFP病例监测工作的各项监测指标完成情况较好,但存在薄弱环节,建议不断提高基层医务人员的AFP病例的识别能力和报告意识,消除薄弱环节,不断提高AFP监测工作质量。     

景德镇市2004-2005年急性弛缓性麻痹病例分析

对景德镇市2004-2005年报告急性弛缓性麻痹(AFP)病例进行的流行病学分析,按AFP监测系统主要指标进行了评价。期间,全市监测系统共报告AFP病例16例,其中外地6例,本地实际报告10例,15岁以下儿童AFP平均报告率1.25/10万。监测系统主要指标除14天内双份合格大便标本采集率未达标准外,其余均达标准。     

2012年广州市荔湾区疑似预防接种异常反应监测情况分析

目的了解广州市荔湾区疑似预防接种异常反应（Adverseevent following immunization,AEFI）监测情况,分析AEFI发生的原因,为改进疫苗质量和提高预防接种服务质量提供依据。方法对2012年荔湾区各预防接种门诊报告的AEFI病例资料进行分析。结果2012年荔湾区开展预防接种的疫苗共82种（不同厂家和剂型）,其中22种疫苗报告AEFI157例。接种共352723剂次,发生率为44．51／10万,其中一般反应、异常反应、偶合症的发生率分别为27．50／10万（占61．78％）、15．88／10万（占35．67％）、11．34／10万（占2．55％）。157例AEFI病例中,0～1岁儿童112例（占71．34％）,0-7岁儿童156例（占99．36％）。AEFI发生率居前的疫苗为七价肺炎球菌结合疫苗、白破疫苗、23价肺炎球菌多糖疫苗,报告发生率分别为253．32／10万、203．94／10万、190．28／10万。结论广州市荔湾区2012年AEFI监测具有较高的覆盖性和灵敏度。荔湾区2012年AEFI以一般反应为主,未发生严重异常反应。加强宣传、加强培训、加强管理,有利于提高预防接种服务的质量。     

63例非典型急性下壁心肌梗死临床分析

目的：研究评价各种常见诱因对急性下壁心肌梗死（IAMI）患者误诊判断的临床意义。方法：选择2002年1月-2009年12月我院急门诊IAMI患者63例,对其首发症状、心电图资料进行回顾性分析。结果：63例中,以头晕乏力首诊19例（30．16％）,以晕厥首诊11例（17．46％）,以上腹痛伴恶心呕吐,偶腹泻首诊13例（20．63％）,以咽痛或牙痛首诊10例（15．87％）,以呼吸困难首诊8例（12．70％）,以左心衰竭首诊2例（3．17％）。结论：对急性下壁心肌梗死患者,常规心电图检查是必要的。再结合心肌坏死生化标志物指标,早诊断,早治疗。     

福建省脊髓灰质炎疫苗转换前后AFP病例病原学监测结果分析

自2016年5月1日起,我国与全球另外154个国家和地区同步实施脊髓灰质炎(以下简称"脊灰")疫苗免疫策略转换,停用三价口服脊灰减毒活疫苗,改用二价口服脊灰减毒活疫苗.为探讨脊灰疫苗转换对福建省急性弛缓性麻痹(Acute flaccid paralysis,AFP)病例监测结果产生的变化,本研究收集2012-2018年福建省AFP病例的流行病学及实验室监测数据,对脊灰疫苗转换前后AFP病例的监测结果进行描述性分析,采集AFP病例及其接触者粪便标本,并使用RD细胞和L20B细胞进行病毒分离;对L20B阳性分离物进行脊灰病毒(Poliovirus,PV)的型内鉴别(Intratypic differentiation,ITD),对PV衣壳蛋白VP1编码区核苷酸序列测定和分析.使用SPSS 21.0软件对数据进行统计检验,比较采用X2检验.结果显示,2012-2018年福建省累计报告AFP病例1 776例,根据AFP病例分类流程确诊的AFP病例1 283例,排除的非AFP病例493例,疫苗转换前后报告发病率平均为2.83/10万和2.71/10万.实验室共检测3123份粪便标本(包括AFP病例、非AFP病例及接触者),其中合格标本采集率为92.42％,7日及时送检率为97.85％,14日内病毒分离完成率接近100％,疫苗转换前后PV平均分离率分别为1.91％(38/1986)、1.58％(18/1137),非脊灰肠道病毒平均分离率分别为10.22％(203/1 986)、5.45％(62/1 137).2016年5月1日之前分离出Ⅰ型PV6株,Ⅱ型PV 13株,Ⅲ型PV 19株;2016年5月1日之后分离出Ⅰ型PV 6株,Ⅲ型PV 12株.本研究结果提示,脊灰疫苗转换前后福建省AFP监测系统运转正常,始终保持较高的敏感性和及时性.2012-2018年福建省分离出的PV均为脊灰疫苗株,毒株血清型别以Ⅲ型为主,VP1编码区核苷酸以低变异为主,未发现疫苗衍生脊灰病毒及脊灰野病毒,疫苗转换后再未检出Ⅱ型PV,提示Ⅱ型脊灰疫苗株病毒可能已被阻断.     

巴彦淖尔市2008—2015年急性弛缓性麻痹病例的监测结果分析

目的分析内蒙古巴彦淖尔市2008—2015年急性弛缓性麻痹(acute flaccid paralysis,AFP)病例的流行病学特征,评价AFP信息监测管理报告系统,为制定本地区预防AFP提供科学依据。方法采用描述性流行病学方法,对巴彦淖尔市2008—2015年15岁以下儿童AFP病例监测数据进行流行病学特征分析,并对AFP监测系统进行评价。结果巴彦淖尔市2008—2015年共报告15岁以下儿童AFP病例65例,年平均报告发病率3.20/10万,无脊髓灰质炎野毒株检出和脊髓灰质炎病例报告;发病时间以夏秋6—9月为多;临河区位居报告病例数首位,占总报告病例数的52.3%;男性多于女性,男女性别比为1.24∶1;1~<5岁儿童占总报告病例数的53.8%;完成全程免疫的儿童占61.0%,未完成免疫史和免疫史不详者占39.0%。各项监测指标均达到国家监测方案要求。结论巴彦淖尔市AFP监测系统灵敏性较高,AFP病例的监测应关注重点地区和重点人群免疫接种情况,继续保持无脊灰状态。     

潍坊市坊子区2012年产前HBsAg筛检及新生儿首针乙肝疫苗接种情况分析

目的：了解住院分娩产妇乙肝病毒表面抗原（ HBsAg）检测及其所生新生儿首针乙肝疫苗及时接种情况,为进一步完善新生儿乙型肝炎的免疫预防策略提供依据。方法对2012年坊子区设有产科的医院每月上报的产妇HBsAg 检测和新生儿首针乙肝疫苗接种资料进行分析。结果坊子区2012年设有产科的医疗机构共报告住院分娩产妇2975名,产前HBsAg筛检2881名,筛检率为96．84％,各医疗机构筛检率在96．55％和97．50％之间;检出HBsAg阳性者66例,阳性率为2．29％,各医疗机构阳性率在0．00％和5．52％之间。新生儿共2975名,其中常住者所生新生儿2612名,流动者所生新生儿363名,常住和流动的新生儿乙肝疫苗接种率分别为96．13％和94．21％,及时接种率分别为93．87％和90．36％,差异均无统计学意义（χ2＝2．98、3．67,P＞0．05）。122名未及时接种首针乙肝疫苗的新生儿系患各种疾病所致。结论坊子区2012年设有产科的医院对住院的孕产妇产前HBsAg筛查率较高,其所生的新生儿24 h内乙肝疫苗及时接种率较高。     

潍坊市2012年疑似预防接种异常反应监测分析

目的分析潍坊市2012年疑似预防接种异常反应的发生特征,评价AEFI监测系统的运转情况。方法通过AEFI监测系统,收集2012年AEFI个案数据,采用描述性方法对AEFI监测系统运转进行评价,对AEFI病例进行流行病学分析。结果全市AEFI监测系统共收到个案1 058例,其中≤1岁占77.32%,男女性别比为1.39∶1。报告的AEFI中,国家免疫规划疫苗占84.31%,其中83.18%发生在接种后≤1 d;一般反应占98.20%,预防接种异常反应占1.42%,其中过敏性皮疹占0.85%,卡介苗淋巴结炎占0.47%。估算全市国家免疫规划疫苗常见预防接种异常反应报告发生率为0.27/105~5.33/105。所有AEFI病例均已痊愈。2012年全市12个县(区、市)均有AEFI数据报告,48 h内报告率、调查率均为100.00%。结论潍坊市AEFI监测敏感性和监测质量尚需提高。AEFI常发生在小年龄儿童、NIP疫苗接种后≤1 d,此为监测重点。     

许昌市2009—2013年麻疹流行病学特征和监测系统运转状况分析

目的分析许昌市2009—2013年麻疹流行特征和监测系统运转状况,为加速消除麻疹制定策略及措施提供科学依据。方法利用描述性流行病学方法对许昌市2009—2013年麻疹监测系统资料进行统计分析。结果许昌市2009—2013年累计报告麻疹病例675例,年均报告发病率为3.16/10万。全市8个县、市区均有病例报告,病例数主要集中在禹州市,占总病例数的55.56%;发病呈明显的季节性分布,主要集中在2—5月份,占总病例数的73.48%;病例主要集中于0~6岁儿童,占总病例数的85.63%,其中1岁以下婴幼儿占总病例数的50.22%;8月龄~14岁麻疹病例中有确切免疫史者仅占38.58%。随着监测系统及时性和特异性逐年提高,48 h完整调查率由2009年的88.32%上升至2012年的100%;血标本3 d内送达率由2009年的51.68%上升至2013年的100%;实验室结果 7 d内报告率由2009年的52.80%上升至2013年的100%;血标本采集率从2009年48.86%上升至2013年的100%;暴发血清学确诊率、病原学标本采集率均上升至100%。2009—2013年麻疹监测系统敏感性低,排除病例报告发病率为0.49/10万~1.43/10万。结论 2009—2013年许昌市麻疹发病率下降,小年龄组发病构成增加。监测系统运转综合质量逐年提升,但敏感性低。今后应进一步加强麻疹类疫苗接种与管理,提高人群免疫水平;加强医疗机构传染病报告与管理,提高监测系统敏感性,防止传染源扩散。     

Outbreaks of paralytic poliomyelitis and polio surveillance in Shandong province of China.

Widespread outbreaks of paralytic poliomyelitis occurred in Shandong province, China, starting from 1988. In 1989, 484 cases were recorded, which was the peak during the past 4 years. Although emergency immunization with trivalent oral poliovirus vaccine (OPV) was carried out in selected counties in 1989 and 1990, control of the outbreak was not satisfactory. OPV mass immunization campaigns were introduced to cover the whole province in early 1991, and the number of patients with paralytic poliomyelitis decreased to 95. In addition to this new immunization strategy, we began to construct new polio surveillance systems. These were a network for case-negative reporting and an immediate reporting system of acute flaccid paralysis (AFP). As for the case-negative reporting, presently more than 90% of counties have been reporting presence or absence of new AFP cases. Monitoring of AFP immediate reporting has also shown a gradual improvement in several aspects. These polio surveillance activities are crucial to polio eradication programme management.     

西安市1995-2008年检出脊髓灰质炎疫苗病毒的急性弛缓性麻痹病例流行病学分析

分析脊髓灰质炎(脊灰)病毒(PV)的急性弛缓性麻痹(AFP)病例流行病学特征,提高对疫苗衍生脊灰病毒(VDPVs)和循环的疫苗衍生脊灰病毒(cVDPVs)的认识,增加AFP病例监测系统敏感性。对西安市1995-2008年检出的PV阳性AFP病例进行流行病学分析。对疫苗变异PV采用VP1基因核苷酸序列测定方法进行分子生物性状分析。西安市1995-2008年共检出PV13株,检出率4.29%。分离到的PV以II、III型为主,AFP病例散在发生,无聚集性。未全程免疫儿童(全程免疫儿童,年龄以≤1岁儿童为主(84.62%)。麻痹残留率高达84.62%。脊灰相关病例(VAPP)的发生危险性为0.24/100万。型内特征鉴定有1株为疫苗变异PV,经VP1基因核苷酸序列测定未达到VDPV的分类标准。维持无脊灰阶段,存在着VDPV和发生cVDPVs的可能,在保持高水平脊髓灰质炎疫苗(OPV)免疫覆盖率的同时,高质量的AFP病例流行病学监测和病毒学监测工作,具有重要的现实意义。     

Trends in Animal Rabies Surveillance in the Endemic State of Minas Gerais,Brazil

Rabies is a viral zoonosis affecting mammal species and causes large economic losses. Included among the neglected diseases, it is still insufficiently addressed by governments and the international community, despite formal surveillance and control programs. This study used a dataset of 10,112 rabies diagnoses in animals provided by the Brazilian passive surveillance system from 2001 to 2012. The positivity rate of the tested samples was 26.4%, and a reduction in the total samples sent during the last six years was observed. The kernel density map indicated case concentration in the south region and a decrease in density of rabies cases in the second period studied (2007 to 2012). The directional trend of positive rabies diagnoses remained in the south region, as shown by the standard deviational ellipse. The spatial scan statistic identified three large clusters of positive diagnoses, one in the first period (2001-2006) and two in the second period (2007-2012), indicating an expansion of risk areas. The decrease in rabies cases from 2006 to 2012 does not necessarily reflect lower viral circulation or improvement in actions by epidemiological surveillance; this decrease could indicate a deficiency in epidemiological surveillance during the observation period due to the increase in the silent areas. Surveillance should maintain an increasing or constant number of tests during the years in addition to a reduction in the number of outbreaks of rabies, which would indicate a lower positivity rate. The findings in this study indicate deterioration in the effectiveness of the passive surveillance for rabies. The number of rabies cases, total number of tests performed and positivity rate are good indicators for evaluating passive surveillance. This paper can function as a guide for the assessment and improvement of the actions in passive surveillance of rabies.     

Quality evaluation for the surveillance system of human prion diseases in China based on the data from 2010 to 2016

The surveillance of CJD or human prion diseases (PrDs) has been conducted for 10 y in China. To evaluate the quality of China CJD surveillance system, the collections of the clinical and epidemiological information, the sampling, the clinical examinations and laboratory tests and follow-up survey were separately analyzed based on the data from 2010 to 2015. The obtaining rates of clinical-information table, epidemiological-information table, sample inspection sheet and medical record of the referring patients from reporting units to the center of CJD surveillance maintained or reached at very high levels, being close to 100% in the past 3 y. 93.82%, 85.23%, 96.21% and 94.70% of the reported cases had the data of MRI, EEG, CSF 14-3-3 and PRNP sequencing, respectively. Follow-up surveys were conducted in about 50% cases in 2010 and 2011, 93.39% cases in 2012 and 100% cases in the last 3 y. High obtaining rates of the clinical and epidemiological data, high conducting rates of the relevant clinical examinations and laboratory tests, high performing rates of follow-up survey for every referring case reflect a good implemental capacity in China CJD surveillance system, which supplies solid basis for recognition and diagnosis of human prion diseases and guarantees good quality of China CJD surveillance system.     

Surveillance of acute flaccid paralysis in Belarus

The ten-years experience of acute flaccid paralysis (AFP) surveillance in Belarus has been summarized. Among 456 AFP cases reported from 1996 to 2005, 11 were classified as vaccine-associated paralytic poliomyelitis (VAPP), 445--as non-polio AFP. The risk of VAPP for the period 1996-2001 was 1 case per 745,000 used doses of oral poliovaccine (OPV). For the recipients of OPV the risk was 1 case per 911,700 doses and for the first-dose recipients--1 case per 96,000 doses. The high incidence of VAPP was a reason for implementation of sequential polio vaccination schedule in 2000. Guillain-Barre syndrome dominated among non-polio AFP (39.3% of cases); more rare were traumatic neuritis (27.9% of cases), transient monoparalysis (12.1%), myelitis (7.6%). Non-polio AFP differed from VAPP by following epidemiological and virological characteristics: predominance of previously repeatedly vaccinated against poliomyelitis; development of paralysis in long-term period after vaccination; isolation of non-polio viruses belonged to three serotypes of Coxsackie B viruses (B1, B4, B6) and six serotypes of Echo viruses (6, 7, 11, 14, 24, 25) in 8.1% of cases; absence of typical for polio residual paralyses in patients who excreted vaccine polioviruses.     

潍坊市2007-2012年水痘流行病学分析

目的：了解潍坊市2007-2012年水痘的流行病学特征,为控制水痘策略提供科学依据。方法对2007-2012年疾病监测信息报告系统上报的水痘病例资料进行描述流行病学分析。结果2007-2012年潍坊市共报告水痘病例2256例,年均发病率为4．22/10万,11月至次年1月及4-6月为发病高峰期;发病主要集中于4～9岁和10～24岁者,其发病率分别为28．76/10万和6．85/10万。发病者主要是学生、散居儿童和托幼儿童,分别占总病例数的52．13％、19．99％、16．93％。报告暴发疫情12起,主要发生在学校和托幼机构。结论潍坊市发生的水痘以4～9岁和10～24岁者为高发人群,应加强对适龄儿童水痘疫苗的查漏补种工作,加强学校及托幼机构传染病管理,减少发生暴发疫情。     

Evaluation of the National Notifiable Diseases Surveillance System for Dengue Fever in Taiwan, 2010–2012

BackgroundIn Taiwan, around 1,500 cases of dengue fever are reported annually and incidence has been increasing over time. A national web-based Notifiable Diseases Surveillance System (NDSS) has been in operation since 1997 to monitor incidence and trends and support case and outbreak management. We present the findings of an evaluation of the NDSS to ascertain the extent to which dengue fever surveillance objectives are being achieved.MethodologyWe extracted the NDSS data on all laboratory-confirmed dengue fever cases reported during 1 January 2010 to 31 December 2012 to assess and describe key system attributes based on the Centers for Disease Control and Prevention surveillance evaluation guidelines. The system’s structure and processes were delineated and operational staff interviewed using a semi-structured questionnaire. Crude and age-adjusted incidence rates were calculated and key demographic variables were summarised to describe reporting activity. Data completeness and validity were described across several variables.Conclusions/SignificanceThe NDSS for dengue fever surveillance is a robust, well maintained and acceptable system that supports the collection of complete and valid data needed to achieve the surveillance objectives. The simplicity of the system engenders compliance leading to timely and accurate reporting. Completeness of hospitalization information could be further improved to allow assessment of severity of illness. To minimize misclassification, an algorithm to accurately classify travel cases should be established.