【作者】 王燕；

【导师】 徐凌忠； 康殿民；

【作者基本信息】 山东大学 ， 公共卫生（专业学位）， 2013， 硕士

【摘要】 研究背景流行性感冒(简称流感)是由甲、乙、丙三型流感病毒引起的急性呼吸道传染病,具有传播快、流行广、危害严重的特点。20世纪人类曾发生过4次流感大流行,每次大流行都给人类生命财产和经济发展带来灾难性打击。2009-2010年全球出现了新型甲型H1N1流感大流行,为应对甲型H1N1流感大流行,2009年6月中国启动了扩大全国流感监测网络的项目,哨点医院和网络实验室分别增加到556家和411家,使流感监测覆盖了全国所有地(市)级行政单元。山东省17个地市均设立了哨点医院和网络实验室。济宁市在市第一人民医院、市中区妇幼保健院设立了国家级流感监测哨点医院,在济宁市疾病预防控制中心设立了国家级流感监测网络实验室,开展有效的流感监测,所采集的数据为预测济宁市甲型H1N1流感流行趋势、做好流感防控工作提供了重要的科学依据。为了解济宁市流感监测系统目前的运行状况,评价流感监测的工作质量,特开展本项研究。研究目的了解济宁市流感监测系统目前的运行状况,监测流感样病例的疫情动态,分析流行特点和趋势；监测济宁市流感病毒的活动水平和抗原变异情况；及时发现流感样病例聚集或暴发疫情,明确流行型别,控制暴发和流行；评价济宁市流感监测工作质量,分析存在的问题,提高监测水平。资料与方法资料来源于济宁市疾病预防控制中心2010年4月～2012年3月中国流感监测信息系统,包括流感样病例监测数据、病原学监测数据、暴发疫情监测数据、流感监测质量数据。资料分析采用SPSS15.0进行。主要结果1.流感样病例监测2010～2012年度四所流感哨点医院共报告监测科室门诊病例2339776人次,ILI36909人次,ILI%为1.58%,低于2009-2010年流感流行年,0～组流感样病例所占比例最高,国家级流感哨点医院ILI%高于省级流感哨点医院,儿科门诊报告的ILI比例最多。2.流感病原监测2010～2012年度两所国家级哨点医院共采集ILI咽拭子标本1743份,分离出流感病毒44株。其中甲型H1N1流感病毒34株、乙型流感病毒3株、甲型H3N2流感病毒7株。2010～2011年度2株、2011～2012年度33株、2012第14～52周9株。所有毒株抗原性分析未发生变异。3.暴发疫情监测2010～2012年全市共报告确诊流感暴发疫情4起,任城区2起、嘉祥县、曲阜市各1起。学校3起、农村1起。甲型H3N2流感1起,乙型流感3起。4起流感暴发疫情共发病360人,波及人口3698人,流感罹患率介于16.67‰～256.72‰,平均罹患率为97.35‰。4.流感监测质量评价2010～2012年四所医院流感样病例报告平均及时率为92.48%,零缺报率为2.45%。济宁市第一人民医院标本送检平均及时率为62.63%、标本符合率为86.25%；市中区妇幼保健院送检平均及时率为62.44%、标本符合率为95%。2010～2011年和2011～2012年两监测年度济宁市流感样病例标本病毒分离阳性率均低于10%,未达到国家规定分离指标。2010～2011年度济宁市病毒分离完成率为6.67%,2011～2012年病毒分离完成率为110%。4起暴发疫情网络报告及时、标本采集合格、处置基本规范,但4起暴发疫情流感罹患率不同,流行强度存在差异。结论与建议1.结论济宁市按照卫生部下发的《全国流感监测方案(2010年版)》要求建立了较为完善、系统的流感监测体系,开展了ILI报告、病毒分离和暴发疫情监测处置工作。流感监测系统总体上运行正常,但也出现监测工作质量下滑,哨点医院存在不同程度的缺报、漏报现象,流感病毒分离阳性率偏低。今后应加强流感监测网络管理和质量控制,加强人员培训和技术指导,完善整个网络运行效果。2.建议一是四所流感监测哨点医院合理设置监测科室,认真做好流感样病例、门诊就诊病例登记和报告、标本采集和运送工作。二是加强对网络实验室、哨点医疗机构专业技术人员的培训,提高监测报告、标本采集及实验室检测技能。疾控机构与哨点医院应加强信息沟通与协调,及时发现和解决问题。三是加强疫情监测,重点关注人口集中的中小学校,做好暴发疫情报告、调查处置,防止疫情扩散蔓延。四是切实加强流感监测项目的组织和领导,加大对辖区内流感哨点医院和网络实验室监督检查力度,提高流感监测工作质量。各网络成员单位实行领导负责制,明确分工、责任到人,确保人员、经费、培训、设施设备、试剂耗材等及时到位,保证各项监测工作的顺利开展。更多还原

【Abstract】 BackgroundInfluenza is an acute viral contagious respiratory disease caused by influenza virus, with wide and rapid spread trend and serious harm. Influenza viruses are grouped into three types, designated A, B, and C. There have been4influenza pandemics During the20th century, which influenced the development of social economy, and seriously threatened people’s lives and properties. Response to the pandemic (H1N1)2009, China started to expand the national influenza surveillance network project, the sentinel hospitals and network laboratory increased to556and411, respectively.17cities have set up a sentinel hospitals and network laboratory in Shandong province, Jining Nol people’s hospital and Shizhong District maternal and child health care hospital in Jining city were national influenza surveillance sentinel hospitals, center for disease control and prevention of Jining city was Influenza surveillance network laboratory at the national level. To analyze the trends of H1N1epidemic from2010to2012, and provide evidence for further H1N1prevention and control. This study was done to understand the performance of the influenza surveillance system operation status and evaluate work quality.ObjectiveTo understand the performance of the influenza surveillance system operation status, monitor dynamic changes of influenza-like cases, analyze epidemiological characteristics and trends of influenza, virus type and activity level of influenza as well as aberrance of the surface proteins antigenicity of influenza virus. To find influenza-like cases together or outbreak timely, identifying the virus type virus type, and control the outbreak. To evaluate influenza monitoring system monitoring quality, analyze the problems and improve monitoring quality. Materials and MethodsThe data were collected from China influenza surveillance information system from April2010to March2012, which include monitoring data of influenza-like cases, monitoring data of etiology, monitoring of outbreak and evaluation of monitoring quality. Data were analyzed using by Statistical Package for Social Science (SPSS)15.0.Main Results1. Monitoring of influenza-like illness A total2930366cases of outpatient and48976cases of ILI were reported, ILI rate was1.67%, which was less than2009to2010influenza pandemic. ILI rate of National influenza sentinel influenza surveillance hospitals was higher than provincial influenza sentinel influenza surveillance hospitals. The highest in the age group was in group of0to4years group.2. Monitoring of etiology1743ILI cases’nasal swabs were collected from two National influenza sentinel influenza surveillance hospitals in2010to2012,44strains of influenza virus were isolated,34strains were H1N1subtype,7strains were H3N2subtype,3strains were B type.2strains in2010to2011,33strains in2011to2012,9strains in2012. All antigenic drift of influenza hadn"d occurred.3. Monitoring of outbreak4outbreaks of influenza were reported from2010to2012,2outbreaks were reported in Rencheng District,1outbreaks was reported in Jiaxiang country,1outbreaks was reported in Qufu county.3of that occurred in schools,1of that occurred in village. B type was the main type.360ILI cases occurred in the outbreak, with97.35%o of attack rate ranged from16.67%o to256.72%o,3698people were affected.4. Evaluation of monitoring quality Rate of average report timeliness was92.48%, zero rate was2.45%. Timeliness of inspection was62.63%, coincidence rate was86.25%in Jining No.1people’s hospital. Timeliness of inspection was62.44%, coincidence rate was95%in Downtown land maternal and child care service centre. The rate of positive separation are less than10%,which were not up to the national standards from2010to2012.4the outbreak report timely, specimen collection qualified, disposal basic norms, but there were significant differences among attack rates and popular intensity.Conclusions and Suggestions 1.Conclusions Influenza monitoring system was relatively perfect and systematic according to the national influenza surveillance solution (2010), and began working in ILI report, virus isolation and outbreak monitoring treatment, which has been basically in normal operation, but there were monitoring the quality of the work in decline, lack of report, the omission of phenomenon, flu viruses isolated positive rate is low, the flu monitoring network management and quality control need to improve, enhance network resource construction and teachers training and so on, to perfect the network operation effect.2. SuggestionsFirstly,4sentinel influenza surveillance hospitals should set reasonable departments, made a serious commitment to outpatient case registration and reporting, specimen collection and transport, and ensure the completion of annual monitoring work.Secondly, strengthening the standardized training for network and medical institutions professionals&technical can improve the monitoring report, specimen collection and laboratory testing skills. The communication between CDC and sentinel influenza surveillance hospitals was advanced and the problems, which was able to be solved in time.Thirdly, it is necessary to reinforce epidemic surveillance to prevent spread of the disease especially for primary and secondary schools.Fourthly, Continue perfect the management of the sentinel influenza surveillance hospitals and netlab with inspect the system, ensure personnel, funds, training, equipment, reagents material etc in place in time, can enhance staffs enthusiasm, guarantee monitor quantity and the quality, to ensure it work smoothly.更多还原