中国麻疹监测系统的建立和运转情况分析

Establishment and Performance of Measles Surveillance System in the People's Republic of China

目的回顾中国(未包括香港、澳门特别行政区和台湾地区,下同)麻疹监测系统(Measles Surveillance System,MSS)建立历程,分析2004～2009年MSS运转情况,为进一步加强麻疹监测提供参考。方法查阅相关历史文件、技术方案并检索文献,对MSS的建立过程进行回顾。分析31个省(自治区、直辖市,下同)2004～2009年通过MSS上报的疑似麻疹病例个案数据库,评价MSS的主要运转指标。结果中国从1959年开始通过中国疾病监测信息报告系统(National Notifiable Disease Reporting System,NNDRS)报告各省麻疹监测汇总数据。1998年制定了全国统一的麻疹监测方案,开始逐步建立MSS。2004年各省开始通过"中国免疫规划监测信息管理系统"报告麻疹病例个案信息。2009年修订了麻疹监测方案,并将麻疹个案监测信息报告功能与NNDRS合并,建立了麻疹专病监测信息报告系统。2004～2009年,全国通过MSS共报告疑似麻疹病例596425例,排除病例报告发病率从2004年的0.6/10万提高到2008年的2.6/10万;疑似麻疹病例48h内完整调查率从2004年的89.8%提高到2008年的97.6%;疑似麻疹病例血标本采集率从2004年的36.5%提高到2008年的66.7%。2009年全国排除麻疹报告发病率为1.2/10万,疑似麻疹病例48h内完整调查率为86.9%,散发疑似麻疹病例血标本采集率为70.1%,实验室血清检测结果7d内报告率为75.3%,386起麻疹爆发疫情中,354起(91.7%)经血清学确诊,92起(23.8%)采集了病原学标本。结论中国已建立了以个案为基础、流行病学和实验室监测相结合的MSS,系统运转质量虽逐步提高,但部分主要监测指标尚未达到监测方案要求,需进一步提高MSS运转质量,以适应消除麻疹需要。

Objective To review the process of measles surveillance system （MSS） establishment and to evaluate the performance of this system during 2004 - 2009 in the People ＇ s Republic of China （not include Hong Kong, Macao and Taiwan）. Methods Relevant policy and strategies implemeuted in measles surveillance were reviewed and literatures on MSS establishment were searched . The case investigation data of suspected measles cases reported by 31 provinces （municipal, autonomous regions） through MSS were analyzed for performance indicators calculation. Results Aggregated data of measles cases were reported in National Notifiable Disease Reporting System （NNDRS） since 1959. Ministry of Health developed national measles surveillance guideline in 1998 and began to establish MSS progressively. Case - based MSS data was reported through polio/acute flaccid paralysis surveillance information reporting system which was put in use since 2004, and was then integrated with NNDRS in 2009. Totally 596425 suspected measles cases were reported through MSS during 2004 - 2009, non - measles cases reported （per 100 thousand population） increased from 0.6 in 2004 to 2.6 in 2008, and proportion of suspected measles cases investigated within 48 hours of report increased from 89.8 % to 97.6 % , proportion of suspected cases with adequate serum specimens increased from 36.5 % to 66.7 % . In 2009, reported non-measles cases was 1.2 per 100 thousand, proportion of suspected measles cases investigated within 48 hours of report was 86.9 % , proportion of suspected cases with adequate serum specimens was 70.1 % , percentage of serum specimen results reported within 7 days of collection was 75.3 % , and 91.7 % of measles outbreaks were laboratory - confirmed, while only 23.5 % with specimen collected for virus detection. Conclusions Case - based MSS has been established with support of high quality laboratory. Although performance indicators increased steadily, it ＇ s still not adequate to support measles elimination program. Extra efforts of the performance of MSS need to be enhanced as well.