1999～2011年全国急性弛缓性麻痹病例监测系统关键环节的及时性分析

Study on Timeliness of Critical Points of Acute Flaccid Paralysis Cases Surveillance System in China from 1999 to 2011

目的评估1999～2011年全国(未包括香港、澳门特别行政区和台湾地区)急性弛缓性麻痹(Acute FlaccidParalysis,AFP)病例监测系统关键环节的及时性。方法计算1999～2011年AFP病例麻痹-就诊、就诊-报告、报告-调查、调查-采样、采样-送样和送样-脊髓灰质炎(脊灰)实验室反馈结果间隔的平均天数和中位数,运用线性回归分析探讨2011年AFP病例麻痹-采样间隔时间的影响因素。结果 1999～2011年,麻痹-就诊平均从2.94d缩短为2.49d,就诊-报告从4.31d缩短为2.90d,报告-调查从0.55d缩短为0.39d,调查-采样从1.05d延长到1.68d,采样-收样从4.99d缩短为4.43d,收样-脊灰实验室反馈结果从24.51d缩短到21.22d,麻痹-脊灰实验室反馈结果总间隔时间从37.33d缩短到34.93d。2011年有6个省(自治区、直辖市)麻痹-脊灰实验室反馈结果间隔<30d,但新疆维吾尔自治区间隔时间>40d。麻痹-采样间隔时间与AFP病例是否有发热、首次就诊医院级别、报告医院级别、调查单位、就诊次数和居住地点有关联。结论我国AFP病例监测质量在逐年提高,但麻痹-脊灰实验室反馈结果各环节间隔时间还有进一步缩短的空间,要重点关注县级医院和疾病预防控制中心的培训、督导,脊灰实验室要全面采取快速检测方法,提高各项监测的及时性。

Objectives To evaluate the timeliness of acute flaccid paralysis （AFP） cases surveillance system in China during 1999-2011, Methods The mean or median days from onset of paralysis to first doctor visit, notification, investigation, sample collection, sample reception, laboratory results report were calculated for AFP cases during 1999-2011. The linear regression analysis was used to explore the association between the mean days from onset of paralysis and relevant factors. Results The mean days changes from 2.94 in 1999 to 2.49 in 2011 for onset of paralysis-doctor visit, from 4.31 to 2.90 for doctor visit-notification, from 0.55 to 0.39 for notification-investigation, from 1.05 to 1.68 for investigation to sample collection, from 4.99 to 4.43 for sample collection-sample reception, from 24.51 to 21.22 for sample reception-laboratory results report. Totally the mean days from onset of paralysis to laboratory result report reduced from 37.33 in 1999 to 34.93 in 2011. There were less than 30 days from onset of paralysis to laboratory results report in 6 provinces, but more than 40 days in Xinjiang Uygur Autonomous Region in 2011. The time interval from onset of paralysis to sample collection were associated with fever with paralysis at the beginning, hospital level of first doctor visit, level of reporting hospital, investigation unit, times of doctor visit and living status. Conclusions The quality of China AFP cases surveillance system has been improved year by year. However, the time interval from onset of paralysis to laboratory results report needs to be shortened. The training and supervision on hospitals and centers for disease control and prevention at county level and fast detecting method for virus isolation in polio laboratories should be conducted so as to improve the timeliness of AFP cases surveillance system.