基于症候群监测及法定传染病监测系统的流行性乙型脑炎发病情况分析

Analysis of Japanese Encephalitis Based on Clinical Syndrome and Incidence of National Notifiable Disease Surveillance System

目的应用急性脑膜炎/脑炎症候群(Acute Meningitisand Encephalitis Syndrome,AMES)的监测资料,估算项目地区流行性乙型脑炎(乙脑)的发病率,并评价基于临床诊断的法定传染病监测系统(National Notifiable Disease Surveillance System,NNDSS)乙脑发病报告的质量。方法在广西壮族自治区贵港市开展AMES症候群监测,对符合监测病例定义的病例进行流行病学个案调查,采集血液和(或)脑脊液(Cerebrospinal Fluid,CSF)标本,检测乙脑免疫球蛋白(Immunoglobulin,Ig)M。结果 2007年5月～2010年12月,监测试点医院共监测1903例,96.85%的病例采集了血液或CSF标本,实验室确诊乙脑114例。1903例监测病例中,临床诊断为乙脑的58例,经实验室检测最终确诊为乙脑21例。实验室确诊的114例乙脑中,临床诊断乙脑21例,漏诊(诊断为病毒性脑炎或其他脑炎)93例,漏诊病例占确诊病例的78.49%。结论基于临床诊断的NNDSS报告乙脑漏报率较高,有必要在每年的高发季节加强针对乙脑的哨点监测和实验室检测。

Objectives To estimate the incidence rate of Japanese encephalitis （JE） and evaluate the quality of the national notifiable diseases surveillance system by using clinical syndrome surveillance technique. Methods We established active surveillance for acute meningitis and encephalitis syndrome （AMES） in Guigang city, Guangxi Zhuang Autonomic Region. Allthe cases meet the surveillance. definition （AMES cases） were conducted a questionnaire, collected serum and/or cerebrospinal fluid （CSF） specimens and test JE immunoglobulin M antibodies by using enzyme-linkedimmunosorbent assay methods. Results From May 2007 to Dec.2010, 1903 cases were reported by the surveillance pilot hospital. 96.85% of AMES cases had collected blood and/or CSF sample, 114 cases JE antibody were positive. Among the 1903 assessment cases, 58 cases were diagnosed as clinical JE cases, which 21 cases were confirmed by laboratory test. It means Among 114 laboratory confirmed cases, 21 cases were clinical diagnosis as JE, 93 （78.49%） cases would miss diagnosis by clinician if without conducting the AMES project. Conclusions The notifiable diseases surveillance system based on clinical diagnosis have a high miss reported rate of JE. It is necessary to carry out the JE syndrome surveillance and laboratory test in the epidemic season, especially in the high risk area.