深圳市不明原因肺炎病例监测系统评估

Evaluation on surveillance system of pneumonia with unknown cause in Shenzhen City

目的评估深圳市不明原因肺炎病例监测系统运行状况,了解系统运行质量,为监测手段的改进和提高提供科学依据。方法参照国际疾病监测系统评估方法,结合该市监测工作运行实际情况,采用问卷调查、访谈及现场查阅病案等方式,选择区疾病预防控制(以下简称疾控)中心和一类监测医院进行评估。结果 2008—2011年,该监测系统共报告发热肺炎28 440例,不明原因肺炎5例,确诊1例人禽流感病例;7家一类监测医院中,2家发现过符合定义的病例,1家进行了网络直报;8家区疾控中心中有6家曾接到并参与了不明原因肺炎病例的报告和处理过程,4家区疾控中心在医院电话报告为"尚未达到标准的疑似病例"后就已经介入调查。分别有24.2%的临床医生和40%的疾控人员认为方案病例定义不易判断,分别有52.1%和54.2%调查对象认为院内、区级专家组排查有一定难度;抽查病案系统未发现漏报病例,发热门诊运转情况不良;24.2%临床医生认为报告受行政部门影响;所有医院均认为监测工作增加了工作量,57.1%医院认为报告对医疗秩序影响大;分别有79.2%和62.5%的调查对象认为通过监测可以达到"及时发现控制SARS和人禽流感病例"、"了解不明原因肺炎报告病例数的动态变化"的目的。结论深圳市不明原因肺炎病例监测系统整体运行质量较好,监测系统有必要进行一定的调整,如开展重症肺炎哨点医院监测;及时向医疗机构、社会反馈监测结果;应急状态下再启动发热门诊等,从而提高监测质量。

[ Objective ] To evaluate the operation status of surveillance system of pneumonia with unknown cause in Shenzhen City, know the operation quality of system, and provide a scientific basis for improvement of surveillance system. [ Methods] According to the international disease surveillance system evaluation method, combined with the actual situation of surveillance system operation in this city, the district-level Centers for Disease Control and Prevention （CDCs） and monitoring hospitals were selected and ana- lyzed by questionnaires, interviews and filed inspection records. [ Results] During 2008-2011,28 440 febrile pneumonia cases were reported, there were 5 pneumonia cases with unknown cause, and 1 case was diagnosed with human avian influenza. In the 7 moni- toring hospitals, cases that met the criterion were found in 2 hospitals, and 1 hospital reported it by direct network report system. Among 8 CDCs, 6 have received the report of pneumonia cases with unknown cause and participated in treatment, and 4 have in- volved in the investigation when the cases had not reached the standard of suspected cases by telephone report. 24.2% of clinicians and 40% of CDC doctors felt it was hard to identify the definition of pneumonia with unknown cause. 52.1% and 54.2% of inves- tigation objects respectively thought it was hard for the hospital and district-level expert group to make a confirmation or elimination of cases. No omission of cases was found by records inspection, and the fever clinics have been running at a bad condition. 24.2% of clinicians thought the reports affected by administrative department. All hospitals thought that surveillance added much workload and 57.1% of hospitals considered it might disturb routine work. 79.2% and 62.5% of investigation objects respectively believed that surveillance system can effectively discover and control the human avian influenza and SARS, as well as can help them to grasp the dynamic change of case number. [ Conclusion] The surveillance system of pneumonia with unknown cause in Shenzhen City runs well. However, it is necessary to alter the monitoring method, such as carrying out sentinel hospital surveillance for severe pneumo- nia, releasing the monitoring results to medical institutions and society in time, and restarting the fever clinics under emergency sta- tus, to improve the surveillance quality.