综合症状监测系统在儿童流行性感冒疫情监测中的应用

The application of integrated surveillance system for symptoms in surveillance of influenza among children

目的 探讨儿童流行性感冒（简称流感）相关类非处方（OTC）药物销售信息及儿童流行性感冒样病例（ILI）就诊量信息综合应用在儿童流感疫情监测中的作用.方法 利用综合监测系统（ISS）收集2012年8月1日至2013年2月28日湖北潜江80家医疗机构儿童ILI就诊量和11家药店14种儿童流感相关OTC药物销售量（人次）,进行累积和模型运算分析拟合度和产生的预警信号,并进行互相关分析.结果 212 d共报告儿童ILI 983例,儿童OTC销售12 819人次.累积和运算拟合度在可接受范围,儿童ILI监测数据产生预警信号31个,3个预警高峰,儿童感冒相关OTC药物销售产生预警信号14个,2个预警高峰,经调查触发信号的病例增加有时间聚集但不具有空间聚集性.双变量互相关分析结果表明,流感相关OTC药物销售量与当天（lag=0）ILI例数相关性有统计学意义（r =0.497,P＜0.05）,与延后4 d（lag=4）的ILI例数相关效果最佳（r=0.505,P＜0.05）.结论 初步证实综合症状监测系统可用于儿童流感疫情监测,存在早期探测到真实疫情暴发的可能性.

Objective To explore the integrated application of sales of child-specific over-the-counter（ OTC ） cold related medications in retail pharmacies and healthcare visits of children for influenza-like illness （ILI） in surveillance and early warning of influenza among children. Methods An integrated surveillance system（ISS） was implemented since 2012 in Qianjiang County,a rural area in Hubei Province of China. The daily information from August 1,2012 to February 28,2013 of health care visits of children for ILI reported by 80 health facilities and sales of 14 child-specific over-the-counter（ OTC ） cold related medications reported by 11 pharmacies were extracted from ISS database. Cumulative sums （CUSUM） model was conducted to analyze the degree of fitting and the early warning signal generated; the correlationship was then analyzed further. Results In 212 days,983 visits of children for ILI and 12 819 sales by person of child-specific OTC were reported. Conducting CUSUM model,the fitting degree was in the acceptable range,31 warning signals were generated from ILI data series with 3 peak periods and 14 from OTC data series with 2 peak periods. A similar time trend of two data series was observed with a correlation （ r = 0. 497,P 〈 0. 05 ） ,but without any spatial clustering. And the optimal correlation （ r = 0. 505, P 〈 0. 05 ） appeared at a time offset of 4 days preceded by OTC sales. Conclusion The availability of integrated surveillance system for symptoms could be applied for surveillance of influenza among children; while it could explore the possibility of real epidemic in the very early stage.