症候群监测系统构建及效果评价

Establishment and effect evaluation of syndromic surveillance system

目的现场评价五大症候群归类监测的科学价值与症候群监测技术的应用效果,构建科学、实用的传染病疫情监测新平台。方法在广西南宁市、合浦县、贵港市、桂平市、灵川县以及伤寒、副伤寒流行区,建立细菌性传染病五大症候群监测网络,用统一的方法和标准对符合监测定义的2 964例病例进行流行病学个案调查,并采集血液与粪便等标本,进行常规检查及细菌分离培养,评价症候群监测技术在临床诊断、预防措施、控制效果等方面的作用。结果共监测五大类症候群临床病例2 964例,其中,发热呼吸道症候群905例,主要病原菌有肺炎克雷伯菌,占该症候群阳性菌总数的23.93%(39/163),肺炎链球菌占22.70%(37/163),铜绿假单胞菌占11.66%(19/163),流感嗜血杆菌占11.04%(18/163);腹泻病症候群939例,沙门菌感染最常见,占81.05%(77/95);发热伴出疹症候群319例,甲型副伤寒沙门菌感染最常见,占88.37%(38/43);脑炎脑膜炎症候群690例,新型隐球菌感染最常见,占39.22%(20/51);发热伴出血症候群111例;2 964例病例中检出病原的320例(共352株),总阳性率为10.80%;通过监测系统发现1起甲型副伤寒暴发疫情以及广西少见传染病如B群流脑、人感染猪链球菌病及空肠弯曲菌肠炎等。结论症候群监测是科学、敏感、实用的疾病监测技术,其应用有利于系统提高疾病的管理能力、监测能力及检测能力。

Objective To evaluate scientific value of syndromic surveillance for 5 categories of syndromes and ap plicative effect of syndromic surveillance techniques for establishing a scientific and practical platform for communicable disease surveillance. Methods In Nanning city, Hepu county, Guigang city, Guiping city, Lingchuan county and epidemic areas of typhoid and paratyphoid fever in Guangxi, a syndromic surveillance system involving 5 categories of syndromes was established. Using standardized procedures and criteria, an epidemiologic investigation was conducted among 2 964 cases who met the surveillance definition. Specimens such as blood or stool samples were collected and rou tine tests and culture were performed. The effect of syndromic surveillance technique on clinical diagnosis, preventive measures and control of the diseases were evaluated. Results Of the 905 cases with febrile respiratory syndrome, the most common pathogens were Klebsiella pneumonia （ 23.93 % , 39/163 isolates ）, Streptococcus pneumonia （ 22. 70%, 37/163 ） ,Pseudomonsa aeruginosa（ 11.66%, 19/163 ）, and Haemophilus Infuenzae （ 11.04%, 18/163 ）. For 939 cases with diarrhea syndrome, Salmonella was the most common pathogen （81.05%, 77/95 ）. For 319 cases with fever and rash syndrome, Salmonella paratyphi A was the most common pathogen （88.37 % ,38/43 ）. For 690 cases with encephali tis and meningitis syndrome, Cryptococcus neoformans was the most common pathogen（ 39. 22%, 20/51 ）. Totally 111 cases of fever and hemorrhage syndrome were observed. A total of 352 strains of pathogens were isolated from the 2 964 cases enrolled, with a positive rate of 10. 80%. Under the syndromic surveillance system, an outbreak caused by Salmo nella paratyphi A was identified. In addition, rare infectious diseases,including a case of group B Meningococcal menin gitis,a case infected with Streptococcus suis, and a case with Campylobacter enteritis were reported. Conclusion The syndromic surveillance is a scientific, sensitive, and practical techniques for disease surveillance. The application of syn dromic surveillance will be helpful for improving capabilities of disease management, surveillance and laboratory test.