预防梅毒母婴传播效果评价指标探讨

Effect evaluation index in syphilis prevention from mother-to-child transmission

目的探讨预防梅毒母婴传播效果的评价指标。方法随机抽取贵州省26个县(市、区),对2012-2014年疾病预防控制"传染病报告信息系统"中的胎传梅毒个案,以及妇幼系统确诊的梅毒感染孕产妇所生儿童的干预结局,进行回顾性分析。结果 2012-2014年,26个抽样县疾病预防控制"传染病报告信息系统"胎传梅毒确诊病例中,88.63%没有实验室检测依据,难以确定先天梅毒的诊断。2012-2014年,抽样县妇幼信息系统共确诊先天梅毒18例,疾病预防控制信息系统漏报9例,漏报率达50%。妇幼系统先天梅毒发生率从2012年的2.77/10万活产上升至2014年3.25/10万活产,不良妊娠结局发生率和梅毒母婴传播率分别从2012年的7.84%、6.24%下降至2014年的6.10%、4.77%,但差异均无统计学意义(P>0.05)。结论近3年实施的预防梅毒母婴传播效果显著。疾病预防控制"传染病报告信息系统"中先天梅毒报告发病率质量较差,不适合作为贵州省预防梅毒母婴传播的效果评价指标。建议采用梅毒母婴传播率作为效果评价指标。

Objective To explore the effect evaluation index for syphilis prevention of mother to child transmission.Methods 26 counties（cities,districts） were randomly selected in Guizhou province,and the information were collected from the ＂reporting system of infectious diseases＂ during 2012-2014,and retrospective analysis was made over the congenital syphilis cases,and maternal syphilis infection cases.Results Among all the congenital syphilis cases confirmed during 2012-2014 in the selected counties,88.63%reported in the ＂reporting system of infectious diseases＂ were not confirmed by laboratory testing,which was difficult to identify congenital syphilis diagnosis.18 cases of congenital syphilis was confirmed in the ＂reporting system of maternal and children＇s health＂,and 9 cases failed to report in the ＂reporting system of infectious diseases＂ with 50%underreported.The incidence of congenital syphilis from 2.77/100 000 live births in 2012 rose to 3.25/100 000 live births in 2014,based on the ＂reporting system of maternal and children＇s health＂,and the incidence of adverse pregnancy and syphilis spreading rate from mother to child decreased from 7.84%and 6.24%in 2012,to 6.10%and 4.77%in 2014,with the difference（P〉0.05） not statistically significant.Conclusion Though syphilis prevention of mother-to-child transmission has made remarkable achievements during 2012-2014,the reported incidence of congenital syphilis in the ＂reporting system of infectious diseases＂ is not well qualified,and not suitable to use for result evaluation of syphilis prevention from mother to child transmission in our province.It is recommended to use the spreading rate of mother to child transmission as the evaluation indicator.