不同流感样病例定义对住院儿童流感监测结果的影响

The effects of influenza-like illness definitions on influenza surveillance in hospitalized children

目的了解不同流感样病例定义对住院儿童流感监测结果的影响。方法利用2017年10月-2018年5月苏州大学附属儿童医院呼吸道疾病综合监测的病原学和临床症状等数据,计算符合中国、欧盟疾病预防控制中心(European center for disease prevention and control,ECDC)和世界卫生组织(world health organization,WHO)的流感样病例定义时的流感病毒检出率,以流感病毒检出为金标准,分别分析三种流感样病例定义确诊的灵敏度、特异度、阳性预测值、阴性预测值与受试者工作特征曲线(receiver operator characteristic curve,ROC)下面积,并采用多因素Logistic回归分析模型分析流感病毒阳性率的相关因素。结果研究共纳入1459例呼吸道感染住院病例,其中流感病毒阳性者204例,阳性率14.0%。ECDC定义的灵敏度最高(91.7%,95%CI:87.9%~95.5%),但其特异度最低(44.6%,95%CI:41.9%~47.4%);WHO定义的灵敏度最低(70.6%,95%CI:64.3%~76.8%);中国定义的灵敏度(91.2%,95%CI:87.3%~95.1%)和特异度(51.5%,95%CI:48.8%~54.3%)均较高,且其ROC曲线下面积最大(71.2%,95%CI:67.9%~74.5%)。多因素分析发现有发热症状(≥38℃)患儿的流感病毒检出率高于不发热患儿(OR=7.03,95%CI:3.89~12.70)。结论在住院儿童中开展流感监测时,采用中国流感监测的流感样病例定义可以获得较好的效果。

Objective To evaluate clinical factors associated with laboratory-confirmed influenza infection and probe into the effects of different influenza-like illness(ILI)definitions on influenza surveillance in hospitalized children.Methods The influenza surveillance on the hospitalized children with acute respiratory infection was carried out in Soochow university affiliated children’s hospital from October 2017 to May 2018.The definition of influenza-like illness(ILI),which proposed by world health organization(WHO),the European center for disease prevention and control(ECDC)and ministry of public health of China,was analyzed to determine the area under receiver operating characteristic curve(ROC),sensibility,specificity,and the positive and negative predictive values of the ILI definition using the laboratory evidence of influenza virus infection as golden criteria.Logistic regression model was employed to explore the risk factors of the laboratory confirmed influenza infection among the hospitalized children.Results Of the enrolled 1459 hospitalized children,204(14.0%)were lab-confirmed influenza cases.The ECDC definition had the highest sensitivity(91.7%,95%CI:87.9%-95.5%)but the lowest specificity(44.6%,95%CI:41.9%-47.4%).The WHO definition had the lowest specificity(70.6%,95%CI:64.3%-76.8%).China’s definition was the most discriminant definition with relatively high sensitivity(91.2%,95%CI:87.3%-95.1%)and specificity(51.5%,95%CI:48.8%-54.3%),and its positive area under curve value(71.2%,95%CI:67.9%-74.5%)was the highest.Multivariate analysis model showed that the detection rate of influenza virus in children with fever(≥38℃)was higher than that in children without fever(OR=7.03,95%CI:3.89-12.70).Conclusions It is suggested to adopt China’s ILI definition to get better output during influenza surveillance among hospitalized children.