2018-2021年广州市学校肺结核自动预警系统运行情况分析

Analysis on the operation of Tuberculosis Automated-alert System in schools in Guangzhou from 2018 to 2021

目的:分析广州市“传染病自动预警信息系统”中学校肺结核自动预警系统运行情况,为更好地应用和改进系统提供建议。方法:从“传染病自动预警信息系统”中导出广州市2018年7月至2021年12月产生的学校肺结核预警信号及响应情况,按照三间分布分析评价,对比同期学校肺结核流行病学调查报告评价预警效果。结果:2018年7月至2021年12月广州市“传染病自动预警信息系统”共发出学校肺结核预警信号12034条,响应率为100.00%,24 h响应率为98.76%(11885/12034),信号响应时间[中位数(四分位数)]为2.02(0.61,6.58)h,最终有23.01%(2769/12034)的预警信号被确定为疑似事件。2018至2021年,预警信号响应时间从2.51(0.63,11.71)h下降到2.01(0.67,7.01)h,疑似事件率从19.94%(429/2151)上升至33.70%(548/1626)。预警信号最多的区是白云区(2735条),疑似事件率最高的是越秀区(38.52%,156/405)。各年龄组中预警信号最多的是22~24组(5318条),疑似事件率最高的是12~14岁组(64.56%,133/206)。男性预警信号比例(60.10%,7232/12034)多于女性(39.90%,4802/12034)。人群分类中预警信号最多的是家务及待业(3708条),疑似事件率最高的是保育员及保姆(8/9)。随着肺结核诊断依据的增加,预警信号数逐渐减少,从7969条下降到56条,病原学阴性肺结核疑似事件率最高(31.03%,818/2636)。预警系统对广州市学校肺结核聚集性疫情的敏感度为41.18%(7/17)。结论:广州市学校肺结核自动预警系统的信号发送功能发挥积极的作用,不过仍存在需要改进的部分,若能在跨区域病例的信号发送方面进行改善,能进一步提高预警信号对聚集性疫情的敏感度。

Objective:To analyze the operation of Automated-alert System for tuberculosis in schools in Guangzhou,and to provide suggestions for further application and improvement of the system.Methods:The signals and response of school tuberculosis in Guangzhou from July 2018 to December 2021 was derived from the Automated-alert System for Tuberculosis,and was analyzed and evaluated according to the spatial,temporal and population distribution,the effect of the System was evaluated by comparing epidemiological survey report of pulmonary tuberculosis in schools in the same period.Results:A total of 12034 early-warning signals were issued by Automated-alert System for Tuberculosis in schools from July 2018 to December 2021 with a response rate of 100.00%,and 98.76%(11885/12034)of signals were responded in 24 hours.The responding time(M(Q 1,Q 3))was 2.02(0.61,6.58)h,23.01%(2769/12034)of early-warning signals were finally identified as suspected events.From 2018 to 2021,the overall signal response time decreased from 2.51(0.63,11.71)h to 2.01(0.67,7.01)h,and the suspected event rate increased from 19.94%(429/2151)to 33.70%(548/1626).Baiyun District had the most warning signals(n=2735),and Yuexiu District had the highest suspected event rate(38.52%,156/405).The 22-24-year-old group had the most warning signals(n=5318),and the 12-14-year-old group had the highest suspected event rate(64.56%,133/206).Male accounted for 60.10%(232/12034)of the total signals,the proportion was higher than that of female(39.90%,4802/12034).The housework and unemployed population group had the most warning signals(n=3708),and the nursery governess and housekeeper population group had the highest suspected event rate(8/9).With the increase of the diagnostic basis of pulmonary tuberculosis,the number of early warning signals decreased from 7969 to 56,the etiological negative pulmonary tuberculosis had the highest suspected event rate(31.03%,818/2636).The Automated-alert System had the sensitivity of 41.18%(7/17)of aggregation tuberculosis outbreaks in Guangzhou schools.Conclusion:The signal sending function of the Automated-alert System for Tuberculosis in Guangzhou schools play a positive role,however,there are still some parts need to be improved.If the signal sending of cross-regional cases could be improved,the sensitivity of alert signals to the clustering epidemic situation could be further improved.