上海市传染性非典型肺炎流行病学调查研究

Epidemiological Investigation of SARS in Shanghai

目的 在全国抗非典取得阶段性胜利的情况下 ,对上海市传染性非典型肺炎的流行病学调查情况作一总结。方法 阐述传染病的感染和传播的基本模式 ,分析现场流行病学调查的基本原理和策略。并对上海市开展流行病学调查的组织结果、流调程序、流调与临床的衔接等问题进行了介绍。结果 上海市非典的流行病学的调查表明2 0 0 3年 3月至 7月 2 0日 ,全市 19个区县报告临床诊断病例 8例、疑似病例 82例。留院观察病例 12 69例。共开展流行病学调查 4165次 ,参加 2 5 888人次 ,平均对每例临床诊断病人进行流调 9 88次 ,每次参与的流调人员为 12人次 ;疑似和留观病人参加流调数为 5 5 1次数和 2 80次数 ,每次分别为 8 10人次和 5 87人次。追踪密切接触者 3 3 0 0 0余人 ,其中确诊病人密切接触者 3 3 3人 ,疑似和留观病人密切接触者分别为 3 2 3 7人和 2 964 5人。确诊病人、疑似病人和留观病人与密切接触者之比为 1∶41 6、 1∶3 9 5、 1∶2 3 4。上海市SARS病人发病至初诊的平均时间为 1 3d ,初诊至隔离的平均时间为 1 5d。SARS病例诊断与卫生部诊断标准的基本符合。参考实验室辅助诊断结果 ,排除SARS的疑似病例中 60 98%为确诊肺炎 ,其次为上感 10 98%。留观病人排除后 ,主要鉴别诊断为肺炎 (66 5 1% )

Objective This paper is a progress analysis of SARS field epidemiological investigation in Shanghai under the condition of national great victory of SARS containing. Methods Infective disease transfer model were explored and the main principle and method of field epidemiological investigation were analyzed.Meanwhile the organization framework,procedure of epidemiological investigation and the relationship between clinics and epidemiology in Shanghai were also introduced. Results The investigation showed that 8 clinical confirmed cases,82 suspect cases and 1269 clinical observational cases were founded during the period of March 2003 to 20 th July 2003.Totally 4165 epidemiological investigations were carried out,25 564 health workers took part in these investigations.For one clinical confirmed case,9.9 investigations were conducted on average,12 health workers took part in,for one suspect case,the number is 5.5 and 8.1;for clinical case,the number is 2.8 and 5.9.In the total cases,about 33 000 people were classified as near contactors,among whom 333 persons were close contacts of 8 clinical confirmed cases,3237 were of 82 suspect cases and 29 645 were of clinical observational cases.The rate of case to close contacts is 1∶41.6 for clinical confirmed cases,1∶39.5 for suspect cases and 1∶23.4 for clinical observational cases.The average period between disease outbreak and elementary diagnose is 1.3 days and the average period between elementary diagnose and medical quarantine is 1.5 days,which also demonstrated the war against SARS timely and efficiently.The case diagnoses were almost consistent with their temporal diagnose standards.The result of experimental assistant tests showed that among those ultimate removed cases,in the suspect cases about 60.98% were diagnosed as pneumonia,and 10.98% were up respiratory infect disease.In the clinical observational cases,66.51% were pneumonia,10.90% were up respiratory infect respectively.Meanwhile some bronchitis and lung infected disease from Chlamydia and mycoplasma were also founded in order to make correct diagnose. Conclusions In this paper,analyses were also focused on the timely and efficient of close contacts medical observation and field disinfection process to point out some suggestion for future war against SARS.