目的 评估东莞市流行性感冒(流感)监测系统的运作情况及质量。 方法 通过对监测数据进行分析、开展专项调查等方法对监测系统的代表性、时效性、可接受性、真实性、敏感性和特异性等属性进行评估。 结果 东莞市流感监测系统由流感样病例(ILI)监测、病原学监测和聚集性疫情监测组成,监测哨点覆盖了全市1/3区域,包括乡镇医院、市属综合性医院和私立医院;监测系统的流程通畅,各环节时效性较好;ILI构成比(ILL%)与聚集性疫情间、ILI%与病毒阳性率间的相关系数分别为0.683和0.707,P值分别为0.003和0.000,能一致地反映出东莞市流感的流行趋势和季节性变化特征;监测门诊部分医生对ILI的病例定义掌握不够完整,50%的门诊医生认为监测任务增加了其工作量,45.45%的临床医生曾出现漏登或错登ILI的情况,而负责数据收集及上报的防保医生则均认为监测工作可以接受。用ILI%较上周上升10%这个指标评价系统敏感性和特异性,其特异度、阳性预测值和阴性预测值均最高,分别为92.42%、58.33%和85.92%,但灵敏度只有41.18%。 结论 东莞市流感监测系统有较好的代表性、时效性、真实性和实用性,系统的可接受性需通过改进监测手段来提高,系统的敏感性和特异性有待进一步评估。
Objective To evaluate the performance of the influenza surveillance system in Dongguan. Methods The analysis was conducted on the surveillance data and specific survey Results to evaluate the representativeness, timeliness, acceptability, facticity, sensitivity and specificity of the surveillance system. Results The influenza surveillance system in Dongguang is composed of the sub-systems of influenza like illness (ILI) surveillance, etiological surveillance and outbreak surveillance, which covers the city general hospitals, township hospitals and private hospitals and performs well. The correlation coefficient was 0.683 between ILI proportion and reported outbreak (P=0.003) and 0.707 between ILI proportion and detection rate of influenza virus (P=0.000), which were consistent in indicating the incidence trend and seasonality of influenza in Dongguan. The definition of ILI was not fully understood by all physicians surveyed, and about half of them thought the surveillance would increase their work load, 45.45% of them failed to report ILI or report false ILI. The specificity, positive prediction value and negative prediction value were highest (92.42%,58.33% and 85.92% respectively), but the sensitivity was only 41.18% when evaluated by using the indicator of more than 10% increase of ILI proportion compared with previous week. Conclusion The representativeness, timeliness, facticity and usefulness of the surveillance system in Dongguan were good, but acceptability of the system should be improved and the sensitivity and specificity of the system should be further evaluated.