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目的了解国家传染病自动预警系统(CIDARS)在四川省的运行情况以及传染病暴发早期探测中发挥的作用,为系统应用改进提供依据。方法对2008年4月21日-2013年4月20日预警系统发出的预警信号数、信号响应率、响应时间、预警信号初步核实结果,以及预警相关病种的报告病例数、暴发事件探测灵敏度进行描述性分析。结果预警系统在四川省共发出93 520条预警短信,平均每县每周接收1.95条预警短信。其中移动百分位数法共对17种传染病发出预警信号85 422条,信号响应率为96.51%,五年度间预警信号响应率呈逐年上升趋势(趋势χ2=2471.19,P<0.001);信号响应时间的中位数为2 h(P25~P75:0.81~9.89 h,响应时间与年度间成负相关(rs=-1,P<0.05);17种传染病中,10种通过突发公共卫生事件管理信息系统报告170起暴发事件,其中160起暴发事件有预警信号发出,灵敏度为94.12%;预警信号数与该病种在大疫情系统中的报告数成正比(F=43.10,b=0.119,P<0.001)。固定阈值法共对13种传染病、不明原因肺炎和手足口病重症病例发出预警信号8 089条,信号响应率为99.09%,五年度间预警信号响应率呈逐年上升趋势(趋势χ2=47.57,P<0.001);信号响应时间的中位数为4.08 h(P25~P75:0.60~20.88 h),响应时间与年度间成负相关(rs=-1,P<0.05);共有3 024例经固定阈值法预警的传染病被确诊,确诊病例较多的有:麻疹、手足口重症病例,占确诊总数的94.31%。确诊病例总数占预警信号总数的37.34%,其中手足口病重症病例、间日疟、恶性疟确诊比例较高,分别为86.33%、78.57%和76.79%。传染性非典、脊髓灰质炎、人禽流感、肺炭疽、白喉和不明原因肺炎的确诊数均为0。结论传染病自动预警系统在四川省运行的五年间,预警信号的响应率逐年升高,响应时间逐年降低,预警信号数与该病种在大疫情系统中的报告数成正比,总体试用推行较好。同时为了更加科学准确的进行传染病预警,系统部分功能还有待进一步完善,提高传染病报告的质量是根本。
Objective To understand the operation of CIDARS in Sichuan Province and the role of early detection of outbreak of infectious diseases in order to provide basis for system application improvement. Methods From April 21, 2008 to April 20, 2013, the number of early warning signals, signal response rate, response time, the preliminary verification results of early warning signals and the number of reported cases of early warning related diseases, the detection sensitivity of outbreaks Descriptive analysis. As a result, a total of 93 520 early-warning sms were issued in Sichuan Province, with an average of 1.95 early-warning sms received by each county each week. Among them, the mobile percentile method issued 85 422 warning signals to 17 kinds of infectious diseases with the signal response rate of 96.51%. The response rate of early warning signals showed an upward trend year by year (trend χ2 = 2471.19, P <0.001); the signal The median response time was 2 h (P25-P75: 0.81-9.89 h), and the response time was negatively correlated with the annual (rs = -1, P <0.05). Of the 17 infectious diseases, 10 were in the public There were 170 outbreaks reported by the Health Events Management Information System (ISIS), of which 160 were issued with an early warning signal with a sensitivity of 94.12%. The number of early warning signals was in direct proportion to the number of reports of this disease in a large outbreak system (F = 43.10, b = 0.119, P <0.001) .There were 8 089 warning signals for 13 kinds of infectious diseases, unexplained pneumonia and hand-foot-mouth disease in the fixed threshold method, and the signal response rate was 99.09%. The response rate of early warning signals increased year by year (Χ2 = 47.57, P <0.001). The median response time was 4.08 h (P25 ~ P75: 0.60 ~ 20.88 h) and the response time was negatively correlated with the annual (rs = -1, P <0.05 ). A total of 3 024 cases of pre-warning of infectious diseases confirmed by the fixed threshold method were diagnosed. More confirmed cases were: measles, hand-foot-mouth severe cases, The total number of diagnosed cases accounted for 37.34% of the total number of early warning signals, among which the diagnosis rate of HFMD, Vivax malaria and P. falciparum were higher, accounting for 86.33%, 78.57% and 76.79% respectively. The number of confirmed cases of plague, human bird flu, pulmonary anthrax, diphtheria and unexplained pneumonia were all 0. Conclusions The response rate of early warning signal increased year by year with the automatic warning system for infectious diseases running in Sichuan Province for five years, The number of early warning signals is proportional to the number of reports of the disease in the major epidemic system and the overall trial implementation is better. In order to make the epidemic warning more scientific and accurate, some functions of the system still need to be further improved, and the quality of infectious disease reporting is improved fundamental.