| 仇小强,董柏青,杨进业,林玫,谭毅,吴兴华,李艺星,StephenHadler.流行性乙型脑炎监测手册中疑似病例定义和分类方法的现场评估[J].Chinese journal of Epidemiology,2011,32(1):38-41 |
| 流行性乙型脑炎监测手册中疑似病例定义和分类方法的现场评估 |
| On-site assessment on the definition and classification of suspected cases in the manual of WHO Japanese Encephalitis Surveillance Standards |
| Received:July 18, 2010 |
| DOI： |
| KeyWord: 流行性乙型脑炎 急性脑炎症候群 现场评估 |
| English Key Word: Japanese encephalitis Acute encephalitis syndrome On-site assessment |
| FundProject:世界卫生组织资助AMES项目 |
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| Abstract: |
| 目的 应用症候群监测资料评估WHO发布的流行性乙型脑炎(乙脑)监测手册(手册)中疑似病例定义和分类方法，为该手册提供现场依据和修订建议。方法 基于急性脑炎脑膜炎症候群监测项目，获取乙脑实验室确诊病例和急性脑炎症候群(AES)病例，利用队列研究中相对危险度(RR)和人群归因危险度百分比(AR%)评估AES与乙脑病例是否存在统计学关联及其强度大小和AES对人群中乙脑病例的覆盖范围。结果 研究期间共评估病例1424例，确诊乙脑103例。AES对人群中乙脑病例，RR=4.62，95%CI：2.80～7.63；AR%=78.35%，95%CI：64.25%～86.89%；筛检敏感度为81%(95%CI：79%～83%)，特异度为53%(95%CI：50%～55%)，约登指数为0.33，Kappa值为0.10，阳性、阴性预测值分别为13%和97%。“AES+抽搐”病例定义对人群中乙脑病例，RR=9.84，AR%=89.83%。结论 AES病例定义对人群中乙脑病例有统计学意义上的筛检作用，AES与乙脑病例间存在较强程度的关联。“抽搐”定义具有良好的乙脑病例筛检价值，建议在新版手册中予以采用。 |
| English Abstract: |
| Objective To assess the new edition of WHO Japanese Encephalitis (JE) Surveillance Standards (WHO Standards) based on syndrome surveillance data and to provide field evidence regarding the standards. Methods Based on syndrome surveillance data, acute encephalitis syndrome (AES) case was categorized, according to the WHO Standards. A cohort study was applied to estimate the AES definition set in the Standard and relative risk was computed to estimate the existence and intensity of statistical correlation between AES and JE cases. Percentage of attributable risk was counted to describe the coverage of AES for JE cases in the studied population. Sensitivity, specificity, Youden index and positive predictive value of AES components were calculated for the purpose of identifying the clinical values under the screening program. Results 1424 suspected cases were evaluated in the surveillance program and 1396 cases with ELISA result, of which 109 positive cases were detected. According to the "standardized" classification, a total of 706 cases in line with AES case deftuition, were categorized into 83 cases of JE, 425 cases of AES unknown and 198 cases of AES other agent. In the cohort study, a relative risk of 4.62 (95%CI: 2.80-7.63) and the percentage of attributable risk as 78.35% (95%CI: 64.25%-86.89%) were observed. Conclusion The AES definition for JE was significantly effecting on the screening programs and a strong correlation strength was observed in the study. AES syndrome could cover most of the JE cases. "Convulsions", with appreciative screening value, was recommended to be involved into the new version of the WHO Standards. |
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