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目的评价不同报告和排除标准的参数设置对15岁以下儿童非脊灰急性弛缓性麻痹(Non-polio acute flaccid paralysis,NPAFP)病例报告发病率的影响。方法采用敏感度分析方法,假设在不同的AFP病例报告和排除标准下,计算NPAFP病例报告发病率的波动情况。结果 2012-2016年北京市NPAFP报告发病率在1.55/10万-2.28/10万之间,平均报告发病率为1.88/10万。若未开展现场核实诊断而未排除任何不符合报告标准的病例,各年报告发病率将上升至2.48/10万-4.09/10万之间,平均报告发病率上升至3.24/10万;若现场核实诊断不准确,未排除部分不符合报告标准的病例,平均报告发病率均上升至2/10万以上。若仅报告同时满足三个急性麻痹症状的病例,各年报告发病率均下降至1/10万以下;若仅报告同时满足两个及以上急性麻痹症状的病例,2012-2015年报告发病率均下降但可达到1/10万的要求,2016年下降至0.83/10万。结论对疑似AFP病例是否开展高质量的现场核实诊断以及采取不同的AFP病例报告标准将大大影响NPAFP报告的敏感性和准确性。医疗机构需严格执行AFP病例报告标准,疾病预防控制机构应重视开展疑似AFP的现场核实诊断,加强非AFP病例的排查工作。
Objective To evaluate the impact of different reporting and exclusion criteria on the reported incidence of non-polio acute flaccid paralysis (NPAFP) in children under 15 years of age. Methods Sensitivity analysis was used, assuming that the reported incidence of NPAFP cases fluctuated under different AFP case reporting and exclusion criteria. Results The incidence of NPAFP in Beijing from 2012 to 2016 ranged from 1.55 / 100 000 -2.28 / 100 000 with an average reported incidence of 1.88 / 100 000. In the absence of an on-site verification and diagnosis of cases that do not meet the reporting criteria, the annual incidence will increase from 2.48 / 104,000 to 4.09 / 100,000 and the average reported incidence will rise to 3.24 / 100,000; Verify that the diagnosis is not accurate, did not rule out some of the cases do not meet the reporting criteria, the average reported incidence rose to 2 / 100,000 or more. If only three cases of acute paralysis were reported at the same time, the reported incidence in each year dropped to below 1/100000. If only reports of two or more cases of acute paralysis were reported at the same time, the reported incidence in 2012-2015 Declining but up to 1/10000 requirement, down to 0.83 / 100000 in 2016. Conclusions A high quality on-site verification of the diagnosis of suspected AFP cases and the use of different AFP case reporting criteria will greatly affect the sensitivity and accuracy of NPAFP reporting. Medical institutions should strictly enforce the AFP case reporting standards, disease prevention and control agencies should pay attention to carry out on-site verification of suspected AFP diagnosis, to strengthen the investigation of non-AFP cases.