麻疹和脊灰的監(jiān)測(cè)系統(tǒng)課件

1、WHO Expanded Programme on Immunizationin China 急性弛緩性麻痹（AFP）監(jiān)測(cè)Acute Flaccid Paralysis Surveillance監(jiān)測(cè)系統(tǒng)舉例WHO Expanded Programme on Immunizationin China1988年WHO倡議全球消滅脊髓灰質(zhì)炎(Poliomyelitis) 實(shí)現(xiàn)目標(biāo)的關(guān)鍵高敏感性的監(jiān)測(cè)系統(tǒng) 病例快速調(diào)查標(biāo)本采集和檢測(cè).為證實(shí)阻斷病毒循環(huán)提供依據(jù) 背景WHO Expanded Programme on Immunizationin ChinaPolio Eradication Initi

2、ative1988350 000 cases125 countries20021918 cases7 countriesWHO Expanded Programme on Immunizationin ChinaAcute Flaccid ParalysisAFP病例定義 指所有15歲以下兒童發(fā)生不能立即確定為其它病因的急性弛緩性麻痹 病例，包括15歲以下明確診斷為格林巴綜合征（GBS）以及15歲以上的疑似脊髓灰質(zhì)炎病例。符合以上定義的病例都是“AFP病例”監(jiān)測(cè)的范圍，都必須按要求進(jìn)行監(jiān)測(cè) WHO Expanded Programme on Immunizationin ChinaAcute

3、Flaccid ParalysisAFP包括的14類疾病（1）脊髓灰質(zhì)炎（小兒麻痹）,（2）格林巴利綜合癥（感染性多發(fā)性神經(jīng)根炎-GBS）,（3）橫貫性脊髓炎（脊髓炎，腦脊髓炎、急性神經(jīng)根脊髓炎）,（4）多神經(jīng)?。ㄋ幬镄远嗌窠?jīng)病、有毒物質(zhì)引起的多神經(jīng)病、原因不明性多神經(jīng)?。?（5）神經(jīng)根炎,（6）外傷性神經(jīng)炎（包括臀肌藥物注射后）,（7）單神經(jīng)炎,（8）神經(jīng)叢炎,（9）周期性麻痹（包括低鉀軟癱、高鉀軟癱、正常鉀軟癱）,（10）肌病（全身性重癥肌無(wú)力、中毒性、原因不明性肌?。?（11）急性多發(fā)性肌炎,（12）肉毒中毒,（13）四肢癱、截癱、單癱（原因不明）,（14）短暫性肢體麻痹WHO Expa

4、nded Programme on Immunizationin ChinaAcute Flaccid Paralysis脊髓灰質(zhì)炎格林巴利綜合癥急性脊髓炎注射損傷重要鑒別診斷WHO Expanded Programme on Immunizationin ChinaCase ClassificationWHO Expanded Programme on Immunizationin China發(fā)現(xiàn)15歲以下兒童AFP病例或任何年齡疑似脊灰病例應(yīng)立即報(bào)告 縣級(jí)疾控中心48小時(shí)內(nèi)完成調(diào)查發(fā)病14天內(nèi)間隔12天采集便標(biāo)本便標(biāo)本采集后7天內(nèi)送省LAB檢測(cè)國(guó)家Lab進(jìn)行型內(nèi)鑒別和序列分析主動(dòng)監(jiān)測(cè)和零病

5、例報(bào)告 監(jiān)測(cè)方法WHO Expanded Programme on Immunizationin ChinaAFP報(bào)告病例免疫史分布WHO Expanded Programme on Immunizationin China 1994-2003年全國(guó)AFP報(bào)告發(fā)病率比較2002，2003年AFP報(bào)告發(fā)病率分省比較WHO Expanded Programme on Immunizationin China2002,2003年各省報(bào)告后48小時(shí)內(nèi)調(diào)查率WHO Expanded Programme on Immunizationin China發(fā)現(xiàn)野病毒和疫苗衍生病毒（VDPV）循環(huán). 監(jiān)測(cè)OPV接

6、種率，發(fā)現(xiàn)低接種率地區(qū) 確定疾病流行的季節(jié)特征，以確定強(qiáng)化免疫時(shí)機(jī) 識(shí)別高危險(xiǎn)地區(qū)和病例，指導(dǎo)補(bǔ)充免疫活動(dòng).為消滅脊灰證實(shí)提供證據(jù) 監(jiān)測(cè)數(shù)據(jù)的利用Wild Poliovirus*, 27 May 2002 to 26 May 2003Data in WHO HQ as of 27 May 2003.*Excludes viruses detected from environmental surveillance and vaccine derived polio viruses.The boundaries and names shown and the designations used

7、on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent appr

8、oximate border lines for which there may not yet be full agreement. WHO 2003. All rights reserved Wild virus type 1 Wild virus type 3ImportationUnder investigation Wild virus type 1 and 3Endemic countriesComparison of 2002 and 2003 Dataas of 27 May of 2002 and 2003Data in WHO HQ as of 27 May 2003. F

9、or the African region, Pending in 2002 is pending laboratory results. Pending in 2003 and Pending 90 Days is pending classification.Non-polio AFP RateApril 2001 - March 2002 1No AFP SurveillanceThe boundaries and names shown and the designations used on this map do not imply the expression of any op

10、inion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet

11、be full agreement. WHO 2003. All rights reservedApril 2002 - March 2003Data in WHO HQ as of 29 Apr 2003.Data as of 27 May 2003Data as of 27 May 2003Data as of 27 May 2003WHO Expanded Programme on Immunizationin ChinaOPV Supplementary Immunization Activities2003/2004年實(shí)際開展強(qiáng)化免疫地區(qū)2003/2004年計(jì)劃開展強(qiáng)化免疫地區(qū)WHO

12、 Expanded Programme on Immunizationin China 麻疹監(jiān)測(cè)監(jiān)測(cè)系統(tǒng)舉例WHO Expanded Programme on Immunizationin China加速麻疹控制 (2)WHO Expanded Programme on Immunizationin China疑似病例經(jīng)受過(guò)正規(guī)醫(yī)學(xué)訓(xùn)練的醫(yī)生診斷的麻疹病例發(fā)熱伴全身斑丘疹，同時(shí)具有以下癥狀之一：咳嗽、流涕、結(jié)膜炎 實(shí)驗(yàn)室確診檢出 IgM 抗體分離到病毒.病例定義 實(shí)驗(yàn)室確診 實(shí)驗(yàn)室陽(yáng)性結(jié)果 合格標(biāo)本 排除 實(shí)驗(yàn)室陰性結(jié)果 疑似麻疹病例 與確診病例有流行病學(xué)聯(lián)系 臨床診斷病例 不合格標(biāo)本 與確診

13、病例無(wú)流行病學(xué)聯(lián)系 臨床診斷病例 中國(guó)麻疹病例分類WHO Expanded Programme on Immunizationin ChinaWHO Expanded Programme on Immunizationin China降低死亡率階段:常規(guī)報(bào)告麻疹病例的年齡別、地區(qū)別和不同免疫史的月累積數(shù) 只對(duì)暴發(fā)進(jìn)行調(diào)查 每起爆發(fā)檢測(cè)10例病例的血標(biāo)本 低發(fā)病率或消除階段 報(bào)告和調(diào)查每一例病例 對(duì)每一例散發(fā)病例采集標(biāo)本檢測(cè).暴發(fā)要經(jīng)實(shí)驗(yàn)室診斷，每起爆發(fā)檢測(cè)510例病例標(biāo)本主動(dòng)監(jiān)測(cè)和零病例報(bào)告 監(jiān)測(cè)方法在AFP監(jiān)測(cè)系統(tǒng)上建立起來(lái)的主動(dòng)監(jiān)測(cè)系統(tǒng)報(bào)告和調(diào)查所有麻疹疑似病例在地區(qū)級(jí)對(duì)所有麻疹疑似病例的

14、血清學(xué)診斷利用監(jiān)測(cè)信息進(jìn)行麻疹控制策略的有關(guān)決策 我國(guó)麻疹監(jiān)測(cè)方案 WHO Expanded Programme on Immunizationin ChinaPercent difference in measles cases reported to Measles Surveillance System (MSS) and National Notifiable Diseases Reporting System (NNDRS), 1999-2002Aggregated vs. Case-based SurveillanceWHO Expanded Programme on Immuni

15、zationin ChinaIndicatorTarget% Cases* notified 48 hours after rash onset80% Cases* investigated with house visit 48 hours after notification 80% Cases* with adequate specimens* and 80%laboratory results within 7 days% Confirmed cases with source of infection identified80%* All cases that meet the cl

16、inical case definition.* An adequate specimens is a blood specimen collected within 28 days of the onset of rash.監(jiān)測(cè)系統(tǒng)質(zhì)控指標(biāo)WHO Expanded Programme on Immunizationin ChinaMeasles Surveillance監(jiān)測(cè)系統(tǒng)質(zhì)控指標(biāo)(1) Shandong: 2,146 suspected cases (2001)Henan: 4,508 suspected cases (2001)Anhui: 3,245 suspected cases

17、 (2001) 19992000年河南、山東主要監(jiān)測(cè)指標(biāo)Henan河南Shandong山東調(diào)查率有免疫史記錄有出生日期記錄標(biāo)本采集率WHO Expanded Programme on Immunizationin China降低死亡率階段:監(jiān)測(cè)發(fā)病率和死亡率以評(píng)價(jià)控制項(xiàng)目進(jìn)展識(shí)別高危地區(qū)和控制項(xiàng)目實(shí)施差的地區(qū) 對(duì)麻疹病例的三間分布和免疫史狀況進(jìn)行分析;幫助確定麻疹補(bǔ)充免疫的恰當(dāng)年齡 低發(fā)病率或消除階段 : 確定傳播鏈;分析麻疹的流行病學(xué)特征（高危年齡組、流行間歇起、免疫狀況等） 指導(dǎo)評(píng)價(jià)強(qiáng)化免疫 :各階段發(fā)現(xiàn)和調(diào)查暴發(fā)，確定爆發(fā)原因 監(jiān)測(cè)數(shù)據(jù)的利用 1999-2000年，山東、河南兩系統(tǒng)報(bào)告麻

18、疹病例數(shù)19992000河南 專病監(jiān)測(cè) 大疫情 (%)差別1,8522,321 -469 (20%)2,8711,951920 (32%)山東專病監(jiān)測(cè) 大疫情 (%)差別1,7761,568208 (11%)843499344 (40%)WHO Expanded Programme on Immunizationin ChinaIdentify High-risk AreasShandongHenanAnhui 2000年河南省麻疹確診病例分布2000年報(bào)告103起暴發(fā)，累及916病例爆發(fā)累及2-52例病例河南省麻疹爆發(fā)Figure 6. Location of measles cases reported to the MSS, Prefecture X, 20031 dot = 1 measles case1 dot=1 confirmed measles case Juye County 2000年山東省麻疹確診病例分布WHO Expanded Programme on Immunizationin ChinaMeasles SurveillanceDescribe epidemiology in terms of age 2000年河南、山東麻疹病例年齡、免疫狀況分