国内外流感监测系统的地理流行病学比较研究

流感监测系统的建立是应对流感大流行的一种极为有效的举措。为此,美国、加拿大、墨西哥、巴西、英国、欧盟、俄罗斯、澳大利亚、新西兰、中国等国家,先后都建立了自己的流感监测系统。为了提高我国流感监测系统的水平,作者选出代表性强、特色显著的美国、欧洲和我国的流感监测系统作为典型,从地理流行病学的角度,着重对流感监测及其数据分析的地理分区、流感疫情动态变化的评价标准等方面进行了比较研究。通过总结先进国家的成熟经验,结合我国的实际情况和需求,作者对我国的流感监测系统提出了改进意见。在综合考虑我国地貌特点、气候分区和管理需要的基础上,建议将现有以秦岭淮河为界划分的南、北两个地理分区,细化为黑吉辽区、京津冀鲁豫区、长江中下游区、闽粤桂琼台区、蒙甘新区、晋陕宁区、渝黔川滇区和青藏区等8个流感监测地理分区;建议将现有流感监测系统引入基于流感样病例占门诊病例百分数的基线,利用归因肺炎及流感的死亡率,计算流感季节基线和流行阈值,以客观地衡量和评价流感流行水平及其严重程度。这些研究成果,不仅对地理流行病学的发展有理论意义,而且也对流感及其他传染病的监测有实用价值。

Geographical Epidemiology Comparative Study on Influenza Surveillance Systems at Home and Abroad

To establish an influenza surveillance system is an effective strategy to monitor or predicate the influenza pandemic.Many countries,such as the United States,Canada,Mexico,Brazil,Britain,the European Union,Russia,Australia,New Zealand and China have established their own influenza surveillance system.In order to improve China＇s influenza surveillance system,the authors analyzed the differences and characteristics of the influenza surveillance systems among the United States,Europe,and China by the geographical epidemiologic methods.The comparative analysis focused on the influenza epidemic by geographic regions and the evaluation indicators of the surveillance.Based on the consideration of the characteristics of China＇s topography,climate zoning and administrative management system,the authors proposed that the current surveillance system which includes only north and south regions can be refined into 8 regions：（1） Heilongjiang,Jilin and Liaoning;（2） Beijing,Tianjin,Hebei,Shandong,and Henan;（3）the areas of middle and lower reaches of Yangtze River;（4） Fujian,Guangdong,Guangxi,Hainan and Taiwan;（5） Inner Mongolia,Gansu and Xinjiang;（6） Shanxi,Shaanxi and Ningxia;（7） Chongqing,Guizhou,Sichuan and Yunnan;and（8） Qinghai and Tibet.Although the operational time of the system is short and the cumulated data is insufficient in China,the percentage of influenza-like illness（ILI） of total out-patient cases the mortality rate attributed to pneumonia and influenza in sentinel hospitals can be used to calculate the baseline and the influenza season epidemic threshold.Those baseline and threshold will measure and evaluate the level and severity of an influenza pandemic objectively.The study not only contributed to the applications of the landscape epidemiology theoretically,but also to the surveillance of influenza and other communicable diseases practically.