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目的分析湖南省2004-2007年报告的30例不明原因肺炎病例相关信息,发现不明原因肺炎病例监测工作中存在的问题,为进一步做好监测工作提供参考。方法描述性流行病学。结果30例病例发病后,首诊时间为发病当天～病后6d,“发病-首诊”时间间隔中位数为1d;先后就诊(住院)医院数为1～7家;“发病-诊断为不明原因肺炎”时间间隔为病后1～33d,中位数7.5d;诊断为不明原因肺炎的医院级别分别为二级(6例)、三级(24例),二级、三级医院正确判定为不明原因肺炎病例的比例分别为24.0%、82.8%,三级明显高于二级医院(χ2=16.47,P=0.00)。医院内专家会诊结果为不明原因肺炎病例的当天,医院均向当地CDC和/或卫生行政部门进行了报告,但首次报告均为电话报告,最终只有11例进行了网络直报;排除SARS和人禽流感的20例病例“发病-排除诊断”时间间隔为病后4～53d,中位数11d,但16例仍未明确病原体。结论不明原因肺炎病例监测对湖南省3例人禽流感病例的及时发现有重要作用;但还存在很多困难和问题,如未很好地执行《方案》,医疗机构尤其市级以下专业人员培训不到位,基层对不明原因肺炎病例的排查存在难度等;建议加大培训力度,进一步提高医疗单位和疾控机构的检测能力,发现病例后科学、适度反应。
Objective To analyze the related information of 30 cases of unexplained pneumonia reported in Hunan Province from 2004 to 2007 and to find out the problems in the monitoring of unexplained pneumonia and provide reference for further monitoring. Methods Descriptive Epidemiology. Results After the onset of the disease, the first visit was from the day of onset to 6 days after the onset of disease, and the median time interval of “onset-first visit” was 1d. The number of hospital visits (from 1 to 7) was from 1 to 7 - diagnosed as unexplained pneumonia “interval from 1 to 33 days after the illness, the median 7.5d; for the diagnosis of unexplained pneumonia, the hospital level were grade 2 (6 cases), grade 3 (24 cases), grade 2, Grade 3 hospitals were correctly identified as unexplained pneumonia cases, the proportion was 24.0%, 82.8%, three significantly higher than the two hospitals (χ2 = 16.47, P = 0.00). The hospital was informed by the local CDC and / or health administration on the day the patient’s pneumonia outbreak was unknown in the hospital. However, the first report was a telephone report, and only 11 of the patients finally made a direct online report. Excluding SARS and people In 20 cases of bird flu, the time between diagnosis and diagnosis of disease was 4 ~ 53 days and the median was 11 days. However, 16 cases were still not yet confirmed as pathogens. Conclusions Unexplained pneumonia cases surveillance plays an important role in the timely detection of 3 cases of human bird flu in Hunan Province. However, there are still many difficulties and problems. For example, the ”program" is not implemented well, and the training of medical institutions, especially those below municipal level, is not In place, the grassroots investigation of unexplained pneumonia cases is difficult; it is proposed to increase training efforts to further improve the testing capability of medical units and disease control agencies, and to find out scientific and appropriate responses after the cases are found.