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Establishment and Evaluation of the Prevention and Control System of Respiratory-borne Diseases
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摘要:
目的 探讨建立以医院为主体的呼吸道传播性疾病防控体系对减少季节性流行性感冒(简称“流感”)院内传播的效果。 方法 回顾性收集并分析2017年11月至2020年2月3个流感季北京协和医院上报的流感病例的临床资料。根据其发生地点分为院内和院外流感病例。比较防控体系建立前(2017—2018年、2018—2019年)与建立后(2019—2020年)流感季院内流感病例比率变化。 结果 共5427例流感病例入选本研究。其中院内335例(6.17%，335/5427)，院外5092例(93.83%，5092/5427)；2017—2018年流感病例1594例(29.37%，1594/5427)，2018—2019年流感病例2579例(47.52%，2579/5427)，2019年—2020年流感病例1254例(23.11%，1254/5427)。2019—2020年院内流感病例比率(3.51%，44/1254)显著低于2017—2018年(7.59%，121/1594)和2018—2019年(6.59%，170/2579)(P＜0.001)，2017—2018年院内流感病例比率与2018—2019年无显著差异(P＞0.05)。相比2017—2018年、2018—2019年，2019—2020年发生院内流感病例的相对危险度(relative risk，RR)分别为0.53(95% CI：0.39~0.74)、0.46(95% CI：0.33~0.65)。 结论 呼吸道传播性疾病院内防控体系的建立可能对院内流感传播的预防有一定价值。 Abstract:Objective The aim of this study is to establish a hospital-based prevention and control system of respiratory-borne diseases for seasonal influenza and to verify the effect. Methods Influenza cases reported by Peking Union Medical College Hospital in the three flu seasons from November 2017 to February 2020 were retrospectively analyzed. According to the location of occurrence, the influenza cases are divided into hospital influenza cases and non-hospital influenza cases. The incidence of hospital influenza cases before and after the implementation of the prevention and control system of respiratory diseases were compared. Results A total of 5427 influenza cases that met the inclusion and exclusion criteria were selected for this study. Among them, there were 335 cases (6.17%, 335/5427) of hospital influenza and 5092 cases (93.83%, 5092/5427) of non-hospital influenza. There were 1594 influenza cases(29.37%, 1594/5427) in the 2017—2018 influenza season, 2579 cases(47.52%, 2579/5427) in the 2018—2019 influenza season, and 1254 cases(23.11%, 1254/5427) in the 2019—2020 influenza season.The incidence of hospital influenza of the 2019—2020 influenza season (3.51%) is much lower than those of the 2017—2018 influenza season (7.59%) and 2018—2019 influenza season (6.59%) (P < 0.001).There was no statistical difference between the 2017—2018 influenza season and 2018—2019 influenza season (P > 0.05). Compared with the 2017—2018 influenza season and 2018-2019 influenza season, the relative risk (RR) of hospital influenza cases in the 2019—2020 influenza season is 0.53 (95% CI: 0.39-0.74) and 0.46 (95% CI: 0.33-0.65), respectively. Conclusion Hospital-based prevention and control system of seasonal influenza may effectively prevent influenza cases from appearing in hospital. 作者贡献：孙芳艳负责实施研究、文献综述及文章撰写；柴文昭提出研究思路，制定整体研究目标；郭勤参与研究实施；何紫棠指导数据整理与统计分析；王爱、张国杰、张占杰负责数据收集。利益冲突： 无 -
表 1 防控体系建立前后院内与院外流感季流感病例构成比较[n(%)]
时间 院内流感病例
(n=335)院外流感病例
(n=5092)χ2值 P值 2017—2018年 121(7.59) 1473(92.41) 2018—2019年 170(6.59) 2409(93.41) 21.683 ＜0.001 2019—2020年 44(3.51) 1210(96.49) 
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表 2 不同性别、年龄段和职业的患者院内与院外流感病例构成比较[n(%)]
指标 院内流感
病例
(n=335)院外流感
病例
(n=5092)χ2值 P值 性别 1.076 0.300 男 147(5.81) 2383(94.19) 女 188(6.49) 2709(93.51) 年龄(岁) 531.475 ＜0.001 0~19 24(0.93) 2553(99.07) 20~39 69(4.49) 1468(95.51) 40~59 85(13.16) 561(86.84) 60~79 129(23.58) 418(76.42) ≥80 28(23.33) 92(76.67) 职业 661.005 ＜0.001 政府/国企/事业
单位40(3.85) 999(96.15) 私企/自由职业 35(7.76) 416(92.24) 农民 32(61.54) 20(38.46) 失业/无业人员 91(13.77) 570(86.23) 退休人员 115(19.39) 478(80.61) 学生/儿童 22(0.84) 2597(99.16) 其他 0(0) 12(100)
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