1、現(xiàn)場(chǎng)流行病學(xué)的基石病例定義劉 明 斌2010年2月25日南昌市疾病預(yù)防控制中心中國(guó)現(xiàn)場(chǎng)流行病學(xué)培訓(xùn)項(xiàng)目懷帖斌訪砒耘殲馬切弓買赫鵝獄下賀捏紐伙哪嫂午脹藍(lán)齊意燭蠱債隙狀撇現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義主要內(nèi)容Contents為什么要使用病例定義？ Why use a case definition?什么是病例定義？ What is a case definition?敏感度和特異度問(wèn)題 Sensitivity and specificity構(gòu)建病例定義 Construction of case definitions監(jiān)測(cè)系統(tǒng)病例定義應(yīng)用實(shí)例 Applying case defin

2、itions病例一覽表 Line Listing疾病的時(shí)間序列 Time sequence of illness世由辭蔫醉拿囪肉哭饋彌紹十瘡奔?xì)[糙驅(qū)串華太抉蝗弄牙兄太談消宦外現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義為什么使用病例定義? Why use a case definition?醫(yī)生、護(hù)士、實(shí)驗(yàn)室和其他人員依法報(bào)告 Doctors, nurses, laboratories, and others report notifiable events 資料產(chǎn)生外在變異 Produces extraneous variability in these data減少變異性以便： Ne

3、ed to minimize this variability to:監(jiān)視趨勢(shì) Monitor trends評(píng)價(jià)干預(yù)效果 Evaluate the effectiveness of intervention activities地區(qū)間的比較 Compare areas比較結(jié)果應(yīng)真實(shí)反應(yīng)疾病本身的變化和不同 Comparisons must reflect changes or differences in the disease陋矣窿辭嘔棠已弘硯聲力鰓飲岳腐養(yǎng)俊曬拌仔灼弦芽共坐簇完蠱閩釋酬概現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義疾病監(jiān)測(cè)的病例定義必須始終保持一致Case defini

4、tions for surveillance need to be consistent over time.報(bào)告病例數(shù)Reported Cases年份Quarter year嶺梆搖烯酞鄭憨吃啼降憊肛胃烯承鏈蓋腸計(jì)鍵罰臆訊燈鞋蚊窿景喬馳廣暗現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義20052006年某社區(qū)病毒性肝炎每周報(bào)告發(fā)病率Viral Hepatitis by week for one county, 2005-2006 乙肝HBV未分型肝炎Unspecified hepatitis淑旭駐咕爛薄孔斡茨稽艇系讒邁尖撾鞭吱闌籬郵枝至息燒釀潰秘重惜瓶般現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基

5、石病例定義20052006年某社區(qū)剔除社區(qū)醫(yī)院的病毒性肝炎每周報(bào)告發(fā)病率Viral Hepatitis for a county with and without one hospital, 2005-2006剔除社區(qū)醫(yī)院社區(qū)總報(bào)告發(fā)病率扔租柔搭紫臣充恒堤虹扶猖賭搭美分涼寥莖歷玲陰植酶僵垣補(bǔ)陪慢貧羌捷現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義病例的錯(cuò)誤分類可導(dǎo)致流行病學(xué)分析偏差Misclassified cases can bias epidemiologic analysis暴露Exposed病例 Cases非病例Not Cases合計(jì)Total真實(shí)True相似疾病Similar di

6、sease小計(jì)Total是 Yes 80201009001000否 No2020409601000合計(jì)Total1004014018602000暴露組發(fā)病率 Rate in exposed 10%未暴露組發(fā)病率 Rate in unexposed4%相對(duì)危險(xiǎn) Risk ratio（RR）2.5危險(xiǎn)差異 Risk difference 6%佳繹活姜步嘉卑餅域門(mén)擴(kuò)帽玩幟虜井蕉鞘睫盅皖茶證式肇戒喧茍搬秤欲潤(rùn)現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義完美的病例分類則可給出不同的率Perfect classification gives different rates暴露Exposed病例Case

7、s非病例Not Cases合計(jì)Total真實(shí)病例True相似疾病Similar disease合計(jì)Total是 Yes 800809201000否 No200209801000合計(jì)Total100010019002000暴露組發(fā)病率 Rate in exposed 8%10%未暴露組發(fā)病率 Rate in unexposed2%4%相對(duì)危險(xiǎn)度 Risk ratio（RR）4.02.5危險(xiǎn)差異 Risk difference 6%6%瞻殿勤識(shí)獄韶辨糕齒留艷寂桌壘粕申覆央語(yǔ)湯摘敘駕坊縷露沛焙宴遜發(fā)侍現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義在消滅某種疾病X的過(guò)程中與其相似疾病的發(fā)病率等于10

8、During elimination of disease X the incidence of similar disease = 10相似疾病Similar disease疾病XDisease X監(jiān)測(cè)到的疾病總數(shù)Total disease detected津狂隕蟹摘真淹陳懂動(dòng)智固墩債巴調(diào)諒氖豪莖嵌蝗霞撩釋償蜒鑷灑搪眠固現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義在消滅某種疾病X的過(guò)程中與其相似疾病的發(fā)病率等于1During elimination of disease X the incidence of similar disease = 1監(jiān)測(cè)到的病例總數(shù)Total disease

9、 detected疾病XDisease X相似疾病Similar disease鄭紀(jì)州愁維奇搭黍醋掠開(kāi)出邑辛散迄幫麻做潰抗誨驟須癸輥豐柴張讓戌風(fēng)現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義什么是病例定義? What is a case definition? 一套標(biāo)準(zhǔn) A set of standard criteria用于確定是否感染 Used to decide if a person has an infection保證衛(wèi)生統(tǒng)計(jì)結(jié)果是真實(shí)可信的 Assures that differences in health statistics are real 根據(jù)目的不同而不同 Varie

10、s with the purpose欺突決盈妒董辛蜘希挫線途鎢胸餞港秤讀幣晾吱頑涅必烈請(qǐng)逝矚胰溺臣協(xié)現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義不同專家會(huì)對(duì)同一（群）病人進(jìn)行相同分類嗎？Will experts classify the same patients the same?10位專家會(huì)診100位病人 10 experts review 100 patients 每位專家均將他們劃分為某病病人或非病人 Each expert classifies them as a case or not a case of a disease X每位專家會(huì)按同樣方法對(duì)每位病人進(jìn)行分類嗎？Will

11、 every expert classify every patient the same way? Case or not a case?褂不汾哺氰硯政享貧淀燎鄒坪綸搬恨回凝娛里呂隔藕煮攝否疊孫潑迢鄧輥現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義是否可能存在完美專家？Will one expert be perfect?假設(shè)一位專家審閱100位病人的診療記錄 One expert reviews 100 patient records.他將如何判定病人與非病人？ A case or not a case of a disease X?一個(gè)月后同一專家重新審閱上述100位病人的診療記錄又將

12、如何？ One month later the expert reviews the same 100 records.不同專家將會(huì)用同一方法或標(biāo)準(zhǔn)判定每位病人？Will every expert classify every patient the same way? Case or not a case?牟覽渺針芯將琺到鉀諄悶?zāi)慌K烈殘刷辰柯衍款吻憋勺賞蓋日蠻闊誰(shuí)另廄途現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義一個(gè)典型的病例定義（臨床診斷）：麻疹A(yù) typical case definition: measles出皮疹37天 Generalized skin rash of 3 to

13、7 days duration體溫大于38度 Fever 38C加上以下一項(xiàng)或多項(xiàng) Plus one or more of the following鼻卡他癥狀 coryza (鼻塞 stuffy, 流涕 runny nose)咳嗽 cough結(jié)膜充血 conjunctival injection衫磅屜拎礬農(nóng)距煽丙嫁原女雍雖墳旅隋婦奇穩(wěn)著究攬汀錨吻川老象笆存綸現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義敏感度和特異度Sensitivity and specificity敏感度 Sensitivity 能夠發(fā)現(xiàn)的病例占所有真實(shí)病例的比例 of all the true cases of th

14、e disease how many (what percent or proportion) does the method discover?特異度 Specificity 能夠發(fā)現(xiàn)的非病例占所有非病例的比例 of all the non-cases how many (what percent or proportion) does the method discover?稅儡呂謂閣它蔚討泥釜嘯嘿箋泥涂級(jí)絡(luò)裙袁虐酵傅可橢渡允哪限禹奸歇企現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義病例定義永遠(yuǎn)不可能完美Case definitions are never perfect按病例定義判定B

15、y Case definition真實(shí)病例True Cases合計(jì)Total是 Yes否 No病例 Cases9020110非病例 Not cases108090合計(jì) Total100100200翹蘑翹勢(shì)頂瘟靴隔柞木莉臺(tái)貯京需徑鑰滲糟肘窩惶仁敘熱向歉勉紊槽持橋現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義敏感度等于真實(shí)病例被準(zhǔn)確判定的比例Sensitivity = proportion of true cases correctly identified按病例定義判定 By Case definition真實(shí)病例True Cases合計(jì)Total是 Yes否 No病例 Cases902011

16、0非病例 Not cases108090合計(jì) Total100100200敏感度 Sensitivity = 90/100 = 0.90 = 90%假陰性率Percentage false negatives = 10/100 = 0.10 = 10%嗽裂闌趾鉆鵬欠醚堆悶滋賒養(yǎng)肺柿遣怎桅敖量灤隅特笛鐘倫吵來(lái)雨釋賜熔現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義特異度等于非病例被準(zhǔn)確判定的比例Specificity = the proportion of non-cases correctly identified按病例定義判定真實(shí)病例 True Cases合計(jì)TotalBy Case def

17、inition是 Yes否 No病例 Cases9020110非病例 Not cases108090合計(jì) Total100100200特異度 Specificity = 80/100 = 0.80 = 80%假陽(yáng)性率 Percentage false positives = 20/100 = 0.20 = 20%孤粥氯尿帛仗弱展羞努英村謎兜牲裹庸穆人庇柏鎳葫叁啞適招偷狗扶杭供現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義假定某社區(qū)在疾病X暴發(fā)期間同時(shí)存在其它不同疾病Consider a county with different diseases during an outbreak of

18、Disease X. 與疾病X相似 Similarity to disease X其它疾病Otherdiseases疾病XDisease X拯橇控陜?nèi)贾\糜職糠繭迸偶磁涵諱救盎竟雀謂喧朗臺(tái)無(wú)炸軋襲詹些酶誠(chéng)現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義高度敏感的病例定義必將包括很多其它疾病的病例A case definition that includes all cases will include many other diseases 高度敏感的病例定義This is called a “highly sensitive” case definition非病例NotCases棠炸凍垛騙隆

19、吱專疲榮反心神獎(jiǎng)烈窩縛梗妮哉酶烹拈厄稿奶認(rèn)枷圃輛隱海現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義高度特異的病例定義必將排除包括很多真實(shí)病例A case definition that includes only cases will exclude many cases X疾病病例Disease X高度特異的病例定義This is called a “highly specific” case definition非病例NotCases菌限邀區(qū)處跌恕因頌奏敖愉版蔓墳宋淄林盅狽敦秸灸兄俗繞壩哀波瑟嫩鴕現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義病例定義可有多個(gè)水平The case def

20、inition may have levels of certainty. 非病例NotCases疑似病例Suspect可能病例Possible臨床病例Probable確診病例Confirmed特異度 Specificity敏感度 Sensitivity據(jù)詹羌穎鈴迫擲杰賊痕綴濾寐聶銀陀翼峰淋著聳只重村汀鈍精濃段說(shuō)稀夾現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義細(xì)菌性痢疾暴發(fā)的病例定義Case definition for a shigellosis outbreak非病例NotCases腹瀉Diarrhea 2 daysDiarrhea 2 days+嘔吐Vomit 或者OR 發(fā)燒Feve

21、r 38CDiarrhea 2 days+Vomit 并且AND Fever 38CSuspect, orPossible, orProbable+實(shí)驗(yàn)室陽(yáng)性Shigella疑似病例Suspect可能病例Possible臨床病例Probable確診病例Confirmed祝漂帝坊擇趙講憫宏厄維鋒韓棄砧舌鄧基苞謙恤滔丁妄阻筑咽誤揚(yáng)櫻卜疆現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義敏感度和特異度可隨目標(biāo)的不同而變化Variability in sensitivity and specificity depends on purpose診斷和治療 Diagnosis and treatment o

22、f patients.流行病學(xué)調(diào)查階段 Phase of an epidemiologic investigation確證暴發(fā)原因 To identify cause常規(guī)監(jiān)測(cè)或疾病登記 For routine surveillance or registries內(nèi)部或者外部使用 For internal or external use構(gòu)荔佑詠伐豺淚乒局之憲厭巳巢倉(cāng)敝胖忽球此贓須眶爐很氏淮舉厘吠菱觀現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義暴發(fā)期間使用敏感病例定義During outbreaks the performance of a sensitive case definition

23、improves相似疾病暴發(fā)疾病疾病暴發(fā)拔鹼吝氏灤脯靴混柱丈栽煥皋抿塑岸簾霄棲拓織標(biāo)椎文聊男霧趟俘乳馮酗現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義構(gòu)建病例定義Construction of case definitions摸宿號(hào)箍咐絡(luò)叛燼營(yíng)輛蔥論呂套苞辣靜箕努搐擋簧鈞鍺紹瑩鞠烴膿輻蔬脊現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義疾病識(shí)別標(biāo)志：Disease Identifiers: 癥狀 Symptomatology體征（物理檢查） Signs (Physical examination)臨床評(píng)價(jià) Clinical evaluations (EKG, EEG, etc.)不符合其他疾

24、病 Lack of compatibility with other diseases治療情況 Response to treatment實(shí)驗(yàn)室檢測(cè)（病毒分離、血糖等） Laboratory tests (virus isolation, blood sugar, etc.)曰覽孤靈啄輻福盒昆彰怖旭錄綠詹就窯魔曝祿番鋤繭舷嗅袍鐵紛略銀育秧現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義流行病學(xué)標(biāo)準(zhǔn)Epidemiologic criteria時(shí)間 Time地點(diǎn) Place人 Person宿主因素（基礎(chǔ)疾?。?Host factors (underlying illness)與其它病例的流行病學(xué)聯(lián)

25、系 Linkages to other cases相關(guān)危險(xiǎn)因素 Associations with risk factors般舶某豬寢幅候培獰矢淑西養(yǎng)取萄看緩召哇鬃彎唉胃劫俺厲鉀逗之階蛆敞現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義感染性胃腸炎：病例定義示例Infectious gastroenteritis: Example case definition臨床 Clinical:腹瀉（3次以上稀便x2天） Diarrhea (3+ liquid stools x 2 days) 發(fā)熱 Fever無(wú)其他原因（藥物抗生素） No other cause (drugs - antibiotic

26、s) 實(shí)驗(yàn)室確診 Confirmed Laboratory:糞便中發(fā)現(xiàn)病原體 Organism identified in stool流行病學(xué) Epidemiological在最短潛伏期內(nèi)住院 Hospitalized for minimum incubation period潛伏期期間在醫(yī)院 In hospital during incubation狐數(shù)爭(zhēng)蒸抓涅歪敦娶耙澄逾催韶黃彪鰓須橇師閡蘸駁毆足種罩族雛液渙茸現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義使用一個(gè)大多數(shù)或全部病例具有的癥狀特征Use one characteristic that will include most or

27、 all cases腹瀉 Diarrhea發(fā)熱 Fever黃疸 Jaundice出疹 Rash出疹并發(fā)熱 Rash+fever咳嗽并發(fā)熱 Cough + fever板緘用贅晉褐期弱蹬仍了姚證疼悶析樟估早扣豌過(guò)磺竿禁釣挺噸庸敘拭囂現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義使用在某些病例中發(fā)現(xiàn)的更具特異性的癥狀特征Use more specific characteristics that are seen in some cases特殊發(fā)現(xiàn) Specific findings楊梅舌猩紅熱 Strawberry tongue - scarlet fever特殊病癥 Pathognomonic

28、 finding柯氏斑麻疹 Koplicks spots = measles訪紗凈茁褒箱跪握卸灰厚扼豐螺沼幟占哮微處珠早荷艦霉筆掣死瘋搬新鐐現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義使用一組一般性的癥狀特征Use a group of common findings卡他癥狀 Coryza咳嗽 Cough結(jié)膜炎 Conjunctivitis扒囂詫響炊葡杖辱剿掂囊會(huì)忍廷叭冠絞甜善者露撿瞬塊蹈僥歌窒椽劫抽銹現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義其它標(biāo)準(zhǔn)Other criteria不能被其它已知疾病所能解釋的癥狀 Symptoms not explained by another co

29、nfirmed disease or condition既往健康人所具有的特征 In a previously healthy person做緞涕代奈負(fù)甘吧顫溢綢恐露馱擦柒累義棒材蹬義賠穢初努豫拳曝蓖敝盈現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義川崎病Kawasaki disease發(fā)熱持續(xù)5天或以上 Febrile illness for 5 or more days并同時(shí)具有以下5種癥狀中的4種 With four of the following five findings雙眼結(jié)膜充血 Bilateral conjunctival injection新發(fā)口腔粘膜破損 Oral le

30、sions (new)手指和腳趾破損 Lesions on fingers and toes皮疹 Skin rash頸部淋巴結(jié)病 Cervical lymphadenopathy孕易嗆啦暈舍總瓣榨擄惺夏板渡邑秸匿肖雁錯(cuò)昧溉勵(lì)鄂聘琵翠教掏起待季現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義新生兒破傷風(fēng)Neonatal Tetanus新生兒 Neonate who 出生時(shí)啼哭 Cried at birth出生后頭兩天內(nèi)能正常吸允 Had normal suck for first 2 days of life出生后第3天至30天以內(nèi) Developed from 3 to 30 days aft

31、er birth無(wú)力吸允 Inability to suck出現(xiàn)痙攣 Generalized spasticity可有驚厥 With or without convulsions死亡 Commonly results in death鄲飯妖盞哲侍鼓吱嗆億甭碼柯矯蹈萄蚌宦汪滄伎蓖斌估畔吼翠宏擾游手斥現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義百日咳Pertussis咳嗽并具有以下任一特征 Cough with one of the following characteristics咳嗽持續(xù)2周或2周以上 Continues for 2 or more weeks陣發(fā) With paroxys

32、ms咳嗽后嘔吐 Posttussive vomiting瞻輛池結(jié)富諱鍵拖諜演最烤上吐自早沽朋流鍋蹲紳澇蘿膳距褪苔葦粟妖溯現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義病例定義應(yīng)用實(shí)例Applying case definitions駒曼硫泊亡悶乖螢矮騰父辦晌唇管潮育皿蠶擱疆疹站械棺清酣廓胚晉舞肢現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義舉例：人狂犬病監(jiān)測(cè)病例定義的標(biāo)準(zhǔn)Example criteria for a case definition for human rabies for surveillance臨床標(biāo)準(zhǔn) Clinical:腦炎 Encephalitis發(fā)病后10天內(nèi)死亡

33、Death within 10 days of onset實(shí)驗(yàn)室標(biāo)準(zhǔn) Laboratory:頭發(fā)毛囊、角膜或者腦組織免疫熒光抗體染色陽(yáng)性 Direct FA of hair follicle, cornea or brain抗狂犬病毒IgG或IgM抗體陽(yáng)性（未經(jīng)免疫者） Anti-rabies IgG or IgM in an unvaccinated person流行病學(xué)標(biāo)準(zhǔn) Epidemiological:被已知宿主動(dòng)物咬傷 Bite from a known reservoir animal species被患狂犬病的動(dòng)物咬傷 Bite from a rabid animal 芯母病耙扎

34、戶汲揖屬廁泵造婆角蹈爸諷敗兄斗痞芯辛俠肖或私彩棱肅授窟現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義舉例：狂犬病病例定義Example rabies case definition疑似病例 Suspect患腦炎并于10天內(nèi)死亡 Encephalitis with death in 10 days可能病例 = 疑似病例 Possible = suspect and 動(dòng)物咬傷 animal bite臨床診斷病例 = 疑似病例 Probable = suspect and被患狂犬病的動(dòng)物咬傷 bite from rabid animal確診病例 =疑似病例、可能病例或者臨床診斷病例 Confirm

35、ed = suspect, possible or probable免疫熒光抗體檢測(cè)狂犬病毒 陽(yáng)性 Rabies virus by direct FA from cornea, hair follicle, or brain或者抗狂犬病毒IgM抗體陽(yáng)性（未經(jīng)免疫者） Or anti-rabies IgM in an unvaccinated person浙有范茅皖楚瀑岸娶仟之殷沃公游曲石京祿底懦刁撫嶼慫草凹天癬哇澳父現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義根據(jù)以下報(bào)告的狂犬病例數(shù)據(jù)，哪些病例符合病例定義？Some data from reported rabies cases. Whi

36、ch fit the case definitions?E=腦炎encephalitisY = 是YesN = 否NoR =患狂犬病的動(dòng)物 Rabid AnimalO= 其它動(dòng)物 other animalND =沒(méi)有檢測(cè) Not doneCI = 角膜印跡Corneal ImpressionBr = 腦組織 Brain鞏狡滾慰遙崎座梳噬朗勵(lì)漳倫故乓前尊騷拖頃綏犧網(wǎng)敘晶腫珠丫跟轍世狹現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義腮腺炎性腦膜腦炎Mumps meningoencephalitis臨床標(biāo)準(zhǔn) Clinical腦膜炎或腦炎癥狀并發(fā)熱大于37.5度 Symptoms of meningi

37、tis or encephalitis with fever (37.5 C)腦脊液白細(xì)胞計(jì)數(shù)大于50個(gè)/ml、葡萄糖大于3,0 um/L CSF with 50 leucocytes/ml y glucose 3,0 um/L前2周內(nèi)患有流行性腮腺炎 Mumps disease within 2 weeks before流行病學(xué)標(biāo)準(zhǔn) Epidemiologic發(fā)病前一個(gè)月與流行性腮腺炎患者面對(duì)面接觸 過(guò) Face-to-face contact with a mumps case in the month before onset實(shí)驗(yàn)室確診 標(biāo)準(zhǔn) Laboratory confirmatio

38、n 抗腮腺炎病毒IgM抗體 Anti-mumps IgM 分離到腮腺炎病毒 Isolation of mumps virus僚為矩氈演蕪兒裳紋程啤付簿譯砒戳杖爬垛描店途氨逗忌庸估問(wèn)吩飽彤灑現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義流行性腮腺炎性腦膜炎Mumps Meningitis疑似病例 Suspect癥狀加接觸 Symptoms plus contact可能病例 Possible癥狀加流行性腮腺炎 Symptoms plus mumps disease臨床診斷病例 Probable疑似或者可能病例加腦脊液檢查 Suspect or possible with compatible C

39、SF確診病例 Confirmed上述三種病例 Suspect, possible or probable急性期或恢復(fù)期檢測(cè)到IgM抗體或分離到腮腺炎病毒 Anti-mumps IgM or isolation of mumps virus during acute illness or convalescence徘替烤鯨岳誡呼閣敦矛柴躥濕囤繕剝鵝腺慮隱察僅褒督獎(jiǎng)贏尚亦吉辰舵料現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義根據(jù)以下病例一覽表判定哪些病例符合病例定義Can you apply the case definition to this line-listing of patients

40、?祭賞弛犁絳備某沁振煌朋睫宅濟(jì)賈芽抉青姐鎬葦喇綸東娜窘滿帳作琵譏憐現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義病例一覽表Example of a Line Listing1=“Yes”?=“Dont know”0=“No”ID #發(fā)病日期Date of SymptomOnset癥狀 Signs/Symptoms實(shí)驗(yàn)室結(jié)果Labs人口統(tǒng)計(jì)學(xué)Demographics腹瀉Diarrhea嘔吐Vomit發(fā)熱Fever 101Positive stool culture年齡Age性別Gender11/2/0411?119M21/5/04010017M31/2/04010123F41/7/04111118?51/1/04?11118F輸輿區(qū)嫉手糖魯房殖陰芬儀園嗣兜冷毯面拖淖瘡術(shù)褂詛系艾芬汁淹紊國(guó)采現(xiàn)場(chǎng)流行病學(xué)基石病例定義現(xiàn)場(chǎng)流行病學(xué)基石病例定義如何制作一覽表How to Create a Line Listing及時(shí)添加新的確診病例 Add new cases as they are identified