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中国疾控中心印发《新型冠状病毒肺炎流行病学调查指南》

2020-03-16 医咖会 医咖会

近日,中国疾控中心制定了一系列新型冠状病毒肺炎防控方案相关技术文件。包括《新型冠状病毒肺炎流行病学调查指南》、《新型冠状病毒肺炎病例密切接触者调查与管理指南》、《新型冠状病毒肺炎实验室检测技术指南》、

近日,中国疾控中心制定了一系列新型冠状病毒肺炎防控方案相关技术文件。包括《新型冠状病毒肺炎流行病学调查指南》、《新型冠状病毒肺炎病例密切接触者调查与管理指南》、《新型冠状病毒肺炎实验室检测技术指南》、《特定场所消毒技术指南》和《特定人群个人防护指南》。

 

本文对《新型冠状病毒肺炎流行病学调查指南》做了整理,其他内容可到

http://www.chinacdc.cn/jkzt/crb/zl/szkb_11803/jszl_11815/202003/t20200309_214241.html 查看

新型冠状病毒肺炎流行病学调查指南

为指导各地疾控机构规范开展新型冠状病毒肺炎的流行病学调查工作,掌握病例发病情况、暴露史、接触史等流行病学相关信息,分析聚集性疫情的传播特征和传播链,做好密切接触者的追踪判定,防范新型冠状病毒肺炎疫情的蔓延和传播,特制定本指南。

一、调查目的

(一)调查病例的传染源,追踪和判定密切接触者;

(二)调查病例的发病和就诊情况、临床特征和危险因素等;

(三)调查分析聚集性疫情的传播特征和传播链。

二、调查对象

新型冠状病毒肺炎疑似病例、确诊病例和无症状感染者,以及聚集性疫情。

三、调查内容和方法

(一)个案调查。

县(区)级疾控机构接到报告后,应当于24小时内完成初次流行病学调查,可通过查阅资料、询问病例、知情人和接诊医生等方式开展。在出院病例完成14天隔离管理和健康状况监测后,尽量补充收集填报病例样本采集与检测信息。

个案调查主要调查疑似病例、确诊病例和无症状感染者的基本信息、发病与就诊、危险因素与暴露史、实验室检测情况等,填写个案调查表(表1),其中疑似病例仅填写病例的姓名、性别、身份证号等基本信息。同时,追踪调查、判定病例的密切接触者,填写密切接触者医学观察健康状况监测个案表,详见《新型冠状病毒肺炎病例密切接触者调查与管理指南》。

表1  个案调查表

(二)聚集性疫情调查。

县(区)级疾控机构根据网络直报信息和病例个案调查情况,对符合定义的聚集性疫情立即开展调查。调查内容包括病例的感染来源、密切接触者等信息,重点调查病例间的流行病学联系,分析传播链和传播途径,调查与分析方法见附件。

四、组织与实施

按照“属地化管理”原则,由病例就诊医疗机构所在的县(区)级卫生健康行政部门组织疾控机构开展新型冠状病毒肺炎病例的流行病学调查。调查单位应当迅速成立现场调查组,明确调查目的,制定调查计划,确定调查组人员及职责分工。调查期间,调查人员要做好个人防护。市级、省级、国家级疾病预防控制中心可根据疫情处理需要赶赴现场,参与开展流行病学调查。

五、信息的上报与分析

县(区)级疾控机构完成确诊病例、无症状感染者个案调查或聚集性疫情调查后,将个案调查表和调查报告及时通过网络报告系统进行上报。各地应对流行病学调查信息质量进行审核,并根据调查进展及时补充和订正相关信息。

聚集性疫情调查结果按照《国家突发公共卫生事件相关信息报告管理工作规范(试行)》的要求,填报事件的基本信息、初次、进展和结案报告,并将聚集性疫情病例关键信息(参见附件)附在结案报告中。

附件

新型冠状病毒肺炎聚集性疫情

调查与分析方法

 一、聚集性疫情定义

聚集性疫情是指14天内在小范围(如家庭、办公室、学校班级、车间等)发现2例及以上的确诊病例或无症状感染者,且存在人际传播的可能性,或共同暴露而感染的可能性。

二、聚集性疫情发现

(一)通过病例的个案调查,查找有密切接触或共同暴露史的确诊病例、疑似病例或无症状感染者。

(二)在中国疾病预防控制信息系统,查找同单位或同住址,且发病间隔在1至2个潜伏期内的确诊病例、疑似病例或无症状感染者。

(三)汇总分析个案流调报告,查找不同地区、在发病前14天内均有乘坐同一航班和火车车次,或参加相同旅行团或会议等具有共同暴露史的确诊病例、疑似病例或无症状感染者。

三、调查内容

(一)病例和密切接触者调查。

聚集性疫情相关病例的调查应重点关注:

①病例及密切接触人员有无武汉市及周边地区,或境内其他有病例报告社区,或境外疫情严重国家或地区的旅行或居住史;

②是否接触过来自武汉市及周边地区,或境内其他有病例报告的社区,或境外疫情严重国家或地区的发热或有呼吸道症状的患者;

③接触类型、接触距离、频率及采取的个人防护措施情况等;

④病例相关活动轨迹;

⑤核实并登记病例姓名、身份证号码及联系电话。

初始调查时,聚集性疫情相关病例的时间范围可不限于14天,相关疑似病例和无症状感染者也需纳入调查。结案时,应根据流行病学和实验室调查做出是否为聚集疫情相关病例的最终判定。

密切接触者调查时应重点关注:①密切接触者发病、标本采集和检测情况;②密切接触类型,如聚餐、家庭共同生活、同乘交通工具等;③密切接触者转归情况。

(二)病例暴露场所调查。

1.家庭暴露:调查病例共同居住的家庭成员人数、接触及个人防护情况;家庭环境,包括房间数、面积和通风与空调使用情况,洗手设施情况;单元楼的电梯使用及消毒情况等。

2.聚餐暴露:调查聚餐时间、地点和人员及座位分布,聚餐环境、通风与空调使用情况、洗手设施情况,可能导致传播风险增加的行为等。

3.集体单位:调查病例所在工作场所的人员数量、工位分布、车间分布、工作接触方式及工作人员防护情况,工作场所、食堂、宿舍、卫生间等相关场所的环境卫生、中央空调、新风系统使用与通风情况、洗手设施情况,电梯使用及消毒情况。

4.交通工具:调查乘坐的交通工具种类、座位分布、通风和空调使用及消毒情况、洗手设施情况,同乘人员数量、健康状况和个人防护情况等。

5.公共场所:病例暴露于商场、超市、公共浴池、酒店、养老院、医院、婚礼/葬礼现场等公共场所的停留时间,人员数量或密集程度及个人防护情况,公共场所布局与面积、通风和空调使用情况、电梯使用及消毒情况、洗手设施情况等。

(三)采样与检测。

所有病例应按照相关要求开展标本采集与检测。聚集性疫情的首例病例、怀疑为无症状感染者或潜伏期内传播等特殊情形,在两次核酸检测阴性的情况下,建议增加采样和检测频次,并采集发病后7天内和3一4周后的双份血清标本留存备查。

三、调查内容

(一)病例传播链分析。

根据病例发病时间绘制流行曲线,结合与首例病例的关系、发病前14天暴露史及发病后的活动轨迹,绘制发病时序图或病例关系图(图1、图2),分析传播链。

(二)病例代际分析。

根据流行曲线、时序图或病例关系图,结合潜伏期、暴露史,逐一判断病例代际。每起聚集性疫情的代际判定可参照以下原则:

第一代病例通常为发病时间最早的病例,即聚集性疫情的首例。如果怀疑存在无症状感染者或潜伏期传染的情况,均需结合流行病学调查和实验室检测结果进行综合分析判定。

第二代病例判定原则上符合以下三个条件:①发病前14天内仅与第一代病例有过接触史;②未曾到过或居住在武汉市及周边地区,或境内其他有病例报告的社区,或境外疫情严重的国家或地区;③无医院就诊等其他可疑暴露史,或所在地区未发生明显的社区传播。

第三代及以上病例判定可参照二代病例判定原则。若病例在发病前14天内与前两代病例均有接触,则代际无法判断。

(三)潜伏期分析。

对单个病例准确计算潜伏期应符合以下三个条件:①二代病例与首例病例有明确的接触史;②二代病例与首例病例接触时间较短;③二代病例除与首例病例接触之外,在发病前无任何其他相关暴露史或接触史。

在聚集性疫情中,若发现单个病例的潜伏期超过现有研究的最短和最长潜伏期范围异常值,应核实是否符合上述条件,确认病例发病时间和与首例接触时间的准确性。

(四)潜伏期传染性分析。

在聚集性疫情中,若判定首例存在潜伏期传播,需满足以下三个条件:①首例与二代病例接触时均无任何临床症状或体征,且二者发病后无接触史;②二代病例在末次接触首例后14天内发病;③二代病例除与首例接触外,无其他相关暴露史或接触史。

建议调查时,首例应尽早采样,若首例阳性标本的采样时间早于二代病例的发病时间,则证据更强。此外,还建议采集首例发病后7天内和3一4周后的双份血清标本留存备查。

(五)无症状感染者传染性分析。

在聚集性疫情中,若判定无症状感染者为传染源,需满足以下三个条件:①无症状感染者与二代病例有明确的接触史,且二代病例发病后与该无症状感染者无接触史;②二代病例在末次接触无症状感染者后14 天内发病;③二代病例除与首例接触外,无其他相关暴露史或接触史。

建议调查时,应尽早采样,若无症状感染者阳性标本的采样时间早于二代病例的发病时间,则证据更强。此外,还建议采集调查当日及3至4周后的血清标本留存备查。

(六)传播途径分析。

在现场调查中,应注意收集病例间的接触方式、距离及时间,接触时个人防护和手卫生等相关情况,调查暴露场所的面积、人员密度、通风及空调使用情况,综合分析可能的传播途径。

发生在飞机、高铁车厢、网吧、歌厅等密闭空间的聚集性疫情,分析发病与首例病例座位距离、近距离交谈时间, 厕所暴露、手卫生及个人防护等相关因素的关联性。如飞沫传播和接触传播无法解释病例的时间和空间分布,怀疑气溶胶传播的可能时,建议尽可能采集机舱、高铁车厢及厕所等

相关场所的空气样品、环境涂抹拭子等,检测病毒含量和活性。

五、调查报告撰写提纲

(一)背景。

介绍事件的发现和报告过程;当地疫情概况,包括发病数、死亡数和病死率等。

(二)流行病学调查。

1.描述事件病例总数和分类(包括确诊病例、疑似病例和无症状感染者)、重症及死亡情况。

2.按发病日期逐一描述每例病例的基本情况(姓名、年龄、性别、职业、发病时的居住地址、身份证号码)、发病和诊疗经过、临床表现、标本采集和检测情况、病情进展及转归情况、暴露史、密切接触者、发病后活动轨迹、个人防护措施情况等。

3.根据病例调查结果,绘制流行曲线、时序图、病例关系图,梳理总结聚集性疫情调查的关键信息填写表2。

表2

(三)病例暴露场所调查。

描述暴露场所的环境、共同暴露人数、人员接触和防护情况。必要时,可绘制暴露场所平面图。

(四)密切接触者调查。

描述病例与其密切接触者的关系、接触方式和频率、最早和最后接触时间,确定密切接触者总数、转归情况及人数。

(五)采取的措施。

描述针对此次聚集性疫情采取防控措施的种类、时间及落实情况。

(六)调查结论。

判断疫情传播代际和传播链,明确传染来源和传播途径。

(七)建议。

基于此次聚集性疫情调查结果和发现的问题,提出针对性防控建议。

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    2020-03-18 zutt
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    2020-03-18 xugumin
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