流行性乙型脑炎监测和控制工作进展情况课件

免疫规划中心免疫规划中心 National Immunization ProgrammeNational Immunization Programme 流行性乙型脑炎监测和控制工作进展情况流行性乙型脑炎监测和控制工作进展情况 The Progress of JE Surveillance and The Progress of JE Surveillance and Control Control 主要内容 Main contents 概述 Summary 2006年乙脑疫情 epidemic of JE in 2006 乙脑疫苗预防接种工作 vaccination of JE vaccine 全国乙脑监测点工作介绍 Introduce of the national JE sentinel site 流脑、乙脑等疾病监测合作项目介绍 Introduce of the AMES project 建议 Recommendations 1951-20061951-2006年乙脑发病趋势年乙脑发病趋势 The trend of JE incidence from 1951 to 2006 19512006年全国乙脑报告发率 发病率 Incidence rate 1991, 1994, 1999 1991, 1994, 1999 和和20052005年乙脑发病分省分布年乙脑发病分省分布 Distribution of JE by province 1991, 1994, 1999 and Distribution of JE by province 1991, 1994, 1999 and 20052005 3 0.5 0.3 0.2 0.01 0 1991 1994 1999 2005 20062006年全国乙脑报告情况年全国乙脑报告情况 Reporting status quo of JE in 2006Reporting status quo of JE in 2006 30 30个省份报告病例个省份报告病例 30 provinces have case reported30 provinces have case reported 青海省无病例报告青海省无病例报告No JE cases in Qinghai provinceNo JE cases in Qinghai province 全国报告全国报告76437643例，死亡例，死亡463463例例 total total 7643 7643 cases cases reported reported nationwide, nationwide, with with 463 463 death cases.death cases. 病死率病死率6.1%6.1%。Case fatality rate was 6.1%Case fatality rate was 6.1% 发病率发病率0.58/100.58/10万；万； incidence rate was 0.58/100,000incidence rate was 0.58/100,000 比上一年度发病率上升比上一年度发病率上升49%49%。 There There 49% 49% increase increase compared to that of last yearcompared to that of last year 20062006年全国乙脑分省发病数年全国乙脑分省发病数 The JE cases by province nationwide 2006The JE cases by province nationwide 2006 1 点= 1 病例 1dot=1case 2006 2006年乙脑分省发病率（年乙脑分省发病率（1/101/10万）万） The incidence rate of JE by province 2006The incidence rate of JE by province 2006 乙脑发病季节性乙脑发病季节性 Seasonal variation of JE incidenceSeasonal variation of JE incidence months Year Year Year Cases 20062006年乙脑年龄别发病率年乙脑年龄别发病率 The age specific incidence rate of JE in 2006The age specific incidence rate of JE in 2006 Female Male 乙脑病例年龄构成变化乙脑病例年龄构成变化 the change of age composition of JE casethe change of age composition of JE case 2006 20062006年全国乙脑报告病例职业构成年全国乙脑报告病例职业构成 Composition of JE case by occupation in 2006Composition of JE case by occupation in 2006 Sparse lived children students Farmer Group 1, Healthy infants receive LJEV at (n=98); Group 1, Healthy infants receive LJEV at 8 months and MV at 9 months.8 months and MV at 9 months. LJEV LJEV与与 MVMV同时在同时在9 9月时接种月时接种 组组2 (n=235);2 (n=235); Group 2, LJEV and MV coadministered at 9 Group 2, LJEV and MV coadministered at 9 months.months. 9 9月接种月接种MV10MV10月接种月接种LJEV LJEV 组组3 (n=223)Group 3, 3 (n=223)Group 3, MV at 9 months and LJEV at 10 months.MV at 9 months and LJEV at 10 months. 免前，接种后免前，接种后1 1月测抗体滴度月测抗体滴度test titers before test titers before vaccination and 1 months postvaccinationvaccination and 1 months postvaccination Data source, Salvacion Gatchalian1, Yafu Yao, Benli Zhou, et al. Measles vaccine immunogenicity after coadministration with live attenuated Japanese encephalitis vaccine shows equivalence to that of measles vaccine given alone. 结果结果resultsresults 麻疹抗体阳转率麻疹抗体阳转率Measles seroprotection Measles seroprotection ratesrates： 组组1 1：100.0%100.0%，组，组2 2：95.5% 95.5% ，组，组3 3 ： 100.0%100.0% 麻疹抗体麻疹抗体GMTGMT： 组组1 1：32413241，组，组2 2：24712471， 组组3 3：32053205 乙脑抗体阳转率乙脑抗体阳转率JE antibodies seroprotection JE antibodies seroprotection ratesrates： 组组1 1：92.1%92.1%，组，组2 2：90.5% 90.5% ，组，组3 3： 90.6%90.6% Data source, Salvacion Gatchalian1, Yafu Yao, Benli Zhou, et al. Measles vaccine immunogenicity after coadministration with live attenuated Japanese encephalitis vaccine shows equivalence to that of measles vaccine given alone. 免疫后免疫后1 1个月抗体滴度变化个月抗体滴度变化 Data source, Salvacion Gatchalian1, Yafu Yao, Benli Zhou, et al. Measles vaccine immunogenicity after coadministration with live attenuated Japanese encephalitis vaccine shows equivalence to that of measles vaccine given alone. 与单独给予任一剂次疫苗比较与单独给予任一剂次疫苗比较 Data source, Salvacion Gatchalian1, Yafu Yao, Benli Zhou, et al. Measles vaccine immunogenicity after coadministration with live attenuated Japanese encephalitis vaccine shows equivalence to that of measles vaccine given alone. 1 1个月后抗体阳性率结果比较个月后抗体阳性率结果比较 Data source, Salvacion Gatchalian1, Yafu Yao, Benli Zhou, et al. Measles vaccine immunogenicity after coadministration with live attenuated Japanese encephalitis vaccine shows equivalence to that of measles vaccine given alone. 结论结论conclusionsconclusions 同时接种阳转率没有显著差异同时接种阳转率没有显著差异The The coadministration of LJEV and MV at 9 months of coadministration of LJEV and MV at 9 months of age showed antimeasles and anti-JE age showed antimeasles and anti-JE immunogenicity equivalent to LJEV and MV given immunogenicity equivalent to LJEV and MV given separately. separately. 安全性相似安全性相似Safety profiles were comparable.Safety profiles were comparable. 可以同时接种可以同时接种coadministrate at the same timecoadministrate at the same time 20062006年乙脑国家级监测点分布年乙脑国家级监测点分布 Distribution of National Surveillance Site 2006Distribution of National Surveillance Site 2006 -12个省 12 provinces -23个监测点（县） -23 surveillance sites (counties) 病例第病例第1 1份血标本份血标本IgMIgM阳性率阳性率 The first blood sample positive rate of IgM of caseThe first blood sample positive rate of IgM of case 资料来源：资料来源：20052005年各省报告乙脑年各省报告乙脑IgMIgM检测结果检测结果 Date source: JE IgM test results reported by province 2005Date source: JE IgM test results reported by province 2005 Positive rate(%) The first blood sample positive rate of IgMThe first blood sample positive rate of IgM Beijing Hebei Jiangsu Zhejiang Anhui Fujian Jiangxi Shandong Henan Hubei Hunan Guangdong Guangxi Hainan Chongqing Sichuan Yunnan Shaanxi Gansu Nation The first blood sample positive rate of IgMThe first blood sample positive rate of IgM RegionRegion 健康人群乙脑抗体阳性率年龄分布 Age distribution of positive rate of JE antibody among healthy population 资料来源：2005年部分国家监测点数据Data source: data from Partly National surveillance site of 2005 Chongqing Hubei Guizhou Zhejianng Province Epidemic season Before/after Before Before Before Before After After After After Positive rate of antibody(%) 蚊虫标本采集检测情况 Mosquito sample collection and detection Mosquito sample collection and detection Mosquito collected Mosquito detected Henan Hubei Sichuan Guizhou Zhejiang 资料来源：2005年部分国家监测点数据Data source: data from Partly National surveillance site of 2005 蚊虫种类监测结果汇总蚊虫种类监测结果汇总 The summarization of type of mosquito of The summarization of type of mosquito of surveillancesurveillance ：河南库蚊数指二带喙库蚊；贵州库蚊数包括淡色库蚊和三带喙库蚊 The Culex of Henan refers to Cx. Biteaniorhynchus, The culex in Guizhou refers to Culex culex pipiens pallens and culex tritaeniorhynchus 贵州 Guizhou 四川 Sichuan 湖北 Hubei 河南 Henan County of surveillance anopheles sinensis culex pipiens pallens culex tritaeniorhynchus Culex Armigeres Other mos The proportion of genius of mosquito 蚊虫季节消长情况蚊虫季节消长情况 The seasonal variation of mosquitoThe seasonal variation of mosquito The seasonal variation of mosquitoThe seasonal variation of mosquitoTimeTime HubeiHubei HunanHunan YunnanYunnan GuizhouGuizhou ZhejiangZhejiang MosquitoesMosquitoes 资料来源：2006年部分国家监测点数据Data source: data from Partly National surveillance site of 2006 猪抗体水平检测情况 The JE antibody of Pig detected 四川省猪血清抗体水平为各次检验平均值四川省猪血清抗体水平为各次检验平均值 The mean of JE antibody detected with pig serum of SichuanThe mean of JE antibody detected with pig serum of Sichuan Positive rate of antibody Henan Sichuan Hubei Guizhou The JE antibody of Pig detected TimeJuneJuly October AugustSept. 流脑、乙脑等疾病监测合作项目介绍流脑、乙脑等疾病监测合作项目介绍 AMES Project introductionAMES Project introduction 项目地区项目地区 新项目省份前期考察新项目省份前期考察 20062006年年1111月月1313日至日至1717日，免疫规划中心、传染病所、病毒病所及日，免疫规划中心、传染病所、病毒病所及WHOWHO专家等对山东、专家等对山东、 湖北项目实施中的病例监测、标本采集及转运和实验室检测情况进行了督导，同时对湖北项目实施中的病例监测、标本采集及转运和实验室检测情况进行了督导，同时对 20072007年扩大的项目省（河北、广西）进行了流脑、乙脑等疾病的监测与报告、实验室年扩大的项目省（河北、广西）进行了流脑、乙脑等疾病的监测与报告、实验室 检测设施及能力等前期工作考察。检测设施及能力等前期工作考察。 项目方案修订讨论项目方案修订讨论Proposal discussionProposal discussion 结合督导及项目地区反映的情况，多次组织免疫中心、传结合督导及项目地区反映的情况，多次组织免疫中心、传 染病所、病毒病所及四个项目省的专家讨论修订项目实施染病所、病毒病所及四个项目省的专家讨论修订项目实施 方案方案Nip, ICDC, IVDC, and 4 provinces Nip, ICDC, IVDC, and 4 provinces 同时对项目监测疾病的检测报告程序进行完善同时对项目监测疾病的检测报告程序进行完善 制定项目病例标本送检表制定项目病例标本送检表 监测情况分析监测情况分析surveillance data surveillance data analysisanalysis 标本采集及检测情况标本采集及检测情况specimens collect and specimens collect and testtest 有待于加强的方面有待于加强的方面Need to improveNeed to improve 与医院的协调、合作与医院的协调、合作collaborate with hospitalscollaborate with hospitals 标本收集或送检标本收集或送检specimens collectspecimens collect 实验室检测实验室检测Lab testLab test 标本采集及检测情况标本采集及检测情况1 1 数据来源：数据来源：2 2省监测报告数据省监测报告数据 湖北数据截至到湖北数据截至到0707年年1 1月月1515日日 JEIgM(LabJEIgM(Lab + + ) )为为CDCCDC检测结果，山东医院检测检测结果，山东医院检测JEIgM(LabJEIgM(Lab + + ) )为为1 1例；第例；第2 2份血标本份血标本 JEIgM(LabJEIgM(Lab + + ) )为为1 1例例 省省调调 查查 病病 例例 数数 实验室检实验室检 测数测数 标本标本SpecimensSpecimens JE JE IgIg MM (La(La b b + + ) ) Nm Nm (cul(cul tureture + + ) ) 血血Blood (Hospital)Blood (Hospital)血血Blood (CDC)Blood (CDC) First timeFirst time 第一次第一次 Second Second timetime第二次第二次 TotalTotal 合计合计 First timeFirst time 第一次第一次 Second Second timetime第二第二 次次 TotalTotal 合计合计 Shan Shan dongdong 8787 4444 (50.6%)(50.6%) 6868-68683838 4 4 4242 8 8 0 0 Hu Hu beibei 7070 3434 (65.3%)(65.3%) 6666-67672121 0 0 2121 0 0 0 0 TotalTotal1571577878134134-1341345959 4 4 6363 8 8 0 0 标本采集及检测情况标本采集及检测情况2 2 数据来源：数据来源：2 2省监测报告数据省监测报告数据 湖北数据截至到湖北数据截至到0707年年1 1月月1515日日 以入院当天或者之前采集以入院当天或者之前采集CSFCSF标本作为在应用抗生素前采集的判断标准标本作为在应用抗生素前采集的判断标准 JEIgM(LabJEIgM(Lab + + ) )为为CDCCDC检测结果检测结果 Nm (cultureNm (culture + + ) )为为CDCCDC检测结果检测结果 省省病病 例例 调调 查查 数数 实验室检实验室检 测数测数 标本标本SpecimensSpecimens JE JE IgIg MM (La(La b b + + ) ) Nm Nm (cul(cul tureture + + ) ) CSF (Hospital)CSF (Hospital)CSF (CDC)CSF (CDC) Before Before Antibiotic Antibiotic useuse抗生素抗生素 应应用前用前 After After Antibiotic Antibiotic useuse抗生素抗生素 应应用后用后 TotalTotal 合合计计 Before In Before In HospitalHospital 入院前入院前 After In After In HospitalHospital 入院后入院后 TotalTotal 合合计计 Shan Shan dongdong 8787 4444 (50.6%)(50.6%) 28(22+6)28(22+6)2626545412(9+3)12(9+3)21213333 7 7 0 0 Hu Hu beibei 7070 3434 (65.3%)(65.3%) 19(16+3)19(16+3)333352529(8+1)9(8+1)18182727 0 0 1 1 TotalTotal157157787847475959106106212139396464 7 7 1 1 建议建议 Suggestion Suggestion 提高乙脑疫苗覆盖率提高乙脑疫苗覆盖率 To increase the coverage of JE vaccineTo increase the coverage of JE vaccine 推动乙脑疫苗纳入免疫规划 Promote inclusion of JE vaccine into EPI 提高及时接种率和全程接种率 Increase timely and full course immunization rate 未纳入免疫规划的高发省，流行