Influenza A H1N1 influenza surveillance program in Shanghai (2009 first edition)

 On the issue of the University, Shen Kang Hospital Development Center, Center for Disease Control and Prevention, the Municipal Health Bureau Health Authority, the city health education, the municipal medical institutions:
To further strengthen the monitoring of influenza A H1N1 influenza, according to the Ministry of Health, influenza surveillance program (first edition) holds many lessons sent to you, please comply.
point medical institutions of the influenza surveillance monitoring program shall be in accordance with the requirements of the practical implementation of monitoring. cities, districts and counties should be prepared CDC Influenza H1N1 influenza surveillance training and business technical guidance to enhance the quality control monitoring report on the monitoring site on a regular basis to monitor the quality of health care organizations assess and improve the monitoring sensitivity.
hereby notified.
Annex: I, influenza A H1N1 influenza surveillance program in Shanghai (2009 first edition)
Second, the Ministry of Health Influenza H1N1 influenza monitoring program (first edition)
June 17, 2009
Annex I:
Shanghai A type H1N1 Influenza Surveillance Programme (2009 first edition)
one for monitoring purposes
(a) timely detection, diagnosis and reporting of influenza A H1N1 influenza cases, and actively respond to the city possible outbreaks of influenza H1N1 influenza to carry out epidemiological investigation and on-site disposal, the implementation of case isolation, contact tracing and close medical observation.
(b) through the analysis of monitoring data and data to assess the city Influenza H1N1 influenza pandemic strength and size class , timely and appropriate to initiate necessary intervention of people and society to control and mitigate the epidemic's spread.
(to) Influenza A H1N1 influenza epidemiology, clinical features and etiological characteristics, for the prevention and control and emergency response measures to provide a scientific basis for the development and deployment.
Second, the formulation according to
(a) of the Ministry of Health, Influenza diagnosis and treatment program (first edition 2009 trial version) Influenza A H1N1 influenza cases: including influenza H1N1 suspected and confirmed cases of influenza, specifically refer to , more than 2 cases and epidemiological links with suspected influenza H1N1 Influenza A and / or confirmed cases.
(c) influenza-like illness: fever (body temperature g38 ℃), cough or sore throat symptoms, the lack of other laboratory confirmed the diagnosis based on.
(d) influenza-like illness outbreaks: one week, in the same school, kindergarten or other collective units and over 30 cases occurred associated with the epidemiology of influenza-like illness or morbidity to 30% or more; or the occurrence of five cases or more hospital admissions because of flu-like symptoms (not including out-patient observation with lesions); or the occurrence of one case of influenza-like illness killed and over.
Fourth, monitoring the contents and methods
( a) Influenza A H1N1 influenza cases to monitor
1.
city set up monitoring points at all levels of the various medical institutions and the entry ports sector (including airports, train stations, ports) as influenza A H1N1 influenza cases sentinel surveillance.
2. case detection and reporting
(1) case detection
various medical institutions at all levels, especially with fever clinics and isolation wards of the medical institutions to comprehensively implement the first diagnosis responsibility system, rigorous screening suspected patients. strengthen the Emergency Department triage and screening of pre-screening, and treatment of acute respiratory infections, asking epidemiological history, suspected influenza H1N1 flu, according to the Ministry of Health, trial version of the first edition in 2009), br> the out ports of entry sector (including airports, train stations, ports) that had traveled from, or within 1 week of fever cases are cases when the state (axillary temperature g37.5 ℃), sent to designated hospitals for the screening, consultation , isolation, and specimen collection and testing, etc., in order to detect cases.
(2) Case Report
various medical institutions at all levels found in the city meet the case definition of suspected cases and confirmed cases, the adoption within 2 hours Report of national disease surveillance information management system network report. municipal, district (county) Center for Disease Control and Prevention (hereinafter analysis of the situation and judged.
port, railway and the Shanghai Disease Control and Prevention found that entry-exit inspection and quarantine authorities meet the case definition of suspected cases and confirmed cases should be located immediately to the port or the local health administration department of disease control and prevention report.
3, epidemiological investigations and statistical reports
(1) epidemiological case investigation
districts (counties) received a CDC case report, as soon as possible on the cases for epidemiological investigation of cases within 24 hours of survey, by the district (county) CDC reports through national disease surveillance information management system platform, based on the patient's condition and progress and in-depth epidemiological investigation, the questionnaire to update the case.
(2) information reporting
various medical institutions at all levels should take the initiative to provide to the CDC Influenza H1N1 influenza cases complete clinical data, including progress notes, prescription orders, laboratory and imaging examination results, etc.
districts (counties) in the good case survey of CDC at the same time, the clinical data should be collected, together with the cases epidemiological survey, and through disease control private network (FTP) and update the City CDC reported. Meanwhile, district (county) and information on CDC Yingjiang findings to the local health administration department, and the corresponding prevention and treatment recommendations.
4, sample collection and testing various types of medical institutions at all levels
Influenza H1N1 influenza is responsible for collecting the clinical specimens.
district (county) CDC Influenza H1N1 influenza cases is responsible for laboratory work; City CDC is responsible for carrying out laboratory work of the technical guidance, training and quality control, when necessary, review of county inspection test specimens.
5, case investigation and revision experiment
chamber test results should be timely feedback to the case of the reporting unit. For the diagnosis of other diseases or explicitly exclude cases of influenza A H1N1 influenza, reporting units should be received within 2 hours of laboratory test results will be revised to clearly diagnose cases of the disease or
Influenza H1N1 influenza cases confirmed to be the Municipal Health Bureau of the municipal expert consultation. authorized by the Ministry of Health, Municipal Health Bureau, the city is responsible to the community influenza H1N1 flu information.
( b) Influenza A H1N1 influenza outbreak surveillance
1, find and report outbreaks
various medical institutions at all levels of the city in the treatment process should be concerned with cases of influenza A H1N1 influenza epidemiological link between the timely county where the outbreak and to find the CDC report. districts (counties) should be strengthened CDC Influenza H1N1 influenza cases within the jurisdiction of the case, to discover outbreaks; should also be concerned about the nurseries, schools and nursing homes and other collective units, to strengthen the collective units of such outbreaks of influenza H1N1 influenza surveillance.
districts (counties) CDC shall promptly after receiving the report on the outbreak of personnel verification, verified case of outbreaks, should be in accordance with the
(1) outbreak after verification, the district (county) in the CDC response to outbreaks of suspected and confirmed cases of each well detailed epidemiological investigation of cases. and make the collection and laboratory testing of specimens work, each collected from outbreaks of at least 20 patients with respiratory tract samples, if the case is now in 20 cases of disease the following should be all the sampling; initial cases, index case, hospitalization or death, severe cases must be sampled. specifically asked to see the Ministry of Health, type H1N1 influenza outbreak investigation and epidemiological treatment technology guide (Trial) control center should carry out in close contact tracing and medical observation, take cover and proper personal hygiene, cases of infection control within the family and reduce opportunities for contact people, give travel or travel recommendations, the implementation of effective health education interventions to control or slow the epidemic spread and spread, specifically asked to see the Ministry of Health, 31 influenza monitoring points, including 19 comprehensive medical institutions as the national influenza surveillance points; 12 comprehensive medical institution for the city of influenza monitoring points (Table 1).
2, influenza-like illness surveillance
(1) of the influenza surveillance point hospital implementation of staff in accordance with national influenza surveillance program requirements and Shanghai, the daily collection, the Pediatric Emergency Department and fever clinics and treatment of influenza-like cases of the total number of cases, good registration and a summary of the weekly before 10:00 am the week before the monitoring data reported to the district (county) CDC. districts (counties) area in CDC received data summary report of monitoring points after 11:00 am Monday through disease control before Private Network (FTP) reported City CDC. is a national influenza monitoring site when the hospital should be logged popular weekly analysis of monitoring data, focusing on treatment of influenza-like illness cases in the constituent ratio, the positive rate of virus isolation, and timely completion of the monitoring rate and other indicators, timely assessment of the status of fashion, fashion trend forecasting influenza in time to the city health Board report and inform the district (county) CDC.
(3) monitoring of sentinel hospitals in the state to strengthen the door and the emergency cases of influenza-like collection of work samples, collected every 20-30 specimens, specimen collection , preservation and transportation in accordance with the > various medical institutions at all levels in the treatment process, found that nurseries, schools and other collective units or influenza-like patients with abnormal increase in line with the definition of influenza-like illness outbreaks in the outbreak, where the county should immediately call the CDC report. both districts (counties) CDC should be concerned about nurseries, schools and other collective units, during the influenza epidemic in the strengthening of the collective unit outbreaks of influenza like illness monitoring.
districts (counties) CDC received reports of After the outbreak of personnel should be promptly verified, verified case of outbreaks, should be in accordance with the reports and final reports.
2, outbreak investigation and control outbreaks
received the report, district (county) CDC should actively organize personnel to carry out epidemiological investigations and on-site disposal. concrete in accordance with the Ministry of Health influenza-like illness outbreak reports and treatment guidelines (for Trial Implementation) undertaken at the request and make a sample collection, detection and outbreak control.
(e) monitoring
graded according to the Ministry of Health and the Shanghai classification of the relevant provisions of the program, the implementation of grading monitoring:
1 preparation stage
(1) monitoring sites
medical institutions in the city of 31 influenza monitoring points set.
(2) monitoring methods and content
1) of the influenza-like illness surveillance
Hospital staff for monitoring sites located within the daily collection, pediatric outpatient and emergency and outpatient influenza-like fever number of cases, treatment of the total cases, number of cases of fever and pneumonia, acute respiratory infections of unknown causes a few deaths and so on. 10:00 am the following day -10:30 to the local district hospital (s) CDC report. districts, counties and districts (counties) CDC summary of monitoring data points to the city after the CDC report daily 10:30-11:00.
2) cases of influenza A H1N1 influenza surveillance
types of hospitals at all levels (including the 31 monitoring sites of influenza hospitals), especially fever clinics and isolation wards set up in the hospital treatment of acute respiratory infections asked to conduct epidemiological history, suspected influenza H1N1 influenza, in accordance with the detection, early diagnosis, early reporting, early quarantine and early treatment abnormal increase in the patient sample or comply with the definition of influenza-like illness outbreaks in the outbreak, telephone or fax immediately to the local district (county) CDC report, district (county) based on Ministry of Health, CDC, Shanghai Case reports and outbreak investigation and handling guidelines (Trial) influenza surveillance point 31 hospitals) in the treatment process, such as influenza A H1N1 flu found to meet the definition of epidemic outbreaks, immediately call on the district (county) CDC. districts (counties) according to Ministry of Health, CDC, type H1N1 influenza outbreak investigation and epidemiological treatment technology guide (Trial) 3) The monitoring data of the city
City CDC regular seasonal flu and H1N1 influenza A comprehensive analysis of influenza surveillance data to understand the characteristics of the city and the flu epidemic trends, and results reported to the Municipal Health Bureau, prevention and control measures for the development of appropriate scientific basis.
2, Ⅳ-level epidemic
(1) monitoring sites set up to evaluate the severity of the disease
to identify high-risk groups and regions, the prevalence of disease trends and forecast assess the effectiveness of prevention and control strategies and measures to monitor the key into the virus etiology, disease hazards and popular strength, and health monitoring of resource requirements, etc., influenza monitoring site set up hospitals in the preparation stage on the basis of an additional 31 to 62 medical institutions.
(2) monitoring methods and content of
Influenza H1N1 flu, outbreak; influenza-like illness, outbreak monitoring, monitoring of content, method and reporting procedures remain unchanged.
(3 ) monitoring data of the city
City CDC regular seasonal flu and H1N1 influenza A comprehensive analysis of influenza surveillance data to understand the characteristics of the city and the flu epidemic trends, and results reported to the Municipal Health Bureau, as develop appropriate prevention and control measures to provide a scientific basis.
3, Ⅲ grade disease
(1) monitoring sites set up monitoring points
grade Ⅳ epidemic by the medical institutions in 62 fever clinics expanded to all health care settings respiratory specialist institutions and some medical institutions to set.
(2) monitoring the content and method of
Influenza H1N1 flu, outbreak; influenza-like illness, outbreak monitoring, monitoring of content, methods change, the implementation of monitoring reports estimated influenza H1N1 flu epidemic situation, and proposed prevention recommendations and report Municipal Health Bureau.
4, Ⅱ grade and stage disease
Ⅱ Ⅰ Ⅰ level epidemic level and expand the state Ⅲ grade symptoms and cases of epidemic scope of monitoring, monitoring of strategy and focus on etiology, disease hazards, prevalence and intensity of medical resource requirements.
(1) monitoring sites set up monitoring points
expand comprehensive health care for all city agencies.
(2) to monitor the contents and methods
1) Influenza H1N1 flu, outbreak; influenza-like illness, outbreak monitoring, monitoring of content, methods change, the implementation of monitoring report > 2) The acquisition Influenza Serological Surveillance
close contact with H1N1 influenza cases and part of healthy human serum samples for influenza A H1N1 influenza virus antibodies.
3) disease hazards, the popular collection of intensity monitoring
The city suspected influenza H1N1 influenza reported, confirmed cases and influenza-like symptoms in close contact with relevant information in a timely manner epidemic features, popular strength; morbidity, mortality, diseases such as hazard monitoring and analysis, analyzing influenza A H1N1 influenza in city trends and provide prevention recommendations.
(f) laboratory testing
1. the division of responsibilities
(1) City CDC influenza laboratory network is responsible for all districts and counties related technology laboratory training, supervision and quality control.
(2) the county area network laboratory is responsible for influenza surveillance sentinel hospitals in collecting specimens for influenza-like illness were separated and identified, and sample input information and results in a timely manner / bird flu monitoring information system Control Center laboratory for review.
2. sampling object
(1) Influenza H1N1 influenza cases: Influenza H1N1 influenza suspected cases and confirmed cases;
(2) Hospital of the sentinel influenza-like illness , hospitalized patients with community-acquired pneumonia;
(3) outbreaks of influenza-like illness.
3. sampling and delivery requirements
specimen collection and transportation in accordance with the Work Programme (provisional) PCR method, recommended by the National Influenza Centre, H1N1 influenza virus H1N1 influenza primers and probes and other related sub-type of influenza primers and probes for detection.
(2) Isolation of the virus: the patients diagnosed with seasonal flu specimens, the county network of laboratories to carry out the virus to be isolated, virus isolation requires BSL-II laboratory. Influenza A H1N1 influenza virus vaccination requirements of BSL-III laboratory.
(3) serologic testing: the area of influenza antibodies in healthy people to monitor serum antibody levels to understand the people. For the relevant occupational groups within its jurisdiction to monitor serum antibodies; the network laboratory to retain good Influenza H1N1 in this serum for the future of the serum antibody titers were detected.
5. test results to determine and report
(1) positive report
1) seasonal flu: chicken embryo cultured cells or by positive strain, and by hemagglutination inhibition and PCR subtypes were identified to the strain.
2) Influenza A H1N1: A type-specific primers could amplify a product of the expected size for influenza A H1N1 influenza virus H1N1 subtype-specific PCR amplified the expected size product. influenza type-specific primers could amplify a product of expected size.
(2) negative reports
1) seasonal influenza: The cultured cells or chick embryo without the strain of seasonal influenza.
2) Influenza A H1N1: Influenza is not universal primers PCR amplified product of expected size; new subtype of influenza A H1N1 influenza virus H1N1 can not be amplified by specific primers, PCR product of expected size. influenza type-specific primers could amplify a product of expected size.
6. laboratory quality control
(1) Staff training: City CDC is responsible for the county network of related laboratory testing personnel unified technical training, including virus isolation, serology and molecular biology.
(2) Ability Test: City CDC at least once a year to network monitoring and detection of influenza laboratories have capacity assessment. and timely feedback to the evaluation results network laboratory the relevant responsible officer.
(3) reagent distribution: the network laboratory standard serum used in each year, every year for seasonal influenza antigen, and primers probe by the National Influenza Centre unified allocation.
(4) Lab Supervisor: City CDC laboratory instruments on the network, operations, personnel, environment and other factors from time to time carry out supervision and inspection.
7. laboratory bio-safety requirements and personnel protective measures during the season
Isolation of influenza and identification process, all the operations are conducted in the BSL-II laboratory. Influenza H1N1 influenza specimens during the testing process, and personnel in accordance with the BSL-III for protection.
V. Annex
1. Network Laboratory Influenza H1N1 influenza specimens flowchart
2. Influenza A H1N1 influenza virus and seasonal influenza virus lab six basic requirements
Schedule
Schedule 1: Shanghai A List of influenza surveillance point type H1NI
Table 2: influenza-like patients (ILI) doors, emergency cases registration form
Schedule 3: Shanghai ___ ___ District Hospital influenza (H1N1) Monitoring Report
Schedule 4: Influenza H1NI flu cases questionnaire
Schedule 5: influenza-like illness cluster investigations
List