暴发调查设计：以急性戊型肝炎暴发为例

朱以敏; 李亚欣; 牟育彤; 阚慧; 张淼; 范伟; 李意杰; 郑英杰

doi:10.16462/j.cnki.zhjbkz.2020.11.001

暴发调查设计：以急性戊型肝炎暴发为例

doi: 10.16462/j.cnki.zhjbkz.2020.11.001

200032 上海，复旦大学公共卫生学院流行病学教研室，国家卫生健康委员会卫生技术评估重点实验室(复旦大学)，复旦大学公共卫生学院公共卫生安全教育部重点实验室

基金项目:

国家自然科学基金 81373065

国家自然科学基金 81773490

国家重点研发计划“生物安全关键技术研发”重点专项 2017YFC1200203

详细信息

通讯作者:
郑英杰，E-mail:yjzheng@fudan.edu.cn

中图分类号: R181
计量
- 文章访问数: 962
- HTML全文浏览量: 389
- PDF下载量: 158
- 被引次数: 0
出版历程
- 收稿日期: 2020-06-18
- 修回日期: 2020-09-04
- 刊出日期: 2020-11-10

The designs for outbreak investigation: an example of acute hepatitis E outbreak

Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China

Funds:

National Natural Science Foundation of China 81373065

National Natural Science Foundation of China 81773490

The National Key Research and Development Program of China 2017YFC1200203

More Information

Corresponding author: ZHENG Ying-jie, E-mail:yjzheng@fudan.edu.cn

摘要

摘要: 疾病暴发一旦确立，则意味着疾病(及其病因或疑似暴露)已经发生。暴发是疾病流行强度指标之一，虽然其本身不具备设计要素，但暴发调查可有多种设计选择。本文采用单次戊型肝炎暴发案例，调查并获得学生们对其设计类型判断的三个答案：横断面设计、病例对照设计和历史队列设计。借助因果思维和因果图，本文发现该案例并不满足或符合上述设计，即只有暴发确立型病例是已知的、可被测量两次；调查实施前暴露是未知的，暴露与结局间可混合存在着两种纵向测量时序。基于调查人群的代表性、暴发确立型病例的两次识别特征，可以将此案例视为横断面队列设计，即在假设的历史人群基础上对当前人群进行的横断面研究。对结局(和暴露)已然发生的情形，因果推断的准确性取决于其历史重建的正确性，应加强对这类基于历史重建的研究设计类型的认识。
- 暴发调查 /
- 因果思维 /
- 因果图 /
- 历史重建 /
- 因果推断 /
- 研究设计
Abstract: Once a disease outbreak is established, it means that disease outcome (and its cause or suspected exposure) has already occurred. Outbreak is one of the indicators for the epidemic intensity of a disease. Although it does not have any design elements, there are many design options for its investigation. This article uses a single hepatitis E outbreak example to investigate on the students and obtain three answers to students' judgments on the design type: cross-sectional design, case-control design and historical cohort design. With the help of causal thinking and causal diagrams, this article finds the example do not meet the designs above: only the cases for outbreak confirmation were known and can possibly be measured twice, the exposure is unknown before the investigation, and two measured temporal sequences between measured exposure and outcome existed. Based on the representativeness of the survey population and the two-time identifying characteristics of the outbreak cases, this example could be considered as a cross-sectional cohort study which is a cross-sectional study of the current population based on a hypothetical historical population. For the outcome (and the exposure) has already occurred, the accuracy of causal inference depends on the accuracy of their reconstruction history. These results imply that we should strength our understanding of such research based on reconstruction history.
- Outbreak investigation /
- Causal thinking /
- Causal diagram /
- Historical reconstruction /
- Causal inference /
- Research design

HTML全文

图 1 15名学生对戊肝暴发案例设计类型的答案

注：CSS：横断面研究，CCS：病例对照研究，HCS：历史性队列研究；图中数字代表对应设计的答案数量。

Figure 1. Answers to the design type of hepatitis E outbreak by 15 students

下载: 全尺寸图片幻灯片

图 2 戊肝暴发及其测量过程

注：A₀和Y₁分别代表暴露和戊肝的发生，Y₂代表研究起点的戊肝感染情况，Y₁^*和Y_2+△t^*分别代表对Y₁和Y₂的测量，△t代表A₂^*和Y_2+△t^*间测量的时间差，可为负值和正值，但不可能为零。代表暴发确立的时间和研究起点。

Figure 2. Outbreak of hepatitis E and its measurement process

下载: 全尺寸图片幻灯片

参考文献(28)

[1]	Palmer SR. Outbreak investigation: the need for quick and clean' epidemiology[J]. Int J Epidemiol, 1995, 24(Suppl 1):S34-38. DOI: 10.1093/ije/24.supplement_1.s34.
[2]	Palmer SR. Epidemiology in search of infectious diseases: methods in outbreak investigation[J]. J Epidemiol Community Health, 1989, 43(4):311-314. DOI: 10.1136/jech.43.4.311.
[3]	Ramsey G. An epidemic of scarlet fever spread by ice cream[J]. Am J Hyg, 1925, 5(5):669-681. DOI: 10.1093/oxfordjournals.aje.a119689.
[4]	Morabia A. Snippets from the past: is Flint, Michigan, the birthplace of the case-control study?[J]. Am J Epidemiol, 2013, 178(12):1687-1690. DOI: 10.1093/aje/kwt221.
[5]	Fonseca MG, Armenian HK. Use of the case-control method in outbreak investigations[J]. Am J Epidemiol, 1991, 133(7):748-752. DOI: 10.1093/oxfordjournals.aje.a115950.
[6]	McCartney G, Cowden J, Murray S, et al. The use of a new virtual cohort study design to investigate an outbreak of E. coli O157 linked to a supermarket delicatessen[J]. Epidemiol Infect, 2010, 138(10):1439-1442. DOI: 10.1017/S0950268810000257.
[7]	Le Polain de Waroux O, Maguire H, Moren A. The case-cohort design in outbreak investigations[J]. Euro Surveill, 2012, 17(25):20202. doi: 10.2807/ese.17.25.20202-en
[8]	Haegebaert S, Duche L, Desenclos JC. The use of the case-crossover design in a continuous common source food-borne outbreak[J]. Epidemiol Infect, 2003, 131(2):809-813. DOI: 10.1017/s0950268803001006.
[9]	Zenner D, Janmohamed K, Lane C, et al. The serotype case-case design: a direct comparison of a novel methodology with a case-control study in a national Salmonella Enteritidis PT14b outbreak in England and Wales[J]. Epidemiol Infect, 2013, 141(11):2346-2353. DOI: 10.1017/S0950268812002968.
[10]	Krumkamp R, Reintjes R, Dirksen-Fischer M. Case-case study of a Salmonella outbreak: an epidemiologic method to analyse surveillance data[J]. Int J Hyg Environ Health, 2008, 211(1-2):163-167. DOI: 10.1016/j.ijheh.2007.02.006.
[11]	Mayet A. Case-case studies: an innovative tool in the field of outbreak investigation[J]. Swiss Med Wkly, 2015, 145:w14203. DOI: 10.4414/smw.2015.14203.
[12]	李意杰, 阚慧, 何一宁, 等.横断面研究能否进行因果推断?[J].中华流行病学杂志, 2020, 41(4):97-101.DOI: 10.3760/cma.j.cn112338-20191030-00770. Li YJ, Kan H, He YN, et al. May cross-sectional studies provide causal inferences?[J]. Chin J Epidemiol, 2020, 41(4):97-101. DOI: 10.3760/cma.j.cn112338-20191030-00770.
[13]	Feinstein AR. Clinical biostatistics. XLⅡ. The architecture of cross-sectional research (Part I)[J]. Clin Pharmacol Ther, 1978, 23(1):81-96. DOI: 10.1002/cpt197823181.
[14]	Feinstein AR. Clinical biostatistics. XLⅢ. The architecture of cross-sectional reserach (conclusion)[J]. Clin Pharmacol Ther, 1978, 23(4):481-493. DOI: 10.1002/cpt1978234481.
[15]	Webb GW, Dalton HR. Hepatitis E: an underestimated emerging threat[J]. Therapeutic advances in infectious disease, 2019, 6:2049936119837162. DOI: 10.1177/2049936119837162.
[16]	Kamar N, Izopet J, Pavio N, et al. Hepatitis E virus infection[J]. Nat Rev Dis Primers, 2017, 3:17086. DOI: 10.1038/nrdp.2017.86.
[17]	Khuroo MS, Khuroo MS, Khuroo NS. Hepatitis E: Discovery, global impact, control and cure[J]. World J Gastroenterol, 2016, 22(31):7030-7045. DOI: 10.3748/wjg.v22.i31.7030.
[18]	Zheng Y, Ge S, Zhang J, et al. Swine as a principal reservoir of hepatitis E virus that infects humans in eastern China[J]. J Infect Dis, 2006, 193(12):1643-1649. DOI: 10.1086/504293.
[19]	谈逸云, 郑英杰, 申惠国, 等.上海市一起聚集性急性戊型肝炎疫情的报道[J].中华流行病学杂志, 2006, 27(3):240. DOI: 10.3760/j.issn:0254-6450.2006.03.025. Tan YY, Zheng YJ, Shen HG, et al. Investigation of a cluster of acute hepatitis E outbreak in Shanghai[J]. Chin J Epidemiol, 2006, 27(3):240. DOI: 10.3760/j.issn:0254-6450.2006.03.025.
[20]	谈春荣, 陈敏, 葛胜祥, 等.一起戊型肝炎暴发的血清流行病学调查[J].中华实验和临床病毒学杂志, 2003, 17(4):361-364. DOI: 10.3760/cma.j.issn.1003-9279.2003.04.016 Tan CR, Chen M, Ge SX, et al. Serological characteristics of a hepatitis E outbreak[J]. Chin J Exp Clin Virol, 2003, 17(4):361-364. DOI: 10.3760/cma.j.issn.1003-9279.2003.04.016
[21]	许可, 王爱萍, 张军, 等.一起敬老院戊肝暴发疫情的流行病学调查[J].中国人兽共患病学报, 2012, 28(3):306-309. DOI: 10.3969/j.issn.1002-2694.2012.03.026 Xu K, Wang AP, Zhang J, et al. Epidemiological investigation of an outbreak of hepatitis E in a nursing home[J]. Chin J Zoono, 2012, 28(3):306-309. DOI: 10.3969/j.issn.1002-2694.2012.03.026
[22]	Huang S, Zhang X, Jiang H, et al. Profile of acute infectious markers in sporadic hepatitis E[J]. PLoS One, 2010, 5(10):e13560. DOI: 10.1371/journal.pone.0013560.
[23]	Hudson JI, Pope HG Jr, Glynn RJ. The cross-sectional cohort study: an underutilized design[J]. Epidemiology, 2005, 16(3):355-359. DOI: 10.1097/01.ede.0000158224.50593.e3.
[24]	Herbst AL, Ulfelder H, Poskanzer DC. Adenocarcinoma of the vagina. Association of maternal stilbestrol therapy with tumor appearance in young women[J]. N Engl J Med, 1971, 284(15):878-881. DOI: 10.1056/NEJM197104222841604.
[25]	Greenland S, Morgenstern H. Design versus directionality[J]. J Clin Epidemiol, 1991, 44(2):213-215. DOI: 10.1016/0895-4356(91)90269-f.
[26]	Greenland S, Morgenstern H. What is directionality?[J]. J Clin Epidemiol, 1989, 42(9):821-824. DOI: 10.1016/0895-4356(89)90092-9.
[27]	郑英杰, 蔡倩莹, 范伟, 等.因果思维在效应估计若干问题中的应用[J].中华流行病学杂志, 2019, 40(10):120-129. DOI: 10.3760/cma.j.issn.0254-6450.2019.10.000. Zheng YJ, Cai QY, Fan W, et al. The application of causal thinking in several issues in estimation of effects[J]. Chin J Epidemiol, 2019, 40(10):120-129. DOI: 10.3760/cma.j.issn.0254-6450.2019.10.000.
[28]	Kesmodel US. Cross-sectional studies - what are they good for?[J]. Acta Obstet Gynecol Scand, 2018, 97(4):388-393. DOI: 10.1111/aogs.13331.