基于移动流行区间法和综合指数法构建广州市手足口病流行分级预警阈值

张婷瑜; 张晓; 李俊熹; 汪慧; 罗雷; 秦鹏哲; 袁俊

doi:10.16462/j.cnki.zhjbkz.2024.04.016

基于移动流行区间法和综合指数法构建广州市手足口病流行分级预警阈值

doi: 10.16462/j.cnki.zhjbkz.2024.04.016

张婷瑜^{1, 2},
张晓²,
李俊熹^{2, 3},
汪慧²,
罗雷²,
秦鹏哲⁴,
袁俊^{1, 3, 4, ,}

1.
南方医科大学公共卫生学院，广州 510515
2.
广州市疾病预防控制中心传染病预防控制部，广州 510440
3.
中山大学公共卫生学院，广州 510080
4.
广州市疾病预防控制中心主任室，广州 510440

张婷瑜和张晓为共同第一作者

基金项目:

广州市科技计划项目重点研发计划 202206080003

广州市卫生健康科技项目 20221A011071

详细信息

通讯作者:
袁俊, E-mail: yuanjuncom@163.com

中图分类号: R181.3
计量
- 文章访问数: 92
- HTML全文浏览量: 23
- PDF下载量: 24
- 被引次数: 0
出版历程
- 收稿日期: 2023-09-01
- 修回日期: 2024-01-09
- 网络出版日期: 2024-05-17
- 刊出日期: 2024-04-10

Establishment of early warning threshold of hand, foot and mouth disease based on moving epidemic method and synthetic index method in Guangzhou

ZHANG Tingyu^{1, 2},
ZHANG Xiao²,
LI Junxi^{2, 3},
WANG Hui²,
LUO Lei²,
QIN Pengzhe⁴,
YUAN Jun^{1, 3, 4
, ,}

1.
School of Public Health, Southern Medical University, Guangzhou 510515, China
2.
Department of Infectious Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
3.
School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
4.
Office of Center Director, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China

ZHANG Tingyu and ZHANG Xiao contributed equally to this work

Funds:

Guangzhou Key Research and Development Program 202206080003

Guangzhou Health Science and Technology Project 20221A011071

More Information

Corresponding author: YUAN Jun, E-mail: yuanjuncom@163.com

摘要

摘要: 目的结合移动流行区间法(moving epidemic method, MEM)和综合指数法构建广州市手足口病流行分级预警阈值，为手足口病防控政策的制定与实施提供科学依据。方法收集2015―2021年广州市手足口病发病率及聚集性疫情监测数据，通过绘制周平均发病率流行曲线对手足口病双流行高峰进行拆分。选择2015―2019年及2021年春夏流行季的周发病率及聚集性疫情数监测资料，运用MEM和综合指数法建立流行分级预警模型，估计2022年春夏流行季手足口病的流行阈值及分级强度阈值，并运用交叉验证法对模型的预警效果进行验证。结果 2022年广州市手足口病第10~37周春夏流行季的流行开始阈值为0.78，流行结束阈值为0.60，中等、高等及极高强度阈值分别为1.85、2.72及3.22。模型最优参数值为2.50，合计灵敏度、特异度及约登指数分别为94.15%、92.67%及0.87，拟合效果较好。结论 MEM和综合指数法的结合可以实现更客观、全面的手足口病流行分级预警。
- 手足口病 /
- 移动流行区间法 /
- 综合指数法 /
- 预警
Abstract: Objective Using moving epidemic method (MEM) and synthetic index method to establish grading early warning threshold of hand, foot and mouth disease, so as to provide scientific evidence for hand, foot and mouth disease prevention and control in Guangzhou. Methods The weekly incidence and clustered epidemic data of hand, foot and mouth disease from 2015 to 2021 were collected. Two peaks of hand, foot and mouth disease were split by plotting the epidemic curve of the average weekly incidence. Then data on weekly incidence and clusters of hand, foot and mouth disease in spring and summer from 2015 to 2021 (except 2020) were extracted to establish grading early warning model by MEM and synthetic index method. The epidemic threshold and grading intensity thresholds in 2022 were estimated and the early warning effect of established model was verified by cross-validation method. Results Based on the established model, the epidemic start threshold of hand, foot and mouth disease in Guangzhou was 0.78 between the 10th and 37th weeks in 2022. And the medium, high and extremely high intensity thresholds of hand, foot and mouth disease were 1.85, 2.72 and 3.22, respectively. The optimal parameter δ was 2.5, and the overall sensitivity, specificity and Youden′s index were 94.15%, 92.67% and 0.87, respectively, which indicated good fitting effect. Conclusions The combination of MEM and the synthetic index method can achieve more objective and comprehensive early warning of hand, foot and mouth disease.
- Hand, foot, and mouth disease /
- Moving epidemic method /
- Synthetic index method /
- Early warning

HTML全文

图 1 2015―2021年广州市手足口病周报告发病率

Figure 1. Weekly incidence rate of hand, foot and mouth disease in Guangzhou from 2015 to 2021

下载: 全尺寸图片幻灯片

图 2 2015―2019和2021年广州市手足口病周平均发病率分布图

Figure 2. Distribution of weekly average incidence rate of hand, foot and mouth disease in Guangzhou from 2015 to 2019 and 2021

下载: 全尺寸图片幻灯片

图 3 2022年第10~37周广州市手足口病流行强度阈值

Figure 3. Epidemic intensity thresholds of hand, foot and mouth disease in Guangzhou during week 10 to 37, 2022

下载: 全尺寸图片幻灯片

表 1 第10~37周广州市手足口病综合指数MEM模型参数δ的筛选

Table 1. Parameter screening of MEM model for the synthetic index of hand, foot and mouth disease in Guangzhou from week 10 to 37

δ值 value	灵敏度 Sensitivity	特异度 Specificity	阳性预测值 Positive predictive value	阴性预测值 Negative predictive value	马修相关系数 Matthews correlation coefficient	约登指数 Youden′s Index
2.0	0.992 3	0.726 6	0.819 2	0.987 0	0.761 3	0.718 9
2.1	0.981 6	0.806 9	0.863 9	0.972 4	0.812 0	0.788 5
2.2	0.981 6	0.806 9	0.863 9	0.972 4	0.812 0	0.788 5
2.3	0.974 5	0.811 3	0.865 8	0.962 2	0.806 6	0.785 8
2.4	0.974 5	0.811 3	0.865 8	0.962 2	0.806 6	0.785 8
2.5	0.960 2	0.860 4	0.895 7	0.945 4	0.830 8	0.820 6
2.6	0.960 2	0.860 4	0.895 7	0.945 4	0.830 8	0.820 6
2.7	0.960 2	0.860 4	0.895 7	0.945 4	0.830 8	0.820 6
2.8	0.939 3	0.874 4	0.903 3	0.920 2	0.818 6	0.813 7
2.9	0.928 5	0.887 8	0.911 8	0.908 7	0.818 4	0.816 4
3.0	0.928 5	0.887 8	0.911 8	0.908 7	0.818 4	0.816 4
注：MEM, 移动流行区间法。 Note: MEM, moving epidemic method.

下载: 导出CSV

表 2 广州市手足口病春夏历史流行季MEM模型拟合效果

Table 2. MEM model fitting effects of historical spring-summer seasons of hand, foot and mouth disease in Guangzhou

年份 Year	灵敏度 Sensitivity	特异度 Specificity	阳性预测值 Positive predictive value	阴性预测值 Negative predictive value	马修相关系数 Matthews correlation coefficient	约登指数 Youden′s Index
2015	0.995 2	0.970 3	0.985 6	0.989 9	0.970 5	0.965 5
2016	1.000 0	0.857 1	0.875 0	1.000 0	0.866 0	0.857 1
2017	0.963 9	1.000 0	1.000 0	0.942 1	0.953 0	0.963 9
2018	0.930 3	1.000 0	1.000 0	0.884 3	0.907 0	0.930 3
2019	1.000 0	0.694 7	0.880 2	1.000 0	0.782 0	0.694 7
2021	0.697 2	1.000 0	1.000 0	0.794 3	0.744 1	0.697 2
合计Total	0.941 5	0.926 7	0.950 9	0.913 1	0.866 1	0.868 2
注：MEM, 移动流行区间法。 Note: MEM, moving epidemic method.

下载: 导出CSV

参考文献(16)

[1]	张静, 李秀惠, 李丽, 等. 手足口病病原学和流行病学研究进展[J]. 中华流行病学杂志, 2022, 43(5): 771-783. DOI: 10.3760/cma.j.cn112338-20211012-00788. Zhang J, Li XH, Li L, et al. Etiology and epidemiology of hand, foot and mouth disease in China[J]. Chin J Epidemiol, 2022, 43(5): 771-783. DOI: 10.3760/cma.j.cn112338-20211012-00788.
[2]	WHO. Global epidemiological surveillance standards for influenza[M]. Geneva: WHO Press, 2013: 39-42.
[3]	朱妮, 周体操, 杨国婧, 等. 2009―2018年陕西省手足口病时空分布规律及发病流行强度[J]. 中华疾病控制杂志, 2021, 25(1): 54-59. DOI: 10.16462/j.cnki.zhjbkz.2021.01.011. Zhu N, Zhou TC, Yang GJ, et al. Spatial and temporal distribution and epidemic intensity of hand, foot and mouth disease in Shaanxi province from 2009 to 2018[J]. Chin J Dis Control Prev, 2021, 25(1): 54-59. DOI: 10.16462/j.cnki.zhjbkz.2021.01.011.
[4]	刘天, 李勤, 漆莉, 等. 基于移动流行区间法建立重庆市手足口病预警模型[J]. 疾病监测, 2020, 35(11): 1020-1024. DOI: 10.3784/j.issn.1003-9961.2020.11.013. Liu T, Li Q, Qi L, et al. Establishment of early warning model of hand, foot and mouth disease based on moving epidemic method in Chongqing[J]. Dis Surveill, 2020, 35(11): 1020-1024. DOI: 10.3784/j.issn.1003-9961.2020.11.013.
[5]	王小梅, 王宇, 霍达, 等. 综合指数法建立北京市手足口病流行水平分级评价体系[J]. 预防医学情报杂志, 2021, 37(9): 1209-1212, 1218. https://www.cnki.com.cn/Article/CJFDTOTAL-YFYX202109007.htm Wang XM, Wang Y, Huo D, et al. Establishment of the graded evaluation system on the prevalence of hand, foot and mouth Disease in Beijing by synthetic index method[J]. J Prev Med Inf, 2021, 37(9): 1209-1212, 1218. https://www.cnki.com.cn/Article/CJFDTOTAL-YFYX202109007.htm
[6]	王宇, 贾蕾, 高志勇, 等. 综合指数法建立北京市诺如病毒急性胃肠炎流行水平分级标准[J]. 国际病毒学杂志, 2019, 26(4): 225-228. DOI: 10.3760/cma.j.issn.1673-4092.2019.04.004. Wang Y, Jia L, Gao ZY, et al. Establishment of grading thresholds for epidemic intensity of norovirus acute gastroenteritis in Beijing by synthetic index method[J]. Int J Virol, 2019, 26(4): 225-228. DOI: 10.3760/cma.j.issn.1673-4092.2019.04.004.
[7]	Vega T, Lozano JE, Meerhoff T, et al. Influenza surveillance in Europe: comparing intensity levels calculated using the moving epidemic method[J]. Influenza Other Resp, 2015, 9(5): 234-246. DOI: 10.1111/irv.12330.
[8]	Vega T, Lozano JE, Meerhoff T, et al. Influenza surveillance in Europe: establishing epidemic thresholds by the moving epidemic method[J]. Influenza Other Resp, 2013, 7(4): 546-558. DOI: 10.1111/j.1750-2659.2012.00422.x.
[9]	O'Brien SJ, Christie P. Do CuSums have a role in routine communicable disease surveillance?[J]. Public Health, 1997, 111(4): 255-258. DOI: 10.1016/s0033-3506(97)00044-9.
[10]	孙振球. 医学综合评价方法及其应用[M]. 北京: 化学工业出版社, 2006: 10-19. Sun ZQ. Comprehensive evaluation method and its application in medicine[M]. Beijing: Chemical Industry Press, 2006: 10-19.
[11]	王宇, 吴双胜, 张莉, 等. 应用移动流行区间法和综合指数建立北京市流感流行分级预警标准[J]. 国际病毒学杂志, 2020, 27(4): 271-274. DOI: 10.3760/cma.j.issn.1673-4092.2020.04.002. Wang Y, Wu SS, Zhang L, et al. Establishing epidemic thresholds for tiered warning alerts of influenza in Beijing based on moving epidemic method and synthetical index[J]. Int J Virol, 2020, 27(4): 271-274. DOI: 10.3760/cma.j.issn.1673-4092.2020.04.002.
[12]	Xing W, Liao Q, Viboud C, et al. Epidemiological characteristics of hand-foot-and-mouth disease in China, 2008-2012[J]. Lancet Infect Dis, 2014, 14(4): 308-318. DOI: 10.1016/S1473-3099(13)70342-6.
[13]	谭亚运, 曾令佳, 秦颖, 等. 移动流行区间法在中国7个气候区流感流行阈值制定中的应用效果评价[J]. 中华预防医学杂志, 2019, 53(10): 1007-1011. DOI: 10.3760/cma.j.issn.0253-9624.2019.10.010. Tan YY, Zeng LJ, Qin Y, et al. Evaluation of the application of moving epidemic method on making influenza epidemic thresholds in the 7 climate zones in China[J]. Chin J Prev Med, 2019, 53(10): 1007-1011. DOI: 10.3760/cma.j.issn.0253-9624.2019.10.010.
[14]	Zhao Z, Zheng CJ, Qi HC, et al. Impact of the coronavirus disease 2019 interventions on the incidence of hand, foot, and mouth disease in mainland China[J]. Lancet Reg Health-W, 2022, 20: 100362. DOI: 10.1016/j.lanwpc.2021.100362.
[15]	Wu KY, Ma XW, Liu HM, et al. Effects of different levels of non-pharmaceutical interventions on hand, foot and mouth disease in Guangzhou, China[J]. BMC Public Health, 2022, 22(1): 2398. DOI: 10.1186/s12889-022-14850-x.
[16]	黄日暖. 面对新冠疫情怎么做?广东省教育厅这样指引[J]. 广东教育(综合版), 2020, 65(3): 13-16. DOI: 10.3969/j.issn.1005-1422.2020.03.005. Huang RN. What to do in the face of the COVID-19 pandemic? The guideline from Guangdong provincial department of education[J]. Guangdong Education(General Edition), 2020, 65(3): 13-16. DOI: 10.3969/j.issn.1005-1422.2020.03.005.