Revision of clinical case definitions: influenza-like illness and severe acute respiratory infection.
Revision of clinical case definitions: influenza-like illness and severe acute respiratory infection.
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DOI：
10.2471/blt.17.194514
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发表时间：
2018-02-01
影响因子：
11.1
通讯作者：
Vandemaele K
中科院分区：
文献类型：
--
作者：
Fitzner J;Qasmieh S;Mounts AW;Alexander B;Besselaar T;Briand S;Brown C;Clark S;Dueger E;Gross D;Hauge S;Hirve S;Jorgensen P;Katz MA;Mafi A;Malik M;McCarron M;Meerhoff T;Mori Y;Mott J;Olivera MTDC;Ortiz JR;Palekar R;Rebelo-de-Andrade H;Soetens L;Yahaya AA;Zhang W;Vandemaele K
制定准确的临床病例定义是有效的公共卫生监测过程的组成部分。尽管理想情况下，此类定义应建立在定义标准的标准化和固定集合的基础上，但它们往往需要修订，以反映有关情况的新知识和诊断测试的改进。最佳案例定义还需要在反映其预期用途的敏感度和特异度之间取得平衡。在2009-2010年H1N1流感大流行之后，世界卫生组织(WHO)启动了关于全球流感监测的技术磋商。这促使流感病例定义的敏感度和特异度有所提高--即，一种缺乏唯一明确症状的呼吸道疾病。修订过程不仅修改了流感样疾病的定义，列入了对流感感染最具预测性的标准的简化清单，还澄清了定义所用的语言，以增强可解释性。为了涵盖需要住院的严重流感病例，还为所有年龄组的严重急性呼吸道感染制定了新的病例定义。新的定义被发现在不影响特异性的情况下涵盖了更多的病例。尽管在流感与其他呼吸道感染的临床分离方面仍然存在挑战，但新的世卫组织病例定义的全球使用应有助于确定流感病毒的特征和传播以及相关疾病负担的全球趋势。
The formulation of accurate clinical case definitions is an integral part of an effective process of public health surveillance. Although such definitions should, ideally, be based on a standardized and fixed collection of defining criteria, they often require revision to reflect new knowledge of the condition involved and improvements in diagnostic testing. Optimal case definitions also need to have a balance of sensitivity and specificity that reflects their intended use. After the 2009–2010 H1N1 influenza pandemic, the World Health Organization (WHO) initiated a technical consultation on global influenza surveillance. This prompted improvements in the sensitivity and specificity of the case definition for influenza – i.e. a respiratory disease that lacks uniquely defining symptomology. The revision process not only modified the definition of influenza-like illness, to include a simplified list of the criteria shown to be most predictive of influenza infection, but also clarified the language used for the definition, to enhance interpretability. To capture severe cases of influenza that required hospitalization, a new case definition was also developed for severe acute respiratory infection in all age groups. The new definitions have been found to capture more cases without compromising specificity. Despite the challenge still posed in the clinical separation of influenza from other respiratory infections, the global use of the new WHO case definitions should help determine global trends in the characteristics and transmission of influenza viruses and the associated disease burden.