Analysis on effect of automatic early warning of pulmonary tuberculosis cases in schools in Zhejiang Province

doi:10.19983/j.issn.2096-8493.20230055

Abstract

Abstract:

Objective: To analyze the application effect of single case early warning of pulmonary tuberculosis in schools in Zhejiang Province in the automatic early warning system for infectious diseases (referred to as the “early warning system”). Methods: The case information of school pulmonary tuberculosis cases from July 6, 2018 to December 31, 2022 was collected from the early warning information of tuberculosis generated by the automatic early warning system of infectious diseases in Zhejiang Province (including the number of warning signals, signal response time, and response results, etc), and the report management system of infectious diseases in the same period. Using February 24, 2021 as the cut-off point, compare the warning effect of the warning system before and after the adjustment of the warning object. Results: From July 6, 2018 to December 31, 2022, a total of 35418 school pulmonary tuberculosis warning signals were issued by the provincial early warning system. The top three cities with the highest number of signals were Ningbo (7531, 21.26%), Wenzhou (6786, 19.16%) and Hangzhou (5344, 15.09%). The early warning signal response rate was 100.00%, the timely response rate was 97.60% (34567/35418), and the median response time (quartile)(M(Q₁,Q₃)) was 1.19 (0.30, 5.83) h. Among them, 5498 (15.52%) signals were initially judged as suspicious signals. After on-site investigation and verification, 4714 cases of school pulmonary tuberculosis were in line with the early warning target, and the positive predictive value of early warning signals was 13.31% (4714/35418). After adjusting the warning objects, the number of daily warning signals decreased by -60.24% ((11.43-28.75)/28.75), and the suspected signal rate increased by 25.29% ((18.43-14.71)/14.71). The suspected signal rate of different diagnostic results (18.43% (1424/7728)) was significantly higher than before adjustment (14.71% (4074/27690)), and the difference was statistically significant (χ²=63.256, P=0.000), of which, before and after adjustment, there was statistical difference in the suspected signal rate of early warning objects with etiological positive (17.94% (615/3429) and 20.91% (586/2803)) and no pathogen results (12.81% (2316/18086) and 14.80% (322/2175))(χ²=8.560,P=0.003; χ²=6.676,P=0.010). Conclusion: The automatic early warning of a single case of pulmonary tuberculosis in Zhejiang Province was operating well, which could preliminarily achieve the early warning of school pulmonary tuberculosis. By adjusting the warning objects, the application effect of early warning could be further improved.

Key words: Tuberculosis,pulmonary, Students, public health, Reminder systems, Patient identification systems

CLC Number:

R184
R521

Lu Qinbao, Wu Haocheng, Ding Zheyuan, Fu Tianying, Wu Chen, Lin Junfen. Analysis on effect of automatic early warning of pulmonary tuberculosis cases in schools in Zhejiang Province[J]. Journal of Tuberculosis and Lung Disease , 2023, 4(3): 223-228. doi: 10.19983/j.issn.2096-8493.20230055

Figures/Tables 3

References 19

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年份	预警信号数(条)	及时响应数 [条,率(%)]	响应时间 [h,M(Q₁,Q₃)]	疑似信号数 [条,率(%)]	学校肺结核患者例数	学校肺结核患者例数/疑似信号条数	预警信号阳性预测值(%)
2018^a	5580	5341(95.72)	1.77(0.42,8.97)	929(16.65)	563	0.61	10.09
2019	11123	10910(98.09)	1.13(0.28,5.61)	1660(14.92)	1170	0.70	10.52
2020	10152	9942(97.93)	1.08(0.28,5.21)	1391(13.70)	1173	0.84	11.55
2021	4478	4395(98.15)	1.06(0.28,5.56)	770(17.20)	951	1.24	21.24
2022	4085	3979(97.41)	1.15(0.29,5.68)	748(18.31)	857	1.15	20.98
合计	35418	34567(97.60)	1.19(0.30,5.83)	5498(15.52)	4714	0.86	13.31

地区	涉及县 (区)数	预警信号数(条)	及时响应数(条)	及时响应率 (%)	响应时间 [h,M(Q₁,Q₃)]	疑似信号数(条)	疑似信号率 (%)
杭州市	14	5344	5280	98.80	1.03(0.27,5.07)	998	18.68
宁波市	10	7531	7043	93.52	2.63(0.64,14.93)	776	10.30
温州市	12	6786	6677	98.39	0.91(0.24,4.21)	1293	19.05
嘉兴市	7	2314	2310	99.83	0.80(0.25,3.14)	241	10.41
湖州市	5	1140	1104	96.84	1.23(0.32,5.45)	126	11.05
绍兴市	6	2268	2259	99.60	1.17(0.26,5.93)	437	19.27
金华市	9	4657	4589	98.54	1.05(0.24,6.52)	549	11.79
衢州市	6	975	955	97.95	1.53(0.43,7.48)	288	29.54
舟山市	4	336	333	99.11	0.65(0.21,4.55)	94	27.98
台州市	9	2941	2932	99.69	0.71(0.22,3.72)	409	13.91
丽水市	9	1126	1085	96.36	1.18(0.35,5.69)	287	25.49
合计	91	35418	34567	97.60	1.19(0.30,5.83)	5498	15.52

病种分类	调整前				调整后				合计		每日信号变化率(%)	疑似信号变化率 (%)	χ²值	P值
病种分类	预警信号数(条)	疑似信号数(条)	每日信号数(条)	疑似信号率(%)	预警信号数(条)	疑似信号数(条)	每日信号数(条)	疑似信号率(%)	每日信号数(条)	疑似信号率(%)	每日信号变化率(%)	疑似信号变化率 (%)	χ²值	P值
利福平耐药	1343	22	0.14	16.42	69	12	0.10	17.39	0.12	16.75	-28.57	5.91	0.031	0.860
病原学阳性	3429	615	3.56	17.94	2803	586	4.15	20.91	3.80	19.27	16.57	16.56	8.560	0.003
病原学阴性	6041	1121	6.27	18.56	2681	504	3.97	18.80	5.32	18.63	-36.68	1.29	0.057	0.811
无病原学结果	18086	2316	18.78	12.81	2175	322	3.22	14.80	12.36	13.02	-82.85	15.53	6.676	0.010
合计	27690	4074	28.75	14.71	7728	1424	11.43	18.43	21.61	15.52	-60.24	25.29	63.256	0.000