Fine Andrew M, Goldmann Donald A, Forbes Peter W, Harris Sion K, Mandl Kenneth D
Division of Emergency Medicine, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
Pediatrics. 2006 Oct;118(4):1431-8. doi: 10.1542/peds.2006-0462.
Development of national biosurveillance systems to advance regional and national data exchange among sites of clinical care and public health authorities is a top federal priority, creating the opportunity to develop a unified national network for tracking and responding to cases of vaccine-preventable diseases. The purpose of this study was to assess the current practice and feasibility of developing a nationwide network of children's hospitals to conduct surveillance for vaccine preventable diseases.
In 2004-2005, Web-based surveys were sent to 506 key hospital personnel from 119 pediatric hospitals, identified by the National Association of Children's Hospitals and Related Institutions. Surveys measured attitudes toward public health initiatives, willingness to join a surveillance network of children's hospitals, knowledge of mandated reporting requirements, methods of disease detection and reporting, and data sources available for surveillance.
A total of 395 (78%) respondents from 119 hospitals completed the survey. Surveillance at pediatric hospitals is largely passive and driven by unreimbursed efforts of infection control staff. It is vulnerable to missing cases that occur in the outpatient setting and are diagnosed clinically without laboratory confirmation or are never diagnosed by clinicians. Nearly 90% of hospital leaders are interested in participating in public health programs, and most are interested in a national network to conduct active surveillance for vaccine-preventable diseases, dependent on the provision of sufficient funding. Pediatric hospitals store records relevant to surveillance in an electronic fashion accessible to query, but <20% of these hospitals use automated methods to report cases of disease.
There is both the will and capability to create a robust active pediatric hospital-based reporting system for vaccine preventable diseases. This effort would dovetail well with the national priority to bolster surveillance, as well as with the goal of reducing morbidity and mortality from vaccine-preventable diseases.
开发国家生物监测系统以促进临床护理场所与公共卫生当局之间的区域和国家数据交换是联邦政府的首要任务，这为建立一个统一的国家网络以追踪和应对疫苗可预防疾病病例创造了机会。本研究的目的是评估建立全国儿童医院网络以开展疫苗可预防疾病监测的当前做法和可行性。
2004 - 2005年，向由全国儿童医院及相关机构确定的119家儿科医院的506名关键医院工作人员发送了基于网络的调查问卷。调查测量了对公共卫生倡议的态度、加入儿童医院监测网络的意愿、对法定报告要求的了解、疾病检测和报告方法以及可用于监测的数据源。
来自119家医院的395名（78%）受访者完成了调查。儿科医院的监测很大程度上是被动的，由感染控制人员的无偿工作驱动。它容易遗漏在门诊环境中发生、临床诊断但未经实验室确认或从未被临床医生诊断的病例。近90%的医院领导有兴趣参与公共卫生项目，并且大多数人对建立一个全国性网络以开展疫苗可预防疾病的主动监测感兴趣，这取决于是否提供足够的资金。儿科医院以可查询的电子方式存储与监测相关的记录，但这些医院中不到20%使用自动化方法报告疾病病例。
既有意愿也有能力创建一个强大的基于儿科医院的疫苗可预防疾病主动报告系统。这项工作将与加强监测的国家优先事项以及降低疫苗可预防疾病的发病率和死亡率的目标很好地契合。
