Alter M J, Mares A, Hadler S C, Maynard J E
Am J Epidemiol. 1987 Jan;125(1):133-9. doi: 10.1093/oxfordjournals.aje.a114496.
To determine if passively reported cases of acute viral hepatitis are representative of the affected population, an active surveillance system was set up that identified all persons in Pierce County, Washington, who had been diagnosed by a physician as having acute viral hepatitis in the period March 1 through August 31, 1984. In this county, this was part of an ongoing epidemiologic study of viral hepatitis that had previously included some stimulation of reporting. The active surveillance system covered all primary sources of medical care, including all private physicians who were most likely to see persons with hepatitis. Secondary sources, those that did not provide direct medical care but might be aware of new cases, were also surveyed. The results of active surveillance showed that passive reporting was about 65% complete in Pierce County. No change occurred in the number of hepatitis A cases reported, but hepatitis B cases increased by 50%, and non-A, non-B hepatitis cases increased by 138%. Most of the increase was a result of enhanced reporting from private physicians. The two risk groups most affected by underreporting were homosexual men with hepatitis B and blood transfusion recipients with non-A, non-B hepatitis. During active surveillance, the proportion of persons with hepatitis B who reported homosexual activity was 52% compared with 20% from passive surveillance. Transfusion recipients represented 24% of the non-A, non-B hepatitis reported from active surveillance compared with 9% reported from passive surveillance. Although Pierce County may not be representative of all counties in the United States, persons responsible for public health prevention programs should recognize that data acquired through passive surveillance may not accurately reflect the magnitude of the risk for specific populations or the amount of disease that can be prevented.
为确定被动报告的急性病毒性肝炎病例是否能代表受影响人群，建立了一个主动监测系统，该系统识别出华盛顿州皮尔斯县在1984年3月1日至8月31日期间被医生诊断为患有急性病毒性肝炎的所有人员。在该县，这是正在进行的病毒性肝炎流行病学研究的一部分，该研究此前曾包括一些促进报告的措施。主动监测系统涵盖了所有医疗保健的主要来源，包括最有可能诊治肝炎患者的所有私人医生。还对那些不提供直接医疗服务但可能知晓新病例的次要来源进行了调查。主动监测的结果表明，皮尔斯县的被动报告完成率约为65%。报告的甲型肝炎病例数量没有变化，但乙型肝炎病例增加了50%，非甲非乙型肝炎病例增加了138%。大部分增加是私人医生报告增加的结果。报告不足影响最大的两个风险群体是患有乙型肝炎的男同性恋者和患有非甲非乙型肝炎的输血接受者。在主动监测期间，报告有同性恋活动的乙型肝炎患者比例为52%，而被动监测为20%。输血接受者占主动监测报告的非甲非乙型肝炎病例的24%，而被动监测报告为9%。尽管皮尔斯县可能不代表美国所有的县，但负责公共卫生预防项目的人员应认识到，通过被动监测获得的数据可能无法准确反映特定人群的风险程度或可预防疾病的数量。
