Salmaso Stefania, Zambri Francesca, Renzi Matteo, Giusti Angela
Già direttrice del Centro nazionale di epidemiologia, sorveglianza e promozione della salute dell'Istituto superiore di sanità, Roma.
Centro nazionale per la prevenzione delle malattie e la promozione della salute, Istituto superiore di sanità, Roma;
Epidemiol Prev. 2020 Sep-Dec;44(5-6 Suppl 2):33-41. doi: 10.19191/EP20.5-6.S2.090.
the ability to implement effective preventive and control measures is rooted in public health surveillance to promptly identify and isolate contagious patients.
to describe some organizational aspects and resources involved in the control of COVID-19 pandemic.
observational cross sectional study.
a survey of methods and tools adopted by the competent service (Prevention department) in the Local public health units (LHU) of the regional Health services has been performed in May 2020. The survey collected data related to activities carried out during the month of April 2020 on the surveillance system for collection of suspected cases, their virological ascertainment, the isolation procedures and contact-tracing activities by means of an online questionnaire filled in by the public health structure of the regional health system. A convenience sample of Prevention departments was recruited.
in 44 Prevention departments of 14 Regions/Autonomous Provinces (caring for 40% of the population residing in Italy), different services were swiftly engaged in pandemic response. Reports of suspected cases were about 3 times the number of confirmed cases in the same month. Local reporting form was used in 46% of the LHUs while a regional form was available in 42% of the Departments (in 9/14 Regions). In one fourth the forms were not always used and 2% had no forms for the reporting of suspected cases. Data were recorded in 52% of LHUs on local databases, while in 20% a regional database (in 7 Regions) had been created. A proportion of 11% did not record the data for further elaboration. The virological assessment with nasopharyngeal swabs out of the hospital setting was carried out on the average in 7 points in each LHU (median 5) and the average daily capacity was 350 (71 per 100,000) swabs. The rate of subjects newly tested during the month of April was of 893 per 100,000 new people. Data collected at the swabbing were recorded on a regional platform in 17 LHUs (39%) of 8 Regions. In 7% LHUs only positive specimens were recorded electronically. Local files were used in 27% LHUs. The interview with confirmed cases was carried out with a local questionnaire in 52% LHUs, while 14% stated that a standardized form was not used. The data collected about cases were recorded on a regional IT platform in 30% Departments (in 8 Regions) and in 41% data were registered only locally. For each confirmed case in April, a median of 4 contacts were identified. Only 13 (30%) Departments in 9 Regions have registered contact data on a regional database. Ten Departments (23%) have only hard copies, while 56% recorded data on local databases. About 5 health professionals for 100,000 resident population were involved in each LHU in each of the following activities as receiving reports of suspected cases, swabs collection, interviews of cases and contact identifications.
the pandemic required rapidly a great organizational effort and great flexibility to increase response capacity, which now must be strengthened and maintained. Several different tools (forms and electronic files) have been developed in each LHU and used for the same surveillance operational processes with a loss in local efficiency. The inhomogeneous data collection and recording is an obstacle for further analyses and risk identifications and is a missed opportunity for the advancement of our knowledge on pandemic epidemiology analysis. In Italy, updating the pandemic response plans is the priority, at national, regional and local level, and the occasion to fill the gaps and to improve surveillance systems to the interruption of COVID-19 transmission.
实施有效预防和控制措施的能力源于公共卫生监测，以便及时识别和隔离传染性患者。
描述新冠疫情防控中涉及的一些组织方面和资源情况。
观察性横断面研究。
2020年5月对地区卫生服务机构中地方公共卫生单位（LHU）的主管部门（预防部门）所采用的方法和工具进行了一项调查。该调查通过地区卫生系统公共卫生机构填写的在线问卷，收集了2020年4月期间在疑似病例收集监测系统、病毒学确诊、隔离程序以及接触者追踪活动方面开展的相关数据。选取了预防部门的一个便利样本。
在14个大区/自治省的44个预防部门（覆盖意大利40%的常住人口）中，不同服务部门迅速投入到疫情应对工作中。4月疑似病例报告数量约为同月确诊病例数量的3倍。46%的LHU使用地方报告表，42%的部门（在9/14个大区）有地区报告表。四分之一的部门并非总是使用这些表格，2%的部门没有疑似病例报告表格。52%的LHU将数据记录在地方数据库中，20%的部门（在7个大区）创建了地区数据库。11%的部门未记录数据以供进一步分析。每个LHU平均在7个地点（中位数为5个）对院外鼻咽拭子进行病毒学评估，日均检测能力为350次（每10万人71次）。4月每新增10万人口中新增检测对象的比例为893人。在8个大区的17个LHU（39%）中，拭子采集时收集的数据记录在地区平台上。7%的LHU仅以电子方式记录阳性标本。27%的LHU使用地方文件。52%的LHU使用地方问卷对确诊病例进行访谈，14%的部门表示未使用标准化表格。4月收集的病例相关数据，30%的部门（在8个大区）记录在地区信息技术平台上，41%的数据仅在地方登记。4月每确诊一例，平均识别出4个接触者。9个大区中只有13个（30%）部门在地区数据库中登记了接触者数据。10个部门（23%）只有纸质记录，56%的数据记录在地方数据库中。每10万常住人口中约有5名卫生专业人员参与以下各项活动，即接收疑似病例报告、采集拭子、访谈病例以及识别接触者。
疫情迅速需要巨大的组织努力和极大的灵活性来提高应对能力，现在必须加强并维持这种能力。每个LHU都开发了几种不同的工具（表格和电子文件）并用于相同的监测操作流程，导致地方效率有所损失。数据收集和记录的不均匀是进一步分析和风险识别的障碍，也是我们在疫情流行病学分析知识进步方面错失的机会。在意大利，更新疫情应对计划是国家、地区和地方层面的优先事项，也是填补空白并改进监测系统以阻断新冠病毒传播的契机。
