NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal.
Epidemiology Department, Epiconcept, Paris, France.
Front Public Health. 2023 Mar 9;11:963464. doi: 10.3389/fpubh.2023.963464. eCollection 2023.
In Portugal, COVID-19 laboratory notifications, clinical notifications (CNs), and epidemiological investigation questionnaires (EI) were electronically submitted by laboratories, clinicians, and public health professionals, respectively, to the Portuguese National Epidemiological Surveillance System (SINAVE), as mandated by law. We described CN and EI completeness in SINAVE to inform pandemic surveillance efforts.
We calculated the proportion of COVID-19 laboratory-notified cases without CN nor EI, and without EI by region and age group, in each month, from March 2020 to July 2021. We tested the correlation between those proportions and monthly case counts in two epidemic periods and used Poisson regression to identify factors associated with the outcomes.
The analysis included 909,720 laboratory-notified cases. After October 2020, an increase in the number of COVID-19 cases was associated with a decrease in the submissions of CN and EI. By July 2021, 68.57% of cases had no associated CN nor EI, and 96.26% had no EI. Until January 2021, there was a positive correlation between monthly case counts and the monthly proportion of cases without CN nor EI and without EI, but not afterward. Cases aged 75 years or older had a lower proportion without CN nor EI (aRR: 0.842 CI95% 0.839-0.845). When compared to the Norte region, cases from Alentejo, Algarve, and Madeira had a lower probability of having no EI (aRR;0.659 CI 95%0.654-0.664; aRR 0.705 CI 95% 0.7-0.711; and aRR 0.363 CI 95% 0.354-0.373, respectively).
After January 2021, CN and EI were submitted in a small proportion of laboratory-confirmed cases, varying by age and region. Facing the large number of COVID-19 cases, public health services may have adopted other registry strategies including new surveillance and management tools to respond to operational needs. This may have contributed to the abandonment of official CN and EI submission. Useful knowledge on the context of infection, symptom profile, and other knowledge gaps was no longer adequately supported by SINAVE. Regular evaluation of pandemic surveillance systems' completeness is necessary to inform surveillance improvements and procedures considering dynamic objectives, usefulness, acceptability, and simplicity.
在葡萄牙，COVID-19 实验室通知、临床通知（CN）和流行病学调查问卷（EI）分别由实验室、临床医生和公共卫生专业人员电子提交到葡萄牙国家流行病学监测系统（SINAVE），这是法律规定的。我们描述了 SINAVE 中 CN 和 EI 的完整性，以为大流行监测工作提供信息。
我们计算了 2020 年 3 月至 2021 年 7 月期间，每个月 COVID-19 实验室报告病例中无 CN 和 EI 报告病例的比例，以及按地区和年龄组划分的无 EI 报告病例的比例。我们测试了这两个流行期每月病例数与这些比例之间的相关性，并使用泊松回归来确定与结果相关的因素。
分析包括 909720 例实验室报告病例。2020 年 10 月后，COVID-19 病例数的增加与 CN 和 EI 提交的减少有关。到 2021 年 7 月，68.57%的病例无相关 CN 或 EI，96.26%的病例无 EI。直到 2021 年 1 月，每月病例数与每月无 CN 或 EI 和无 EI 的病例比例之间呈正相关，但之后不再相关。75 岁及以上的病例无 CN 或 EI 的比例较低（ARR：0.842 CI95%0.839-0.845）。与北部地区相比，来自阿连特茹、阿尔加维、马德拉的病例发生无 EI 的概率较低（ARR；0.659 CI 95%0.654-0.664；ARR 0.705 CI 95%0.7-0.711；ARR 0.363 CI 95%0.354-0.373）。
2021 年 1 月后，CN 和 EI 仅在一小部分实验室确诊病例中提交，且因年龄和地区而异。面对大量 COVID-19 病例，公共卫生服务部门可能采用了其他登记策略，包括新的监测和管理工具，以应对业务需求。这可能导致官方 CN 和 EI 提交的放弃。SINAVE 不再充分支持有关感染背景、症状特征和其他知识空白的有用知识。定期评估大流行监测系统的完整性对于为监测改进提供信息以及考虑动态目标、有用性、可接受性和简单性的程序是必要的。
