The Ministry of Health on the issuance of the "National unexplained pneumonia cases of monitoring, investigation and management program," the notice
Wei emergency fat [2007] No. 158
Provinces, autonomous regions and municipalities directly under the central health bureau, Xinjiang Production and Construction Corps Health Bureau, the China Disease Prevention and Control Center, the Ministry of Health Health Monitoring Center:
To further strengthen the cases of pneumonia of unknown causes monitoring, investigation and management, early detection, early warning and effective control of severe acute respiratory syndrome, human infection of highly pathogenic avian influenza and other respiratory diseases together, I organized experts "National unexplained pneumonia cases to monitor the implementation of the program (Trial)" on the basis of summing up the previous stage experience, developed a "national cases of pneumonia of unknown causes monitoring, investigation and management program." Is issued to you, please follow the implementation.
May 10, 2007
Unexplained pneumonia cases nationwide monitoring, investigation and management program
Severe acute respiratory syndrome (hereinafter referred to as "SARS") and human infection of highly pathogenic avian influenza (hereinafter referred to as "bird flu") are based on pneumonia as the main clinical manifestations (light cases and inapparent infection except) Acute respiratory diseases, is "the People's Republic of Communicable Disease Prevention Act" in accordance with the provisions of Group A of infectious diseases prevention and control measures taken by the Group B of infectious diseases. Screening people for SARS and bird flu, as well as other clusters of respiratory infections occurred in the timely detection of outbreaks and to take appropriate measures to effectively control the epidemic prevention and control to prevent the spread of the epidemic, made the final version of the program.
First, the purpose of
1, to strengthen the cases of pneumonia of unknown causes monitoring, investigation and regulation of the disposal of the epidemic;
2, the timely detection of SARS, human avian influenza cases;
3, to the timely detection of other clinical manifestations of pneumonia as the main clusters of respiratory infections.
Second, case definition
1, cases of pneumonia of unknown causes
At the same time have the following four, can not be clearly diagnosed as pneumonia cases of other diseases:
(1) fever (axillary temperature ≥ 38 ℃);
(2) with the imaging features of pneumonia;
(3) to reduce the incidence of early or normal WBC or lymphocyte count reduced;
(4) by the norms of antibiotic therapy 3 - 5 days (with reference to the Chinese Medical Association of Respiratory Diseases credits will be issued by 2006 version of "community-acquired pneumonia diagnosis and treatment guidelines," are listed in Annex 2), the disease showed no significant improvement or sexual heavier.
2, clusters of cases of pneumonia of unknown causes
Occurred within two weeks epidemiological relevance of the two cases or more than two cases of pneumonia cases of unknown causes.
There are epidemiological relevance of cases prior to the onset of means have been living together, live, work, exposed to the same environment, or have had close contact with, or for Disease Control professionals that epidemiological relevance of the other cases, specific to judge by clinical medical staff in the reception of cases and asked in detail about the process of epidemiological history, or by professionals in disease control, as detailed epidemiological investigation to be judged.
Third, work
Health administrative departments at all levels and at all levels of medical institutions, disease prevention and control institutions (hereinafter referred to as "the disease control agency") is responsible for cases of pneumonia of unknown causes to carry out the monitoring, investigation and management.
(A) the discovery of cases and reporting
Various types of medical institutions at all levels of medical staff found to comply with the definition of unexplained pneumonia cases should be immediately reported to the relevant departments of medical institutions, medical institutions by the 12-hour period in the organization of the unit group of experts to carry out consultation and investigation is still not clear diagnosis, infectious diseases should be immediately filled out the report card, marked with "pneumonia of unknown causes" and Direct Network Report. Direct Network Report does not have the conditions of medical institutions, should be immediately disclosed to the local disease control agencies at the county level, and within 24 hours to complete the report card sent to an infectious disease. County-level disease control agencies in the call report, should be immediately reported to the network straight.
County-level disease control agencies to found unexplained pneumonia cases promptly to the county-level health administrative department.
Medical personnel gathered in the discovery of unexplained pneumonia cases, the hospitals should immediately organize our group of experts to carry out consultation and Direct Network Report, at the same time to the county-level disease control agency. Disease control agencies at the county level after receiving the report immediately to the county-level health administrative department.
Do not have the appropriate diagnosis and treatment of conditions of the township, community and other primary health care institutions have found unexplained pneumonia cases should be immediately transferred to hospitals at the county level and above the diagnosis and treatment, from hospitals to receive cases of unexplained pneumonia cases reported to the network straight.
At all levels of disease control agencies in the day-to-day monitoring of the epidemic, we should take the initiative to monitor and analyze daily online reported cases of pneumonia of unknown causes data, analysis of whether there is the same time, space or specific occupational clusters of unexplained pneumonia cases have occurred.
(more) (B) the epidemiological investigation and handling
County-level disease control agencies received a report of unexplained pneumonia cases should be within 24 hours of completion of the preliminary epidemiological investigation of cases (the survey are listed in Annex 3), and timely registration of close contacts. Investigation focused on understanding the history of epidemiological cases, including: whether or not gathered around the incidence of the phenomenon, with or without a corresponding high-risk occupational history (for example, engaged in SARS-CoV testing, research and related work or may be exposed to animal and human avian flu virus or potentially infectious materials laboratory personnel; keeping, selling, slaughtering, processing of poultry and poultry disease prevention and control of personnel engaged; failure to take stringent personal protective measures, disposal of animal outbreaks of highly pathogenic avian influenza of the staff; failure to take strict personal protective measures, treatment, care of people suspected of bird flu or SARS, clinical diagnosis or laboratory confirmed cases of health care workers, etc.), as well as other contact with poultry or wild animal or exposed to these animals and their droppings pollute the environment, etc.内容.
County-level disease control agencies received aggregation report cases of pneumonia of unknown causes, the epidemiological investigation should be carried out immediately, while the Organization of the close contacts of cases the registration, tracking and medical observation.
Disease control agencies at the county level should unexplained pneumonia cases and clusters of unexplained pneumonia cases in a timely manner to the epidemiological findings of county-level health administrative departments, and the corresponding proposals.
(C) consultation with the investigation of cases
County-level health administrative departments received a report of unexplained pneumonia cases should be organized within 24 hours at the county level expert group to carry out consultation. Of a clear diagnosis of other diseases or explicitly ruled out SARS and human cases of avian flu, should be revised to have a clear diagnosis of disease or "other diseases of unknown causes", they shall be reported to the city (prefectural) level health administrative departments for the record, city (prefecture) level of health the executive branch need to be organized under the city (prefecture) level expert group to review. Consultation at the county level group of experts still can not clearly exclude SARS or human bird flu cases, county-level health administrative departments shall immediately report the city (prefecture) level health administrative departments and city (prefectural) level health administrative departments received a report, should be within 24 hours of the organization of expert group to carry out consultation.
City (prefecture) level expert group consultation, the exclusion of SARS and avian flu, should be revised to clarify the diagnosis of disease or "other diseases of unknown causes", and municipal (prefectural) level health authorities reported that the provincial health administration departments for the record , provincial health authorities need to be organized according to the provincial level expert group to conduct the final audit. City (prefecture) level group of experts who can not be ruled out SARS or bird flu, city (prefecture) level health administrative departments shall immediately report the provincial health administration departments, provincial health authorities received a report, the provincial-level expert group should be immediately to carry out consultation.
Health administrative departments at all levels received aggregation of cases of pneumonia of unknown causes report, it is necessary to immediately level expert group to carry out consultation.
Group of Experts at all levels should strictly follow the Ministry of Health who developed the avian flu and SARS diagnostic criteria for diagnosis, in the consultation should be written after the end of consultations, such as diagnosis of other diseases or "other unknown causes of disease", health administrative departments shall immediately be level views of the expert group consultation notice to the original report, units, units of the revised report by the original report.
Consultation at all levels of the Group of Experts on the basis of the report cases of pneumonia of unknown causes the disease should be within 1 month after the revised report.
(D) case management
Hospitals above the county level found unexplained pneumonia cases should be immediately admitted to hospital patients, according to respiratory infections treated in isolation. Township, community health care institutions have found unexplained pneumonia cases, the patient should be immediately transferred to hospitals at the county level and above.
Medical staff of unexplained pneumonia cases the diagnosis and treatment, it is necessary to take basic personal protective measures (such as wearing overalls, work wear a hat and medical protective masks, etc.). Found clusters of cases of pneumonia of unknown causes, they should take immediate measures to respiratory isolation of infectious diseases and the corresponding nosocomial infection control measures.
By the expert group consultation, diagnosed as SARS, bird flu suspected cases or cases of clinically diagnosed or laboratory confirmed cases, and shall be in accordance with the appropriate prevention and treatment of the Ministry of Health to carry out the disposal of the work program.
(E) specimen collection and laboratory testing
County-level group of experts on the unexplained cases of pneumonia, after consultation, still can not be ruled out SARS and avian flu, the county-level disease control agencies and treated cases of medical institutions should closely cooperate, collecting clinical samples related cases as soon as possible to the conditional Laboratory for SARS and avian flu pathogen detection. Found clusters of cases of pneumonia of unknown causes, he or she shall collect relevant specimens SARS, avian flu and other infectious respiratory disease laboratory testing. Specimen collection personnel should do a good job in personal protection, and fill out the registration form specimens.
Collection of clinical specimens including the patient's nose and throat swab, lower respiratory tract specimens (such as the trachea secretions, tracheal lessons objects) and serum specimens. If a patient died, the consent of their families as far as possible to convince the autopsy, timely autopsy, collection organizations (such as lung tissue, trachea, bronchi Organization) specimens. Clinical specimens should be collected as much as possible cases of early onset of respiratory specimens (especially the lower respiratory tract specimens) and the incidence of 7 days, as well as the acute phase serum interval 2 ~ 4-week convalescent serum.
For unexplained pneumonia cases related to specimen collection, packaging, transportation and laboratory testing should be carried out risk assessment in advance. If the suspected infection of highly pathogenic pathogenic microorganisms, according to the results of hazard assessment in the light of "pathogenic microorganisms Laboratory Biosafety Management Ordinance" and "can infect humans of highly pathogenic bacteria pathogenic microorganisms (drug) or a sample of the provisions of Transport Management" ( The Ministry of Health Order No. 45) and "human-borne pathogens List" (The Guardian science fat 〔2006〕 15) requirements, according to highly pathogenic micro-organisms pathogenic specimen collection, packaging, transportation and laboratory testing work.
Consultation by the provincial-level group of experts could not gather a clear diagnosis of unexplained pneumonia cases, the provincial disease control agencies to send specimens to the Chinese Center for Disease Control and Prevention for testing. When necessary, the provincial disease control agency in accordance with the China Disease Prevention and Control Center's request, the provincial level and below have been made after the expert group consultation clear diagnosis of unexplained pneumonia cases were sent to the Chinese Center for Disease Control and Prevention review detection.
Fourth, the duties of relevant units
Health administrative departments at all levels, medical institutions, disease control agencies and health oversight agencies the following functions.
(A) health authorities,
Health administrative departments at all levels responsible for leading the area of unexplained pneumonia monitoring, investigation and management of the funding for security work, organizational assessment and supervision and inspection of the steering. Organization of expert group of medical institutions to report cases of pneumonia of unknown causes to carry out consultation. Will be a clear diagnosis of other diseases or explicitly excluded from SARS and bird flu survey data reported a higher level health administrative departments for the record, and in accordance with the needs of lower-level health administrative departments for a clear diagnosis of other diseases or explicitly excluded from SARS and human cases of avian flu audit. Found clusters of cases of pneumonia of unknown causes, it is necessary to promptly report to the people's governments at the same level and to make prevention and control measures.
(B) medical institutions
1, at all levels of medical institutions in charge of unexplained pneumonia cases in the diagnosis and treatment, investigation work. Medical personnel in the acquisition of a history of unexplained pneumonia cases when asked about the patient should pay attention to epidemiological history and the surrounding whether the incidence of the phenomenon of aggregation;
2, the medical staff to diagnose cases of pneumonia of unknown causes, the medical institutions should immediately report the relevant departments; hospitals to the timely organization of expert group on the medical staff report cases of pneumonia of unknown causes for consultation;
3, of pneumonia of unknown causes in patients with respiratory diseases should be taken to quarantine measures and the corresponding nosocomial infection control measures;
4, responsible for the aggregation of cases where the hospital in close contact with the registration, medical observation and data reporting;
5, for epidemiological investigations and consultations at all levels of the Expert Group to provide relevant clinical data;
6, medical institutions, health care or prevention of nosocomial infection control departments in accordance with the relevant provisions of unexplained pneumonia cases Direct Network Report and follow-up to the revised report;
7, to assist the disease control agency unexplained pneumonia cases epidemiological survey;
8, responsible for cases of pneumonia of unknown causes collection of clinical specimens, and proper preservation to prepare for inspection;
9, according to the local health authorities, the relevant provisions of, and disease control agencies to carry out transit specimens.
(C) disease prevention and control institutions
1, the county (district) level disease control agency
(1) of the report of unexplained pneumonia cases epidemiological survey;
(2) on the aggregation of unexplained pneumonia cases in close contact tracing and medical observation;
(3) the guidance of medical institutions on the aggregation of cases of pneumonia of unknown causes segregation, guiding the relevant units to take appropriate prevention and control measures;
(4) the guidance of medical institutions for unexplained pneumonia cases specimen collection;
(5) cases collected specimens to the timely delivery of conditional city (prefecture) level or provincial-level laboratories;
(6) promptly unexplained pneumonia cases in the laboratory test results feedback to the reported cases of medical institutions;
(7) regular analysis of aggregate area of monitoring data and report on the monitoring results.
(8) of a clear diagnosis of other diseases or explicitly ruled out SARS and human cases of avian influenza will be to collate information on their investigation, they shall be reported to the same level health administrative departments and disease control institutions superior record.
2, city (prefecture) level disease control agency
(1) regular analysis, summary, reported area of monitoring data and feedback from the monitoring results;
(2) the guidance of disease control agencies at the county level aggregation unexplained pneumonia cases epidemiological survey;
(3) conditional laboratories SARS, avian flu virus (H5N1) and other respiratory diseases related to pathogen detection;
(4) regularly area medical institutions and county-level disease control agencies to carry out supervision, inspection and quality control.
(5) a clear diagnosis of other diseases or explicitly ruled out SARS and human cases of avian influenza will be to collate information on their investigation, they shall be reported to the same level health administrative departments and disease control institutions superior record.
3, the provincial disease control agency
(1) cases of pneumonia of unknown causes to carry out laboratory testing and reporting, feedback experimental test results;
(2) regular analysis, aggregation, reporting, feedback province's monitoring results;
(3) periodically city (prefecture) level and county-level business personnel training CDC;
(4) of the province to monitor the work of supervision, inspection and quality control;
(5) a clear diagnosis of other diseases or explicitly ruled out SARS and human cases of avian influenza will be to collate information on their investigation, they shall be reported to the same level of health administrative departments and the Chinese Center for Disease Control and Prevention record.
4, China Center for Disease Control and Prevention
(1) organizations to the provincial disease control agency training of professionals;
(2) guidance, to participate in the provincial clusters of unexplained pneumonia cases in the investigation and treatment;
(3) of the provincial transport of specimens or isolates related testing or review, identification;
(4) organizations to the national monitoring system for supervision, inspection and evaluation;
(5) of the laboratory network test and quality control;
(6) the establishment, management, maintenance of national monitoring database pneumonia of unknown causes;
(7) regular analysis, summary, feedback from the national monitoring results.
(D) health monitoring body
In accordance with the relevant provisions and requirements of the program of medical institutions to monitor cases of pneumonia of unknown causes, investigation and management of the implementation of the relevant system of supervision and inspection carried out daily.
Fifth, information collection, analysis and feedback
(A) the content of information-gathering
Monitoring system to collect information on the contents of cases of pneumonia of unknown causes, including report cards, the case questionnaire, consultation records, cases of pneumonia of unknown causes specimens submitted tables and clusters of cases of pneumonia of unknown causes in close contact with medical observation and so on.
(B) periodic reports, feedback
1, cases of pneumonia of unknown causes of infectious disease report card by the medical institutions, relevant information on disease surveillance and timely entry of information in China report management system.
2, cases of unexplained pneumonia cases questionnaire disease control agencies at the county level shall be filed, according to a copy of the need to level reported to the China Disease Prevention and Control Center. Clusters of cases of unexplained pneumonia cases in the investigation and handling of questionnaires and reports should be reported up to the level of China Center for Disease Control and Prevention.
3, hospital organizations unexplained pneumonia cases Original consultation records kept in the medical records, and timely reporting of local health administrative departments. Health administration sector organizations Original records expert consultation work of a department filing. Clusters of unexplained pneumonia cases recorded in a copy of consultation should be reported to the provincial level health administrative departments and the Chinese Center for Disease Control and Prevention.
4, Case specimens submitted by the medical institution or table disease control agency to fill. Laboratory test results timely feedback to the inspection unit.
5, clusters of cases of pneumonia of unknown causes in close contact with medical observation table disease control agencies at the county level shall be responsible for completing, summary, and promptly report to the provincial level disease control agency.
6, disease control institutions at all levels will be monitored regularly the results of the analysis system at the same level reported higher-level health administrative departments and disease control institutions, and back to the area disease control agencies and medical institutions.
VI, annex
Annex 1. Diagnosis of unexplained pneumonia cases, reports, process
Annex 2. Community-acquired pneumonia diagnosis and treatment guidelines
Annex 3. Cases of pneumonia of unknown causes questionnaire
Annex 4. Cases of pneumonia of unknown causes consultation records
Seven, the program since the date of implementation, I Division in July 2004 issued a "national unexplained pneumonia cases to monitor the implementation of the program" abolished at the same time.
Annex 1 diagnosis of pneumonia cases of unknown causes, reports, process
Annex 2
Community-acquired pneumonia diagnosis and treatment guidelines
Chinese Medical Association of Respiratory Diseases credits will
Community-acquired pneumonia (community-acquired pneumonia, CAP) is defined as outside the hospital suffering from pulmonary infection in real terms (including the alveolar wall, that is, in a broad sense interstitial lung) inflammation, including a clear incubation period of pathogens in the hospital after the incubation period within the incidence of pneumonia. CAP is a threat to human health, one of common infectious diseases, the pathogen resistance of the composition and characteristics of various countries and regions there are significant differences between, and over time changing. In recent years, due to population aging, immune damage to the host increase in antibiotic resistance of pathogens and changes in rates and other reasons, CAP diagnosis and treatment of facing many new problems. Recently, the Chinese Medical Association of Respiratory Diseases credits will be completed two large national samples CAP epidemiological investigations, and on this basis, combined with CAP treatment abroad, the latest research progress in 1999 on the development of the "community-acquired pneumonia diagnosis and treatment guidelines (draft)) to carry out the appropriate modifications to guide the establishment of a reliable clinical diagnosis, a comprehensive assessment of the patient's condition to determine the approach to improve the prognosis and to help avoid inappropriate empirical treatment, choice of antibiotics to reduce the pressure, delaying resistance drugs, medical and health resources saving.
A, CAP clinical diagnosis based on
1. Newly emerging cough, sputum or respiratory symptoms of the original increase, and a purulent sputum, with or without chest pain.
2. Fever.
3. Lung real signs of change and (or) smell and moist啰音.
4.WBC> 10 × 10 9 / L or <4> 25 / low times the vision, or both the ratio of <1:2.5). onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhf39PfjXAZWN9iuvooOrkKbpLAhCjsa4r3aqsFe0IJ4zNDb45dWfogAotS1AC3SQ25hyrLxmWsyaRlPEimiwCJs5693WodzpfTxVFsZBMs-7UtEPvR7h0gldlJchrGmsRn1jkjyAMncsA/s1600-h/Picture+1.png">
Note: BALF: bronchoalveolar lavage fluid; PSB: anti-pollution brush; PPD: TB Yin Su-purified protein derivative; PCR: polymerase chain reaction; FA: fluorescent antibody staining; IFA: indirect fluorescent antibody method; EIA: enzyme immunoassay; KOH; potassium hydroxide; HE: hematoxylin - eosin staining; GMS: Gomori Urotropine silver staining; CF: complement fixation test; MIF: trace immunofluorescence assay; LA: latex agglutination test. ELISA: enzyme-linked immunosorbent assay. When the sputum culture with the majority of bacteria isolated sputum smear interleukin consistent patterns of micro-organisms, the results of sputum culture will be more reliable. Urine antigen test is a diagnosis of I-type of Legionella pneumophila infection in the most effective way to quickly, and often the application of EIA law or immunochromatography; +: Positive; -: negative
5. Etiological diagnosis of options: (1) out-patient treatment of mild to moderate patients generally do not have to carry out inspections etiology, and only when the initial empirical therapy only needs to carry out inspections etiology. (2) patients should also be routine blood culture and respiratory specimens Etiological examination. Where the combined pleural effusion and can puncture, the diagnosis should be pleural puncture, samples of pleural effusion pleural effusion line of conventional, biochemical and pathogenic inspection. (3) invasive diagnostic techniques only selectively applied to patients with CAP following: ① empirical treatment fails or the progress of the disease remains, especially antibiotics has replaced more than 1 is still ineffective; ② special suspected pathogens, while using conventional respiratory specimens obtained is not clear when the pathogens; ③ immunosuppressive CAP host cancer treatment by antibiotics ineffective; ④ needs and non-infectious pulmonary infiltration from the differential diagnosis of lesions.
Third, CAP admitted to hospitals for treatment standards and the evaluation of the severity of illness
1. Hospitalization criteria: one to meet the following criteria, in particular the conditions of two or more co-exist, it is recommended hospitalization; (1) age ≥ 65 years old. (2) the existence of the following diseases or one of the factors: 1) chronic obstructive pulmonary disease; 2) diabetes; 3) chronic heart, renal insufficiency; 4) malignant solid tumors or blood disease; 5) Acquired immune deficiency syndrome Levy (AIDS); 6) aspiration pneumonia, or the existence of the factors likely to inhalation; 7) nearly 1 year because of CAP hospitalization; 8) abnormal mental state; 9) after splenectomy; 10) after organ transplantation; 11) chronic alcoholism or malnutrition; 12) long-term immunosuppressant. (3), one of the following abnormal signs: ① respiratory frequency ≥ 30 times / min; ② pulse ≥ 120 times / min; ③ artery systolic blood pressure <90mmhg 1mmhg =" 0.133kPa);"> 20 × 10 9 / L or <4> 50mm Hg; ③ creatinine (SCr)> 106μmol / L or blood urea nitrogen (BUN)> 7.1mmol / L; ④ hemoglobin <90g>
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