群聚感染的延遲通報與流行日間距的關係探討

The Relationship of Delay of Notification and Epidemic Interval in Clustered Infections of Facilities in Taiwan

傳染病通報是防疫重要的方法之一。本研究以疾病管制局感染管制組接受2004年9日至2005年6月通報群聚感染的監測結果為樣本，探討台灣醫院及非醫院人口密集機構群聚感染的流行病學結果以及醫院及非醫院機構延遲通報日數與傳染病流行日間距之關係。此為回溯性研究，共有990人有臨床症狀，受檢病人中34%由實驗室確定病原。資料分析確認出有42件群聚感染發生，其中流行性感冒群聚感染與諾羅病毒群聚感染各有16件、桿菌性痢疾（6件）、阿米巴痢疾（2件）、以及疥瘡（2件）。通報件數以醫院為最多、依次為學校、長期照護中心及部隊。精神科專科醫院佔醫院通報件數的71%。統計發現不同人口密集機構與群聚感染病原在發病病人數、延遲通報日數及傳染病流行日均無顯著差異。若將人口密集機構分類為醫院與非醫院兩類，比較醫院發生群聚感染，其延遲通報日數明顯比非醫院機構長，所造成的傳染病流行日亦較長。進一步透過迴歸分析 （regression analysis），發現“延遲通報日數＂能夠顯著用來預測“流行日間距”亦即，越快及時通報群聚感染，越能早日控制傳染病流行。（感控雜誌 2009; 19: 341-53）。

Notification is one of methods for preventing clustered infections of contagious diseases. The purpose of this study was to describe the epidemiology of clustered infections and to establish the relationship of delay of notification and epidemic interval. The study was based on laboratory confirmed 42 clusters, which were the clusters from notification to Taiwan Centers of Disease Control during the period from September 2004 to June 2005. The samples involved 990 residents with clinical symptoms. Pathogens included influenza virus (16 clusters), norovirus (16 clusters), shigella (6 clusters), ameba (2 clusters) and scabies (2 clusters). Descriptive statistical analysis indicated that 33% took place in hospitals, 26% in schools, 19% in long term care centers and 10% in military. Among those clusters in hospital, 71% occurred in psychiatric wards. The results of two-way ANOV A revealed that neither patterns of facilities or pathogens had any significant effect on delay of notification, epidemic interval and infected population. However, further analysis of independent t-test showed that hospital had longer delay of notification and longer epidemic intervals than those of non-hospital facilities. Regression analysis indicated that the delay of notification can serve as a valid predictor of the length of epidemic interval. That is, the sooner the clustered infection is reported, the easier control of the infectious diseases. (Infect Control J 2009;19:341-53).