Objective: To evaluate the quality of Japanese Encephalitis (JE) case reports based on the establishment of surveillance on acute meningitis and encephalitis syndrome (AMES) in Baoji. Methods: A surveillance network on AMES cases was set up in Baoji city of Shaanxi province between July 2013 and December 2016. All the cases met the surveillance definition of AMES cases were conducted a questionnaire, collected serum and/or cerebrospinal fluid (CSF) specimens to test JE immunoglobulin M antibodies by using enzyme-linkedimmunosorbent assay methods.The information of the incidence of JE in Shaanxi and Baoji from 2009 to 2016 originated from the China information system for disease control and prevention. Chi square test was used to compare the difference in JE incidence in Baoji, Shaanxi before and after the implementation of AMES monitoring project. Results: 75 out of 855 collected cases were laboratory confirmed as JE, Including 42 suspected JE cases and 33 other suspected cases diagnosed after hospitalization. Except 1 case occurring in December, all the other cases occurred between July and October, especially in August with a peak of 55 cases (73.3%), and 6 cases (8.0%) in July, 11 cases (14.7%) in September, 2 cases (2.7%) in October. The proportion of patients aging 0-6, 7-14 and ≥15 years old were respectively 4.0% (3 cases), 8.0% (6 cases) and 88.0% (66 cases). The biochemical test showed the cerebrospinal fluid in 13 cases (17.3%) were slightly turbid, the white blood cell in 31 cases (41.3%) elevated, the glucose levels in 24 cases (32.0%) were abnormal, and the chloride level in 23 cases (30.7%) were abnormal. A total of 103 cases of JE were diagnosed in Baoji from 2009 to 2016, with an average annual incidence rate at 0.34/100 000. The average incidence of JE in 2009-2012 and 2013-2016 was 0.21/100 000 and 0.48/100 000 respectively. From 2013 to 2016, the proportion of JE cases in Baoji, Shaanxi was 19.3% (71/369), and it was 8.9% (32/362) between 2009 and 2012 (χ(2)=4.15, P=0.040). Conclusion: The AMES surveillance project improved the quality of the JE case report in Baoji. Changes appeared in biochemistrical and epidemiological characteristics of cerebrospinal fluid. The incidence of JE was seriously underestimated in Shaanxi province and therefore the sensitivity of Japanese encephalitis surveillance cases should be further improved.
目的： 评价宝鸡建立脑炎/脑膜炎症候群（AMES）监测系统后流行性乙型脑炎（乙脑）病例报告质量。 方法： 于2013年7月至2016年12月在宝鸡建立AMES监测系统，以9所医院作为监测哨点医院、其他县级以上医院作为监测医院。以监测系统中急性起病，具有发热、头痛、呕吐等症状，且伴有不同程度的意识障碍或脑膜刺激征等表现的病例为研究对象，共855例。收集研究对象的基本信息及入院疑似诊断结果，并采集血液和脑脊液标本，进行生化检验和乙脑IgM检测。2009—2016年陕西和宝鸡乙脑疾病发病信息来源于中国疾病预防控制中心传染病报告系统。采用χ(2)检验比较AMES监测项目执行前后宝鸡乙脑发病在陕西占比差异。 结果： 855例监测病例中，实验室确诊乙脑病例为75例，其中入院诊断为疑似乙脑的病例为42例，33例在入院时诊断为疑似其他疾病；除1例在12月份发病，其他病例发病时间均在7—10月份，其中8月份病例最多，为55例（73.3%），7月份为6例（8.0%），9月份为11例（14.7%），10月份为2例（2.7%）；0~6、7~14和≥15岁病例分别占4.0%（3例）、8.0%（6例）和88.0%（66例）。生化检验结果显示，13例（17.3%）病例的脑脊液有微混浊，31例（41.3%）病例为白细胞升高，24例（32.0%）病例为葡萄糖水平异常，23例（30.7%）病例为氯化物水平异常。宝鸡2009—2016年共确诊乙脑病例103例，年均发病率为0.34/10万；2009—2012和2013—2016年乙脑年均发病率分别为0.21/10万和0.48/10万。2013—2016年宝鸡乙脑病例占陕西乙脑总病例数的比例为19.3%（71/369），2009—2012年为8.9%（32/362）（χ(2)=4.15，P=0.040）。 结论： AMES监测项目提高了宝鸡乙脑病例的报告质量，乙脑病例脑脊液生化和流行病学特征发生不同程度变化；乙脑发病率被严重低估，乙脑病例报告敏感性有待进一步提高。.
Keywords: Acute meningitis and encephalitis syndrome; Epidemic encephalitis type B; Japanese encephalitis.