报告假象—影响监测敏感性和特异性主要因素.pptVIP

* This diagram of shigellosis illustrates how at each step of the case detection and reporting process, cases are lost. In the end only 6% of total shigella infections are reported to the county health department. If this is a consistant percentage between all counties and over time then we really do not have an important problem. Even small “random” differneces will not affect our interpretation or analysis. The other issue is timliness. Each step of the process introduces an error in time. In general the tendency will be to make abrubt changes appear more gradual. * Now let’s get onto a related topic. Severity. Diseases for various reasons will vary in severity from simply presence of the agent in the body of the host to severe disease in death. Here we have an example of a few infectious diseases. Ask the class what factors could determine this variability. they should mention: Dose or intensity of exposure. Sensitivity or immunity of the host The method by which the person was exposed. For infectious diseases we normally use three terms: Infectivity meaning the ability of the causative organism to enter and multiply in the human host. Pathogenicity: meaning the degree to which the agent causes apparent disease in the host. Virulence meaning the severity of the disease that results. This diagram indicates that polio has a lower pathogenicity than the other infections. A greater proportion of infections result in no disease. In contrast rabies in measles are 100 percent pathogenic, but rabies is more virulent. * The green line represents background of other diseases that are similar to the disease that we are interested in. The black line represents all diseases picked up by the case definition real disease plus misclassified disease. * * * * * * * * * * Here we see that during 2002 the proportionate mortality for injuries was 32 percent and injuries ranked No. 1 among the causes of death in Epi land. This proportionate mortality was compu