关键词: 结核, 疾病暴发流行, 中小学生卫生保健服务, 综合预防, 思考

Abstract:

In recent years, the incidence of tuberculosis in schools has been decreasing. However, the aggregated epidemic still occurs. Up to now, nearly 80 tuberculosis epidemic cases have been reported in the country since 2006. Most happened in boarding schools, about 70% in high school or secondary school, and about 20% in private schools. Common misunderstandings for the disposal of tuberculosis in schools (1) reduce or blindly expand the scope of close contact screening. At the beginning, there was a lack of screening range, which caused the patients to find untimely, and after the aggravation of the epidemic, the scope of screening was expanded blindly, resulting in the waste of resources. (2) the screening method for close contacts is not standardized. The guidelines for tuberculosis prevention and control in schools require that close contacts should be screened by symptom screening, tuberculin skin test and chest X-ray examination. Part epidemic sites only provide chest fluoroscopy rather than chest X ray examination for people over 15 years old or only provide chest X ray examination resulting in untimely detection. Some sites were screened for close contacts by chest CT examination because of abundant resources or epidemic pressure. Many inactive or active small nodules lesions were found due to increased sensitivity, causing panic among people and increasing the pressure of outbreaks. (3) the intervention of close contact with tuberculin test strong positive was not effective. In most areas, tuberculosis preventive treatment was not performed on those with strong positive tuberculin test, and some of the epidemic occurred repeatedly. (4) non-standard anti-tuberculosis treatment and unnecessary adjuvant therapy. No reasonable selection of second-line anti-tuberculosis drug treatment often occurs; low-dose or overdose of medication in children patients with tuberculosis; intravenous medication; anti-infection drug abuse and treatment without combined infection evidence, unnecessary immune enhanced treatment, excessive liver protection treatment. The prevention and control of tuberculosis in schools should take educational system and schools as the main body of responsibility, and work under the guidance of education and health administration departments according to the requirements of school tuberculosis prevention and control work (2017 edition).

Key words: Tuberculosis, Disease outbreaks, School health services, Universal precautions, Thinking