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中国防痨杂志 ›› 2021, Vol. 43 ›› Issue (11): 1194-1198.doi: 10.3969/j.issn.1000-6621.2021.11.015

• 论著 • 上一篇    下一篇

一起校园肺结核疫情的流行病学调查分析

王大宽*, 何翼君, 刘自森, 王坤, 王静, 张利超, 李杰, 高磊, 潘守国()   

  1. 451450 河南省郑州市中牟县卫生防疫站(王大宽、刘自森、王坤、王静、张利超、李杰、潘守国);中国医学科学院/北京协和医学院病原生物学研究所(何翼君、高磊)
  • 收稿日期:2021-08-18 出版日期:2021-11-10 发布日期:2021-11-02
  • 通信作者: 潘守国 E-mail:pansg698@163.com
  • 基金资助:
    中国医学科学院医学与健康科技创新工程(2019-I2M-2-005)

Epidemiological investigation on an outbreak of tuberculosis epidemic in school

WANG Da-kuan*, HE Yi-jun, LIU Zi-sen, WANG Kun, WANG Jing, ZHANG Li-chao, LI Jie, GAO Lei, PAN Shou-guo()   

  1. *The Center for Disease Control and Prevention of Zhongmu County, Zhengzhou, Henan Province, Zhengzhou 451450, China
  • Received:2021-08-18 Online:2021-11-10 Published:2021-11-02
  • Contact: PAN Shou-guo E-mail:pansg698@163.com

摘要:

目的 对一起校园肺结核疫情进行调查和分析,发现学校结核病疫情处置工作中的难点和不足,为完善学校结核病控制策略提供思路和建议。方法 采用描述性流行病学方法,对2020年10月至2021年6月一起学校结核病疫情进行流行病学调查和分析。同时采用结核菌素皮肤试验(tuberculin skin test, TST)和胸部X线摄片(简称“胸片”)开展肺结核筛查和密切接触者调查。结果 在确诊1例痰涂片阳性肺结核病例之后,共开展4次密切接触者筛查并陆续确诊4例活动性结核病病例。其中,针对指示病例的54名密切接触者(学生47名,教职工7名)开展首次调查时,调查对象的胸片均未见异常,学生的TST强阳性率为4.44%(2/45),教职员工为1/7。本次疫情TST强阳性且排除活动性结核病的学生无人接受预防性治疗。与首次筛查相比,后续筛查中与指示病例同宿舍的学生TST阳转率为6/8、同小组学习的学生TST阳转率为4/5、经常性共同就餐的学生TST阳转率为3/3。此外,后续筛查中发现的4例肺结核新发患者均为随访过程中的TST阳转者。结论 本次学校肺结核疫情的流行病学调查分析提示,密切接触者调查和处置工作需要进一步加强,对新近感染的追踪应成为随访密切接触者的重要内容,预防性治疗对象的界定应更加明确并应提高预防干预的覆盖率。

关键词: 学生, 结核,肺, 疾病暴发流行, 接触者追踪

Abstract:

Objective The epidemiological investigation on an outbreak of school tuberculosis epidemic was conducted to explore the challenges and deficiencies in the management of the tuberculosis epidemic in schools. Methods Descriptive epidemiological tools were used to investigate and analyze an outbreak of school tuberculosis epidemic occurred between October 2020 and June 2021. Active case finding and close contacts tracing were conducted using the tools including tuberculin skin test (TST) and chest X-ray. Results After 1 case with sputum smear positive tuberculosis was diagnosed, a total of another 4 active tuberculosis cases were identified during 4 times of close contacts surveys. The first-round survey was conducted among 54 close contacts (47 students, 7 faculty) of the index case. The prevalence of TST≥15 mm was 4.44% (2/45) for students and 1/7 for faculty, and chest radiographs were found to be normal for all of them. None of the students with TST≥15 mm and without active pulmonary tuberculosis received preventive treatment on the basis of informed consent. In the subsequent survey, the TST conversion rate was 6/8 among students living in the same dormitory with the index case, 4/5 among the students studied in the same group with the index case and 3/3 among those ate together regularly with the index case. In addition, the 4 new identified cases were all TST converters. Conclusion Our results indicated that the investigation and management of close contacts need to be further strengthened in the process of handling tuberculosis epidemic in schools. To identify recent infections among close contacts and to improve the coverage of preventive treatment are key work should be improved.

Key words: Students, Tuberculosis,pulmonary, Pandemics, Contact tracing