Comparative study and suggestions on the return to school policy of students with tuberculosis

doi:10.19982/j.issn.1000-6621.20240149

Abstract

Abstract:

Students represent a critical demographic in the prevention and control of tuberculosis, with return-to-school policies after the contraction of active tuberculosis playing an essential role in safeguarding the health and developmental trajectories of adolescents. Notably, policy variations exist internationally, and China experiences relatively prolonged absences from school, potentially affecting students’ academic performance, social interactions, and psychological well-being. Recent advancements in diagnosing and treating tuberculosis in children and adolescents now facilitate more practical adjustments to these policies for cases responsive to treatment. This paper reviews global return-to-school policies, presents a case study from Zhuhai City highlighting decreased infectivity following regulated treatment, and proposes new policy recommendations. These aim to permit earlier school re-entry for affected children and adolescents, thereby laying a groundwork for policy optimization in China.

Key words: Tuberculosis, Students, public health, Health policy, Communicable disease control

CLC Number:

R521

Huang Xian, Meng Weiyu, Luo Tao, Zhang Weihua, Li Xinyan, Lai Yanfen, Guo Hongge, Tang Vengkai, Lai Xiaoyu, Li Kefeng, Huang Mingxing. Comparative study and suggestions on the return to school policy of students with tuberculosis[J]. Chinese Journal of Antituberculosis, 2024, 46(9): 998-1005. doi: 10.19982/j.issn.1000-6621.20240149

Figures/Tables 5

References 40

[1]	World Health Organization. Global tuberculosis report 2023. Geneva: World Health Organization, 2023.
[2]	陈卉, 张灿有, 张慧, 等. 2004—2021年全国学校肺结核疫情分析. 中国防痨杂志, 2022, 44(8):768-776. doi:10.19982/j.issn.1000-6621.20220200.
[3]	Segal-Maurer S. Tuberculosis in Enclosed Populations. Microbiol Spectr, 2017, 5(2):10.1128/microbiolspec.TNMI7-0041-2017. doi:10.1128/microbiolspec.TNMI7-0041-2017.
[4]	中华人民共和国国家卫生健康委员会办公厅, 中华人民共和国教育部办公厅. 中国学校结核病防控指南(2020年版). 国卫办疾控函〔2020〕910号. 2020-10-16.
[5]	中华人民共和国国家卫生健康委员会办公厅. 中国结核病预防控制工作技术规范(2020年版). 国卫办疾控函〔2020〕279号. 2020-04-02.
[6]	GovHK香港政府一站通. 预防及处理结核病守则(学校篇)[EB/OL]. [2024-05-22]. https://www.info.gov.hk/tb_chest/tb-chi/contents/Guidelines_School.htm.
[7]	中华人民共和国澳门特别行政区政府卫生局. 教育和托儿机构常见传染病的预防[EB/OL]. [2024-05-22]. https://www.ssm.gov.mo/docs/1487/1487_d8c2ff16ec784803b07b77d91a6e30e5_000.pdf.
[8]	中华人民共和国澳门特别行政区政府卫生局. 学校群集性传染病处理指引[EB/OL]. [2024-05-22]. https://www.ssm.gov.mo/docs2/file/pv/e1rpHykg5O1B7oisB8g/ch.
[9]	中国台湾“疾病管制署”. 2023年结核病防治工作手册[EB/OL]. [2024-05-22]. https://www.cdc.gov.tw/Uploads/1f7a58e8-349d-4cd8-9fba-316e7a6a8a9b.pdf.
[10]	中国台湾地区台湾大学. “国立台湾大学”结核病感染防治与管理办法. 2022-07-14.
[11]	World Health Organization. WHO guidelines on tuberculosis infection prevention and control, 2019 update. Geneva: World Health Organization, 2019.
[12]	World Health Organization. Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children. 2nd ed. Geneva: World Health Organization, 2014.
[13]	World Health Organization. WHO consolidated guidelines on tuberculosis: module 5: management of tuberculosis in children and adolescents. Geneva: World Health Organization, 2022.
[14]	World Health Organization. WHO operational handbook on tuberculosis: module 5: management of tuberculosis in children and adolescents. Geneva:World Health Organization, 2022.
[15]	U.S. Centers for Disease Control and Prevention. Treatment of Tuberculosis[R/OL]. Atlanta:U. S. Centers for Disease Control and Prevention, 2005[2024-05-22]. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm.
[16]	Sosa LE, Njie GJ, Lobato MN, et al. Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019. MMWR Morb Mortal Wkly Rep, 2019, 68(19):439-443. doi:10.15585/mmwr.mm6819a3.
[17]	Blok N, van den Boom M, Erkens C, et al. Variation in policy and practice of adolescent tuberculosis management in the WHO European Region. Eur Respir J, 2016, 48(3):943-946. doi:10.1183/13993003.00704-2016. pmid: 27471205
[18]	Zvonareva O, Witte S, Kabanets N, et al. Adolescents in a tuberculosis hospital: Qualitative study of how relationships with doctors, caregivers, and peers mediate their mental wellbeing. PLoS One, 2021, 16(10):e0257379. doi:10.1371/journal.pone.0257379.
[19]	Department of Health, Philippines. National TB Control Program[EB/OL]. Manila:Department of Health, Philippines[2024-05-22]. https://ntp.doh.gov.ph/about-tb/faq/.
[20]	Malaysian Health Technology Assessment Section (MaHTAS), Ministry of Health Malaysia. Management_of_Tuberculosis (4th_Edition)[EB/OL]. Putrajaya:Malaysian Health Technology Assessment Section, 2021[2024-05-22]. https://www2.moh.gov.my/moh/resources/Penerbitan/CPG/Respiratory/CPG-_Management_of_Tuberculosis_(4th_Edition).pdf.
[21]	Oliva Rapoport VE, Altamirano E, Senador L, et al. Impact of prolonged isolation on adolescents with drug-susceptible tuberculosis in Lima, Peru: a qualitative study. BMJ Open, 2022, 12(9):e063287. doi:10.1136/bmjopen-2022-063287.
[22]	Rouillon A, Perdrizet S, Parrot R. Transmission of tubercle bacilli: The effects of chemotherapy. Tubercle, 1976, 57(4):275-299. doi:10.1016/s0041-3879(76)80006-2. pmid: 827837
[23]	Hobby GL, Holman AP, Iseman MD, et al. Enumeration of tubercle bacilli in sputum of patients with pulmonary tuberculosis. Antimicrob Agents Chemother, 1973, 4(2):94-104. doi:10.1128/AAC.4.2.94. pmid: 4208508
[24]	Jindani A, Aber VR, Edwards EA, et al. The early bactericidal activity of drugs in patients with pulmonary tuberculosis. Am Rev Respir Dis, 1980, 121(6):939-949. doi:10.1164/arrd.1980.121.6.939.
[25]	Brooks SM, Lassiter NL, Young EC. A pilot study concerning the infection risk of sputum positive tuberculosis patients on chemotherapy. Am Rev Respir Dis, 1973, 108(4):799-804. doi:10.1164/arrd.1973.108.4.799.
[26]	Riley RL, Mills CC, O’Grady F, et al. Infectiousness of air from a tuberculosis ward. Ultraviolet irradiation of infected air: comparative infectiousness of different patients. Am Rev Respir Dis, 1962, 85:511-525. doi:10.1164/arrd.1962.85.4.511.
[27]	Riley RL, Mills CC, Nyka W, et al. Aerial dissemination of pulmonary tuberculosis. A two-year study of contagion in a tuberculosis ward. Am J Epidemiol, 1995, 142(1):3-14. doi:10.1093/oxfordjournals.aje.a117542. pmid: 7785671
[28]	Proaño A, Bravard MA, López JW, et al. Dynamics of Cough Frequency in Adults Undergoing Treatment for Pulmonary Tuberculosis. Clin Infect Dis, 2017, 64(9):1174-1181. doi:10.1093/cid/cix039. pmid: 28329268
[29]	Tracey BH, Comina G, Larson S, et al. Cough detection algorithm for monitoring patient recovery from pulmonary tuberculosis. Annu Int Conf IEEE Eng Med Biol Soc, 2011, 2011:6017-6020. doi:10.1109/IEMBS.2011.6091487. pmid: 22255711
[30]	Loudon RG, Spohn SK. Cough frequency and infectivity in patients with pulmonary tuberculosis. Am Rev Respir Dis, 1969, 99(1):109-111. doi:10.1164/arrd.1969.99.1.109.
[31]	Robert CN. Infectiousness of pulmonary tuberculosis after starting chemotherapy: Review of the available data on an unresolved question. Am J Infect Control, 1981, 9(1): 6-10. doi:10.1016/S0196-6553(81)80003-X.
[32]	Calderwood CJ, Wilson JP, Fielding KL, et al. Dynamics of sputum conversion during effective tuberculosis treatment: A systematic review and meta-analysis. PLoS Med, 2021, 18(4):e1003566. doi:10.1371/journal.pmed.1003566.
[33]	管红云, 谭卫国, 杨应周, 等. 2009—2013年深圳市学生结核病流行特征分析. 临床肺科杂志, 2016, 21(8):1496-1499. doi:10.3969/j.issn.1009-6663.2016.08.040.
[34]	中华人民共和国国家卫生计划生育委员会办公厅, 中华人民共和国教育部办公厅. 学校结核病防控工作规范(2017版). 国卫办疾控发〔2017〕22号. 2017-06-29.
[35]	高谦, 梅建. 我国学校结核病预防与控制的思考. 中国防痨杂志, 2020, 42(3):195-199. doi:10.3969/j.issn.1000-6621.2020.03.003.
[36]	U.S. Centers for Disease Control and Prevention. Controlling tuberculosis in the United States,Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America[R/OL]. Atlanta:U. S. Centers for Disease Control and Prevention, 2005[2024-05-22]. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5412a1.htm.
[37]	U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, et al. Questions and answers about tuberculosis[EB/OL]. Atlanta: Centers for Disease Control and Prevention, 2014. https://www.cdc.gov/tb/media/Question_Answers_About_TB_English.pdf.
[38]	Moscibrodzki P, Enane LA, Hoddinott G, et al. The Impact of Tuberculosis on the Well-Being of Adolescents and Young Adults. Pathogens, 2021, 10(12):1591. doi:10.3390/pathogens10121591.
[39]	Chiang SS, Waterous PM, Atieno VF, et al. Caring for Adolescents and Young Adults With Tuberculosis or at Risk of Tuberculosis: Consensus Statement From an International Expert Panel. J Adolesc Health, 2023, 72(3):323-331. doi:10.1016/j.jadohealth.2022.10.036. pmid: 36803849
[40]	World Health Organization. Roadmap towards ending TB in children and adolescents, 3rd ed. Geneva: World Health Organization, 2023.

区域	参考文献	休学规定	隔离时长	休学时长	复学标准和要求	治疗要求
中国内地	[5]	经医生确诊为病原学阳性或重症病原学阴性即休学	具有传染性期间	6个月以上	(1)病原学阳性及重症病原学阴性患者经规范全疗程治疗后达到治愈或完成治疗的标准。(2)其他病原学阴性患者经过2个月的规范治疗后,症状减轻或消失,胸部X线摄片显示病灶明显吸收;并在此基础上自治疗3个月末起,至少2次涂片检查均阴性且至少1次分枝杆菌培养为阴性	标准方案治疗
中国香港	[6]	经医生确诊为病原学阳性即休学	2周	2周	隔离治疗2周,经医疗评估后	6个月或以上
中国澳门	[7-8]	经医生确诊为病原学阳性即休学	医生声明不再具有传染性为止	医生声明不再具有传染性为止	医生证明不再具有传染性为止	世界卫生组织批准的标准化有效抗结核治疗方案
中国台湾	[9]	经医生确诊为病原学阳性即休学	2周	2周	有效服药14d后	世界卫生组织批准的标准化有效抗结核治疗方案

区域	参考文献	休学规定	隔离时长	休学时长	复学标准和要求	治疗要求
世界卫生组织	[13]	经医生确诊为病原学阳性即休学	2周	规范化治疗2周后身体状况良好,应尽快重返学校	身体状况良好,主要指标包括:患者没有明显不适症状或并发症,如发热、咳嗽、胸痛等;患者体质量没有明显下降,营养状态基本良好等。但复学后仍要坚持服药完成治疗方案,并定期随访	对于3个月至16岁的非严重结核病儿童和青少年患者,应使用缩短至4个月的治疗方案
美国	[15]	经医生确诊为病原学阳性即休学	2周	2周隔离+3次涂片和1次培养均为阴性(1次/间隔1~2周),共5~8周	痰涂片连续3次(间隔1~2周不等)检测结果均为阴性,由专科医生证实结核病病情得到控制为止	可能需要4、6或9个月,具体取决于治疗方案
欧洲西部国家	[17]	经医生确诊为病原学阳性即休学	具有传染性期间(一般为2周)	2周隔离+3次涂片和1次培养均为阴性(1次/间隔1~2周),共约5~8周	涂片和培养结果均为阴性(应1次/间隔1~2周,连续3次),且患者对药物敏感	标准方案治疗
欧洲东部国家	[18]	经医生确诊为病原学阳性即休学	全部治疗疗程	药物敏感结核病3个月,耐多药结核病6个月及以上	全部疗程结束后	药物敏感结核病3个月,耐多药结核病6个月或以上
菲律宾和马来西亚	[19]	经医生确诊为病原学阳性即休学	2~3周	2~3周	服药2~3周后,单次痰涂片阴性后	世界卫生组织批准的标准化有效抗结核治疗方案
秘鲁	[21]	经医生确诊为病原学阳性即休学	2个月	2个月	隔离2个月,单次痰涂片阴性后	世界卫生组织批准的标准化有效抗结核治疗方案

登记年份	全人群				学生
	治疗前病原学阳性患者例数	治疗后阴转情况			治疗前病原学阳性患者例数	治疗后阴转情况
	治疗前病原学阳性患者例数	2个月末	3个月末	5个月末	治疗前病原学阳性患者例数	2个月末	3个月末	5个月末
2014	522	456(87.36)	495(94.83)	522(100.00)	18	18(100.00)	18(100.00)	18(100.00)
2015	468	429(91.67)	443(94.66)	452(96.58)	12	12(100.00)	12(100.00)	12(100.00)
2016	588	548(93.20)	550(93.54)	551(93.71)	19	17(89.47)	18(94.74)	18(94.74)
2017	570	517(90.70)	538(94.39)	545(95.61)	13	13(100.00)	13(100.00)	13(100.00)
2018	656	597(91.01)	616(93.90)	627(95.58)	13	13(100.00)	13(100.00)	13(100.00)
2019	742	669(90.16)	689(92.86)	701(94.47)	30	29(96.67)	29(96.67)	29(96.67)
2020	691	623(90.16)	647(93.63)	659(95.37)	25	24(96.00)	24(96.00)	25(100.00)
2021	703	629(89.47)	651(92.60)	660(93.88)	31	31(100.00)	31(100.00)	31(100.00)
2022	573	495(86.39)	518(90.40)	526(91.80)	21	21(100.00)	21(100.00)	21(100.00)
2023	701	604(86.16)	626(89.30)	635(90.58)	35	35(100.00)	35(100.00)	35(100.00)
合计	6214	5567(89.59)	5800(93.34)	5892(94.82)	217	213(98.16)	214(98.62)	215(99.08)