江苏省无锡市滨湖区2014—2018年学校结核病密切接触者筛查

Screening results of close contacts with tuberculosis in schools in Binhu District, Wuxi, Jiangsu,2014-2018

目的了解无锡市滨湖区学校结核病疫情现状和密切接触者筛查情况,为学校结核病防控策略提供科学依据。方法对辖区内2014—2018年所有学校结核病患者的密切接触者进行结核可疑症状、结核菌素试验(tuberculosis test)和/或胸部X线摄影等检查,并对筛查数据进行描述性分析。结果2014—2018年滨湖区共发现学校结核病患者62例,男∶女=1.82∶1,其中2018年发病26例,占当年发病数的11.30%,各年构成比差异有统计学意义(P<0.01)。结核菌素试验筛查3893人,结核菌素试验阳性者627人(16.11%),其中结核菌素试验强阳性者309人(7.94%),共确诊新患者12例。涂阳、涂阴、结核性胸膜炎患者的密切接触者结核菌素试验阳性率和强阳性率分别为18.11%和10.57%、16.02%和7.88%、14.69%和5.08%,差异均无统计学意义(P>0.05)。涂阳患者的强阳性比例高于结核性胸膜炎患者(P<0.05)。第1~4季度报告患者构成比分别为12.90%、16.13%、25.81%和45.16%,差异有统计学意义(P<0.01)。病例中大学34例(占54.84%),学校发病构成比差异有统计学意义(P<0.01)。聚集性和散发疫情筛查强阳性率分别为20.59%和5.44%,差异有统计学意义(P<0.01)。结论2014—2018年滨湖区学校结核病发病人群以大学生为主,各种类型结核患者的密切接触者均需开展结核菌素试验筛查,聚集性疫情结核菌素试验筛查强阳性率较散发疫情高,第4季度发病构成比最高。应提高强阳性密切接触者的预防性服药率,强化结核病健康知识宣传,避免学校结核病的暴发流行。

Objective To investigate the current status of tuberculosis(TB)epidemic in schools in Binhu District of Wuxi City and screen for the close contacts,so as to provide scientific basis for controlling the epidemic situation of TB in schools.Methods The suspicious symptoms of TB,tuberculosis tests and/or X-ray chest radiography were carried out among the close contacts of TB patients in all schools in Binhu District from 2014 to 2018,and the screening data were analyzed descriptively.Results From 2014 to 2018,62 TB cases were found in schools in Binhu District,the ratio of male to female was 1.82∶1,26 of which occurred in 2018,accounting for 11.30%of the total number of cases in 2018.There was a significant difference in the composition ratio of TB cases during these years(P<0.01).Tuberculosis tests were performed among 3893 people,of which 627 people were positive(16.11%)and 309 people(7.94%)were strongly positive.As well,a total of 12 new patients were diagnosed.Tuberculosis testpositive rates of the close contacts of sputum smear positive,sputum smear negative and TB pleurisy patients were 18.11%,16.02%and 14.69%respectively,and strong positive rates were 10.57%,7.88%and5.08%respectively.And there were no significant differences of overall positive rate and comparison between two groups(P>0.05).There was no significant difference in strong positive rate(P>0.05).The strong positive rate of smear positive patients was higher than that of tuberculosis pleurisy(P<0.05).The proportion of reported patients in schools in the first quarter was 12.90%,16.13%in the second quarter,25.81%in the third quarter and 45.16%in the fourth quarter.There were significant differences in the proportion of incidences among four quarters(P<0.01).And 34 cases were from universities,which accounting for54.84%,there were significant differences among school incidence composition ratio(P<0.01).The strong positive rate of screening result of one clustered epidemic was 20.59%and that of other epidemics was 5.44%,the difference between them was statistically significant(P<0.01).Conclusion The majority of TB patients in schools in Binhu District were college students from 2014 to 2018.The tuberculosis test is to be performed in close contact with all types of tuberculosis patients.The strong positive rate of screening result of clustered epidemic was higher than other epidemics.The most proportion of reported patients was found in the fourth quarter.So it is necessary to strengthen the management of preventive medication for positive close contacts,publicity of tuberculosis health knowledge in autumn and winter should be strengthened.The outbreak of tuberculosis in schools can be avoided.