上海市学校结核病聚集性疫情分析

Descriptive analysis of tuberculosis outbreak at schools in Shanghai

目的 了解分析学校结核病聚集性疫情的发生发展,为有效控制其传播提供参考依据.方法 回顾性分析上海市2011年4月至2015年12月间发生的8起学校结核病聚集性疫情的发生发展和处置情况;开展密切接触者筛查和医学观察,随访追踪其发病情况;对培养阳性菌株进行基因型分型,判断患者间的传播情况.结果 8起疫情共12例指示患者.指示患者均为上海市疾病预防控制系统监测发现,7例在寒、暑假期间发病.筛查密切接触者2353名,随后的2年医学观察中有84例发病,6个月内密切接触者发病占后续发现患者的73.81％（62/84）,6个月至1年中发病占15.48％（13/84）,1年后发病占10.71％（9/84）.对2～9例的聚集性疫情进行分级处置,平均处置延误时间由2013年前的47.00 d下降到2013年后15.50 d（经Wilcoxon秩和检验,P＜0.05）.分子流行病学调查结果显示,2起引起聚集性疫情的8株菌株（一起3株、另一起5株）VNTR14位点基因型拷贝数均相同.结论 应加强学校结核病健康教育,严格落实新生入学体检及学生假期后返校时的传染病自主申报制度,加强疾病预防控制系统的主动监测和对聚集性疫情中密切接触者的管理,及时发现和治疗肺结核患者,有效控制学校结核病聚集性疫情的蔓延和传播.

Objective Understand the development of tuberculosis outbreak in schools to provide a reference for effective control of its spread.Methods Descriptive analysis was conducted on the data of 8 tuberculosis outbreak at schools in Shanghai from Apr.2011 to Dec.2015.Close contacts were investigated and followed up,field epidemiological investigation and molecular epidemiology study were also carried out.Results Eight tuberculosis outbreaks were detected at schools in Shanghai and 12 index cases were diagnosed as TB,7 of them were diagnosed during winter or summerbreak.Two thousand three hundred and fifty three close contacts were screened and 84 were diagnosed as TB patients during the two year follow up.Among those TB patients,about 73.81% （62/84） were diagnosed within 6 months after the screening,15.48% （13/84） were diagnosed between the 6th and the 12th months,and 10.71% （9/84） were diagnosis after one year follow up.After taking relevant measures based on different scale of the outbreak,the period of disposal delay reduced from 47.00 days before 2013 to 15.50 days after 2013 （P〈0.05）.By doing VNTR analysis on the 8 strains of 2 clustered tuberculosis cases,we found they were all mycobacterium tuberculosis.the number of copy of 14 points MIRU-VNTR genotyping was same,Conclusion Health education should be enhanced to students so that they do self-report on infectious disease while returning to school after break.Close contacts should also be followed up to detect new case early.