2018年上海市松江区学校师生结核病流行及密切接触者筛查结果分析

Analysis on tuberculosis epidemical situation and screening results of close contacts in schools of Songjiang District of Shanghai in 2018

目的了解上海市松江区学校结核病疫情现状,对密切接触者进行筛查,为松江区学校结核病防控工作提供科学依据.方法以辖区内所有学校(其中普通高校9所,中专及高职学校2所,中学28所,小学56所,托幼机构157所)的师生为监测对象,其中2018年高校师生有79011名,中专职校、中小学及托幼机构师生有261196名.对松江区学生结核病患者不仅通过《结核病管理信息系统》获取数据,还收集了其他省市疾病预防控制中心及学校直接报告的患者信息.对密切接触者筛查时,同时进行症状、X线胸部摄影(以下简称“胸片”)及结核菌素纯蛋白衍生物(PPD)皮肤试验等诊断与检查.结果2018年松江区16所学校共发现肺结核患者69例,男∶女=1.09∶1(36/33),高校肺结核发病率为69.61/10万(55/79011),中专职校、中小学及托幼机构发病率为5.36/10万(14/261196),差异有统计学意义(X^2=123.49,P<0.001).第一季度报告患者构成比为17.39%(12/69),第二季度为30.43%(21/69),第三季度为27.54%(19/69),第四季度为24.64%(17/69),各季度发病率差异无统计学意义(X^2=2.59,P>0.05).《结核病管理信息系统》中登记报告的患者38例,占55.07%;与外省市疾病预防控制中心之间通过信息交流确定患者20例,占28.99%;校医院上报至我区疾病预防控制中心患者11例,占15.94%.筛查密切接触者2617名,其中行胸片筛查2235名,发现异常者2例;PPD试验筛查2392名,PPD阳性者735名(30.73%),PPD强阳性者48名(2.01%);通过对筛查异常者进一步检查,共确诊新患者2例.涂阳与涂阴(含结核性胸膜炎)患者的密切接触者PPD阳性率分别为29.03%(234/806)和32.85%(521/1586);强阳性率分别为2.48%(20/806)和1.77%(28/1586),差异均无统计学意义(X^2=3.61,P>0.05;X^2=1.39,P>0.05).结论2018年松江区学校结核病发病人群以大学生为主,第二季度发病构成比最高;及时有效地进行密切接触者筛查,可避免学校结核病的暴发流行.

Objective To get comprehensive understanding of the tuberculosis epidemic and screen the close contacts in schools in Songjiang, and to provide scientific evidence for the tuberculosis prevention and control in schools. Methods The pulmonary TB (PTB) epidemic information in local schools was collected from the Tuberculosis Information Management System (TBIMS) and cases reported by Center for Disease Control and Prevention (CDC) of other provinces and schools. The monitoring objects include 9 universities, 2 vocational schools, 28 middle schools, 56 elementary schools and 157 kindergartens. The number of students and teachers were 79 011 for universities and 261 196 for other schools, respectively. The research screened close contacts by suspicious symptoms, chest X-ray and tuberculin (PPD) skin test. Results In 2018, a total of 69 tuberculosis cases were reported in 16 schools of Songjiang with the ratio of male versus female was 1. 09 : 1 (36/33). The reported incidence was 69. 61/100 000 (55/79 011) in university and 5. 36/100 000 (14/261 196) in other schools, and the difference was significant (X^2= 123. 49, PV0. 001). The constituent ratios of reported PTB students in four quarters were 17. 39%(12/69), 30.43%(21/69), 27.54%(19/69) and 24.64%(17/69) respectively without statistical difference between each quarter (X^2= 2.59, P>0.05).38 (55.07%) cases registered in TBIMS, 20 cases (2& 99%) were identified by information communication with other provinces and 11 cases (15. 94%) were reported by school medical clinics. A total of 2617 close contacts were screened, 2235 of whom were screened by chest X-ray and 2 students had abnormalities. Tuberculin skin test was carried out among 2392 students, among whom 735 (30.73%) were positive. 48 (2.01%) were strong positive. 2 new cases were detected by further examination The positive rates of PPD for close contacts of smear-positive and smear-negative (including tuberculous pleurisy cases) cases were 29. 03%(234/806) and 32. 85%(521/1586), and the strong positive rates of PPD were 2. 48%(20/806) and 1. 77%(28/1586).respectively. Both had no statistical difference (X^2=3. 61, P〉0. 05;= 1. 39, P>0. 05). Conclusion In 2018, the incidence of tuberculosis in schools in Songjiang district is mainly among college students, with the highest incidence ratio in the second quarter. Timely and effective screening of close contacts can prevent outbreaks o￡ tuberculosis in schools.