江苏省启东市某中学一起结核病疫情流行病学调查

Epidemiological investigation analysis of a tuberculosis epidemic in a middle school in Qidong,Jiangsu

目的分析2019年江苏省启东市某中学一起结核病疫情流行病学特点及调查处置过程,为学校结核病疫情防控策略提供参考建议。方法按照《学校结核病防控工作规范(2017版)》开展学校疫情处置和密切接触者筛查,根据病例发病时间轴和班级分布等情况判断疫情流行病学关联性。结果 2019年7月-2020年4月,江苏省启东市某中学一起结核病疫情,疫情共持续9个月,共确诊肺结核病例11例,罹患率为0.67%,其中男性学生7例,女性学生4例,病例全部为同一班级学生,具有班级聚集性。11例病例痰涂片结果 1例呈阳性,10例阴性,所有患者均采用2HEZR/4EHR一线抗结核治疗方案,治疗成功率100.0%。共筛查密切接触者361名,结核菌素皮肤试验强阳性12例,强阳性率为3.32%,学生和教师的强阳性率分别为3.22%(11/342)和5.26%(1/19),差异有统计学意义(P<0.05);对370名师生进行X线胸片/CT筛查,X线胸片异常者9例,胸片异常率为2.43%,其中学生胸片异常率为2.42%(8/331),教师胸片异常率为2.56%(1/39),差异无统计学意义(P=0.955)。结论本次学校肺结核病疫情传播的主要原因为首发涂阳病例未及时诊断治疗,在班级中造成传播。学校结核病疫情应严格按照规范处置,定期开展随访工作,可及时发现新病例,有利于及时采取有针对性的防控措施,是控制学校肺结核疫情的重要手段。

Objective To describe the epidemiological characteristics and investigation and disposal process of a tuberculosis outbreak in a middle school in Qidong City,2019,and we provide suggestions for the prevention and control of the school tuberculosis outbreak.Methods In accordance with the"School Tuberculosis Prevention and Control Work Regulations(2017 Edition)",control work and close contacts screening were carried out,and epidemiological links were judged based on the timeline of the onset of patients and the distribution of classes.Results The school outbreak lasted for 9 months from July 2019 to April 2020.A total of 11 tuberculosis patients were diagnosed,with an attack rate of 0.67%,including 7 male students and 4 female students.All of the 11 students were in the same class,with class aggregation.1 of 11 tuberculosis patients was sputum smear positive,and the others were negative.All the patients took the first-line anti-tuberculosis treatment with a regimen of 2HEZR/4EHR,and were treated successfully,with the treatment success rate was 100.0%.A total of 361 close contacts were screened,and 12 contacts were strongly positive of tuberculin skin test,with a strong positive rate of 3.32%.The strong positive rate of students and teachers were 3.22%(11/342)and 5.26%(1/19),respectively,and the difference was statistically significant(P<0.05).370 teachers and students were screened by X-ray chest radiographs/СТ,9 cases with abnormal chest radiographs,and the abnormal chest radiographs rate was 2.43%,among which the abnormal chest radiographs rate of students was 2.42%(8/331)and that of teachers was 2.56%(1/39),the difference was not statistically significant(P=0.955).Conclusion The main reason for the spread of this school outbreak was the delay diagnosis of the first index patient,which caused further transmission in the class.Standardized treatment and regular follow-up screening work can make early detection of subsequent cases,which is an important means to control the epidemic of tuberculosis in schools.