某部队结核病聚集流行的现场调查与控制研究

Field Investigation and Control of an Outbreak of Tuberculosis in an Army

目的探讨部队某部新兵连一起结核病聚集的流行因素,控制结核的进一步蔓延。方法对该部所有新兵及密切接触者进行流行病学调查、X线检查、结核菌素试验、X线检查异常者进行痰结核菌检查,查找结核菌,确诊结核病人,追踪传染源。结果 2008年2月-2009年2月1年内,640名新兵中共确诊活动性结核34例,罹患率5.31%。时间分布呈现两个小高峰,在春秋季。PPD检测人数扩大到新兵密切接触者,共833例,阳性共598例,结核感染率71.79%;强阳性48例,强阳性率5.76%。大大高于对照的未发病部队(P<0.01)。结论首发病例的误诊和未隔离是本次暴发的源头。应加强上下级卫生防疫部门的沟通,采取综合性的结核病防治措施,预防结核病的聚集流行。

Objective To investigate the related factors of an outbreak of tuberculosis in the recruits stationed in an army,and to further control the spread of tuberculosis. Methods Epidemiological investigation,chest X-ray examination and PPD test were performed in all recruits and their contacts.Sputum smear test was conducted among the soldiers with abnormal results of X-ray examination,and TB patients were confirmed by laboratory tests.The source of infection was traced. Results Thirty-four active TB cases were detected among 640 recruits during the one-year period（from February 2008 to February 2009）,and the attack rate was 5.31%.TB cases peaked in March and September.Among 833 recruits and contacts, 598 were PPD positive,with TB infection rate of 71.79%.There were 48 PPD strong-positive cases,with the strong-positive rate of 5.76%.TB infection rate was statistically significant different between the army and the other control army without TB case（P〈0.01）. Conductions Lack of timely treatment and isolation of infective TB case is the main reason of this TB breakout.It is necessary to enhance the communication among the TB control departments and adopt comprehensive measures so as to prevent and control TB aggregation epidemic.