补习学校肺结核暴发的特征及原因调查

Survey for the characteristics and cause of pulmonary tuberculosis outbreak in a continuation school for college entrance examination

目的 2013年4-7月某高考补习学校多名学生陆续被诊断为活动性肺结核。方法采用肺结核可疑症状调查、胸部影像学、结核菌素(PPD)试验、痰涂片检查等对全体师生和被诊断学生的家庭密切接触者进行筛查;收集病例的社会人口学资料进行横断面分析。结果首例患者发病后约2个月才明确诊断,随后该班级45人中有10名学生先后被诊断为活动性肺结核,罹患率22.2%。肺结核病例除与首发病例有密切接触之外,与性别、年龄、户籍等无明显关联。结论这是一起典型的学校班级内感染的结核病暴发,具有发病水平较高、季节性和聚集性等特征。本次暴发原因主要是学校结核病防控意识欠缺、综合医疗机构迟报、漏报、转诊不及时等因素共同造成的。

Objective To investigate the characteristics and causes of pulmonary tuberculosis outbreak in a continuation school for college entrance examination. Methods The cases were searched in all students and school staff, and families closely contacted by student diagnosed as PTB, by investigating suspected PTB symptoms, chest imaging, PPD skin testing, sputum smear microscopy. The socio-demographic data of all cases were collected for the cross-sectional analysis. Results The initial case was diagnosed SS- PTB in April, 2013. After about 2 months of incubation, 10 students of the total diagnosed as active PTB and belonged to a class of students constantly. The attack rate of active was 22.2%. In addition to close contact with initial case, the pulmonary tuberculosis patients had no significant association with gender, age, household registration, accommodation etc. Conclusion This is a typical outbreak of PTB infected within the school, whose characteristics include higher incidence level in late spring and early summer season, longer duration of exposure, evident case clustering. The outbreak is mainly due to schools without awareness and lacking sensitivity of TB control and prevention, and the comprehensive medical institutions failed to report and referral of tuberculosis students timely.