5起学校结核病聚集性疫情分析

Analysis of tuberculosis epidemic situation clusters in five schools

目的分析学校结核病疫情发生的原因,为进一步完善学校结核病防控措施提供建议。方法回顾性分析北京市西城区2014—2016年发生的5起学校结核病疫情的调查资料。结果 5起疫情的首发病例均为涂阳肺结核患者,均存在诊断延误。学校的结核病防控工作落实不到位、患者发现不及时是导致疫情发生的主要原因。医疗机构对肺结核可疑症状缺乏警惕性、诊疗手段有限致患者诊断延误也是疫情发生的原因之一。1所大学存在既往病例且未休学治疗,当地结防所机构密接筛查范围过小、对胸部异常者未追踪诊断结果,致患者漏发现。结防机构疫情处置不规范是导致疫情发生的另一个原因。结论导致学校结核病聚集性疫情发生的原因是多方面的,学校作为结核病防控工作的主体单位,要严格落实各项防控措施,便于患者的早发现早治疗。医疗机构要提高对肺结核可疑症状的认识,尽量避免诊断延误。结防机构规范开展密切接触者筛查,避免结核病患者漏诊。

Objective To analyze the causes of school tuberculosis（TB） epidemic situation clusters, so as to provide thesuggestions for TB control in schools.Methods The investigation data of TB epidemic situation clusters in five schools inXicheng District of Beijing from 2014 to 2016 were collected and analyzed retrospectively. Results All the initial patientswere sputum positive pulmonary TB cases and had a delay in diagnosis. The main cause of the outbreak was that the TBprevention and control work in the schools was not in place which made the patient not be found timely. One of the other causeswas that the medical institutions lacked the vigilance about the suspicious symptoms of TB and effective diagnosis method,which led to the diagnosis delay. Another cause was that the TB epidemic disposal was nonstandard. In one university, therewere previous TB cases that were not suspended from the school. In addition, the local TB institution designated the smallscreening scope and did not track the results of the abnormal chest examinations which made the patient not be found timely.Conclusions There are many causes for the outbreak of TB in schools. As the main unit of TB prevention and control, theauthorities of the schools should implement the prevention and control measures strictly to make sure the patients be diagnosedand treated early. The medical institutions also should raise the awareness of suspected symptoms of TB and try to avoid delaysin diagnosis, and the TB institutions should screen the contacts normatively to avoid misdiagnosing.