天津市某成人职教中心一起肺结核聚集性疫情调查

Investigation of an outbreak of tuberculosis in an adult education centre in Tianjin

目的对天津市某成人职教中心一起肺结核聚集性疫情进行调查分析?为制定学校结核病例处置方法提供依据。方法收集2017年10月至2018年4月天津市某成人职教中心一起肺结核疫情流行病学调查及筛查结果材料,对该起疫情的流行特征、发生原因和处置措施进行分析、结果该成人职教中心自发现首发病例起.共组织3次密切接触者结核菌素皮肤试验和胸片检查.筛查范围覆盖全校,陆续共确诊17例病例。前2例病例为因症就诊,其余15例病例均为筛查发现。17例确诊病例分布在5个班级,主要集中在首发病例所在班,23名学生中确诊12例(52. 2%);同楼层其他班级159名学生中确诊2例(1. 3%)。首发病例所在班级学生肺结核发病风险是同楼层其他班级学生的86.73倍(95%CI:17.22~436.87X^2=67. 19.PV0.01)。首发及第2例涂阳培阳病例所在宿舍10名学生中确诊8例;同楼层其他宿舍129名学生中确诊4例。首发及第2例涂阳培阳病例所在宿舍学生肺结核发病风险是同楼层其他宿舍学生的125. 00倍(95%CI: 19. 82~788.44,X=^2=60.17P<0. 01).胸片异常和结核菌素皮肤试验强阳性的肺结核确诊率分别为66.7%(10/15)和11.0%(16/145)。结论校内通风不良.容易造成结核分枝杆菌的传播。学生病例不能尽早发现并隔离.容易引起同班级、宿舍接触者的感染和发病.学校疫情暴发期间.筛查手段的阳性预测值较高,需重点关注检查结果异常的学生。

Objective To analyze an outbreak of tuberculosis (TB) in an adult education centre in Tianjin, and to provide evidences for formulating disposition measures of school TB. Methods The information of an epidemiological investigation and screening on the outbreak of TB in the adult education center in Tianjin from October 2017 to April 2018 were collected, and the epidemiological characteristics, causes and disposition measures of the epidemic were analyzed. Results The center had organized three rounds of screening for close contacts by tuberculin skin test and chest X-ray examination since the first case was found. Seventeen students were diagnosed as TB in succession. The first two cases were detected by passive identification, and the remaining 15 cases were detected by screening. The 17 confirmed cases were distributed in five classes, mainly in the class of the first case (12 cases (52. 2%) were detected among the 23 students in the class). Two cases (1.3%) were diagnosed as TB among 159 students in other classes on the same floor. The risk of TB infection in the class of first case was 86. 73 times higher than other classes (95%C7: 17. 22 - 436. 87;X^2=67. 19, PV0. 01). Among the ten students in the dormitories of the first and second smear-positive cases? eight were diagnosed as TB. Four of the 129 students in the dormitories on the same floor were diagnosed as TB. The risk of TB infection in the dormitories of the first two cases was 125. 00 times higher than other classes ( 95% CI: 19. 82 - 78& 44;X^2=60. 17, P<0.01). In the outbreak, the diagnosis rates of abnormal chest X-ray and strong positive TB skin test were 66. 7%(10/15) and 11. 0%(16/145), respectively. Conclusion Poor ventilation is easy to cause the spread of Mycobacterium tuberculosis. The students with TB cannot be detected and put in quarantine as soon as possible, which is likely to cause infection and morbidity of contacts in the same classes and dormitories. During the outbreaks, the positive predictive value of screening measures is high so that the students with abnormal test results should be given special attention.