从新密市20年学生结核病发病情况反思学校结核病防治策略的实施

Rethinking the implementation of tuberculosis prevention and control strategy in school from the incidence of tuberculosis among students in Xinmi for 20 years

目的评价学校结核病防治策略的实施效果。方法对所有新发现的学生结核病病例统一建立病案,正规管理治疗;对网络报告的24岁以下可疑结核病例指定专人登记追踪,查明学生身份,确诊或者排除;定期到综合医院和乡镇卫生院检查漏诊漏报情况,重点关注24岁以下可疑学生身份结核病例。结果 1999-2018年新密市新登记学生结核病患者686例,年均登记34.30例,以高中生发病人数最多,占总发病人数的41.84%,各学龄段之间差异有统计学意义(χ^2=154.703,P<0.05);病例来源以因症就诊及转诊最高(54.81%),其它来源依次是健康检查(含高考体检)(22.16%)、接触者检查(16.91%)和入学新生体检(6.12%)。结论学校开展结核病防控工作是一项复杂繁重的系统工程,只要做好防痨宣教、重视患者日常发现、开展高中等重点学校的预防性体检和对结核菌素试验强阳性学生落实预防服药等措施,减少或消除结核病在学校的传播和流行还是大有希望的。

Objective To observe the incidence of tuberculosis among students in 20 years under the comprehensive prevention and control measures of Xinmi City School, and provide evidence for the development of school tuberculosis prevention and control strategies. Methods Establish a medical record for all newly discovered student tuberculosis cases and formalize treatment. Designate special person registration tracking for suspected tuberculosis cases under the age of 24 reported by the network to identify the student’s identity, confirm or exclude. Regularly go to general hospitals and township hospitals to check for missed reports, focusing on tuberculosis cases of suspicious students under the age of 24. Results From 1986 to 2018, Xinmi registered 686 new cases of tuberculosis students, with an average annual registration of 34.30 cases. The number of high school students was the highest(41.84 %), The difference between the school age groups was statistically significant(χ^2=154.703,P<0.05). In these tuberculosis students, the highest rate of diagnosis and referral was 54.81 %, other sources were health check(including college entrance examination) 22.16 %,contact check 16.91 % and enrollment freshmen were 6.12 %. Conclusions It is necessary to do a good job of tuberculosis prevention and control, pay attention to the daily discovery of patients, carry out preventive physical examination in key schools such as high school and carry out preventive measures for the students with strong positive for tuberculin test, It is still promising to reduce or eliminate the spread and prevalence of tuberculosis in schools.