天津市某职业技术学校一起结核病聚集性疫情的调查分析

Investigation and analysis of a cluster outbreak of tuberculosis epidemic in a vocational and technical school in Tianjin City

目的对某职业技术学校一起结核病聚集性疫情进行调查分析,为制定学校结核病防控工作策略提供参考。方法收集2017年3~5月天津市某职业技术学校一起结核病聚集性疫情流行病学调查和筛查资料,分析该起疫情的确诊病例个案调查结果、密切接触者筛查结果、病例空间分布特征、处置措施、发生原因等。结果共组织4次密切接触者筛查,累计筛查1563人,其中在校学生1459人;共发现18例临床确诊的学生结核病患者,在校学生结核病总发病率为1.23%(18/1459),其中4例为主动就诊后确诊,其余14例均为筛查过程中发现。患者均分布在机电专业,主要集中在一年级3班(9例),宿舍主要分布在305室(4例),病例及结核菌素强阳性者呈现一定的聚集性。延误诊断、师生对结核病核心知识了解不足、知晓率低是造成本次聚集性疫情的主要原因。结论本次聚集性疫情的发病率较高,延误诊断、师生对结核病核心知识了解不足、知晓率低是造成本次聚集性疫情的主要原因。应加强学校结核病防治的健康教育,做好密切接触者的主动筛查,强化各级各类医疗机构的责任意识,以控制学校结核病疫情。

Objective To investigate and analyze a cluster outbreak of tuberculosis epidemic in a vocational and technical school in Tianjin City,and to provide reference for the development of school tuberculosis prevention and control strategies.Methods The epidemiological investigation and screening data of a cluster outbreak of tuberculosis epidemic in a vocational and technical school in Tianjin City from March to May 2017 were collected,and the investigation results of confirmed cases,the results of close contacts screening,the spatial distribution characteristics of the cases,treatment measures,and the causes of the epidemic were analyzed.Results A total of four rounds of close contacts screening were carried out,totaling 1563 people screened,wherein 1459 in-school students;a total of 18 students were identified clinically with tuberculosis,among in-school students the total incidence rate of tuberculosis was 1.23%(18/1459),wherein four cases got a confirmed diagnosis of tuberculosis after going to the medical institution for treatment voluntarily,and the remaining 14 cases were found by the screening.All patients majored in electromechanics,mainly came from Grade 1 Class 3(9 cases)and in the dorm room 305(4 cases),and the patients and those tested strongly positive for tuberculin showed a certain clustering.Delays in diagnosis,poor understanding and low awareness rate of the core knowledge of tuberculosis in teachers and students were the main causes for this cluster outbreak.Conclusion The incidence rate of this cluster outbreak is relatively high.Delays in diagnosis,poor understanding and low awareness rate of the core knowledge of tuberculosis in teachers and students are the main causes for this cluster outbreak.It is necessary to strengthen health education of tuberculosis prevention and treatment in schools,do a good job in active screening of close contacts,intensify responsibility consciousness of various medical institutions so as to control tuberculosis epidemic in schools.