重庆市一起学校肺结核聚集性疫情调查分析

Investigation and analysis of a school pulmonary tuberculosis aggregated epidemic in Chongqing

目的:对重庆市一起学校肺结核疫情进行调查和分析,为强化学校结核病防控工作提供思路和建议。方法:采用描述性流行病学方法,对重庆市2020年12月至2021年5月一起学校肺结核疫情进行流行病学调查和分析。采用症状筛查、结核菌素皮肤试验(tuberculin skin test,TST)和胸部X线摄片(简称“胸片”)开展肺结核筛查,并对接触者开展流行病学调查。结果:在确诊1例病原学阳性肺结核病例(指示病例)后,经过4次接触者筛查及1次随访检查,检出8例活动性肺结核患者和42例结核分枝杆菌潜伏感染者。校内8例学生患者均集中在指示病例所在班级,该班肺结核罹患率为12.7%(8/63),病原学阳性者占2/8,结核分枝杆菌潜伏感染者34例,潜伏感染率为61.8%(34/55),均全部完成预防性治疗。指示病例所在班级学生发病风险和感染风险均高于其他班级(RR=27.6,95%CI:13.5~56.4)。校内8例学生肺结核患者中,男生6例,女生2例,年龄分布以15岁组最多(6例)。因首次接触者筛查胸片质量差,未能及时发现学生患者,导致后续因症就诊发现3例患者。2例学生潜伏感染者因未规范服药,在预防性治疗期间转为肺结核患者。结论:本次肺结核疫情聚集性明显,筛查质量低、未能规范完成预防性治疗是疫情蔓延的重要原因。在处置学校肺结核疫情时,应提高筛查质量,根据流行病学调查情况充分考虑窗口期问题,保证预防性治疗的规范性和完成率。

Objective:To investigate and analyze a school aggregated pulmonary tuberculosis epidemic in Chongqing and to provide thoughts and suggestions for the prevention and control of tuberculosis in schools.Methods:Descriptive epidemiological methods were used to investigate and analyze a school pulmonary tuberculosis epidemic in Chongqing from December 2020 to May 2021.Pulmonary tuberculosis screening was conducted with symptom screening,tuberculin skin test(TST)and chest X-ray,and epidemiological investigation of close contacts was also carried out.Results:After confirming 1 case of pulmonary tuberculosis with positive etiology(the index case),8 active pulmonary tuberculosis patients and 42 latent tuberculosis infection patients were detected after 4 close contacts screening and 1 follow-up screening.All the 8 pulmonary tuberculosis students were concentrated in the class of the indicator case,with the incidence rate of 12.7%(8/63)and the etiological positive rate of 2/8.There were 34 latent tuberculosis infection patients,the latent infection rate of pulmonary tuberculosis was 61.8%(34/55),and all of them had completed preventive treatment.The incidence risk and infection risk of students in the class of the indicator case(RR=27.6,95%CI:13.5-56.4)were higher than those in other classes.Among the 8 cases of pulmonary tuberculosis in school,6 were male,and 2 were female.The age distribution of cases was most in the 15-year old group(6 cases).Due to the poor quality of the chest X-ray of the first contact screening,the student patients were not found in time,resulting in the subsequent diagnosis of 3 patients.Two latent infected students were transformed into pulmonary tuberculosis patients during preventive treatment due to non-standard medication.Conclusion:The clustering of the epidemic was obvious.The low quality of screening and the failure to complete preventive treatment were important reasons for the spread of the epidemic.Therefore,when dealing with the school pulmonary tuberculosis epidemic,the quality of screening should be improved,the window period should be fully considered according to the epidemiological survey,and the standardization and completion rate of preventive treatment should be ensured.