江苏省南通市某中学一起结核病突发公共卫生事件回顾性分析

A retrospective analysis of a public health emergency of tuberculosis in a middle school in Nantong, Jiangsu

目的 分析南通市某中学一起结核病突发公共卫生事件,探讨疫情扩散的原因,为科学制定学校结核病疫情的防控措施的提供参考依据。方法 回顾该起突发公共卫生事件的流行病学调查、疫情处置等相关资料,对疫情的流行病学特征采用描述性分析。结果 首发病例症状不典型,非结核定点医疗机构对肺结核诊断的敏感性不高,以及对结核病患者报告、转诊不及时,导致传染源的长期存在,引发本次疫情在校园内的广泛传播。本次疫情共确诊肺结核病例26例,其中女性16例,男性10例,主要集中在高一(1)班(学生21例,教师1例)和高一(2)班(学生4例),具有班级聚集性。本次疫情先后对密切接触者进行PPD/胸片筛查4次,共计406人次,随访监测2次,共计189人。其中第1、4次筛查中共发现胸片异常者20例,第2、3次筛查中发现PPD强阳性20例,预防性服药率为94.12%。2次随访监测发现胸片异常者2例,PPD强阳性/T-Spot阳性/一年内PPD净增≥10 mm者共31人,应预防性服药25人,实际预防性服药25人,预防性服药率为100%。结论 应加强非结核定点医疗机构的培训和督查,全面实行新生入学肺结核筛查工作,尤其是对高感染生源地学生健康的监测及症状筛查,夯实学校主体责任制,规范疫情处置流程,加强学校健康教育,做好师生及家长的情绪稳定及心理支持工作,提高结核病防病意识,防止疫情的扩散。

Objective in a middle school of the students in Nantong, and discuss the reasons for the spread of the disease. To provide references for making scientific prevention and control measures for tuberculosis epidemic in schools.Methods investigation, epidemic situation disposal and other relevant data of the public health emergency were reviewed, and the epidemiological characteristics of the epidemic situation were analyzed by descriptive analysis.Results atypical cases were not typical, the sensitivity of non tuberculosis designated medical institutions to tuberculosis diagnosis was not high, and the reports and referral of tuberculosis patients were not timely, leading to the long-term existence of the infection source, which has led to the widespread spread of the epidemic in the campus. A total of 26 cases of pulmonary tuberculosis were diagnosed in this outbreak, including 16 females and 10 males, mainly in the senior one(1) class(21 students, 1 teachers)and one(2) class(4 students), with class aggregation. In this epidemic, close contacts were screened for PPD/chest film for 4times(406 people-times in total) and followed up for 2 times(189 people in total). Among them, 20 cases with abnormal chest X-ray were found in the first and fourth screening, 20 cases with strong PPD positive were found in the second and third screening, and the preventive medication rate was 94.12%. Two cases of chest X-ray abnormalities were found in follow-up monitoring. There were 31 cases of strong PPD positive/T-SPOT positive/PPD net increase ≥10 mm within one year. 25people should take preventive medicine, 25 people actually take preventive medicine, and the preventive medicine rate was100%.Conclusions medical institutions, fully implement the pulmonary tuberculosis screening of freshmen, strengthen the health monitoring and symptom screening of teachers and students, especially students from high infection source areas, consolidate the school main responsibility system, standardize the epidemic disposal process, and strengthen school health education. We should do a good job of emotional stability and psychological support for teachers and parents, improve awareness of tuberculosis prevention and prevent the spread of the epidemic.