一起寄宿制学校肺结核聚集性疫情调查分析

Investigation of pulmonary tuberculosis cluster in a boarding school in Beijing

目的:对北京市丰台区某寄宿制学校一起肺结核聚集性疫情进行调查和分析,为寄宿制学校及肺结核高发地区集体来京就读学生的肺结核防控提供参考。方法:采用描述性流行病学方法对北京市丰台区一起学校肺结核聚集性疫情进行流行病学调查。根据对首发病例的流行病学调查,划定密切接触者范围,采用症状筛查、结核菌素皮肤试验(tuberculin skin test,TST)及胸部X线摄片(简称“胸片”)检查等方法开展密切接触者筛查,胸片异常者进一步明确诊断。2018年6月至2019年4月,共进行了4次密切接触者筛查,每3个月1次。结果:该校共发现23例活动性肺结核患者和81名结核分枝杆菌潜伏感染者,其中17例患者为胸片筛查发现。该校高中部肺结核罹患率为4.8%(23/483),其中首发病例班级高三(5)班的罹患率为28.3%(15/53),其他班级罹患率为1.9%(8/430),高三(5)班学生的患病风险高于其他班级,差异有统计学意义(χ^(2)=72.74,P<0.001),是高中部其他班级的15.21(95%CI:6.06~38.17)倍。高中部青海省玉树藏族自治州学生组成的班级(简称“玉树班级”)学生整体罹患率为8.7%(20/229),结核分枝杆菌潜伏感染率为27.3%(62/227),其他班级结核分枝杆菌潜伏感染率为7.5%(19/252),玉树班级学生的感染风险高于其他班级,差异有统计学意义(χ^(2)=33.23,P<0.001),是其他班级的3.62(95%CI:2.09~6.29)倍。结论:应加强寄宿制学校传染病防治体系的规范性,特别是针对肺结核高发地区集体来京就读学生要制定有效的防控手段,合理使用胸片检查,及早发现肺结核患者,有效遏制肺结核在校内的传播。

Objective:To investigate and analyze a cluster epidemic of pulmonary tuberculosis in a boarding school in Fengtai District of Beijing,and to provide reference for the prevention and control of pulmonary tuberculosis in boarding schools and students from high-risk areas.Methods:A descriptive epidemiological method was used to investigate an outbreak of pulmonary tuberculosis in a school in Fengtai District of Beijing.According to the epidemiological investigation of the first case,the range of close contacts was determined.Symptom screening,tuberculin skin test(TST)and chest X-ray were used to screen the close contacts,and those with abnormal chest X-ray were further diagnosed.From June 2018 to April 2019,a total of 4 close contacts were screened,once every 3 months.Results:A total of 23 active pulmonary tuberculosis patients and 81 latent tuberculosis patients were found in the school,of which 17 patients were found by chest X-ray screening.The attack rate of pulmonary tuberculosis in senior high school was 4.8%(23/483),of which the attack rate of the first case class was 28.3%(15/53),and the attack rate of other classes was 1.9%(8/430).The risk of tuberculosis in class 5 was higher than that in other classes,and the difference was statistically significant(χ^(2)=72.74,P<0.001),which was 15.21(95%CI:6.06-38.17)times that of other classes in senior high school.The overall attack rate of students in the class composed of students in Yushu Tibetan Autonomous Prefecture of Qinghai Province(referred to as‘Yushu class’)was 8.7%(20/229),the latent infection rate of Mycobacterium tuberculosis was 27.3%(62/227),and the latent infection rate of Mycobacterium tuberculosis in other classes was 7.5%(19/252).The infection risk of students in Yushu class was higher than that in other classes,and the difference was statistically significant(χ^(2)=33.23,P<0.001),which was 3.62(95%CI:2.09-6.29)times that of other classes.Conclusion:It is necessary to strengthen the standardization of the infectious disease prevention and control system in boarding schools.In particular,it is necessary to develop effective prevention and control measures for collectively enrolled students in Beijing in areas with high incidence of tuberculosis,rationally use chest X-ray examination,detect tuberculosis patients as early as possible,and effectively curb the spread of tuberculosis in schools.