学校肺结核疫情风险与指示病例就诊间隔的关联

Association between the risk of tuberculosis outbreak in schools and the visit interval of index cases

目的分析学校肺结核疫情风险与指示病例就诊间隔的关系,为公共卫生部门预判肺结核疫情聚集风险和制定干预措施提供科学依据。方法以2015年1月至2022年12月期间,苏州市学校肺结核疫情630例指示病例为研究对象,收集其人口统计学、就诊史、病原学诊断以及发现方式等资料。采用限制性立方样条(RCS),非条件Logistic回归和受试者工作特征曲线(ROC曲线)进行统计学分析。结果RCS拟合曲线显示,当病原学阴性患者就诊间隔>5.79 d,或病原学阳性患者就诊间隔>8.37 d时,肺结核疫情风险呈线性增加。调整性别、年龄和病原学检查后,指示病例就诊间隔每延长1 d,疫情发生高风险的OR值(95%CI)为1.10(1.07~1.13)(P<0.05)。按就诊间隔三分位分析,与就诊间隔<14 d相比,就诊间隔在14~<28 d和≥28 d的学校肺结核发生高风险疫情的OR值(95%CI)分别为10.32(3.04~35.10)和82.58(28.42~239.95)(P值均<0.01),呈就诊间隔延长,疫情风险上升趋势。通过ROC曲线分析,预测学校肺结核疫情高风险的最佳阈值为23.5 d,曲线下面积为0.93(95%CI=0.89~0.98)。结论指示病例就诊间隔延长是学校肺结核高风险疫情的良好预警指标,可作为疫情早期干预和风险控制的关键考量。

Objective To analyze the relationship between the risk of tuberculosis outbreaks in schools and the visit interval of index cases,so as to provide a scientific reference for predicting the risks of tuberculosis outbreak and making preventive measures.Methods A total of 630 index cases from school tuberculosis outbreaks were studied during January,2015 to December,2022.Data on demographics,consultation history,etiological diagnosis,and methods of detection were collected.Restricted Cubic Splines(RCS),unconditional Logistic regression,and the receiver operating characteristic curve(ROC curve)were used for analysis.Results The RCS fitted curve showed that the risk of a tuberculosis outbreak linearly increased when the consultation interval for etiologically negative patients exceeded 5.79 days,or for etiologically positive patients exceeded 8.37 days.After multifactor adjustment,for every additional day in the visit interval of the index case,the odds ratio(OR)value for a highrisk outbreak was 1.10(95%CI=1.07-1.13)(P<0.05).When analyzed by tertiles of visit intervals,compared to an interval of<14 days,the OR values(95%CI)for highrisk outbreaks in schools with intervals of 14-<28 days and≥28 days were 10.32(3.04-35.10)and 82.58(28.42-239.95),respectively(P<0.01),indicating a trend of increasing outbreak risk with longer visit intervals.Based on the ROC curve analysis,the optimal threshold for predicting a highrisk school tuberculosis outbreak was 23.5 days,with an area under the curve(AUC)of 0.93(95%CI=0.89-0.98).Conclusion An extended visit interval of index cases is a good early warning indicator for highrisk tuberculosis outbreaks in schools and could be considered a key factor in early intervention and risk control strategies.