1起高中肺结核聚集性疫情的流行病学调查

Epidemiological investigation of a cluster of tuberculosis in a senior high school

目的 了解济南市某中学结核病疫情处置情况,为学校结核病防控工作制订策略和措施提供科学依据。方法 采用肺结核可疑病例症状问询、结核菌素皮肤试验(TST)和胸部X光片检查等方法对2022年8月1日起高中肺结核聚集性疫情开展流行病学调查。结果 本次疫情共确诊4例活动性肺结核患者,其中2例病原学阴性肺结核,2例结核性胸膜炎,分布在同一个班级。首轮筛查纳入64名密切接触者,TST试验强阳性率为14.06%;扩大筛查纳入295名一般接触者,TST试验强阳性率为3.05%,两轮筛查的强阳性率比较,差异有统计学意义(P<0.001)。结论 指示病例的就诊延迟和校方常规防控措施落实不到位,是造成此次聚集性疫情的重要原因。提示校方今后应落实日常防控措施,加强学生结核病健康教育等工作,必要时开展针对高二学生的结核病主动筛查工作。

Objective To investigate the treatment of tuberculosis epidemic in a middle school in Jinan City,so as to provide scientific evidence for formulating strategies and measures for tuberculosis prevention and control in schools.Methods The epidemiological investigation of the cluster of pulmonary tuberculosis in a senior high school on August 1,2022 was carried out by symptom inquiry,tuberculin skin test(TST)and chest X-ray examination.Results A total of 4 patients with active pulmonary tuberculosis were confirmed in this outbreak,including 2 cases of pathogen-negative pulmonary tuberculosis and 2 cases of tuberculous pleurisy,which were distributed in the same class.The first round of screening included 64 close contacts,and the strong positive rate of TST test was 14.06%,and the expanded screening included 295 general contacts,and the strong positive rate of TST test was 3.05%,and the strong positive rates of the two rounds of screening were statistically significant(P<0.001).Conclusions The delay in the treatment of the index cases and the lack of implementation of the school’s routine prevention and control measures are important reasons for this cluster outbreak.It is suggested that the school should implement daily prevention and control measures in the future,increase tuberculosis health education for students,and carry out active tuberculosis screening for sophomore students when necessary.