贵州省2021年学校结核病筛查结果分析

Analysis of tuberculosis screening results in schools of Guizhou Province in 2021

目的了解贵州省各级各类学校开展结核病筛查情况,为加强学校结核病重点年龄段的主动发现和有效防控措施提供科学依据。方法对2021年贵州省入学新生和教职员工开展主动筛查和入学体检,填报“全省学校结核病筛查调查表”,通过“健康贵州智慧疾控云平台”上传体检信息,根据《中国学校结核病防控指南(2020年版)》中对不同体检对象采取不同的筛查方法进行筛查;筛查方法主要包括3种,即结核菌素皮肤试验、拍摄胸部X线检查(X线胸片)、肺结核可疑症状调查。结果共筛查18192所学校1789108人,其中新生体检人数为1739680人,中高考体检人数为16922人,教职员工体检人数为32506人。贵州省2021年报告结核病入学体检发病率为85.40/10万,报告发病率排前三位的是毕节市、黔南州、遵义市;9个市州症状筛查58380人,可疑症状者3440人(5.89%);结核菌素皮肤筛查1180442人,强阳性22175例(1.88%);X线胸片筛查366170人,胸片异常2837人(0.77%)。公办学校可疑症状者比例(8.11%)高于民办学校(1.63%);非寄宿学校可疑症状者比例(6.06%)高于寄宿制学校(5.46%);学校类别中技工学校的可疑症状者比例最高(9.09%),职业高中最低(0.32%);差异均有统计学意义(χ^(2)=994.19、7.69、1257.5,P<0.01)。寄宿制学校强阳性比例(2.15%)高于非寄宿制学校(1.32%),差异有统计学意义(χ^(2)=981.40,P<0.01);学校类别中大学的强阳性率最高(6.61%),幼儿园最低(0.59%),差异有统计学意义(χ^(2)=10707.60,P<0.01)。学校类别中9年制(小学、初中)的胸片异常比例最高(4.09%),普通中专最低(0.08%),差异有统计学意义(χ^(2)=1418.191,P<0.01)。结论开展入学体检筛查是降低学校结核病疫情的重要措施之一,我省主动筛查工作还需进一步做到全覆盖,应加强高疫情地区学校的主动发现,尤其是大学、高中等重点人群的筛查力度和健康教育,遏制学校结核病疫情的发生。

Objective To understand the situation of pulmonary tuberculosis(TB)screening in schools of various levels and types in Guizhou Province,and to provide a scientific basis for strengthening the proactive detection and effective prevention and control measures for TB in key age groups in schools.Methods In 2021,proactive screening and entrance physical examination were conducted for new students and faculty members in Guizhou Province."Tuberculosis Screening Questionnaire for Schools in Guizhou Province"was filled out,and the physical examination information was uploaded through the"Healthy Guizhou Smart Disease Control Cloud Platform".According to the Prevention and Control Guidelines of China's Learning Schedule(2020 edition),different screening methods were adopted for different physical examination subjects.The main screening methods included three types,namely tuberculin skin test,chest X-ray examination(X-ray chest X-ray),and investigation of suspicious symptoms of pulmonary tuberculosis.Results A total of 1789108 students from 18192 schools were screened,including 1739680 new students who underwent physical examinations,16922 students who underwent middle and high school entrance examinations,and 32506 teachers and staff who underwent physical examinations.In 2021,the reported TB incidence rate in Guizhou Province was 85.40 per 100000,with the highest rates reported in Bijie City,Qiannan Prefecture,and Zunyi City.Symptom screening was conducted for 58380 individuals across nine cities and prefectures,of which 3440 individuals(5.89%)presented with suspicious symptoms;PPD tests were conducted for 1180442 individuals,with 22175 cases(1.88%)testing strongly positive;chest X-ray screening involved 366170 individuals,with 2837 individuals(0.77%)showing abnormal chest radiographs.The proportion of individuals with suspicious symptoms in public schools(8.11%)was higher than in private schools(1.63%);non-boarding schools had a higher proportion of individuals with suspicious symptoms(6.06%)compared to boarding schools(5.46%).Among the different school types,vocational schools had the highest proportion of individuals with suspicious symptoms(9.09%),while vocational high schools had the lowest(0.32%);these differences were statistically significant(χ^(2)=994.19,7.69,and 1257.5,all P<0.01).The proportion of strong positive students in boarding schools(2.15%)was higher than that in non-boarding schools(1.32%),with a statistically significant difference(χ^(2)=981.40,P<0.01);among school types,universities had the highest rate of strong positivity(6.61%),while kindergartens had the lowest(0.59%),with statistically significant differences(χ^(2)=10707.60,P<0.01).Among different school types,nine-year schools(elementary and junior high)had the highest proportion of abnormal chest radiographs(4.09%),while ordinary secondary vocational schools had the lowest(0.08%),with statistically significant differences(χ^(2)=1418.191,P<0.01).Conclusions Carrying out physical examination and screening for admission is one of the important measures to reduce the tuberculosis epidemic in schools.The proactive screening work in Guizhou Province needs to be further implemented to achieve full coverage.It is necessary to strengthen the proactive detection of schools in high epidemic areas,especially the screening efforts and health education for key populations such as universities and high schools,to curb the occurrence of TB epidemic in schools.