一起学校肺结核聚集性疫情调查  

Survey of a school clustering epidemic of pulmonary tuberculosis

作　　者：徐哲[1] 方利洪[1] 王翔 程庆林[2] 赖运恒 陈平 周卫群[1] XU Zhe;FANG Li-hong;WANG Xiang;CHENG Qing-lin;LAI Yun-heng;CHEN Ping;ZHOU Wei-qun(Jiande Center for Disease Control and Prevention,Zhejiang311600,China;不详)

机构地区：[1]建德市疾病预防控制中心,浙江311600 [2]杭州市疾病预防控制中心

出　　处：《医学动物防制》2021年第3期275-279,共5页Journal of Medical Pest Control

基　　金：浙江省医药卫生科技计划项目(2020PY064)。

摘　　要：目的调查一起学校肺结核聚集性疫情,探讨密切接触者筛查和预防性服药的重要性。方法对指示病例发生学校开展流行病学调查,采用结核菌素纯化蛋白衍生物(Tuberculin Purified Protein Derivative,TB-PPD)试验、X线胸片检查和症状监测对指示病例的密切接触者进行3次筛查,对TB-PPD强阳性密切接触者实施预防性服药。结果三次密切接触者TB-PPD筛查共筛查417人,TB-PPD强阳性率、阳性率分别为8.39%、32.13%,其中首次筛查的强阳性率(χ^(2)=20.24,P<0.01)、中度阳性率(χ^(2)=14.10,P=0.001)显著高于第二次、第三次筛查。X线胸片共筛查462人,胸片异常率为2.38%,首次筛查、第三次筛查的胸片异常率明显高于第二次筛查(χ^(2)=8.65,P=0.013)。指示病例班级学生TB-PPD筛查强阳性率(χ^(2)=67.89,P<0.01)、阳性率(χ^(2)=91.03,P<0.01)、胸片异常率(χ^(2)=4.73,P<0.05)均高于其他班级学生;指示病例所在寝室学生的胸片异常率高于其他寝室学生(χ^(2)=4.18,P<0.05)。结论指示病例延误诊断、同班同寝室持续密切接触可能是导致疫情发展的主要因素。通过及时、高效开展密切接触者TB-PPD、X线胸片筛查和高覆盖率的预防性服药干预,能有效降低疫情的发生发展。Objective To investigate a school clustering epidemic of pulmonary tuberculosis(TB),and to explore the importance for close contact screening and preventive medication.Methods The epidemiological investigation was conducted in schools where indicated cases occurred.The tuberculin-purified protein derivative(TB-PPD) test,X-ray chest examination,and symptom monitoring were used to take three screenings on close contacts of the indicated cases three times,and preventive medication was implemented for close contacts with strong positive TB-PPD test.Results A total of 417 people were screened in TB-PPD screenings for three close contacts,the strong positive rate and positive rate of TB-PPD were 8.39% and 32.13%,respectively.The strong positive rate of the first screening(χ^(2)=20.24,P<0.01) and moderate positive rate(χ^(2)=14.10,P=0.001) was significantly higher than that of second and third screening.A total of 462 people were screened by X-ray chest examinations,and the abnormal rate of chest radiographs was 2.38%,and the abnormal rate of chest radiographs in the first and third screenings was significantly higher than such index in the second screening(χ^(2)=8.65,P=0.013).The strong positive rate(χ^(2)=67.89,P<0.01),positive rate(χ^(2)=91.03,P<0.01) and chest radiograph abnormality rate(χ^(2)=4.73,P<0.05) of students in the indicated case class were higher than such indexes of other classes;the chest radiograph abnormality rate of the students in the indicated cases was higher than that of the students in other dorms(χ^(2)=4.18,P<0.05).Conclusion Delayed diagnosis of indicated cases and continuous close contact in the same class and dormitory may be main factors leading to the progress of the epidemic.Timely and efficient implementation of TB-PPD test,X-ray chest screening and high coverage preventive medication intervention on close contacts can effectively reduce the occurrence and development of the epidemic.

关 键 词：肺结核 学校 聚集性 结核菌素试验 X线胸片 密切接触者筛查 预防性服药 

分 类 号：R521[医药卫生—内科学]