Objective By analyzing 7 cases of TB epidemic in boarding schools, to discuss the risk factors of the epidemic, in order to provide reference for scientific prevention and control of tuberculosis in schools.
Methods The investigation data of cluster TB epidemic in 7 schools were analyzed retrospectively in Baoding from Jan.2013 to Jan.2019.
Results All of the seven schools are boarding schools, the per capita area qualification rate of classrooms was 57.14%, and the per capita area qualification rate of dormitories was 42.86%, classrooms and dormitories ventilated well; the incidence of the cluster epidemic in the seven schools was 0.89%(62/6 958). The male TB patients accounted for 67.74%, female TB patients accounted for 32.26%, and the ratio was 2.1:1. The age range was 15–22 years old, mainly occurred in the third middle school to third year of junior high school, and the cases were clustered in the same class. The percentage of smear positive in the first cases of seven epidemics was 85.71%, and all had symptoms of cough and expectoration over 2 weeks. Class I close contacts strong positive rate was 36.64% (144/393), the incidence was 10.18% (40/393), class II close contacts strong positive rate was 8.61% (187/2 172), the incidence was 0.64% (14/2 172), class III close contacts strong positive rate was 6.35% (279/4 393), the incidence was 0.02% (1/4 393). The comparison of positive rates was statistically significant ( P< 0.01). The difference in incidence was statistically significant( P<0.01); the first cases in seven schools were all in winter and spring seasons, with an average delay of 49 d in diagnosis. Routine preventive measures in schools were not in place, screening of close contacts was not standardized, follow–up monitoring and follow–up were lacking, and medical institutions had a low level of professional skills, and active monitoring was not effectively carried out.
Conclusions The occurrence of school tuberculosis clustering epidemic involves many factors. It is of great significance to strengthen routine preventive measures in schools, strengthen screening and follow–up monitoring of close contacts, and establish a three–level school–hospital–disease control network to control the spread of TB in schools.
摘要： 目的 通过分析7起寄宿制学校结核病疫情, 探讨疫情发生的危险因素, 为科学防控学校结核病提供参考。 方法 回顾性分析保定市2013年1月—2019年1月7起学校结核病聚集性疫情调查资料。 结果 7所学校均为寄宿制学校, 教室人均面积合格率为57.14%, 宿舍人均面积合格率为42.86%, 教室及宿舍通风状况良好; 7起学校聚集性疫情报告发病率为0.89%(62/6 958), 学生肺结核患者男生占67.74％,女生占32.26％, 男女比例为2.1∶1, 年龄分布在15~22 周岁, 主要发生在初三至大三阶段, 病例聚集于同一班级; 7起疫情中首发病例涂阳百分率为85.71%, 且均有咳嗽、咳痰 >2周的症状; Ｉ级密切接触者强阳性率36.64% (144/393), 发病率10.18% (40/393), Ⅱ级密切接触者强阳性率8.61% (187/2 172), 发病率0.64% (14/2 172), Ⅲ级密切接触者强阳性率6.35% (279/4 393), 发病率0.02% (1/4 393), 强阳性率比较差异有统计学意义 ( P<0.01) ; 发病率比较差异有统计学意义 ( P<0.01) ; 7所学校首发病例时间均在冬春季节, 平均延误诊断时间49 d, 学校常规预防措施不到位, 密切接触者筛查不规范, 缺乏后续监测和随访, 医疗机构业务水平较低, 未有效开展主动监测。 结论 学校结核病聚集性疫情的发生涉及诸多因素, 应强化学校常规预防措施, 加强密切接触者筛查与随访监测, 建立学校-医院-疾控三级防护网络, 对控制学校结核病传播流行具有重要意义。