重庆市一起学校肺结核聚集性疫情调查分析

目的: 对重庆市一起学校肺结核疫情进行调查和分析,为强化学校结核病防控工作提供思路和建议。方法: 采用描述性流行病学方法,对重庆市2020年12月至2021年5月一起学校肺结核疫情进行流行病学调查和分析。采用症状筛查、结核菌素皮肤试验(tuberculin skin test,TST)和胸部X线摄片(简称“胸片”)开展肺结核筛查,并对接触者开展流行病学调查。结果: 在确诊1例病原学阳性肺结核病例(指示病例)后,经过4次接触者筛查及1次随访检查,检出8例活动性肺结核患者和42例结核分枝杆菌潜伏感染者。校内8例学生患者均集中在指示病例所在班级,该班肺结核罹患率为12.7%(8/63),病原学阳性者占2/8,结核分枝杆菌潜伏感染者34例,潜伏感染率为61.8%(34/55),均全部完成预防性治疗。指示病例所在班级学生发病风险和感染风险均高于其他班级(RR=27.6,95%CI:13.5~56.4)。校内8例学生肺结核患者中,男生6例,女生2例,年龄分布以15岁组最多(6例)。因首次接触者筛查胸片质量差,未能及时发现学生患者,导致后续因症就诊发现3例患者。2例学生潜伏感染者因未规范服药,在预防性治疗期间转为肺结核患者。 结论: 本次肺结核疫情聚集性明显,筛查质量低、未能规范完成预防性治疗是疫情蔓延的重要原因。在处置学校肺结核疫情时,应提高筛查质量,根据流行病学调查情况充分考虑窗口期问题,保证预防性治疗的规范性和完成率。     

古蔺县某初级中学结核病聚集性疫情处置与医学观察结果分析

目的对2018-2019年期间古蔺县某初级中学发生的一起结核病聚集性疫情进行调查处置分析,以期为学校结核病防控工作提供参考,为疾控机构相关疫情处置提供借鉴。方法开展学校结核病流行病学调查和指示病例个案调查,对密切接触者和一般接触者进行症状、PPD试验和X光胸片筛查,对疑似患者进一步开展CT和痰涂片检查。结果对该校初三(4)班指示病例的67名密切接触师生进行筛查,发现可疑患者11例,经专家确诊肺结核5例,其中涂阳2例;扩大筛查范围时对初三年级的454名一般接触师生进行筛查,发现可疑患者47例,经专家确诊肺结核6例,其中涂阳病例1例。医学观察发病2例,其中涂阳1例,此次疫情共发现肺结核患者14例。指示病例班级发现涂阳肺结核4例(包括指示病例),其中2例与指示病例座位相邻,1例与指示病例同宿舍,提示存在相互传播的可能。结论延迟发现传染源并归口治疗可能是造成疫情传播的主要原因,及时规范开展密切接触者筛查、诊断和治疗有利于防止疫情的进一步扩大,加强学校师生及其学生家长结核病防治知识宣传提高自我辨识能力对学校结核病防控具有重要意义。     

铜陵市某精神疾病专科医院结核病聚集性疫情调查处置

目的调查处置铜陵市某精神疾病专科医院聚集性疫情,为今后类似疫情处置提供参考。方法对2015年安徽铜陵市某专科医院发生的结核病聚集性疫情开展现场流行病学调查和密切接触者筛查,诊断方法包括结核菌素(PPD)皮肤实验、X线胸片、痰涂片检查。结果疫情共发现肺结核病例12例,均为菌阴肺结核,A病区6例,罹患率6.12%; B病区6例,罹患率8.11%; A病区密切接触者PPD强阳性率为8. 70%,B病区密切接触者PPD强阳性率为24.66%,预防性服药率19.04%。结论此次疫情发生由于未早期发现、隔离并治疗肺结核患者,专科医院未及时开展密切接触者筛查及消毒措施,未做好患者管理控制工作。早期发现、隔离并治疗结核病患者,把好患者进出关口,加强结核病相关知识的培训等措施,是预防控制精神疾病专科医院发生的结核病疫情的关键。     

结核分枝杆菌感染检测两步法在学校结核病筛查中的应用价值

目的: 初步评估结核菌素皮肤试验(TST)联合γ-干扰素释放试验(IGRA)(简称“两步法”)检测在学生健康体检中筛查结核分枝杆菌(Mycobacterium tuberculosis,MTB)感染和活动性肺结核的应用价值。方法: 采用横断面研究的方法,选取2017—2021年广东省74358名学生作为研究对象,其中50701(68.18%)名完成了胸部X线摄片(简称“胸片”)筛查,74148名(99.72%)完成了TST筛查;9702(13.08%)名TST检测阳性者进一步完成了IGRA检测。最后对胸片异常、TST和IGRA检测“双阳者”完善肺结核相关检查。结果: 以IGRA检测结果为参照标准,分别以TST检测硬结平均直径为5、10和15mm为阳性临界值,TST与IGRA检测MTB感染的一致率分别为15.97%(1549/9702)、26.63%(2584/9702)、81.11%(7869/9702),Kappa值分别为0.014、0.014和0.112。TST检测MTB感染率[11.67%(8652/74148)]明显高于两步法[1.02%(759/74148)],差异有统计学意义(χ²=7068.423,P<0.001)。对TST中阳和强阳者完善结核病相关检查后的肺结核检出率[0.29%(15/5219)]明显低于对“双阳者”的检出率[1.84%(14/759)],差异有统计学意义(χ²=30.133,P<0.001)。结论: TST和IGRA检测MTB感染的一致性较差,“两步法”可明显提高MTB感染的精准性和肺结核患者筛查效率。     

西昌市1起学校结核病疫情的调查分析

目的对西昌市某镇中心小学1起结核病疫情进行调查分析,为学校结核病防控工作提供参考依据。方法对报告病例开展流行病学个案调查,对密切接触者进行PPD试验(结核菌素实验)筛查,PPD阳性、强阳性者进一步做DR胸片、痰涂片查抗酸杆菌,确诊的结核病患者纳入规范抗结核治疗,并严格实行休复学管理。对患者15岁以上家属做DR胸片、痰涂片查抗酸杆菌检查,确诊患者纳入规范抗结核治疗。结果对129名密切接触者进行PPD筛查,强阳性率为1.55%、阳性率为11.63%;PPD强阳性、阳性者进一步检查排除肺结核。通过近半年定期随访检查,无新病例发生。患者家属15岁以上的经检查后排除肺结核。结论该起疫情来自于家庭内部感染,因就诊及时,疫情处置迅速、规范,未造成学校聚集性疫情的发生。     

学校结核病疫情流行病学调查和现场处置专家共识

学校是人群密集的场所,容易发生结核病聚集性疫情甚至结核病突发公共卫生事件。本专家共识从学校结核病流行病学调查、现场处置及效果评估三方面,对指示病例及密切接触者调查方法、活动性结核病患者及结核潜伏感染者诊断治疗与管理等提出了相关建议。     

2021年北京市高中及以下学段入学新生肺结核筛查结果分析

目的:分析2021年北京市高中及以下学段入学新生肺结核筛查结果，为科学规范开展新生结核病筛查工作提供依据。方法:选取“北京市新生肺结核筛查系统”中2021年3804所学校高中及以下学段筛查信息记录完整的467 088名新生作为调查对象，收集其基本信息、肺结核可疑症状及密切接触史、结核菌素皮肤试验(tuberculin skin test, TST)结果，以及胸部X线摄片(简称“胸片”)检查结果等资料，并进行分析。结果:467 088名调查对象中，有肺结核可疑症状者占0.17‰(80/467 088),有肺结核密切接触史者占0.40‰(187/467 088)。69 519名调查对象进行了TST,阳性率为13.45%(9353/69 519)。寄宿制学校初中学段调查对象TST阳性率为11.07%(960/8673),明显低于高中学段调查对象的13.77%(8369/60 758),差异有统计学意义(χ²=52.927,P<0.001)。有肺结核可疑症状或密切接触史者TST中度及以上阳性率为12.64%(23/182),明显高于无肺结核可疑症状或密切接触史者的4...     

2020年绵阳市某职业技术学校1起肺结核聚集性疫情调查与处置

目的 分析2020年绵阳市某职业技术学院1起肺结核聚集性疫情的流行病学特征及疫情调查处置过程,探讨该事件发生发展可能的原因,为以后学校结核疫情处置和制定学校结核防控策略提供科学依据。方法 应用结核菌素皮肤试验（PPD试验）和DR胸片筛查对2020年绵阳市某职业技术学院1起肺结核聚集性疫情中肺结核病例的密切接触者进行排查,收集相关流行病学资料并开展描述性流行病学分析,率的比较用χ2检验,检验水准α=0.05。结果 2020年绵阳市某职业技术学校2018级汽修专业11班和2018级护理专业4班师生的PPD试验结果差异均有统计学意义,P均<0.05。全校共确诊10例活动性肺结核患者,2018级汽修11班罹患率15.56%,该班为聚集性疫情,其余班级病例为散发。结论 绵阳市某职业技术学校及学生结核防病治病意识淡薄。应加强结核病防治健康教育,提高学校及学生的防病治病意识,指导学校严格落实因病缺勤追踪等防控措施。     

2018年济南市学校肺结核患者密切接触者筛查结果分析

目的调查2018年济南市学校肺结核患者密切接触者的筛查情况,对全市学校肺结核疫情和处置情况进行分析。方法建立2018年济南市学校肺结核的发病情况和处置结果数据库,包括济南市市、县两级监测到《传染病报告信息管理系统》中报告的患者、学校方告知患者及外地单位反馈的学校患者。2018年全市共发现学生或教师肺结核患者197例,除去实习、毕业或近期接受过筛查等原因的10例患者,对187例肺结核患者开展个案流行病学调查,确定密切接触者共11617名。对其中24例病原学阳性肺结核患者确定密切接触者2138名,实际筛查2104名;163例病原学阴性及无病原学结果的肺结核患者确定密切接触者9479名,实际筛查9384名。密切接触者采用全市统一配发的卡介菌纯蛋白衍生物(BCG-PPD)试剂进行结核菌素皮肤试验(简称"PPD试验")筛查。结果2018年济南市学校肺结核患者以大学生为主81.28%(152/187)。11488名密切接触者的PPD试验结果中,阴性8898名(77.45%),一般阳性1434名(12.48%),中度阳性651名(5.67%),强阳性505名(4.40%)。24例病原学阳性患者的密切接触者PPD试验强阳性率(7.41%,156/2104)明显高于163例非病原学阳性患者密切接触者PPD试验的强阳性率(3.72%,349/9384),差异有统计学意义(χ^2=55.84,P<0.001)。通过筛查共发现肺结核患者31例。结论通过对学校肺结核患者密切接触者的筛查,可发现部分结核病患者;落实肺结核患者密切接触者的结核病筛查工作,可减少结核病在学校中的传播。     

滨州市结核病防治院住院涂阳肺结核患者家庭密切接触者菌阳情况分析

发现涂阳患者、治愈菌阳患者，是我国结核病防治的重要措施之一。涂阳肺结核患者作为传染源，与之密切接触的家庭成员有高度被传染的危险，据报道在密切接触者中至少可检出1%～5%的新发活动性结核患者。本研究对山东省滨州市结核病防治院住院涂阳肺结核患者家庭密切接触者菌阳检出情况进行调查分析，为本地区制定肺结核患者发现、疫情控制措施提供参考。     

Detection of tuberculosis infection using a whole blood interferon gamma assay in a contact investigation--evaluation using quantiFERon TB-2G

OBJECTIVE: The purpose of this study was to evaluate the usefulness of a novel method of detecting tuberculosis infection, QuantiFERON TB-2G (QFT), in a large scale contact investigation when an outbreak of mass tuberculosis infection was suspected. SUBJECTS AND METHODS: The index case was a health-care worker who worked in a maternity hospital. The investigated contacts were categorized as follow according to the grade of closeness of contact; the "very close" contact group (11 subjects), the "close" contact group (33 subjects), and the "non-close" contact group (3,791 subjects). For the former two groups, tuberculin skin test (TST), chest X-ray examination and QFT were conducted. For the last contact group, TST and chest X-ray examination were conducted only to subjects who aged less than 29 years old, while only chest X-ray examination was conducted to those aged 30 years or older. The QFT test, i.e., a whole blood interferon-gamma assay using Mycobacterium tuberculosis-specific antigens, was performed to the "very close" and "close" contacts, and for strong tuberculin reactors among the "non-close" contacts. RESULTS: The number of infected subjects in the "very close" contact group, the "close" contact group, and the "non-close" contact group were 7, 7, and 277, respectively, based on TST results. On the other hand, the number of infected subjects in each group were 3, 2, and 5, respectively, based on the QFT test. CONCLUSION: If the indication of chemoprophylaxis was determined based on TST test, this case would have been regarded a large tuberculosis outbreak. However, the use of the QFT test greatly reduced the number of the infected persons, so that the possibility of such massive TB outbreak was denied. Thus, the use of QFT, with which TB infection could be detected more accurately, seems to be very beneficial in contact investigations.     

Tuberculosis outbreak among students in a boarding school.

Tuberculosis (TB) outbreaks present a public health challenge. Six cases of active TB emerged in a boarding school in Israel during 1 yr. An epidemiological outbreak investigation was performed, followed by implementation of control measures. The investigation included interviews, tuberculin skin test (TST) and chest radiographs of the students. Close contact (n = 155) was defined as being in the same class or dormitory with a patient. Remote contact (n = 246) was defined as being in the school. An epidemiological association was detected among five of the cases and a distinct pattern was found in molecular analysis. TST was performed in 398 (99.2%) students. Repeated (two-step) TST was applied to the close contacts. The degree of contact, country of origin and previous bacille Calmette-Guérin vaccination were significantly associated with TST reactions. Preventive directly observed therapy was completed by 157 (91.3%) students. During 5 yrs follow-up, no additional cases emerged. While investigating a tuberculosis outbreak, the definition of degree of contact is a significant predictor for detecting positive tuberculin test. Immigration from an endemic country, as well as previous bacille Calmette-Guérin vaccination have a major effect on tuberculin skin-test results. The directly observed therapy approach was found to be successful in preventing further morbidity.     

吉林省某市寄宿制中学一起结核病暴发疫情调查分析

目的通过对某寄宿制中学一起结核病暴发的流行病学调查,分析学校结核病防治工作中存在的问题,为全省学校结核病防控工作提供指导和依据。方法采用问卷调查法,对所有密切接触者胸透检查,有异常阴影者进行X线摄片和痰涂片检查。结果共查出肺结核病患者9例,其中涂阳患者1例、涂阴患者8例,发病率0.28%;9例患者情绪稳定、病情明显好转,其中车某已于2013年6月7日出院,继续院外督导化疗。结论专科医院传染病报告卡质量不佳,师生结核病防治知识缺乏,学校因病缺课登记管理制度不健全,是导致结核病暴发的主要原因。     

学校结核病突发疫情处置的思考

近年来,学校结核病疫情总体呈现下降趋势,但聚集性疫情仍时有发生。2006年至今,全国共报告近80起学校结核病聚集性疫情。发生结核病聚集性疫情的学校多为寄宿制学校,约70%发生在高中或中专,约20%发生在民办学校。学校结核病聚集性疫情处置常见误区:(1)缩小或盲目扩大密切接触者筛查范围。疫情处置初期多存在筛查范围不足,造成患者发现不及时;疫情加重后又盲目扩大筛查范围,造成资源的浪费。(2)密切接触者筛查方法不规范。《学校结核病防治工作规范》要求,对密切接触者采取症状筛查、结核菌素皮肤试验和胸部X线摄影检查相结合的筛查方法。部分疫情现场对15岁以上人群不进行X线摄影检查或仅进行X线胸部透视(简称“胸透”)检查,造成患者发现不及时。有的现场因资源丰富或疫情压力,采用胸部CT检查方法进行密切接触者筛查,由于敏感度增加而发现了许多非活动或活动性不易鉴别的小结节病变,造成人群恐慌,也增加了疫情处置的压力。(3)结核菌素皮肤试验强阳性密切接触者干预不力。多数地区未对结核菌素皮肤试验强阳性者进行抗结核药物预防性治疗,部分现场出现疫情反复。(4)不规范抗结核药物治疗及不必要的辅助治疗。不合理地选用二线抗结核药物治疗现象常有发生;低剂量或超限剂量给儿童结核病患者用药;医生迷信静脉用药;患者无并发其他感染依据情况下,滥用抗生素进行抗感染治疗;不必要的免疫增强治疗,过度的护肝治疗。学校结核病防控工作应以教育系统和学校作为责任主体,在教育和卫生行政部门的领导下,按照《学校结核病防控工作规范(2017版)》的要求开展。     

Avoiding the effect of BCG vaccination in detecting Mycobacterium tuberculosis infection with a blood test.

Bacille Calmette-Guérin (BCG) vaccination can confound tuberculin skin test (TST) reactions in the diagnosis of latent tuberculosis infection (LTBI). The TST was compared with a Mycobacterium tuberculosis (MTB)-specific enzyme-linked immunospot (ELISPOT) assay during an outbreak of MTB infection at a police academy in Germany. Participants were grouped according to their risk of LTBI in close (n = 36) or occasional (n = 333) contacts to the index case. For the TST, the positive response rate was 53% (19 out of 36) among close and 16% (52 out of 333) among occasional contacts. In total, 56 TST-positive contacts (56 out of 71 = 78.9%) and 27 TST-negative controls (27 out of 298 = 9.1%) underwent ELISPOT testing. The odds ratio (OR) of a positive test result across the two groups was 29.2 (95% confidence interval (CI) 3.5-245.0) for the ELISPOT and 19.7 (95% CI 2.0-190.2) for the TST with a 5 mm cut-off. Of 369 contacts, 158 (42.8%) had previously received BCG vaccination. The overall agreement between the TST and the ELISPOT was low, and positive TST reactions were confounded by BCG vaccination (OR 4.8 (95% CI 1.3-18.0)). In contrast, use of a 10-mm induration cut-off for the TST among occasional contacts showed strong agreement between TST and ELISPOT in nonvaccinated persons. In bacille Calmette-Guérin-vaccinated individuals, the Mycobacterium tuberculosis-specific enzyme-linked immunospot assay is a better indicator for the risk of latent tuberculosis infection than the tuberculin skin test.     

A suspected case of mass outbreak of tuberculosis infection in a small company separated into two floors

The number of tuberculosis outbreak among adult groups has increased. In some of them, it is difficult to identify the route of infection and sometimes many people are involved in the outbreak. We experienced a suspected case of mass outbreak in a small company separated into 2 floors. The first patient, who lived in another city, was diagnosed as pulmonary tuberculosis in April with bilateral extensive cavitary lesions complicated with pleurisy on chest X-ray, and his sputum smear was Gaffky No. 8 and culture (+) (resistant to isoniazid). We conducted tuberculin skin test (TST) for those under-30 year-old. In TST, 4 persons showed strong positive reaction. After consulting with tuberculosis specialists, three were diagnosed as newly infected with tuberculosis and one as hilar lymph node tuberculosis. So we added 25 staffs under 60s for TST and found that another 13 people were suspected to be infected with tuberculosis. From the initial information, the index cast was said to work only in the 2nd floor, so the staffs in 7th floor were excluded from the survey. Through the interview with staffs by a public health nurse and an inspection of the work place with sanitary inspectors, it was concluded to expand the survey to the staffs working in the 7th floor, and another newly infected persons were found. Staffs in a small company do not belong to "danger group", but the importance of investigations by public health officials was suggested in the case of suspected outbreak.     

Analysis of tuberculosis infection among foreigners using QuantiFeron TB-2G test

OBJECTIVE: The purpose of this study was to investigate contacts of a tuberculosis patient among foreigners using QuantiFERON TB-2G (QFT-2G) test. SUBJECTS AND METHODS: Three index cases in this study were all foreigners. Contacts, who were mostly foreigners and some Japanese, were investigated by a chest X-ray examination, tuberculin skin test (TST) and QFT-2G, and all data were compared. RESULTS: Among 48 subjects (30 Vietnamese and 18 Japanese) in case 1, 8 Vietnamese and 2 Japanese were QFT-2G positive. One contacts among 3 most close contacts who lived in the same room with the index case was QFT-2G positive. In case 2, three Chinese among 22 contacts were QFT-2G positive, and a very close contact who lived in the next door to the index case was QFT-2G negative. Seven QFT-2G positive Chinese were identified among 24 contacts in case 3. However, four very close contacts among them were QFT-2G negative. CONCLUSION: Although it was unclear whether QFT-2G positives in cases 1 and 2 were infected with M. tuberculosis through the index cases, it is possible to speculate that these QFT-2G positives were already infected with M. tuberculosis while they live in their own country based on the prevalence of TB in their countries and the fact that many very close contacts were QFT-2G negative. Also, it was suggested that QFT-2G positives in case 3 may not be infected through the index case, but infected in their country, since all close contacts were QFT-2G negative. The results of this study suggested that using the QFT-2G test for foreigners prior to or soon after their entry to Japan and recommending chemoprophylaxis for those who are QFT-2G positive would be a very efficient control measures against immigrant foreigners with TB infection.