一起学校耐药肺结核聚集性疫情的调查

目的对北京市朝阳区某学校一起耐药肺结核疫情进行分析,为今后耐药结核病疫情的处置提供参考。方法对病例进行流行病学调查,对病例密切接触者采用PPD试验、X线胸片和CT相结合的方式筛查。结果 2018年10月—2019年6月,该校共发生36例肺结核病例,发病率为4.5%。其中5例耐多药,3例耐利福平。36例病例分布在四个班,15a班27例、15b班4例、15c班2例、17d班3例。各班发病率分别为56.3%、8.3%、5.7%、7.1%,差异有统计学意义(P<0.01)。8例耐药病例中6例为15a班学生,占耐药病例总数的75.0%。经CT筛查68名密切接触者中确诊23例肺结核患者,检出率33.8%。结论该起学校聚集性疫情为全国首起耐药肺结核聚集性疫情,首发病例未及时就医,传染源隐匿存在时间长,是导致该起疫情发生的主要原因。疫情处置中开展密切接触者筛查对于及时发现新病例非常重要。

Investigation of a drug-resistant tuberculosis cluster in a school

Objective To supply evidence with prevention and control of drug-resistant tuberculosis in school,through investigation and analysis of the epidemic cluster of drug-resistant tuberculosis in a school of Chaoyang District,Beijing.Methods The cases were investigated of epidemiology,PPD,chest X-ray and CT screening were carried out in close contacts of patients.Results From October 2018 to June 2019,36 cases of pulmonary tuberculosis occurred in the school,with an incidence of 4.5%.5 were multi-drug resistant,and 3 were rifampicin resistant.36 cases were mainly distributed in four classes,27 cases in class 15a,4 in class 15b,2 in class 15c,and 3 in class 17d.The incidence rate of each class was 56.3%,8.3%,5.7% and 7.1% respectively.The difference was statistically significant(P<0.01).6 of the 8 drug-resistant cases were students of class 15a,accounting for 75.0% of the total cases.23 cases of tuberculosis were diagnosed by CT screening in 68 close contacts,the detection rate were 33.8%.Conclusions It is the first case to deal with the cluster epidemic of drug-resistant tuberculosis transmission in schools.The main reason for the outbreak was that the first case was not treated in time and the source of infection existed for a long time.Close screening is very important for the timely detection of new cases in school cluster epidemic management.