某县10年间儿童肺结核流行趋势分析

目的 :了解儿童肺结核流行特征 ,探讨实施卫生部加强和促进结核病控制项目 (卫 项目 )工作及停止 BCG复种对儿童结核病的影响。方法 :对赣榆县 1991年以来登记的 15岁以下儿童肺结核病人进行统计分析。结果 :儿童发病以7岁以上为主 ,占 87.4 % ,发病的型别构成从 、 型为主逐渐转化为以 型为主 ,实施结核病控制项目工作以来儿童肺结核构成比和新登记率大幅下降 ,分别下降 5 3.9%、 5 6 .7% ,停止 BCG复种前后新登记率分别 6 .6 2 / 10万、 3.14 / 10万 (P<0 .0 0 5 ) ,疫情未出现上升趋势。结论 :10年间该县儿童肺结核的疫情下降 ,型别有所改变     

卡介苗停止复种1年后肺结核流行特征初步报告

赣榆县根据江苏省卫生防疫站的统一布置,于1998年春停止对7岁、12岁儿童的卡介苗复种,为了观察、分析停止卡介苗复种后肺结核发病情况、流行规律,及时掌握疫情动态,探讨这一措施的科学性、可行性、实用性,以科学地指导结核病防治工作,我们将停止卡介苗复种前后的1997年、1998年新肺结核监测结果初步报告如下。1 内容与方法1.1 疫情资料来源我站疫情室及《肺结核年报表》,人口资料来源我县统计局。     

卡介苗停止复种两年后肺结核流行状况分析

赣榆县根据江苏省卫生防疫站的统一布置 ,于1998年春停止对 7岁、12岁儿童的卡介苗复种。为了观察、分析停止卡介苗复种后肺结核发病情况 ,探讨这一措施的科学性、可行性 ,以便指导结核病防治工作 ,将停止卡介苗复种前后的 1997～ 1999年新发肺结核监测结果分析如下。1　资料与方法疫情资料来自赣榆县卫生防疫站疫情室及江苏省肺结核年报表 ,人口资料来自县统计局。分析指标包括肺结核新登记率与涂阳新登记率。2　结果2 1　肺结核病人新登记情况　 3年合计新登记活动性肺结核病人 162 3例 ,新登记率为 52 7/ 10万 ;其中新登记涂阳病人 648…     

学校涂阳肺结核密切接触者筛查及预防性服药效果分析

目的对学校涂阳肺结核疫情发生后密切接触者进行筛查,并观察预防性服药的效果。方法选取2008-2012年嵊州市6起学校涂阳肺结核,疫情发生后密切接触者和一般接触者进行结核菌素试验（PPD试验）,PPD强阳性胸片未见异常者建议给予抗结核预防性服药,并随访观察预防性服药的效果。结果6起学校肺结核疫情共确诊肺结核34例,密切接触者710人,一般接触者190人。密切接触者中179名PPD筛查呈强阳性,其中86名开展预防性服药,随访1年无人发病;93名未服药的学生随访1年后,23人（24．73％）发病。预防性服药过程中,4人出现轻度的胃肠道反应,3人出现肝功能异常,停药好转后继续治疗,无严重不良反应发生。结论通过PPD试验筛查,掌握密切接触者结核分枝杆菌感染状况,有针对性地进行预防性服药,能有效控制结核病扩散。     

一起学校肺结核聚集性疫情的随访调查

目的调查一起已经前期处置的学校肺结核聚集性疫情,探讨预防性服药和随访监测工作的重要性。方法对首发病例进行回顾调查,采用结核菌素纯化蛋白衍生物(PPD)试验对首发病例的密切接触者进行2次筛查,收集3份PPD阳性者痰标本进行实验室涂片检查,同时对该起聚集性疫情前期处置进行回顾调查。结果本次疫情共确诊5例肺结核病例。首发病例是高二(9)班的19岁男生,该病例出现咳嗽、咳痰症状未及时就医,10 d后确诊为涂阳肺结核,确诊前未休课。60名密切接触者中,初筛PPD试验阳性率为57.45%(27/47),发现1例涂阴肺结核;复查PPD试验阳性率为76.92%(30/39),发现3例涂阴肺结核。结论首发病例延误诊断、密切接触者未进行预防性服药可能是导致疫情发展的主要因素。应加强学校结核病健康教育,对密切接触者进行预防性服药和随访监测,以防止疫情进一步扩大。     

武汉洪山区5起高校肺结核聚集性疫情密切接触者筛查结果

了解洪山区高校肺结核聚集性疫情密切接触者的筛查情况,为高校结核病防治工作提供科学依据.方法 对武汉市洪山区2018年1-6月发生的5起高校肺结核聚集性疫情以及所有肺结核散发病例的密切接触者进行筛查.结果 5所学校筛查的聚集性疫情病例和散发病例密切接触者强阳性率分别为12.24%和0.63%,胸片异常率为4.67%和0.88%.聚集性疫情密切接触者PPD筛查强阳性反应率高于散发病例,差异有统计学意义(x2=81.32,P<0.05).聚集性疫情密切接触者的患病率高于散发疫情,差异有统计学意义(x2=23.92,P<0.05).单纯PDD强阳性者进行预防性服药,服药率为40.48%.结论 学校结核病聚集性疫情病例的密切接触者更容易感染结核杆菌和罹患肺结核.及时规范进行结核病筛查,加强对学生进行健康教育,对单纯PPD强阳性的密切接触者进行预防性服药,可降低感染者发病风险.     

某中学肺结核聚集性疫情调查

目的 调查某中学肺结核聚集性疫情发生的原因和传播因素。方法 通过结核菌素试验、可疑症状、X线及痰涂片等方法对513名肺结核密切接触者进行病例搜索和调查,并对24名结核菌素纯蛋白衍化物试验（TB-PPD）强阳性者进行预防性服药拒绝的原因调查。结果 首例肺结核涂阳病例所在班级学生的 PPD 强阳性率和罹患率分别为64.70％和19.60％,均高于同年级其他班级（P ＜0.01）;第2例肺结核涂阳病例所在班级学生的 PPD 强阳性率为24.10％,高于同年级其他班级（P ＜0.01）。首发病例寝室学生的罹患率为66.67％（RR ＝6.56,95％CI：2.24～19.24）。79.20％的非肺结核 PPD 强阳性学生担心药物不良反应大而拒绝预防性服药,20.80％认为自己无症状、无病而不需要预防性服药。结论 某中学肺结核罹患率较高,应及时加强首发病例管理,做好密切接触者筛查及管理。     

停止卡介苗复种前后儿童结核病疫情分析

目的了解广州市停止卡介苗复种前后儿童结核病疫情变化情况。方法根据1994—2004年广州市肺结核病人登记资料进行分析。结果随着病人发现工作的加强，全市活动性肺结核新发新登记率逐年上升，但5—9岁组从1995年的5．15／10^5到2004年的1．65／10^5，10-14岁组从1995年的5．82／10^5到2004年的6．10／10^5，儿童各年龄组的疫情并没有上升。结论停止卡介苗复种，没有引起广州市儿童结核病疫情的上升。     

一起学校肺结核聚集性疫情的调查与分析

目的对苏州市某高校一起肺结核病疫情进行分析,为今后类似疫情处置提供参考。方法按《江苏省结核病疫情处置工作规范》,对病例进行流行病学调查,对病例接触者进行X线胸片、结核菌素(PPD)皮肤试验、痰检及预防性服药。结果 2017年10-12月,该校共发生有流行病学关联的肺结核病例17例,发病率为688.82/10万。病例均为男生,年龄19~22岁,涂阳1例,涂阴16例,分布在7个班级14个宿舍。首次PPD强阳性率、复查PPD反应级别增强比例密切接触者均高于一般接触者,差异均有统计学意义(P值均0.05)。近期复查PPD反应级别增强者发病率为4.90%,首次PPD强阳性者发病率为3.66%,PPD非强阳且复查反应级别未增强者发病率为1.71%,差异有统计学意义(P=0.038)。应预防性服药115人,实际服药41人,服药率为35.65%。采取消毒通风、疫情监测及健康教育等综合干预措施后,截至本学期结束未有后续病例出现。结论 PPD试验结果与和患者接触程度及后续是否发病有一定关系。建议尽早对单纯PPD强阳性者及复查PPD发应级别增强者进行预防性服药,加强学校肺结核健康教育及疫情处置长效管理机制。     

文登市0～12岁儿童结核免疫状况调查

根据卫生部要求,文登市自1997年3月开始停止对7、12周岁儿童的卡介苗(BCG)复种。为了解停止BCG复种后我市健康儿童结核免疫水平,我们于2001年3～6月份对居住在我市的0～12岁儿童的BCG免疫情况及结核免疫水平进行了调查,现将结果报告如下。 1 对象和方法 选择文登市区(城市)、文城(镇)、宋村(农村)3个监测点0～12岁儿童,每个年龄组随机抽查40名儿童。采用北京高科     

BCG vaccination and tuberculosis in Japan

This paper summarizes Bacillus Calmette-Guerin (BCG) vaccination and revaccination policies in Japan, its cost-effectiveness, side effects, proposed selective vaccination strategy, and present tuberculosis situation in Japanese perspectives based on Medline database and other published reports. Universal BCG vaccination in infants and revaccination among children were not found economically justifiable. Overall tuberculosis incidence in Japan is higher than that of other developed countries. Trend of decline in tuberculosis incidence is similar to that of the countries where universal BCG vaccination has never been implemented. In the recent years, the number of tuberculosis group infection has been escalating. Since BCG revaccination program has already been discontinued, a consensus on universal BCG vaccination is also essential based on social, political, and economical factors. Side by side, more pragmatic strategies such as well-defined tuberculin test, selective vaccination policy based on tuberculosis incidence in each administrative zone, and early vaccination of high risk groups, should be formulated.     

Survey of BCG vaccination policy in Europe: 1994-96.

A retrospective survey, based on a standardized questionnaire sent to qualified public health experts in tuberculosis in 50 European countries, was carried out to evaluate the following: concordance between national vaccination programmes and WHO recommendations on BCG vaccination for prevention of tuberculosis; relation between BCG vaccination and revaccination policy and the tuberculosis epidemiological situation; and differences in BCG vaccination policy between Western and Central-Eastern European countries. The results obtained (from 41 (82%) of the 50 countries) revealed that BCG vaccination programmes met WHO recommendations in 44% of European countries. Mass primary vaccination and general revaccination were extremely common in countries where the prevalence of tuberculosis was high. A highly significant difference was found between Western and Central-Eastern European countries in terms of their adhesion to WHO recommendations. Within Central-Eastern Europe no difference was found between countries that had or had not been part of the former Soviet Union. The implementation of WHO recommendations into national tuberculosis programmes must be intensified, based on the available body of evidence. Preventive methods whose cost-effectiveness has not been properly established should be discouraged.     

化疗加用卡介苗免疫治疗预防耐多药结核病的研究

目的 探讨卡介苗(BCG)免疫治疗对结核病化疗效果的影响及预防耐多药结核病形成的可能性能.方法 初治菌阳肺结核病志愿者360例,按年龄、性别、病灶范围、空洞和初始耐药等情况相近的原则,配对数字表法随机分成加用BCG的4个月短程化疗组、6个月单纯化疗组.比较两组的细菌学、影像学等临床疗效,以及对继发耐药病例形成的影响.结果 (1)两组结束疗程时痰菌阴转率分别是98.3%(177/t80)和97.2%(175/180),χ2=0.1278,P＞0.05.(2)5年随访痰菌复阳率BCG免疫治疗组2.3%(4/177),对照组6.9%(12/175),χ2=4.2864,P＜0.05.5年细菌学总成功率BCG免疫治疗组高出对照组5.5%,差异有统计学意义(96.1%,173/180;90.6%,163/180,χ2=4.4643,P＜0.05).(3)5年随访期内,两组病例影像学改变与细菌学结果相一致.(4)BCG免疫组继发性耐多药发生率2.3%(4/177),6个月单纯短化组病人中继发性耐多药发生率7.3%(13/178),两组差异有统计学意义,χ2=4.9513,P＜0.05.结论 化疗1个月后加用BCG免疫治疗可提高化疗效果和减少耐多药病例发生率.     

天津某高校肺结核病例密切接触者筛查结果分析

目的 了解大学生肺结核病例密切接触者的预后情况,探讨预防结核病在高校流行的防控措施。方法 对2017年天津某高校肺结核发病病例密切接触者116例行结核菌素试验(PPD)和胸部X线检查,对结核菌素试验强阳性者及有咳嗽、咳痰症状者行结核分枝杆菌涂片检查及血清结核抗体检查。结果 116例密切接触者中17例PPD实验结果强阳性,强阳性率为14.65%;胸部X线检查未见明显异常;分枝杆菌涂片均为阴性; 血清结核抗体检查结果显示4例为阳性。在访视时限内复查和服药,未出现新发确诊病例。结论 该校目前尚未形成肺结核病疫情。加强对大学生的健康教育及学校各部门的预防措施可以有效防控结核病传播。     

Neonatal revaccination with Bacillus Calmette-Guérin elicits improved, early protection against Mycobacterium tuberculosis in mice

The protective effect of revaccination with Mycobacterium bovis Bacillus Calmette-Guérin (BCG) against Mycobacterium tuberculosis in animals is controversial. To investigate whether revaccination of neonates with BCG could improve the protection against M. tuberculosis, C57BL/6 neonates were vaccinated with BCG on day 1, or on days 1, 7, and 14, and the mice at eight weeks of age were challenged with M. tuberculosis and monitored for survival. The M. tuberculosis burden in their livers and lungs, the pathological changes in the lungs, their splenic T cell responses and serum cytokines were examined longitudinally post-challenge. BCG vaccination significantly prevented the M. tuberculosis-related mouse death and reduced the burden of M. tuberculosis in the liver and lungs, and lung damage in the mice, particularly at early stage of the pathogenic process in the BCG-revaccinated mice. However, the BCG revaccination-induced protection waned over time. BCG vaccination did not significantly modulate the levels of serum IFN-γ and the frequency of splenic PPD-reactive IFN-γ-secreting T cells, but significantly decreased the levels of serum TNF-α and PPD-specific IL-4 responses at 3 weeks post challenge. Taken together, these data suggest that revaccination of neonates with BCG elicits improved, early protection against M. tuberculosis by modulating cytokine responses in adult mice.     

Tuberculin reactivity in a population of schoolchildren with high BCG vaccination coverage.

OBJECTIVE: To investigate the influence of BCG vaccination or revaccination on tuberculin skin test reactivity, in order to guide the correct interpretation of this test in a setting of high neonatal BCG vaccination coverage and an increasing BCG revaccination coverage at school age. METHODS: We conducted tuberculin skin testing and BCG scar reading in 1 148 children aged 7-14 years old in the city of Salvador, Bahia, Brazil. We measured the positive effect of the presence of one or two BCG scars on the proportion of tuberculin skin test results above different cut-off levels (induration sizes of > or = 5 mm, > or = 10 mm, and > or = 15 mm) and also using several ranges of induration size (0, 1-4, 5-9, 10-14, and > or = 15 mm). We also measured the effects that age, gender, and the school where the child was enrolled had on these proportions. RESULTS: The proportion of tuberculin results > or = 10 mm was 14.2% (95% confidence interval (CI) = 8.0%-20.3%) for children with no BCG scar, 21.3% (95% CI = 18.5%-24.1%) for children with one BCG scar, and 45.0% (95% CI = 32.0%-58.0%) for children with two BCG scars. There was evidence for an increasing positive effect of the presence of one and two BCG scars on the proportion of results > or = 5 mm and > or = 10 mm. Similarly, there was evidence for an increasing positive effect of the presence of one and two scars on the proportion of tuberculin skin test results in the ranges of 5-9 mm and of 10-14 mm. The BCG scar effect on the proportion of results > or = 5 mm and > or = 10 mm did not vary with age. There was no evidence for BCG effect on the results > or = 15 mm. CONCLUSIONS: In Brazilian schoolchildren, BCG-induced tuberculin reactivity is indistinguishable, for results under 15 mm, from reactivity induced by Mycobacterium tuberculosis infection. BCG revaccination at school age increases the degree of BCG-induced tuberculin reactivity found among schoolchildren. This information should be taken into account in tuberculin skin test surveys intended to estimate M. tuberculosis prevalence or to assess transmission patterns as well as in tuberculin skin testing of individuals used as an auxiliary tool in diagnosing tuberculosis. Taking this information into consideration is especially important when there is increasing BCG revaccination coverage.     

BCG vaccination and WHO's global strategy for tuberculosis control 1948-1983

Mass vaccination with BCG against tuberculosis has been one of the major health interventions of WHO since the Second World War. This article traces the history of the controversial BCG vaccine from its adoption by WHO in 1948 up to 1983. In 1948, there was no clear scientific evidence to support the vaccine, and its adoption by WHO seems to have been urged by the existence of the UNICEF funded 'International Tuberculosis Campaign' and a fear of a threatening global epidemic. Moreover, BCG fitted well with the post Second World War perception of public health interventions. The vaccine was not systematically reviewed by WHO until 1959, and this review appears to have been biased in favour of the vaccine. In 1979 the results from the South Indian Chingleput trial, which showed no protective effect of BCG against pulmonary tuberculosis in adults, prompted WHO to change the arguments for recommending the vaccine. Since 1983 BCG has been recommended with specific reference to its protective effect against severe forms of childhood tuberculosis. The story of the BCG vaccine and WHO is a story of medical uncertainty, institutional inertia, strategic obduracy, and not least, hope.     

Is Bacillus Calmette-Guerin revaccination necessary for Japanese children?

BACKGROUND: Bacillus Calmette-Guerin (BCG) revaccination has been implemented in Japan among tuberculin-negative first grade primary and first grade junior high school students for decades. Controversies regarding the effectiveness of BCG revaccination and low incidence of tuberculosis (TB) among Japanese children prompted this study. METHODS: Cost-effectiveness and cost-benefit analyses were conducted for a cohort of schoolchildren who underwent revaccination during 1996. The study population was a hypothetical cohort comprising 1.35 million first grade primary school and 1.51 million first grade junior high school students enrolled in 1996 at locations throughout Japan. Assuming 50% vaccine efficacy for revaccination, a 10-year duration of protection, and 5% annual discount rate, we calculated the total hypothetical number of TB cases averted, the cost and number of immunizations per TB case averted, and the benefit-cost ratio for the program. RESULTS: The revaccination program for 1996 schoolchildren cohort would prevent 296 TB cases over a 10-year period at a cost of US$ 108,378 per case averted. About 4,963 immunizations would be required to prevent one child from developing TB. The benefit-cost ratio remained at 0.13 with baseline assumptions and ranged from 0.05 to 0.29 and from 0.02 to 0.74 for one-way and two-way sensitivity analyses, respectively. CONCLUSION: BCG revaccination among schoolchildren is not supported by available scientific and economic data. Based on the results of this study, current BCG revaccination policies in Japan and other countries should be reexamined.     

BCG vaccination and WHO's global strategy for tuberculosis control 1948–1983

Mass vaccination with BCG against tuberculosis has been one of the major health interventions of WHO since the Second World War. This article traces the history of the controversial BCG vaccine from its adoption by WHO in 1948 up to 1983. In 1948, there was no clear scientific evidence to support the vaccine, and its adoption by WHO seems to have been urged by the existence of the UNICEF funded ‘International Tuberculosis Campaign’ and a fear of a threatening global epidemic. Moreover, BCG fitted well with the post Second World War perception of public health interventions. The vaccine was not systematically reviewed by WHO until 1959, and this review appears to have been biased in favour of the vaccine. In 1979 the results from the South Indian Chingleput trial, which showed no protective effect of BCG against pulmonary tuberculosis in adults, prompted WHO to change the arguments for recommending the vaccine. Since 1983 BCG has been recommended with specific reference to its protective effect against severe forms of childhood tuberculosis. The story of the BCG vaccine and WHO is a story of medical uncertainty, institutional inertia, strategic obduracy, and not least, hope.     

苏州市2006～2009年新生儿卡介苗接种质量分析

[目的]了解苏州市2006～2009年新生儿卡介苗接种效果,为预防结核病提供科学依据。[方法]对在2006～2009年间市辖区医院出生时接种卡介苗和市疾控门诊补种卡介苗新生儿,进行结核菌素实验(PPD)观察比较。[结果]卡介苗接种市辖区医院、市疾控以及两者之间差异均有统计学意义(P﹤0.05);而在接种卡介苗3个月后PPD测试结果,市疾控与市辖区医院之间差异无统计学意义(P﹥0.05)。[结论]进一步提高医院接种率水平,尽早发现患结核可能性患者,避免产生新的感染者。