北京市丰台区外来儿童卡介苗接种状况的研究

目的掌握本地区外来儿童卡介苗接种状况。方法对小学二年级学生进行卡介苗接种史、卡痕、户口所在地、出生地情况调查，同时进行人型-PPD试验。结果外来儿童卡介苗接种率、卡痕率明显低于本地儿童。而未接种卡介苗儿童结素阳性率明显高于本地儿童。结论外来儿童的卡介苗接种工作应予加强。     

北京市新生儿卡介苗接种质量的监测

目的　了解近10年来北京市新生儿卡介苗接种工作的质量情况。方法 对1991～2000年本市各年新生儿卡介苗接种工作记录和质量监控结果记录进行统计,逐年分析。结果 近10年全市新生儿卡介苗接种率(简称接种率)、接种及时率、接种后12周结素试验阳转率(简称阳转率)和卡痕率以及结素反应平均直径、卡痕平均直径等6项指标均比较稳定。城区、近郊区和远郊区的接种率无明显差别,均在97%以上;农村的阳转率和结素反应平均直径两项指标也非常接近城区(包括近郊区)。结论 北京市新生儿卡介苗接种工作质量较高并在近10年中保持了各项监测指标的稳定。     

上海市宝山区外来简易学校学生结核菌素反应状况分析

目的掌握宝山区外来简易学校学生结核菌素反应现状,为上级主管部门制定在这一特殊人群中开展肺结核病防治工作的政策措施提供科学依据。方法对宝山区4所外来简易学校5 037名学生进行年龄、性别、户籍、来沪年限、卡介苗接种情况、卡痕、结核病接触史、人型-PPD试验、胸片、痰找结核菌整群抽样调查。结果儿童卡介苗接种率65.3%,有卡痕率55.1%,结核病接触史率2.8%。PPD试验阴性率71.6%、阳性率28.4%,(其中强阳性6.5%,异影摄胸片1.1%,需门诊随访3例,确诊为肺结核病1例)。结论对外来简易学校学生结核病防控工作需要加强。     

云南省红河州哈尼族结核病疫情调查分析

目的　调查云南省哈尼族肺结核流行情况。方法 出生满3个月以上婴儿至15周岁以下儿童作结核菌素试验(PPD)及卡介苗接种的卡痕检查,PPD强阳性者进行胸部摄片检查,有症状者进行痰菌检查。结果 402名哈尼族人中检出活动性肺结核23例,检出率5.7%,痰菌阳性3人,涂阳率746.27/10万。PPD强阳性反应25名,强阳性率4.0%。结论 云南省红河州哈尼族肺结核疫情严峻。     

铜陵市新生儿卡介苗接种质量监测结果分析

目的　探讨提高和确保新生儿BCG接种工作质量的方法和途径。方法 采取完善全市组织管理体系、全员培训、设常年新生儿BCG监测门诊、扩大监测面等措施。结果 1999— 2 0 0 1年 ,新生儿BCG接种率、接种后 12周末PPD阳转率、卡痕率、PPD反应平均直径、卡痕平均直径等监测指标均稳定达标 ,及时发现消除不利因素 ,对接种无效的 10 2名进行了补种。结论 强化组织管理体系 ,全员培训 ,连续、动态、全覆盖监测有利于BCG接种质量的恒定提高。     

531例住院儿童结核病情况分析

目的　分析25年间531例住院儿童结核病情况,评价儿童结核病的防治效果。方法 对25年间住院的儿童结核病例进行全面的调查分析。结果 25年间共收治儿童结核病531例,占同期住院病人总数的3.8%,其中原发性肺结核和结核性脑膜炎297例,占儿童结核病总数的55.9%。死亡率由3.6%下降为0。结论 由于新生儿卡介苗的普遍接种,结核病防治工作的深入开展,住院原发性结核病呈明显下降趋势。     

济南军区肺结核危险因素的病例对照研究

目的　了解影响部队肺结核发病的危险因素,有针对性地采取预防措施。方法 按1：1配比对20个单位中新发肺结核病人进行病例对照调查,计算各因素的比值比(OR)和95%可信区间(CI),并用条件logistic回归模型进行多因素逐步回归分析。结果 单因素分析中,劳动强度、体质指数、卡痕、住房类别、结核病接触史、入伍地、性格等因素的OR值分别为5.12、0.37、0.42、0.51、1.82、0.57和1.63(P<0.05)。上述因素中除性格外均进入回归模型。结论 完善卡介苗的接种,加强对肺结核传染源的发现、治疗、管理工作,以及针对其他发病危险因素采取相应的防治措施对于结核病疫情的控制具有重要意义。     

武钢新生儿卡介苗质量监测评价

目的分析武钢20年新生儿卡介苗接种质量监测情况。方法对1985-2004年武钢医院各年新生儿卡介苗接种和质量监测的原始记录进行统计分析。结果20年武钢的新生儿卡介苗及时接种率、卡介苗接种12周末阳转率、PPD平均直径、有卡痕率、合格卡痕率、卡痕大小的分布频率均逐年稳步提高到理想水平,对接种无效的506名进行了补种。结论武钢新生儿卡介苗接种质量稳步提高到较高水平,为预防儿童结核病发挥了重要作用。     

福建省畲族人群结核病疫情调查分析

目的　调查福建省畲族人群结核病流行状况。方法 参照全国第四次结核病流调方案与实施细则进行。结果 6个调查点活动性肺结核患病率429.0/10万,涂阳患病率237.3/10万,菌阳患病率248.6/10万,分别是同年福建7个结核病调查点的1.8倍,2.5倍,1.9倍。调查发现21例涂阳病例中已知11例只有3例已经登记管理,仅占27.3%,复治与慢性排菌病人占52.4%,儿童卡痕率为63.9%。结论 畲族人群肺结核流行状况严重,防治工作滞后。     

现代结核病控制措施下结核病传染参数的研究

目的　探索现代结核病控制措施 (DOTS)下的结核病传染参数。方法 北京市顺义区自1978年开始对传染性肺结核病人采取现代结核病控制措施 (DOTS)。1988年7月全县开始停止新生儿卡介苗接种,并对儿童采取了一系列保护性预防措施。1995年按照WHO和IUATLD推荐的国际标准结核菌素试验技术并采用国际标准PPD,对1988～1989年停止卡介苗接种的12849名6～7岁小学一年级儿童进行PPD皮内试验。根据PPD试验反应硬结分布情况,以PPD反应硬结横径≥10mm为结核自然感染标准,然后,根据公式计算年结核感染率和传染参数。结果 顺义区结核自然感染率为1.35%,推算年结核感染率为0.21%。与此同时,痰涂片阳性肺结核病人的年患病率为21.7/10万～39.1/10万,由此计算传染参数约为6。结论 北京市顺义区的结核病传染参数约为6,也就是1名传染源每年平均传染6名健康人,充分说明北京市顺义区所采取的现代结核病控制措施(DOTS)对控制结核病传染源、减少结核菌传播以及保护健康人群十分有效。     

67例婴幼儿肺结核临床诊断分析

目的分析婴幼儿肺结核的临床诊断特点。方法对67例婴幼儿肺结核的卡介苗接种情况、结核接触史、临床表现、实验室检查、胸部影像学特点、PPD试验结果进行回顾性分析。结果67例患儿中未接种卡介苗20例(29.9%);有结核接触史31例(46.3%),外来人口26例(38.8%);发热51例(76.1%),有呼吸道症状者59例(88.1%),有神经系统症状者15例(22.4%);PPD(-)14例(20.9%),CRP升高50例,ESR升高45例(67.1%)血常规检查示白细胞升高45例(67.2%),白细胞分类中性粒为主者49例(73.1%);67例行X线胸片检查,其中16例(23.9%)仅见两肺纹理增多增粗、未见实质性病灶,CT检查58例,其中2例未见明显异常。最后诊断为原发型肺结核40例,占59.7%,血行播散性肺结核14例,占20.9%;继发性肺结核5例,占7.5%;结核性胸膜炎8例,占11.9%。结论婴幼儿肺结核有一定的临床特点,临床应注意早期诊断;同时应该加强外来流动人口的结核病防治工作,普及外来人口儿童的卡介苗接种率。     

The current value of tuberculin testing and BCG vaccination in school children

We have examined the value of routine tuberculin testing and BCG vaccination in Edinburgh school children from 1970 to 1983. Over 89,000 children were observed for a mean period of 7 years, during which 77 new cases of tuberculosis were notified in Caucasians. The average annual incidence of tuberculosis in the 65,692 children receiving BCG vaccination at school was 7/10(5), significantly less than the 19/10(5) estimated in 12,987 Heaf negative children who missed BCG vaccination, and the 41/10(5) in 5,308 tuberculin positive children (P less than 0.001). The efficacy of BCG vaccination in this study exceeded 60%. The 5,308 tuberculin positive children were offered chest radiographs with an initial yield (new cases of tuberculosis detected/radiographs taken) of 1/555 for Heaf grade II children, 1/75 for grade III, and 1/25 for grade IV (P less than 0.001). During the period of this study approximately 700 BCG vaccinations were necessary to prevent one new case of tuberculosis and this represents considerably greater benefit than in England and Wales during the same period. There may be a case for continuing the schools' BCG programme in Scotland for a number of years longer than in England and Wales. A national BCG survey for Scotland would be valuable.     

铜陵市婴幼儿卡介菌纯蛋白衍生物试验结果分析

目的了解卡介苗（BCG）预防接种质量,分析存在的问题及其影响因素,提出改进措施,促进预防接种规范、安全、有效地开展。方法用卡介菌纯蛋白衍生物（BCG-PPD）试验方法,随机调查300名儿童接种卡介苗3个月后的阳转率。结果卡介菌纯蛋白衍生物试验总阳性率86.33%,城市儿童卡介菌纯蛋白衍生物试验阳性率高于农村儿童。卡痕大小与卡介菌纯蛋白衍生物试验阳性率呈正相关;县级及以上医院产科接种卡介苗的儿童卡介菌纯蛋白衍生物试验阳性率高于乡镇级医院产科和预防接种门诊接种卡介苗的儿童。结论加强对卡介苗接种人员,尤其要加强农村乡镇卫生院和接种门诊的接种人员的技术培训,提高接种质量。     

Design of the leprosy component of the Brazilian BCG revaccination trial for assessing BCG effectiveness against leprosy in school children

BACKGROUND: BCG vaccination confers protection against leprosy, and vaccination among household contacts has been recommended in Brazil. Nevertheless, vaccination of the entire community against leprosy is not advocated as leprosy has low incidence in most populations. Despite that, in Brazil, BCG vaccination is recommended among school children to prevent tuberculosis and this large scale vaccination may also affect the occurrence of leprosy, which led to investigations of its impact on leprosy in endemic areas of Brazil. OBJECTIVES: To estimate the effectiveness against leprosy of a dose of BCG vaccine given to school children in a population with a high coverage of neonatal BCG. Long term objectives are to compare the impact of vaccination among schoolchildren with the existing recommendation to vaccinate household contacts of leprosy. STUDY DESIGN: Cluster randomized controlled field trial with no placebo. STUDY POPULATION: Children aged 7 to 14 years attending state schools with high coverage of neonatal BCG. METHODS: 286 state schools in the city of Manaus, Brazil, were randomized to receive BCG or not. Identifying information was collected for 152,438 school children, of whom 72,980 are in intervention schools. BCG vaccination was given intradermically to children in schools allocated to vaccination. Follow-up relies on ascertainement of cases diagnosed at the health services and notified to the reference center for leprosy.     

BCG vaccination of children with differing perinatal pathology]

Information on 586 newborns with perinatal abnormalities who were not given BCG vaccination in the maternity homes of Novosibirsk is analysed. The most common causes of BCG vaccination refusal were intrauterine hypotrophy (35%), CNS affection (29.2%) and prematurity (22.7%). A follow-up of 693 children with perinatal abnormalities who received BCG vaccination in polyclinics has shown that this vaccination is sufficiently effective and the course of the vaccination reaction does not differ from that in children who were vaccinated in the maternity homes. It has been concluded that BCG vaccination can be given to the majority of children with perinatal abnormalities within the first 2 months of life provided their condition is satisfactory.     

The effect of bacille Calmette-Guérin vaccination at birth on tuberculin skin test reactivity in Ugandan children.

SETTING: In Uganda, bacille-Calmette Guerin (BCG) vaccination coverage at birth is between 82 and 84%. OBJECTIVE: To evaluate the effect of neonatal BCG vaccination on tuberculin skin test positivity in Ugandan children exposed to infectious cases. DESIGN: As part of an ongoing prevalence study of household contacts of new tuberculosis cases, 365 children were evaluated to determine if BCG vaccination at birth had an impact on tuberculin skin testing. The children were classified as contacts (179) and non-contacts (186) depending on the presence of a sputum acid-fast bacilli (AFB) smear-positive adult tuberculosis case in the household. RESULTS: Regardless of prior BCG vaccination, children exposed to a smear-positive adult were more likely to have a positive skin test (purified protein derivative >5mm) (68% versus 36%, P < 0.01). BCG-vaccinated children below 1 year of age without a known household contact with active tuberculosis had a lower frequency of tuberculin skin reactions (29%) compared to their counterparts in the contact households (65%, P = 0.031). CONCLUSION: BCG vaccination at birth had no important effect on the interpretation of the tuberculin skin test reactivity in this group of Ugandan children. The tuberculin skin test remains a valuable tool for the evaluation of household contacts and suspected cases of tuberculosis in BCG-vaccinated children.     

Tuberculin reactivity in first‐year schoolchildren in Madagascar

Objective The tuberculin skin test (TST) is an important tool in the diagnosis of tuberculosis infection in children. However, the interpretation of TST may be complicated by prior Bacillus Calmette‐Guerin (BCG) vaccination. We evaluated the effect of vaccination with BCG on TST reactivity in first‐year pupils attending state schools in Antananarivo. Methods STs were performed on 376 first‐year schoolchildren, aged 6 and 7, attending two state primary schools. The relationships between epidemiological information, BCG status (vaccination, BCG scars) and TST reactivity were assessed to compare TST sensitivity between children with and without BCG vaccination and between those with and without a BCG scar. Result The prevalence of positive TST results of ≥5, ≥10 and ≥ 15 mm was 20.2% (76/376), 18.3% (69/376) and 11.4% (43/376), respectively. BCG vaccination was not associated with TST reactivity, whatever the threshold used: ≥5 mm (odds ratio (OR, 1.2; 95% confidence interval (CI), 0.7–2.0); ≥10 mm (OR, 0.9; 95% CI, 0.6–1.7); ≥15 mm (OR, 0.6; 95% CI, 0.3–1.2). Conclusion These results suggest that in Madagascar, a positive TST result indicates TB infection (active or latent) rather than past BCG vaccination. Therefore, high BCG vaccination coverage does not appear to impair the usefulness of the TST as a tool for diagnosing tuberculosis.     

Study on BCG vaccination and incidence of children's tuberculous meningitis in Liaoning province

The purpose of this study was to assess the effect of BCG vaccination on the incidence of tuberculous meningitis in children. A retrospective review was undertaken to find out vaccination rate of BCG and positive conversion mantoux rate in newborn infants. The results obtained were as follow: in 1980, vaccination rate was 51.61%, and the positive conversion Mantoux rate was 87.86%; in 1988 vaccination rate was 96.06%, and the positive conversion Mantoux rate was 94.92%. With the increase vaccination rate of BCG the incidence of tuberculous meningitis in children have decreased: in 1980 it was 3.27/100000; in 1988 it was 0.95/100000. The annual average incidence rate decreased by 14.28%.     

Sensitisation by mycobacteria and the effects of BCG on children attending schools in the slums of Bombay

Quadruple skin testing with new tuberculins was used to evaluate the effects of previously administered BCG Madras in children attending schools in the slums, or living in Kopri Leprosy Colony in Bombay. There were differences between schools both in the level of sensitisation of children without BCG scars and in the effects of BCG vaccination. Results obtained at one school resembled those obtained in a previous study in Agra, where BCG was thought to be ineffective. Results from the other schools and Kopri were more like those previously reported from Ahmednagar, where BCG was considered to be much more effective. Thus within the same city groups of children of the same social status may vary widely both in their contact with mycobacteria and in their capacity to benefit from BCG vaccination.