江苏省苏州市学校结核病聚集性疫情接触者筛查分析

目的 分析苏州市学校结核病聚集性疫情接触者筛查结果,为学校结核病防控工作提供依据。方法 以苏州市2016—2018年间发生的11起学校结核病聚集性疫情接触者为研究对象,回顾性收集和分析肺结核可疑症状调查,结核菌素试验,X线胸片及结核分枝杆菌检查等筛查资料。结果 11起聚集性疫情共判定接触者5 443例,PPD强阳性率为14.73%,续发患者检出率为0.97%。其中,密切接触者577例,PPD强阳性率为39.51%,续发患者检出率为6.24%;一般接触者4 866例,PPD强阳性率为11.80%,续发患者检出率为0.35%。密切接触者强阳性率和续发患者检出率均显著高于一般接触者,差异具有统计学意义(P <0.001)。在签署知情同意书基础上共有81例单纯PPD强阳性接触者接受了预防性服药治疗,筛查检出的53例活动性肺结核均在定点医院进行了规范治疗。结论 学校结核病聚集性疫情接触者的结核菌潜伏感染及患病风险较高,应及时准确判定接触者,分级逐步扩大筛查范围,对筛查后的感染者应有效落实预防性治疗,有效控制学校结核病暴发流行。

Screening of contacts among school tuberculosis outbreak in Suzhou,Jiangsu

Objective To screen contacts among school tuberculosis outbreak in Suzhou, to provide the basis for tuberculosis prevention and control in schools. Methods A total of contacts among 11 school-based tuberculosis outbreaks in Suzhou from 2016 to 2018 were included in the present study. The screening data on tuberculosis suspicious symptoms survey, purified protein derivative test (PPD), chest X-ray and Mycobacterium tuberculosis examination were collected and analyzed retrospectively. Results Totally 5 443 contacts were screened among 11 school-based tuberculosis outbreaks, the strong positive rate of PPD was 14.73%, and the detection rate of secondary patients was 0.97%. Among them, there were 577 cases of close contacts, the strong positive rate of PPD was 39.51%, and the detection rate of secondary patients was 6.24%. Among 4 866 general contacts, the strong positive rate of PPD was 11.80%, and the detection rate of secondary patients was 0.35%.The strong positive rate and secondary detection rate of the close contacts were significantly higher than those of the general contacts (P <0.001). On the basis of signed informed consent, a total of 81 patients with strong positive PPD alone received preventive drug treatment, and 53 patients with active tuberculosis detected by screening received standard treatment in designated hospitals. Conclusion The risk of latent infection and disease is higher in contacts exposed to clustered tuberculosis outbreaks in schools. It is necessary to timely and accurately identify contacts, stepwise expand the scope of screening, and implement preventive therapy of latent tuberculosis infection in order to control the outbreak of tuberculosis in schools.