某校一起肺结核聚集性疫情的流行病学调查与分析

目的 对南京某职业技术学校一起肺结核聚集性疫情进行调查分析,为规范疫情处置提供依据。方法 对病例及其密切接触者进行胸部X线检查、PPD试验和流行病学调查工作,描述发病分布、查找可能的传染源。所有数据的统计分析利用SPSS 19.0进行。结果 本起疫情共发现肺结核病例 10 例,均为男生,年龄21~22岁之间。发病班级学生罹患率16.1%,男生罹患率18.1%。确诊病例中90%通过密切接触者筛查发现,且无任何临床症状。整起疫情共对209名师生进行PPD筛查,强阳性率为16.7%。其中,学生强阳性率15.7%,教职员工强阳性率36.4%。发病班级PPD强阳性率（47.6%）高于其他班级（1.46%）,差异有统计学意义（P<0.01）,学生PPD强阳性者肺结核罹患率（22.6%）高于学生PPD阳性者（2.78%）,差异有统计学意义（P<0.01）。指示病例所在宿舍罹患率83.3%（5/6）,生活中距指示病例越近的宿舍人群发病风险越高（P<0.05）。此外,对213名师生进行X 线胸片检查,胸片异常率5.16%。结论 本次疫情的传染来源可能为指示病例,应加强学校疫情监测,开展健康教育,落实各项防病措施及制度,及时对密切接触者进行筛查和预防性服药是控制聚集性疫情有效手段。

Investigation and analysis of an outbreak of tuberculosis in one college

Objective In order to analyze the reasons of the TB outbreak in one vocational school in Nanjing, and we provide the measures of preventing TB in college. Methods Chest X-ray, PPD test and epidemiological investigation for the patients and their close contacts were carried out. The epidemical distribution by epidemiological investigation were described, and the possible source of infection were found out. We used SPSS19.0 statistical software for all the data analysis. Results Totally 10 male TB cases were detected in the outbreak. The age of the cases ranged from 21 to 22 years. The attack rate of the incidence class was 16.1%, and the attack rate in males was 18.1%. 90% of confirmed cases were detected through screening of close contacts with patients with no clinical symptoms. A total of 209 teachers and students were screened for PPD, and the strong positive rate was 16.7%. The strong positive rate of PPD test of students was 15.7%, and the rate of teaching staff was 36.4%. Strong positive rate of PPD test in incidence class (47.6%) was higher than that in other class (1.46%)(P<0.01). The attack rate of pulmonary tuberculosis in students with strong PPD positive (22.6%) was higher than that in students with PPD positive (2.78%)(P<0.01). Five cases were found from the same dormitory of the indicate case, with the attack rate of 83.3% (5/6). People close to the indicate case were higher risk of pulmonary tuberculosis than that in people far away from the indicate case (P<0.05). A total of 213 teachers and students were examined by X-ray, the abnormal rate of chest X-ray was 5.16%. Conclusion This is a TB epidemic situation in college and the first case is likely to be the infectious source. Strengthening the surveillance of the epidemic situation in college, carry out health education, implementation all infectious disease prevention measures and timely screening and prevention of medication to close contacts were effective control measures of the TB outbreak in college.