上海市青浦区某中学少数民族班肺结核患者密切接触者随访3年发病情况

目的 通过对2018年上海市青浦区某中学一起肺结核疫情密切接触者筛查处置情况及3年随访观察结果的分析,为学校结核病防控策略提供参考。方法 回顾性分析2018年青浦区某中学来沪少数民族班一起肺结核疫情中密切接触者筛查情况,探讨结核菌素试验强阳性的密切接触者3个月预防性抗结核治疗措施的实施并随访观察3年发病情况。结果 该起疫情的指示病例为1例来沪学习的少数民族学生,该生104例密切接触者中92例为学生,其中结核菌素皮肤试验(TST)强阳性6例(6.52%)。密切接触者不同性别、年龄、民族、接触地点、居住楼层及班级TST阳性、阴性组别的差异均无统计学意义(P>0.05)。6例单纯TST强阳性学生中5例(83.33%)全疗程完成异烟肼联合利福喷汀3个月的预防性抗结核治疗,不良反应发生率为0。所有密接3年均未发生肺结核可疑症状。5例接受治疗的密切接触者中1例停药7个月后诊断为肠结核,发病率为20%。结论 青浦区来沪少数民族班的密接人群具有较高结核分枝杆菌感染率,是学校结核病防控的重点人群。学校、疾控及定点医院三方密切配合可以提高预防性抗结核治疗接受度。密接人群的随访需要建立长效机制,针对特殊人群适当增加随访项目,高度警惕肺外结核的发生。

Close contacts of tuberculosis patients in minority class of a middle school in Qingpu District,Shanghai were followed up for 3 years

Objective To provide reference for tuberculosis prevention and control strategy, by analyzing the results of screening and disposal and followed up for 3 years of a close contact with TB cases in a middle school in Qingpu District in 2018. Methods The screening of close contacts in a pulmonary tuberculosis epidemic was retrospectively analyzed in a minority class in a middle school of Qingpu district in 2018. The implementation of 3-month preventive anti tuberculosis treatment measures for close contacts with strong positive tuberculin test was discussed and the incidence was followed up for 3 years. Results The indicator case of the epidemic was one minority student who came to Shanghai to study. 92 of the 104 close contacts of the student were students, 6 cases (6.52%) were strongly positive for TST. There was no significant difference between the TST positive and negative groups of close contacts in different gender, age, nationality, contact location, living floor and class (P>0.05). 5 cases (83.33%) of the 6 TST positive students completed 3 months of preventive anti-tuberculosis treatment with isoniazid combined with rifapentin, and the incidence of adverse reactions was 0%. There was no suspicious symptoms of tuberculosis in all 3 years. 1 patient of the 5 close contacts who received treatment was diagnosed with intestinal tuberculosis 7 months after drug withdrawal, the incidence was 20%. Conclusions The close contact population of the minority classes in Shanghai has a high infection rate of Mycobacterium tuberculosis, and is the key population for tuberculosis prevention and control in schools. The school, disease control and designated hospitals can improve the acceptance of preventive anti tuberculosis treatment. It is necessary to establish a long-term mechanism for the follow-up of closely connected populations. We be highly vigilant against the occurrence of extrapulmonary tuberculosis.