关键词: 结核, 学生, 疾病暴发流行, 流行病学研究

Abstract:

The epidemiological investigation data of a tuberculosis cluster epidemic in a high school in Xinmi city, Henan province in January 2018 were collected, as well as the tuberculosis-related physical examination results of students in this grade at the time of enrollment and the original data of the tuberculosis patient registration at the municipal Tuberculosis Prevention and Control were collected. Finally, a total of 1306 students were included for a descriptive analysis of the data. The investigation showed that the patient, female, 17 years old, high school sophomore, had a history of contact with tuberculosis, and the tuberculin pure protein derivative (PPD) test was strongly positive during the physical examination in senior high school, and no preventive anti-tuberculosis drug treatment was carried out. In November 2017, she developed cough and other symptoms, and the symptomatic treatment was not standardized. On January 29, 2018, cough, low fever and other symptoms were aggravated, and the patient was diagnosed with secondary tuberculosis, cavitation and positive sputum bacteria (). In January, May, October, 2018 and January 2019, the patients in the patient’s class were registered for suspicious symptoms of tuberculosis, chest X-ray photography and PPD test. The strong positive rate of the PPD test was 16.9% (12/71) at the initial screening, and increased to 51.5% (35/68) after 3 months. Among the 56 students who were negative for PPD test at enrollment, 30 turned strongly positive for PPD test, with an infection rate of 53.6% (30/56). In May 2018, tuberculosis screening was performed on the students in the grade of the patient, and 51.0% (666/1306) of the students in that grade had negative PPD test; 13 patients (1.0%, 13/1306) had suspected symptoms of pulmonary tuberculosis; chest radiographs showed cough in 1 of 6 patients and no symptoms in the remaining 5. After 2 years of follow-up, as of January 2020, 16 cases of close contacts of the patients had become TB, including 10 cases of tuberculosis (62.5%) and 6 cases of tuberculous pleurisy (37.5%); 8 cases (50.0%) were found in non-tuberculosis designated medical institutions after showing symptoms of tuberculosis, and then transferred to tuberculosis prevention and treatment institutions. The survey suggests that tuberculosis prevention knowledge propaganda and education in schools, freshmen tuberculosis health screening, focusing on students with family history of tuberculosis, strengthening the morning check and absence of classes due to illness registration tracking system for early detection of tuberculosis suspicious symptoms, playing a role of school doctor, checking close contacts, preventive anti-tuberculosis drug therapy for students with strong positive of PPD test are the important measures to reduce the occurrence and spread of tuberculosis in schools.

Key words: Tuberculosis, Students, Pandemics, Epidemiologic studies