关键词: 学生, 结核,肺, 疾病暴发流行, 接触者追踪

Abstract:

Objective: To investigate and analyze an epidemic situation of pulmonary tuberculosis in an off campus study room, and put forward opinions and suggestions for the optimization of tuberculosis prevention and control for students in the future. Methods: On January 30th, 2022, Disease Control and Prevention Center of Ji’nan Shizhong District received the early warning information of a single case of school pulmonary tuberculosis from the Disease Control and Prevention Center of other cities. According to the relevant requirements of the Guidelines for Tuberculosis Control and Prevention in Chinese Schools (2020 Edition), the center immediately conducted a case epidemiological telephone survey of the index case (during the holidays). According to the contact intensity, the contact persons were informed to go to the local tuberculosis fixed-point hospital to complete tuberculosis screening (including symptom screening, tuberculin skin test (TST) and chest X-ray examination, further pathogenic examination was conducted for those with abnormalities in the three, and species identification and drug sensitivity test were conducted for those with positive etiology), and the screening results were reported to the school and our district control center for summary. Results: A total of 5 active pulmonary tuberculosis patients were found in the tuberculosis cluster epidemic in the school, and all of them were treated with anti-tuberculosis drugs. Among them, the first round of close contacts screening in the dormitory and off-campus study room of the index case found 3 cases, including 2 cases who prepared for the test in the same off-campus study room and 1 case who prepared at home from different schools in the same off-campus study room. In the second round of general contact investigation, 1 case was found to be a student preparing for examination in an adjacent off-campus study room on the same dormitory floor of the index case, and the further investigation was terminated because the management of the study room stopped cooperating with the notification work. A total of 82 contacts were screened from this epidemic investigation, including 22 close contacts, the strong positive rate of TST was 36.36% (8/22), and the abnormal rate of chest X-ray was 13.64% (3/22); a total of 60 general contacts were screened, with a strong positive TST rate of 8.33% (5/60) and an abnormal chest X-ray rate of 1.67% (1/60); the difference of strong positive rates was statistically significant (χ²=7.496, P=0.006), but there was no statistically significant difference in the abnormal rate of chest X-ray imaging (χ²=2.726, P=0.099). All 13 cases with strong positive TST were monitored. No new patients were found within 3 month follow-up of student patients, TST positive patients and their families. Conclusion: The prevention and control of tuberculosis among students should strengthen the implementation of the main responsibility of school tuberculosis management, especially the health management of students in the graduation preparation or internship stage. The prevention and control of tuberculosis among students should not only pay attention to the close contacts in the school, but also verify whether there is a stay history in the crowded places such as the study room outside the school through epidemiological investigation. Education departments, health supervision agencies, market supervision departments and community street administrative department should jointly do a good and new solution in the prevention and control of tuberculosis among students.

Key words: Student, Tuberculosis, pulmonary, Epidemic, Contact tracing