文章摘要
黄玉,钟节鸣,张钰,陈松华,王晓萌.浙江省一起校内肺结核聚集性疫情暴发原因及影响因素调查[J].中华流行病学杂志,2015,36(2):172-175
浙江省一起校内肺结核聚集性疫情暴发原因及影响因素调查
Outbreak of tuberculosis in a high school in Zhejiang,China
收稿日期:2014-10-09  出版日期:2015-02-06
DOI:10.3760/cma.j.issn.0254-6450.2015.02.016
中文关键词: 肺结核;聚集性疫情;流行病学
英文关键词: Tuberculosis;Outbreak;Epidemiology
基金项目:浙江省医药卫生科技计划项目(2011KYB027)
作者单位E-mail
黄玉 浙江省疾病预防控制中心, 杭州 310051 xiuzi811122@126.com 
钟节鸣 浙江省疾病预防控制中心, 杭州 310051  
张钰 浙江省疾病预防控制中心, 杭州 310051  
陈松华 浙江省疾病预防控制中心, 杭州 310051  
王晓萌 浙江省疾病预防控制中心, 杭州 310051  
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中文摘要:
      目的 探讨一起校内聚集性肺结核疫情暴发的促发因素,及时发现首发病例对疫情监测、随访和相关控制措施的重要性。方法 对首发病例进行病例回顾,评估病情的严重性及其传播时间;对疫情前期处理进行回顾调查,通过现场调查探讨促发疫情最终扩大的因素。结果 该起疫情共发现肺结核25例,其中14例来自同一班级,并出现首发病例,该班级患肺结核的风险是其他班级的10.74倍(χ2=42.31,P<0.001).首发病例在发病初期有典型的咳嗽、咳痰等肺结核症状,1个月后发现肺部空洞才被确诊,在此前未休课。64名密切接触者中,56人(87.5%)完成筛查,52人(92.9%)结核菌素试验筛查结果为阳性,初次筛查未发现病例。结论 首发病例延误诊断、密切接触者拒绝预防性服药、分班以及对疫情后期监测、密切接触者随访不足是导致疫情进一步发展最终暴发的促发因素。
英文摘要:
      Objective To identify precipitating factors of a tuberculosis (TB) outbreak in a school and discuss the importance of index case detection on outbreak monitoring,follow up and related control measures. Methods A case survey of the index patient was conducted to evaluate the illness severity and infectious duration of the case. The initial response to this case was surveyed to understand the factors leading to the outbreak. Results A total of 25 TB cases were detected in the outbreak,including 14 cases in one class. The risk of catching TB among the classmates of the index case was 10.74 times higher than that among students in other classes(χ2=42.31,P<0.001). Although the index case had typical TB symptom of cough and expectoration,TB was not diagnosed until pulmonary cavity was detected by chest radiograph one month later. Among 64 close contacts,56(87.5%) completed TB screening,52(92.9%) were purified protein derivative positive. No TB cases were detected. Conclusion The factors leading to the outbreak included delayed diagnoses of the index case,no chemoprophylaxis taken by the close contacts;poor surveillance and follow-up for close contacts.
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