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目的对一起学校结核病疫情进行回顾,为学校结核病防控工作提供借鉴。方法对与病例所在学校高一、高二年级学生进行结核病筛查以确定新发病例及高危人群;自行设计访谈提纲及调查问卷,对校方及既往病例开展流行病学调查,追溯事件发展过程。结果学生胸部X线小片荧光缩影筛查率为99.86%(802/803),其中2例确定为活动性病变。PPD筛查率为94.40%(758/803),强阳性率为15.96%(121/758);高二年级强阳性率(19.91%)明显高于高一年级(9.25%),差异有统计学意义(χ2=23.750,P<0.05)。在高二同一班级新发现2例活动性肺结核病人,且病例来源于同一班级的PPD强阳性率(82.22%,37/45)明显高于其他班级,差异具有统计学意义(P<0.05)。流行病学调查发现,病例所在年级先后出现7例学生结核病人且病例间有密切接触史,除首发病例外,其余病例没有明确的校外接触史;除1例密接筛查病例外,其余病例均出现过结核病相应症状且存在就诊及/或确诊延误。结论对结核病人家庭中的学生成员及学生结核病人的密切接触者开展主动筛查,建立、落实包括入学体检及症状监测在内的学校病例主动发现机制,同时加强全民健康教育及医务人员专业培训,协同做好学校结核病疫情控制。
Objective To review a school of tuberculosis epidemic and provide reference for prevention and control of tuberculosis in schools. Methods To screen the tuberculosis patients of high school and high school in the case where the case was located to identify new cases and high-risk groups. The interviewer and questionnaire were designed by themselves. Epidemiological investigation and retrospective development were carried out on the school and previous cases. Results The screening rate of fluorescence miniature of chest X-ray was 99.86% (802/803), of which 2 were confirmed as active lesions. The PPD screening rate was 94.40% (758/803) and the strong positive rate was 15.96% (121/758). The strong positive rate of grade 2 (19.91%) was significantly higher than that of the first grade (9.25%), the difference was statistically significant (χ2 = 23.750, P <0.05). Two cases of active pulmonary tuberculosis were found in the same class of Grade 2, and the positive rate of PPD (82.22%, 37/45) was significantly higher than that of other classes in the same class of cases. The difference was statistically significant (P <0.05). Epidemiological survey found that in the grade of the case, there were 7 cases of tuberculosis patients and there was a close contact history among the cases. Except for the first case, there was no clear history of out-of-school exposure. Except for one case of close screening, all the other cases There have been symptoms of tuberculosis and there is a delay in diagnosis and treatment. Conclusion Active screening of students in TB families and close contact with TB students was carried out to establish and implement a proactive mechanism for detecting cases in schools, including entrance examination and symptom monitoring. At the same time, universal health education and professional training of medical personnel were strengthened , Work together to control school tuberculosis outbreaks.