论文部分内容阅读
近年来,学校结核病疫情总体呈现下降趋势,但聚集性疫情仍时有发生.2006年至今,全国共报告近80起学校结核病聚集性疫情.发生结核病聚集性疫情的学校多为寄宿制学校,约70％发生在高中或中专,约20％发生在民办学校.学校结核病聚集性疫情处置常见误区:(1)缩小或盲目扩大密切接触者筛查范围.疫情处置初期多存在筛查范围不足,造成患者发现不及时;疫情加重后又盲目扩大筛查范围,造成资源的浪费.(2)密切接触者筛查方法不规范.《学校结核病防治工作规范》要求,对密切接触者采取症状筛查、结核菌素皮肤试验和胸部X线摄影检查相结合的筛查方法.部分疫情现场对15岁以上人群不进行X线摄影检查或仅进行X线胸部透视(简称“胸透”)检查,造成患者发现不及时.有的现场因资源丰富或疫情压力,采用胸部CT检查方法进行密切接触者筛查,由于敏感度增加而发现了许多非活动或活动性不易鉴别的小结节病变,造成人群恐慌,也增加了疫情处置的压力.(3)结核菌素皮肤试验强阳性密切接触者干预不力.多数地区未对结核菌素皮肤试验强阳性者进行抗结核药物预防性治疗,部分现场出现疫情反复.(4)不规范抗结核药物治疗及不必要的辅助治疗.不合理地选用二线抗结核药物治疗现象常有发生;低剂量或超限剂量给儿童结核病患者用药;医生迷信静脉用药;患者无并发其他感染依据情况下,滥用抗生素进行抗感染治疗;不必要的免疫增强治疗,过度的护肝治疗.学校结核病防控工作应以教育系统和学校作为责任主体,在教育和卫生行政部门的领导下,按照《学校结核病防控工作规范(2017版)》的要求开展.“,”In recent years,the incidence of tuberculosis in schools has been decreasing.However,the aggregated epidemic still occurs.Up to now,nearly 80 tuberculosis epidemic cases have been reported in the country since 2006.Most happened in boarding schools,about 70％ in high school or secondary school,and about 20％ in private schools.Common misunderstandings for the disposal of tuberculosis in schools (1) reduce or blindly expand the scope of close contact screening.At the beginning,there was a lack of screening range,which caused the patients to find untimely,and after the aggravation of the epidemic,the scope of screening was expanded blindly,resulting in the waste of resources.(2) the screening method for close contacts is not standardized.The guidelines for tuberculosis prevention and control in schools require that close contacts should be screened by symptom screening,tuberculin skin test and chest X-ray examination.Part epidemic sites only provide chest fluoroscopy rather than chest X ray examination for people over 15 years old or only provide chest X ray examination resulting in untimely detection.Some sites were screened for close contacts by chest CT examination because of abundant resources or epidemic pressure.Many inactive or active small nodules lesions were found due to increased sensitivity,causing panic among people and increasing the pressure of outbreaks.(3) the intervention of close contact with tuberculin test strong positive was not effective.In most areas,tuberculosis preventive treatment was not performed on those with strong positive tuberculin test,and some of the epidemic occurred repeatedly.(4) non-standard anti-tuberculosis treatment and unnecessary adjuvant therapy.No reasonable selection of second-line anti-tuberculosis drug treatment often occurs;low-dose or overdose of medication in children patients with tuberculosis;intravenous medication;antiinfection drug abuse and treatment without combined infection evidence,unnecessary immune enhanced treatment,excessive liver protection treatment.The prevention and control of tuberculosis in schools should take educational system and schools as the main body of responsibility,and work under the guidance of education and health administration departments according to the requirements of school tuberculosis prevention and control work (2017 edition).