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目的调查一起已经前期处置的学校肺结核聚集性疫情,探讨预防性服药和随访监测工作的重要性。方法对首发病例进行回顾调查,采用结核菌素纯化蛋白衍生物(PPD)试验对首发病例的密切接触者进行2次筛查,收集3份PPD阳性者痰标本进行实验室涂片检查,同时对该起聚集性疫情前期处置进行回顾调查。结果本次疫情共确诊5例肺结核病例。首发病例是高二(9)班的19岁男生,该病例出现咳嗽、咳痰症状未及时就医,10 d后确诊为涂阳肺结核,确诊前未休课。60名密切接触者中,初筛PPD试验阳性率为57.45%(27/47),发现1例涂阴肺结核;复查PPD试验阳性率为76.92%(30/39),发现3例涂阴肺结核。结论首发病例延误诊断、密切接触者未进行预防性服药可能是导致疫情发展的主要因素。应加强学校结核病健康教育,对密切接触者进行预防性服药和随访监测,以防止疫情进一步扩大。
Objective To investigate a cluster of tuberculosis epidemic in schools that has been disposed of earlier and discuss the importance of preventive medication and follow-up monitoring. Methods The first case was retrospectively investigated. The patients in close contact with the first case were screened twice by PPD test. Three sputum samples of positive PPD were collected for laboratory smear test. The pre-gathering epidemic outbreaks were reviewed. Results A total of 5 cases of pulmonary tuberculosis were diagnosed in this outbreak. The first case was a 19-year-old boy from a Grade II (9) class who had cough and phlegm symptoms not seen on time and was diagnosed smear-positive for tuberculosis 10 days after the diagnosis. Among 60 close contacts, the positive rate of PPD test was 57.45% (27/47), and 1 case of smear negative tuberculosis was found. The positive rate of PPD test was 76.92% (30/39), and 3 cases were smear negative tuberculosis. Conclusion The first case of delayed diagnosis, close contact with patients without preventive medication may be the main factor leading to the development of the epidemic. Health education should be strengthened for tuberculosis in schools and prophylactic medication and follow-up monitoring of close contacts should be taken to prevent the epidemic from further expanding.