江苏省结核病疫情周报在学校结核病预警及处置中的应用

目的 描述江苏省学校结核病疫情周报系统和运行情况,并评估其实施效果.方法 对近10年江苏省全人群和学生结核病流行特征进行描述分析.描述学校结核病疫情周报设计思路、数据收集和分析预警功能,并对2019-2020年学校结核病周报实施效果进行评估.结果 2011-2020年,江苏省共登记肺结核患者301772例,年均登记发病率37.82/10万;学生结核病登记病例11185例,年均登记发病率8.12/10万.10年间,全省登记发病率和学生登记发病率分别下降42.20％和27.92％,均呈逐年下降的趋势(x2趋势=9805.90和153.51,P值均＜0.0l).江苏省从2019年1月1日起,在国内首次尝试开展学校结核病疫情周报制度,内容主要包括:内容提要,≤24岁年龄肺结核报告发病情况,学生、教师及幼托儿童报告发病情况和半年内同一学校报告发病人数≥2例情况分析.2019-2020年在国家学校肺结核单病例预警系统的基础上,周报补充预警了114例学生结核病病例.结论 江苏省学校结核病疫情周报设计合理、运行正常,对学校结核病病例的发现和聚集性疫情预警具有重要的公共卫生意义,并对学校结核病的规范处置起到积极的督促作用.     

2014-2018年沈阳市学生结核病流行病学特征分析

目的 分析2014-2018年沈阳市学生肺结核流行特征,为进一步完善学校结核病防控措施提供依据。方法 利用“结核病信息管理系统”资料分析近五年学生结核病流行特征。结果 2014-2018年沈阳市共登记学生肺结核患者1365例,年均报告发病率19.87/10万,其中病原学阳性病例发病率2.08/10万。男、女性别比1.65〖DK〗∶1,以15~24岁年龄组发病为主,每年第二季度病例较多。五年发生聚集性疫情13起。寝室内传播9起,占69.23%,明确传染源10起,占76.92%。病例发现不及时(76.92%),教室寝室通风不好(53.85%),无结核病入学体检(46.15%),校医管理不利和教室学生密集(各占23.08%)是聚集性疫情发生的危险因素。结论 学生结核病疫情依然严峻。针对重点人群开展主动防控,着重加强病例监测、入学体检和改善学习环境,加强校医的培训和专业素质提高,保证学生健康服务管理。〖JP〗     

某幼儿师范学校西藏班结核病暴发疫情调查

目的探讨学校聚集性结核病疫情处置策略,关注迁入的少数民族学生结核病疫情防控。方法对结核病暴发的学校发病班级的学生基本情况、发病情况、学习生活环境等进行调查,描述发病分布,查找传染源并做出相应处置。结果 2012年2月—2013年3月,该校共发现18例结核病例(13例Ⅲ型结核、4例Ⅳ型结核、1例Ⅴ型结核),均为西藏班学生,西藏班结核病的罹患率为11.84%。其中,2010级、2011级两个年级结核病罹患率分别为17.72%、5.48%,差异有统计学意义(χ2=4.34,P<0.05)。密切接触人群中不同PPD试验结果的结核发病情况无统计学差异(χ2=4.69,P>0.05)。结论本次疫情为一起学校结核病疫情,传染源极有可能为首发病例,西藏学生感染结核后易发病。     

近年结核病发现方式分析

病例的发现是目前结核病控制工作中最重要的措施,因症就诊是结核病人发现的主要方式,50%左右的病人由综合医院转诊而来。提高人群对结核病防治知识的知晓率,有可疑症状时到医疗单位或结防机构检查。综合医院转诊是肺结核病人发现的最主要来源,明确落实综合性医院的肺结核病人转诊工作,形成标准化、规范化的结核病防治管理程序,可最大限度地提高结核病人的发现率和登记率。     

南京市2005-2011年学生结核病发病特征分析

了解南京市学生结核病的报告发病特征,为制定学校结核病防治对策提供依据.方法 采用描述流行病学方法,对南京市2005-2011年学生结核病患者登记资料进行分析.结果 2005-2011年学生报告结核病发病率分别为24.82/10万,22.54/10万,17.55/10万,15.43/10万,20.64/10万,15.86/10万,14.92/10万,平均报告发病率18.68/10万,各年份报告发病率差异有统计学意义(x2=59.38,P<0.01),随年份变化呈下降趋势(x2趋势=37.76,P<0.01);涂阳登记比例逐年降低(x2趋势=28.28,P<0.01);患者中男生多于女生;年龄分布以20~24岁最多(52.15%),其次为15~ 19岁(37.04%);经主动发现方式发现的学生患者比例较低;报告病例数在4-5月和9月较多.学生平均就诊延迟率为26.70%,且就诊延迟率随学生年龄增长呈下降趋势(x2趋势=14.46,P<0.01).结论 南京市学生结核病报告发病率呈下降趋势,15~24岁年龄段的学生是学校结核病防控的重点人群.应加大对学生结核病例的主动发现力度,重视对学生结核病防治知识的健康宣教.     

泰安市大中专院校结核病控制的研究

目的探索大中专院校结核病控制模式。方法对泰安市2003~2007年10所大中专院校121 876名新生进行结核菌素(PPD)试验。强阳性反应者或有可疑症状者行胸片、痰菌检查并给予预防性治疗。对发现的结核病人进行规范治疗,在校期间实施结核病健康教育,设立学生疫情报告员,实施动态监测与管理。结果PPD试验阳性39 122人,占32.1%。硬结横径≥15 mm 7434人,占6.1%,其中6765人进行了预防性治疗(91.0%)。共发现结核病人168例,其中入校新生查体发现101例(60.1%),学生疫情报告员发现43例(25.6%),自动就诊24例(14.3%)。结论对大中专院校学生实施的入校结核病筛查、药物预防、健康教育、设立学生疫情报告员结核病控制模式是控制学校结核病的有效措施。     

2010—2014年天津市南开区结核病流行特征分析

目的通过分析天津市南开区2010—2014年结核病发病水平及流行特点,为控制结核病传播提供科学依据。方法用excel和SPSS 17.0软件对南开区2010—2014年结核病管理信息系统中的结核登记资料进行描述流行病学分析。结果 2010—2014年南开区共报告结核病病例1 541例,死亡20例,年均报告发病率为25.61/10万。2010—2011年报告的病例数较稳定,发病率最低的是2012年(19.98/10万),2013—2014年发病率呈现上升趋势,2013年发病率最高(31.40/10万);每年各月均有病例报告,总体分布无明显的季节性和周期性;发病以青壮年组(15~24岁)例数最多,儿童组(0~14岁)最少;家政、家务及待业例数为413例,占报告发病总数的26.80%。患者来源方式以因症就诊和转诊为主。结论南开区推行现代结核病控制策略,加强了全程督导下短程化疗(DOTS)管理落实,肺结核疫情总体较为平稳。但近2年疫情有上升趋势,应继续加大肺结核防治工作的投入和管理。     

天津市中高等院校结核病防控工作现状

了解天津市中高等院校结核病防控工作能力及工作现状,为进一步完善学校结核病防控策略提供参考.方法 自行设计问卷,对市教委管辖的中、高等院校开展结核病防控工作现况进行问卷调查,对资料采用x2检验或Fisher确切概率法进行分析.结果 接受调查的152所院校均建立了结核病防控工作领导责任制.93.42% (142/152)的院校配备有卫生保健机构(含卫生室、保健室、校医院等)和卫生保健人员,在校生人数与专职卫生保健人员配备比为1 430∶1.专职卫生保健人员中专科学历占50.36%(207/411),有医学背景及执业医师资格的卫生人员比例分别为79.32%和57.66%.各院校日常结核病防控措施落实整体较好,但仍有近20%的院校不能开展学生因病缺勤追踪;l2.5%的院校不能落实新生入学体检,27.63%的院校不能落实在校生体检,且各类院校之间开展体检比例(新生入学、在校生)差异均有统计学意义(P值均<0.05),高等院校在校生体检工作开展比例最低(25.0%).有超过10%的院校在出现结核病例后不能及时开展密切接触者筛查,各类院校间差异无统计学意义(P>0.05);落实因结核病休/复学管理制度的院校比例为77.97%,且各类院校间差异有统计学意义(x2=6.71,P<0.05),其中以高中学校明显偏低,仅为55.56%.结论 天津市中、高等院校的结核病防控工作整体开展情况较好,但仍应继续加强卫生保健人员队伍建设和加强各项防控措施的落实,以确保学校结核病疫情的平稳.     

1起学校聚集性结核病疫情流行病学调查分析

目的 分析某校聚集性结核病疫情流行病学特征。方法 以广东省平远县某中学高三学生作为研究对象,采集该校2011年3月份高考学生体检数据,并进行流行病学调查,即采取痰涂片检查、胸片X线检查等,详细登记并分析检查结果。结果 高三体检者中,共发现有18例学生患有肺结核病,病例分布在高三5个班级中。结论 学校未开展新生入学结核病筛查和学生未能及时就诊是引发结核病疫情的主要原因,今后需要开展针对初中以上的新生入学结核病筛查和加强学校结核病知识宣传力度。     

山东省淄博市2005-2011年结核病疫情分析

目的探讨山东省淄博市近7年来结核病的流行特征,为制定结核病防治对策和开展防治工作提供科学依据。方法用Excel和SPSS17.0对淄博市2005-2011年结核病管理信息系统中的结核登记资料进行描述性流行病学分析。结果 2005-2011年共报告结核病例11 362例,年均发病率37.534/10万,新涂阳6 717例,年均新涂阳率22.190/10万;2006年报告病例最多,2008年以来病例数呈持续下降趋势;男性发病高于女性,发病率比为2.11︰1;年龄集中在15~74岁,占病例总数的89.94%,发病率为41.664/10万;职业分布中以农民最多,其次为工人和学生,共占病例总数的79.90%;地区分布中前三位依次为桓台县、淄川区和张店区,占病例总数的49.45%;结核患者主要来源于因症就诊(44.46%)、转诊(37.39%)和追踪(11.93%),不同年度和地区情况不同;治疗情况中完成疗程比例逐年提高,但治愈比例却没有提高,结核死亡比例近年来有所下降。结论近年来淄博市结核疫情总体较为平稳,但防控任务依然繁重,应更加重视高危人群和高危地区结核病的发现、治疗和追踪管理工作。     

Factors associated with latent tuberculosis infection in the contacts of tuberculosis patients

BACKGROUND: As tuberculosis control programs have reached acceptable levels in the identification and treatment of persons with active tuberculosis, the next step should be to develop methods of preventing new cases. Persons with latent tuberculosis infection (LTI) are considered to have a higher risk of developing active tuberculosis. The objective of this study was to evaluate the prevalence of LTI and its associated factors in the contacts of tuberculosis patients. METHODS: We studied the contacts of tuberculosis patients who were examined in the Center for Tuberculosis Control and Prevention in Lleida (Spain) from 1991-1997. Factors associated with the index case (demographic, radiographic, bacteriologic and therapeutic) and tuberculin skin test results and demographic data in contacts were collected. Data on HIV infection, injection drug use and alcohol consumption in tuberculosis patients were also collected. The associations were assessed by obtaining crude and adjusted odds ratios. RESULTS: The prevalence of LTI among contacts was 36.1% (780/2,161). In the multivariate analysis a higher frequency of LTI was detected in contacts older than 14 years (ORa = 3.34; 95% CI, 2.51-4.45), contacts who had a higher degree of exposure to the index case (ORa = 1.96; 95% CI, 1.59-2.42), contacts of pulmonary tuberculosis patients (ORa = 1.54; 95% CI, 1.01-2.35), contacts of patients with a positive sputum smear (ORa = 1.51; 95% CI, 1.15-1.99), contacts of patients with caverns on chest x-ray (ORa = 1.27; 95% CI, 1.01-1.61) and contacts of patients with delayed treatment (ORa = 1.31; 95% CI, 1.05-1.62). CONCLUSIONS: The overall prevalence of LTI in the contacts of patients with tuberculosis was high. Among the factors studied, delayed treatment in the index case was independently associated with the frequency of LTI in tuberculosis contacts. Measures for the early diagnosis and treatment of tuberculosis should be intensified.     

Delay in the diagnosis of tuberculosis

In five patients, a 46-year-old Surinamese man, a 45-year-old Dutch barkeeper, a 41-year-old woman from Eritrea, and an 18-year-old Afghan woman and her 43-year-old mother, tuberculosis was diagnosed and treated after a considerable delay. Such a late diagnosis and subsequent treatment is not uncommon for tuberculosis as the symptoms, physical examination, laboratory tests, imaging techniques and bacteriological results are often not very specific. However under certain circumstances, tuberculosis (including the extrapulmonary manifestations) should be considered at an earlier stage, especially among certain risk groups such as the homeless, drug addicts, immigrants and asylum seekers. In the five patients discussed the causes of delay were identified as: delay caused by the asymptomatic phase of the disease, the patient's delay in presenting, a delay on the part of the physician, a delay in diagnostic confirmation and a delay in the treatment.     

Respiratory tuberculosis in the potteries

A comparison of the notification rates for pulmonary tuberculosis from 1930 onwards between England and Wales and Stoke-on-Trent County Borough shows an excess for Stoke-on-Trent which lasted until the 1950s. A comparison of mortality rates, however, reveals an excess in Stoke-on-Trent which has lasted until the present day. This excess mortality is attributed to a difference in the age distribution of pulmonary tuberculosis in England and Wales compared with Stoke-on-Trent, where there is a striking peak in the incidence of the disease in elderly men and women from the 1950s onwards. It is suggested that this peak is due to reactivation of pulmonary tuberculosis in the cohort who were born in the early years of this century and experienced a severe epidemic of tuberculosis in early adult life which was worse in Stoke-on-Trent than in England and Wales as a whole. The severity of the epidemic in the Potteries may have been attributable to poor environmental conditions including exposure to silica dust among workers in the ceramics industry.     

The resurgence of tuberculosis in the tropics. Improving tuberculosis control--social science inputs

Public health has for long been dominated by the notion of 'control'. However, social science research on tuberculosis in the tropics indicates that policies and programmes that take 'control' as their primary focus may fail to meet the health needs of patients and their communities. It is proposed that research and programmes meet the public health goal of lowering the prevalence of disease in populations by forging and cementing partnerships which take the support and care of patients as their focus. These will be partnerships between researchers in the North and the South, between research and programmes/policy, between outside 'experts' and communities themselves and between (public) health and other social service sectors. Social science approaches to operations research in tuberculosis are outlined, and data from a recent project in New Delhi are introduced.     

Relapse and recurrent tuberculosis in the context of a national tuberculosis control programme

The proportion of patients with recurrent tuberculosis (TB) is reported to be increased in TB patients with human immunodeficiency virus (HIV) infection after they have completed treatment. Despite rising HIV seroprevalence amongst TB patients in Malawi, notifications of patients with relapse smear-positive pulmonary TB (PTB) and recurrent smear-negative TB have remained stable during the past 12 years. We suspected that patients with recurrent or relapse TB were being missed under routine programme conditions. Forty-three hospitals in Malawi were visited in 1999, and TB inpatients who had been registered as 'new' cases in the TB register and treatment card were interviewed about previous episodes of TB. A previous history of TB was elicited in 94 (7.5%) of 1254 patients who were being treated as new cases. Compared with patients with smear-positive PTB, a previous episode of TB was significantly more common in patients with smear-negative PTB (OR 3.5, [95% CI 2.1-5.7], P < 0.001) and patients with extrapulmonary TB (OR 2.0, [95% CI 1.1-3.7], P < 0.05). Of 94 patients with a previous episode of TB, 76 had completed treatment and 18 had defaulted from treatment during this episode. Patients with recurrent or relapse TB are being incorrectly registered within the Malawi TB Control Programme, and in the case of smear-positive PTB patients this is associated with administration of incorrect treatment. Measures have been put in place to rectify the situation, and further operational research is planned to monitor treatment outcomes of patients with recurrent smear-negative TB.     

老年结核病患者对中国结核病控制的影响

目的 分析在现代结核病控制策略(DOTS策略)下老年结核病患者对中国结核病控制的影响。方法 根据2000年全国结核病流行病学抽样调查中老年结核病的患病特征,对照分析在实施DOTS策略地区和非DOTS策略地区老年结核病患者的发现、治疗和管理现状。结果 ≥65岁年龄组肺结核涂阳患病率为440/10万,是各年龄组平均涂阳患病率的3.6倍;≥65岁老年人涂阳病例数占全人口涂阳病例数的28.6％;在已实施DOTS策略的13个省和未实施DOTS策略的15个省中,老年涂阳病例数分别占各年龄组涂阳病例数的28.8％和28.9％;1992～2000年在实施DOTS策略的13省新涂阳病例登记数中,≥65岁老年结核病患者占11.4％。结论 老年结核病患者涂阳患病率高,不论在实施DOTS策略地区或非DOTS策略地区,所有涂阳病例中老年涂阳病例构成比例大,而新涂阳病例登记比例却最低。老年结核病患病率高、发现率低是结核病控制工作中值得关注的问题。     

月经血结核杆菌检测在女性生殖器结核诊断中的作用

目的探讨月经血结核杆菌检测在女性生殖器结核诊断中的作用。方法对2009年10月—2014年3月145例不孕及复发流产患者,行结核菌素PPD试验、月经血结核杆菌培养、抗酸染色及荧光定量聚合酶链反应(PCR)检测,并与宫、腹腔镜检查结果相对照。结果经宫、腹腔镜确诊生殖器结核21例,确诊率14.5%,其中不孕16例,复发性流产5例。确诊患者中,月经血结核杆菌荧光定量PCR检测阳性3例,阴性18例,培养、抗酸染色均无阳性。124例非生殖器结核中,月经血结核杆菌荧光定量PCR检测阳性1例,培养、抗酸染色均阴性。月经血结核杆菌荧光定量PCR方法诊断生殖器结核的灵敏度14.3%,特异度99.2%。21例生殖器结核患者中,PPD强阳性18例,124例非生殖器结核患者中强阳性1例。结论月经血结核杆菌荧光定量PCR检测灵敏度高于传统检测方法,结合PPD试验可以提高阳性率,但能否用于生殖器结核的诊断还需进一步研究。