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目的调查某中学肺结核聚集性疫情发生的原因和传播因素。方法通过结核菌素试验、可疑症状、X线及痰涂片等方法对513名肺结核密切接触者进行病例搜索和调查,并对24名结核菌素纯蛋白衍化物试验(TB-PPD)强阳性者进行预防性服药拒绝的原因调查。结果首例肺结核涂阳病例所在班级学生的PPD强阳性率和罹患率分别为64.70%和19.60%,均高于同年级其他班级(P<0.01);第2例肺结核涂阳病例所在班级学生的PPD强阳性率为24.10%,高于同年级其他班级(P<0.01)。首发病例寝室学生的罹患率为66.67%(RR=6.56,95%CI:2.24～19.24)。79.20%的非肺结核PPD强阳性学生担心药物不良反应大而拒绝预防性服药,20.80%认为自己无症状、无病而不需要预防性服药。结论某中学肺结核罹患率较高,应及时加强首发病例管理,做好密切接触者筛查及管理。
Objective To investigate the causes and transmission factors of pulmonary tuberculosis epidemic in a middle school. Methods A total of 513 patients with close contacts of pulmonary tuberculosis were enrolled in the study by means of tuberculin test, suspicious symptoms, X-ray and sputum smear. Totally 24 TB-PPD positive tests Preventive medication for refusal reasons investigation. Results The positive rate of PPD and the prevalence rate of the first class of patients with smear positive pulmonary tuberculosis were 64.70% and 19.60%, respectively, which were higher than those of other classes in the same grade (P <0.01). The second class of students with smear positive pulmonary tuberculosis The positive rate of PPD was 24.10%, higher than other classes in the same grade (P <0.01). The incidence of first-case dormitory students was 66.67% (RR = 6.56, 95% CI: 2.24-19.24). 79.20% of the strong positive PPD-positive non-TB patients worried about the adverse reactions of the drug and refused to take preventive medicine. 20.80% thought they were asymptomatic and disease-free and did not need preventive medication. Conclusions The high prevalence of tuberculosis in a middle school should promptly strengthen the management of the first case and do a good job screening and management of close contacts.