Outbreak of pulmonary tuberculosis in a Chinese high school, 2009-2010.
Outbreak of pulmonary tuberculosis in a Chinese high school, 2009-2010.
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DOI：
10.2188/jea.je20120216
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发表时间：
2013
影响因子：
4.7
通讯作者：
Zhu BP
中科院分区：
文献类型：
--
作者：
Fang Y;Zhang L;Tu C;Ye D;Fontaine R;Ma H;Hao J;Fu L;Ying X;Chen Q;Wang Y;Liu H;Zhu BP
2009年2月，一名高中生被诊断为痰涂阳肺结核。一年后，同一年级的另外两名学生患上了痰涂片阳性结核病。我们使用了结核菌素皮肤试验(TST)、胸片、痰涂片和症状学来鉴定病例。我们将潜伏性结核感染(LTBI)定义为TST硬化15 mm或更大，可能的TB为胸片显示结核合并咳嗽/咯血至少2周或TST硬化15 mm或以上，确认TB为2个或2个以上阳性痰涂片或1个阳性痰涂片+胸部X线片。在与小学生相同年级的学生中，26%(122/476)患有LTBI，4.8%(23/476)患有疑似/确诊结核病。在教师中，43%(18/42)有LTBI，没有疑似/确诊的结核病。与初级病例学生共用一间教室会增加LTBI(Rate Ratio=2.5；95%CI：1.9-3.4)和疑似/确诊结核病(Rate Ratio=17，95%CI：7.8-39)风险。在2009年2月拒绝预防的LTBI患者中，50%(11/22)的学生在2010年4月可能/确诊为结核病。这场结核病暴发很可能是由病例学生对结核病的延迟诊断引发的，并因缺乏暴露后化学预防措施而加剧。强烈建议所有TST阳性学生进行接触后预防。
In February 2009, a high school student was diagnosed with sputum-smear positive pulmonary tuberculosis (TB). One year later, 2 other students in the same grade developed sputum-smear positive TB. We used tuberculin skin testing (TST), chest radiography, sputum smear, and symptomatology for case identification. We defined latent TB infection (LTBI) as a TST induration of 15 mm or larger, probable TB as a chest radiograph indicative of TB plus productive cough/hemoptysis for at least 2 weeks or TST induration of 15 mm or larger, and confirmed TB as 2 or more positive sputum smears or 1 positive sputum smear plus a chest radiograph indicative of TB. Of students in the same grade as the primary case-student, 26% (122/476) had LTBI and 4.8% (23/476) had probable/confirmed TB. Of teachers, 43% (18/42) had LTBI and none had probable/confirmed TB. Sharing a classroom with the primary case-student increased risk for LTBI (rate ratio = 2.5; 95% CI: 1.9–3.4) and probable/confirmed TB (rate ratio = 17, 95% CI: 7.8–39). Of students with LTBI in February 2009 who refused prophylaxis, 50% (11/22) had probable/confirmed TB in April 2010. This TB outbreak was likely started by delayed diagnosis of TB in the case-student and was facilitated by lack of post-exposure chemoprophylaxis. Post-exposure prophylaxis is strongly recommended for all TST-positive students.
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DOI：
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发表时间：
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