Epidemic characteristics and associated factors of pulmonary tuberculosis aggregation in school in Wuhan during 2017-2020
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摘要:
目的 分析2017—2020年武汉市学校肺结核聚集性疫情流行病学特征及其影响因素, 为科学制定学校结核病疫情防控策略和措施提供依据。 方法 采集全市各类学校结核病防控相关数据, 参照《学校结核病防控自查表》, 修改形成最终问卷, 利用问卷星网络平台进行问卷调查。采用多因素Logistic回归分析法分析学校结核病聚集性疫情发生的影响因素。 结果 2017—2020年武汉市共报告学校肺结核聚集性疫情37起, 涉及28所学校, 其中大学24所, 高中4所; 报告肺结核病例176例, 其中病原学阳性39例, 利福平耐药17例; 单起聚集性疫情持续时间中位数为48(28, 368)d; 大学比中学更易发生聚集性疫情(χ2=75.27, P < 0.01), 聚集性疫情中罹患率男生较女生高(χ2=22.82, P=0.00)。多因素Logistic回归分析结果显示, 学生是否寄宿(OR=5.12)、新生入校是否进行结核病筛查体检(OR=3.27)、是否开展病因追踪登记(OR=7.28)、患病学生是否按时就诊隔离(OR=9.12)、寝教室是否经常通风(OR=4.97)、是否严格执行休复学管理(OR=4.68)是学校结核病聚集性疫情发生的影响因素(P值均 < 0.05)。 结论 学校应扎实落实新生入校结核病筛查体检工作, 严格执行学生病因追踪登记和患病休复学管理, 有针对性地开展结核病健康教育, 引导师生养成勤通风、讲卫生、有疑似症状及时就诊和报告的良好习惯, 避免聚集性疫情的发生。 Abstract:Objective To analyze the epidemiological characteristics and assoicated factors of tuberculosis (TB) aggregation in schools in Wuhan from 2017 to 2020, and to provide scientific basis for school-based TB prevention and control strategies. Methods Questionnaire star was used to collect data on tuberculosis prevention and control in various schools in Wuhan. Multivariate logistic regression analysis was used to analyze the influencing factors of tuberculosis aggregation in schools. Results A total of 37 outbreaks of tuberculosis aggregation in schools were reported in Wuhan from 2017 to 2020, which involved 28 different schools, including 24 colleges and universities and 4 senior high schools, 176 cases were reported, among which 39 were positive for pathogens and 17 cases of rifampicin resistant, and the median duration of single cluster epidemic was 48 (28, 368) days, universities were more prone to cluster outbreaks than middle schools (χ2=75.27, P < 0.01), the incidence in male was higher than that of in female in cluster outbreak (χ2=22.82, P=0.00). The Results of multivariate Logistic regression analysis showed that boarding school (OR=5.12), TB screening at school entry (OR=3.27), etiology tracking and registrationin school (OR=7.28), treatment and isolation of sick students on time (OR=9.12), whether the dormitories and classrooms were often ventilated (OR=4.97), and whether the management of school suspension and return was strictly implemented (OR=4.68) were associated with the occurrence of TB cluster outbreak(P < 0.05). Conclusion Schools should actively strive for policies and funding, strictly implement TB screening and physical examination for freshmen, as well as the management of contact tracing and registeration, targeted TB health education, guidance for teachers and students for cleaning, disinfection and hand hygiene, timely treatment and reporting of suspected symptoms, to prevent the occurrence of TB clustering outbreaks. -
Key words:
- Tuberculosis, pulmonary /
- Disease outbreaks /
- Regression analysis /
- Students
1) 张正斌与余爱平共为第一作者。 -
表 1 武汉市2017—2020年学校结核病疫情情况
Table 1. Epidemic situation of tuberculosis in Wuhan from 2017 to 2020
年份 全人口肺结核发现登记数 学生肺结核发现登记数 学生聚集性疫情 人数/万 活动性肺结核 病原学阳性 人数/万 活动性肺结核 病原学阳性 起数 肺结核发现病例数 2017 1 089.29 6 074(55.76) 2 216(20.34) 191.32 397(20.75) 81(4.23) 5 31 2018 1 108.10 5 952(53.71) 3 082(27.81) 199.69 314(15.72) 141(7.06) 12 45 2019 1 121.20 5 937(52.95) 3 172(28.29) 203.69 320(15.71) 148(7.26) 16 81 2020 1 232.65 4 922(39.93) 2 684(21.77) 203.80 300(14.72) 167(8.20) 4 19 合计 4 551.24 22 885(50.28) 11 154(24.51) 798.50 1 331(16.67) 537(6.73) 37 176 注： ( )内数字为发现登记率/10-5。 
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表 2 武汉市2017—2020年结核病聚集性疫情学生病例特征分析
Table 2. Analysis on the characteristics of tuberculosis cluster epidemic among students in Wuhan from 2017 to 2020
组别 选项 2017(n=31) 2018(n=45) 2019(n=81) 2020(n=19) 合计(n=176) 地区 近城区 18(58.06) 35(77.78) 54(66.67) 9(47.37) 116(65.91) 远城区 13(41.94) 10(22.22) 27(33.33) 10(52.63) 60(34.09) 性别 男 27(87.10) 35(77.78) 60(74.07) 14(73.68) 136(77.27) 女 4(12.90) 10(22.22) 21(25.93) 5(26.32) 40(22.73) 学段 大学 27(87.10) 41(91.11) 71(87.65) 10(52.63) 149(84.66) 中学 4(12.90) 4(8.89) 10(12.35) 9(47.37) 27(15.34) 病例发现 健康体检 6(19.35) 12(26.67) 15(18.52) 2(10.53) 35(19.89) 方式 症状就诊 10(32.26) 13(28.89) 21(25.93) 5(26.32) 49(27.84) 密接筛查 15(48.39) 20(44.44) 45(55.56) 12(63.16) 92(52.27) 注：( )内数字为构成比/%。
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表 3 武汉市学校结核病聚集性疫情单因素Logistic回归分析(n=994)
Table 3. Univariate Logistic regression analysis of tuberculosis aggregation in schools in Wuhan (n=994)
自变量 β值 标准误 Wald χ2值 P值 OR值(OR值95%CI) 学校性质 -1.12 0.47 4.87 0.03 0.36(0.21~0.92) 学校寄宿 1.58 0.46 17.78 < 0.01 5.52(2.45~14.35) 学校规模 0.01 0.38 0.01 0.98 1.02(0.46~1.96) 城乡分布 0.36 0.48 0.39 0.67 1.38(0.63~3.93) 学校建立传染病防控体系 0.28 0.53 0.26 0.63 1.35(0.57~3.76) 学校开展新生入学体检 0.86 0.42 9.45 < 0.01 3.43(1.21~8.86) 开展晨午检 0.38 0.43 1.45 0.23 1.25(0.63~2.32) 开展因病缺勤和病因追踪 1.93 0.46 18.27 < 0.01 7.48(3.27~19.37) 开展结核病防控知识宣传 0.27 0.52 0.27 0.62 1.36(0.62~3.88) 寝、教室是否定期开窗通风 1.56 0.45 17.56 < 0.01 5.47(2.35~13.21) 严格执行患者休复学管理 1.43 0.44 10.68 < 0.01 4.68(1.21~12.36) 学生患病是否及时就诊 1.98 0.56 21.67 < 0.01 8.52(3.57~21.52) 是否有校医务室 0.28 0.51 0.26 0.52 1.28(0.48~6.37) 是否有专兼职校医 -0.02 0.36 0.01 0.99 1.00(0.53~1.98)
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表 4 武汉市学校肺结核聚集性疫情多因素Logistic回归分析(n=994)
Table 4. Multivariate Logistic regression analysis of tuberculosis aggregation in schools in Wuhan (n=994)
自变量与常数 β值 标准误 Wald χ2值 P值 OR值(OR值95%CI) 学生是否寄宿 1.25 0.33 5.46 < 0.01 5.12(2.53~14.75) 学校是否开展新生入学体检 1.63 0.52 7.67 <0.01 3.27(2.32~8.23) 开展因病缺勤和病因追踪 3.17 0.34 18.15 <0.01 7.28(3.18~19.36) 学生患病是否及时就诊 4.25 0.48 21.32 <0.01 9.12(3.62~22.50) 寝、教室是否定期开窗通风 1.05 0.32 4.12 <0.01 4.97(2.42~14.12) 严格执行患者休复学管理 1.38 0.36 5.83 <0.01 4.68(1.21~12.37) 常数项 -6.84 1.26 36.43 <0.01
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[1] MA M J, YANG Y, WANG H B, et al. Transmissibility of tuberculosis among school contacts: an outbreak investigation in a boarding middle school, China[J]. Infect Genet Evol, 2015, 32(1): 148-155. http://www.sciencedirect.com/science/article/pii/S1567134815000702 [2] 周丽平, 侯双翼, 刘勋, 等. 湖北省2010—2013年学校结核病聚集性疫情分析[J]. 中国学校卫生, 2015, 36(6): 887-893. http://www.cjsh.org.cn/article/id/zgxxws201506026ZHOU L P, HOU S Y, LIU X, et al. Epidemic analyses of aggregation tuberculosis outbreaks in Hubei schools during 2010-2013[J]. Chin J Sch Health, 2015, 36(6): 887-893. http://www.cjsh.org.cn/article/id/zgxxws201506026 [3] 丁守华, 万青灵, 潘恩春, 等. 一起学校结核病聚集性疫情的流行病学调查[J]. 中国学校卫生, 2019, 40(9): 1423-1425. doi: 10.16835/j.cnki.1000-9817.2019.09.042DING S H, WANG Q L, PANG E C, et al. Epidemiological investigation on a cluster epidemic of tuberculosis in a school[J]. Chin J Sch Health, 2019, 40(9): 1423-1425. doi: 10.16835/j.cnki.1000-9817.2019.09.042 [4] 武汉市统计局, 国家统计局武汉调查队. 武汉市统计年鉴(2020年)[M]. 北京: 中国统计出版社, 2020: 228-229.Wuhan Bureau of Statistics, Wuhan Investigation Team of National Bureau of statistics. Wuhan Statistical Yearbook (2020)[M]. Beijing: China Statistics Press, 2020: 228-229. [5] 国家卫生和计划生育委员会法制司. 关于发布《结核病分类》等两项强制性卫生行业标准的通告[EB/OL]. [2017-11-09]. http://www.nhc.gov.cn/fzs/s7852d/201711/0819ad84540b4d97a1644bbc6ec4306d.shtml.Legal Affairs Department of the State Health and Family Planning Commission. Circular on issuing two mandatory health industry standards such as tuberculosis classification[EB/OL][2017-11-09]. http://www.nhc.gov.cn/fzs/s7852d/201711/0819ad84540b4d97a1644bbc6ec4306d.shtml. [6] 国家卫生健康委办公厅, 教育部办公厅. 关于印发《中国学校结核病防控指南》[EB/OL]. [2020-10-16]. http://www.gov.cn/zhengce/zhengceku/2020-12/05/Content_5567137.htm.General Office of National Health Commission, General Office of Ministry of Education. About printing and distributing "guidelines for tuberculosis prevention and control in Chinese schools"[EB/OL]. [2020-10-16]. http://www.gov.cn/zhengce/zhengceku/2020-12/05/Content_5567137.htm. [7] 张正斌, 王桂阳, 王晓君, 等. 武汉市2011—2018年学生结核病患者就诊延迟及影响因素[J]. 中国学校卫生, 2020, 41(9): 1368-1371. doi: 10.16835/j.cnki.1000-9817.2020.09.024ZHANG Z B, WANG G Y, WANG X J, et al. Delay in treatment and influencing factors of student tuberculosis patients in Wuhan from 2011 to 2018[J]. Chin J Sch Health, 2020, 41(9): 1368-1371. doi: 10.16835/j.cnki.1000-9817.2020.09.024 [8] 李文辉, 冯汉阳, 钟明浩, 等. 东莞市青少年2009—2018年结核病患者就诊延迟及影响因素分析[J]. 中国学校卫生, 2021, 42(2): 265-269. doi: 10.16835/j.cnki.1000-9817.2021.02.026LI W H, FENG H Y, ZHOGN M H, et al. Delay on care-seeking and influencing factors among adolescent tuberculosis patients in Dongguan City from 2009 to 2018[J]. Chin J Sch Health, 2021, 42(2): 265-269. doi: 10.16835/j.cnki.1000-9817.2021.02.026 [9] 国家卫生计生委办公厅, 教育部办公厅. 关于印发《学校结核病防控工作规范(2017版)》[EB/OL]. [2017-06-26]. http://www.moe.gov.cn/srcsite/A17/moe_943/s3285/201707/t20170727_310182.htm.General Office of National Health and Family Planning Commission, General Office of Ministry of Education. About printing and Distributing "school tuberculosis prevention and control work specification (2017 Edition)"[EB/OL]. [2017-06-26]. http://www.moe.gov.cn/srcsite/A17/moe_943/s3285/201707/t20170727_310182.htm. [10] 湖北省教育厅, 湖北省卫生计生委, 湖北省物价局. 印发《关于加强高校学生健康体检工作的通知》[EB/OL]. [2018-08-14]. http://www.hubei.gov.cn/zwgk/bmdt/201808/t20180822_1332197.shtml.Hubei Provincial Department of Education, Hubei Provincial Health and Family Planning Commission, Hubei Provincial Price Bureau. Printing and distributing the notice on strengthening the physical examination of College Students[EB/OL]. [2018-08-14]. http://www.hubei.gov.cn/zwgk/bmdt/201808/t20180822_1332197.shtml. [11] 王晓君, 付谦, 张正斌, 等. 武汉市2008—2017年结核病患者就诊延迟情况及影响因素分析[J]. 中华流行病学杂志, 2019, 40(6): 643-647. doi: 10.3760/cma.j.issn.0254-6450.2019.06.008WANG X J, FU Q, ZHANG Z B, et al. Delay on care-seeking and related influencing factor among tuberculosis patients in Wuhan, 2008-2017[J]. Chin J Epidemiol, 2019, 40(6): 643-647. doi: 10.3760/cma.j.issn.0254-6450.2019.06.008 [12] 张晓龙, 蒋骏, 傅颖, 等. 江苏省苏州市学校结核病聚集性疫情接触者筛查分析[J]. 中国热带医学, 2020, 20(2): 139-141.ZHANG X L, JIANG J, FU Y, et al. Screening of contacts among school tuberculosis outbreak in Suzhou, Jiangsu[J]. Chin T Med, 2020, 20(2): 139-141. [13] LI Y, EHIRI J, TANG S, et al. Factors associated with patient, and diagnostic delays in Chinese TB patients: a systematic review and meta-analysis[J]. BMC Med, 2013(11): 156. [14] 魏建军, 曾令霞. 2014—2017年陕西汉中市肺结核患者就诊延迟及影响因素[J]. 公共卫生与预防医学, 2018, 29(5): 61-64.WEI J J, ZENG L X. Status and associated factors analysis of health seeking delay among pulmonary tuberculosis patients in Hanzhong City (2014-2017)[J]. Public Health Prev Med, 2018, 29(5): 61-64. [15] 刘婧楠, 李政, 王燕玲, 等. 运用健康信念模式分析中学生结核病就诊意向的影响因素[J]. 中华疾病控制杂志, 2019, 23(1): 60-64.LIU J N, LI Z, WANG Y L, et al. Analysis of tuberculosis medical intention and the influencing factors among middle school students with health belief model[J]. Chin J Dis Control, 2019, 23(1): 60-64. [16] 张正斌, 王婷萍, 谢红, 等. 武汉市2010—2014年学生肺结核发病特征分析[J]. 中国学校卫生, 2016, 37(12): 1908-1910. doi: 10.16835/j.cnki.1000-9817.2016.12.048ZHANG Z B, WANG T P, XIE H, et al. Analysis on the characteristics of tuberculosis among students in Wuhan city from 2010 to 2014[J]. Chin J Sch Health, 2016, 37(12): 1908-1910. doi: 10.16835/j.cnki.1000-9817.2016.12.048 [17] 张晓龙, 王斐娴, 傅颖, 等. 淄博市2015—2017年苏州市学校结核病聚集性疫情调查[J]. 现代预防医学, 2019, 46(14): 2634-2637.ZHANG X L, WANG F X, FU Y, et al. Investigation on tuberculosis cluster epidemic situation in schools of Suzhou City from 2015 to 2017 in Zibo City[J]. Mod Prev Med, 2019, 46(14): 2634-2637. [18] 高风华, 李源, 边文建, 等. 淄博市2008—2017年学生肺结核流行特征及诊疗管理情况[J]. 中国学校卫生, 2018, 39(12): 1891-1894. doi: 10.16835/j.cnki.1000-9817.2018.12.038GAO F H, LI Y, BIAN W J, et al. Epidemiological characteristics and diagnosis and treatment management of tuberculosis among students in Zibo City from 2008 to 2017[J]. Chin J Sch Health, 2018, 39(12): 1891-1894. doi: 10.16835/j.cnki.1000-9817.2018.12.038 -
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