Investigation of a drug-resistant tuberculosis cluster in a school

Objective To supply evidence with prevention and control of drug-resistant tuberculosis in school, through investigation and analysis of the epidemic cluster of drug-resistant tuberculosis in a school of Chaoyang District, Beijing. Methods The cases were investigated of epidemiology, PPD, chest X-ray and CT screening were carried out in close contacts of patients. Results From October 2018 to June 2019, 36 cases of pulmonary tuberculosis occurred in the school, with an incidence of 4.5%. 5 were multi-drug resistant, and 3 were rifampicin resistant. 36 cases were mainly distributed in four classes, 27 cases in class 15a, 4 in class 15b, 2 in class 15c, and 3 in class 17d. The incidence rate of each class was 56.3%, 8.3%, 5.7% and 7.1% respectively. The difference was statistically significant ( P <0.01). 6 of the 8 drug-resistant cases were students of class 15a, accounting for 75.0% of the total cases. 23 cases of tuberculosis were diagnosed by CT screening in 68 close contacts, the detection rate were 33.8%. Conclusions It is the first case to deal with the cluster epidemic of drug- resistant tuberculosis transmission in schools. The main reason for the outbreak was that the first case was not treated in time and the source of infection existed for a long time. Close screening is very important for the timely detection of new cases in school cluster epidemic management. 摘要：目的 对北京市朝阳区某学校一起耐药肺结核疫情进行分析, 为今后耐药结核病疫情的处置提供参考。 方法 对病例进行流行病学调查, 对病例密切接触者采用 PPD 试验、X 线胸片和 CT 相结合的方式筛查。 结果 2018 年 10 月—2019 年 6 月, 该校共发生 36 例肺结核病例, 发病率为 4.5%。其中 5 例耐多药, 3 例耐利福平。36 例病例分布在 四个班, 15a 班 27 例、15b 班 4 例、15c 班 2 例、17d 班 3 例。各班发病率分别为 56.3%、8.3%、5.7%、7.1%, 差异有统计学意 义 ( P <0.01)。8 例耐药病例中 6 例为 15a 班学生, 占耐药病例总数的 75.0%。经 CT 筛查 68 名密切接触者中确诊 23 例肺 结核患者, 检出率 33.8%。 结论 该起学校聚集性疫情为全国首起耐药肺结核聚集性疫情, 首发病例未及时就医, 传染 源隐匿存在时间长, 是导致该起疫情发生的主要原因。疫情处置中开展密切接触者筛查对于及时发现新病例非常 重要。