The Study On Prevention And Control Strategy Of School Tuberculosis Outbreaks

Objective: To study prevention and control strategy of school tuberculosis by investigating and analyzing pulmonary tuberculosis epidemiologic situation in Dalian and its schools and universities.By screening the risk factors that influence the outbreak of tuberculosis in schools and universities,the quantitative indicators of the school tuberculosis outbreaks were established.A theoretical basis for the formulation of scientific and effective prevention and control measures could be provide,after explored the establishment of this risk assessment evaluation model.Methods: Pulmonary tuberculosis patients and related information in Dalian which were entered during 2005 January 1st and 2014 December 31 st from China Information System for Disease Control and Prevention were collected,and used for the general statistics and analysis of the epidemic situation.Student tuberculosis TB cases in Dalian during December 2010 and December 2014 which were registration reported with their close contact information were collected,within one year follow-up and discovery of secondary cases were included into TB outbreak study cases,single factor analysis and logistic analysis were used to selection and quantitative risk factors.By means of literature review,expert grading method and analytic hierarchy process(AHP),risk assessment was analyzed.With weights determination of the pair wise comparison matrix and risk factors,the probability of risk was calculated,and school tuberculosis outbreak risk assessment model was established.Excel 2003 software was used for data collection;SPSS 19.0 was used for data statistical description,chi-square test and logistic regression analysis.Matlab(R2010a)was used to carry on the AHP and the matrix judgment analysis.Results: 1.According to the general analysis,patients were in an average age of(39.72±0.09)years old,with the age of 15-24 to the most of ratios of 25.6%.In occupations of patients,students with 8.4% are the third of the top five of proportions.In this decade,the number of tuberculosis patients in Dalian displayed a fluctuating trend.Negative sputum status patients accounted for 56.6%.Constitute ratio of 15-24 years old patients showed a sudden rise in 2014,which prompting that student class has increased patients’ proportion.2.Single factor analysis showed that the student pulmonary tuberculosis(PTB)of the first case of sputum,dormitory personnel intensive,close contact screening in PPD strong positive rate have statistical significance in different levels of outbreaks,with each P value was less than 0.05.Multiple regression analysis showed that protective factors were negative sputum status first case and state level Ⅱof ventilation condition;while PPD strong positive rate and state level Ⅲ of exposure time were acted as risk factors;and all P values were less than 0.05.3.Under the decision-making level,characteristics of infection source,transmission,prevention and control measures were determined as the first level,;there were 14 indicators in the second criteria layer;and 53 indicators in the third layer.There was no logically chaotic in the weight coefficient,and the CR values of comparison between every to indexes are less than 0.10,which means the consistency of the matrix could be accepted.The results showed that characteristics of infection source were on the high risk with weight value of 0.5743.The sputum of patient has the high risk in the second criterion layer(0.1970).In the third criteria layer,top five risk indicators were severe disease(0.8862),exposed for a long time(0.8766),sputum state positive(0.8757),TB prevention and treatment institutions monitoring and analyzing epidemic situation and bulletin related information to school timely(0.8712),and TB bacteria via in the dormitory or adjacent room to spread outward(0.7568).Conclusion: Students are the high risk population of tuberculosis.An effectively prevention and control of school tuberculosis outbreaks should be established by strengthened the management of the epidemic situation,by which of early discovery and diagnosis and treatment of PTB according to the infectious source characteristics and propagation characteristics of the environment,PPD strong positive rate of close contact screening and suspected patients in active treatment,under the holonomic,standardized,and quantitative establishment of guidelines for the prevention and control of school tuberculosis.