Analysis And Trend Forecast Of The Prevalence Of Tuberculosis In Schools From 2007 To 2017 In Gansu Province

Objective To understand the epidemic situation of tuberculosis in schools in Gansu in the past 10 years.To analyze the characteristics of the clustered epidemic,to predict the incidence trends of school tuberculosis in Gansu in order to provide a scientific evidence for the surveillance and prevention of tuberculosis.Methods The data of school tuberculosis epidemic from 2007 to 2017 were collected by the national infectious information management system.Descriptive epidemiology method and case analysis method were respectively used to describe and analyze the epidemiological status and the clustered epidemic of school tuberculosis.ARIMA time series model was used to predict the incidence trends of tuberculosis among students in the next two years in Gansu Province.Results The reported incidence of school tuberculosis ranged from 12.12/100,000 to35.85/100,000 from 2007 to 2016 in Gansu Province.The incidence of student tuberculosis reported was negatively correlated with years?r_s=-0.988,P<0.01?.The incidence of student tuberculosis reported in Gansu Province was higher than that of the nation student through the same period from 2007 to 2012,while the report incidence rate of student tuberculosis in Gansu had been lower than that of the same period nation student since 2013.Among the totally reported cases of tuberculosis during 2007 to 2016,The ratio of the male student to the female student was 1.39:1.The highest incidence rate of tuberculosis among students aged in 19 to 27 years old in these years.Han Nationality with accumulated cases of 10030 which always accounts for the highest proportion of reported cases each year.In these 10 years,Pulmonary tuberculosis occurred among students in Gansu Province in all four seasons.According to the incidence of tuberculosis reported in different months,the incidence peak existed from March and April each year.According to the reported incidence of student tuberculosis in 14different prefectures in the ten years in Gansu Province,Baiyin Prefecture ranked first in terms of incidence in most years,but the incidence showed a continuous decrease from 97.07/100,000 in2007 to 17.69/100,000 in 2016,and the reported incidence of the student tuberculosis showed the negative correlation with the year?r_s=-0.903,P<0.01?.Ganan Prefecture ranked second and the incidence fluctuations were not obvious,and the reported incidence of student tuberculosis showed no correlation with the year?r_s=-0.176,P=0.627?.According to the ways of discovery for the tuberculosis cases,clinical counseling and hospital referrals were mainly ways in every year during the past ten years.Delay rates of visiting doctors of the student tuberculosis cases varied from 33.73%to 52.42%in province wide and the median of the days of delay ranged from 2 to 8 days.Among the cumulative cases reported in the10 years in Gansu Province,delay rates of visiting doctors of the student tuberculosis cases in different region of Gansu Province ranged from 35.48%to 84.09%,the median of the days of delay ranged from 0 to 24 days,the delay rates showed a significant difference among different prefectures??2=215.45,P<0.01?.From 2007 to 2016,the reported incidence rate of teacher tuberculosis fluctuated from16.62/100,000 to 46.06/100,000 in Gansu Province,which showed the negative correlation with years?r_s=-0.939,P<0.01?.The reported incidence of teacher tuberculosis had showed an obvious decrease since 2011 especially.Among the totally 1145 teacher tuberculosis cases detected in these ten years;there were 743 male cases and 402 female cases;the teacher cases mainly came from Han Nationality;seasonal distributions of the cases were no obvious.The cases fluctuated from 2 to 191 among different prefectures,which mainly came from clinical counseling and hospital referrals.The reported incidences of the teacher tuberculosis were positively correlated with the reported incidences of the students tuberculosis over the years?r_s=0.927,p<0.01?.The event of tuberculosis in a vocational middle school in Gansu Province in 2017 showed clustered epidemic.Based on the reported incidences of the students tuberculosis from 2007 to 2017 in Gansu Province,the model ARIMA?0,1,1??0,1,1?₁₂ was fitted,by which the trend of students tuberculosis incidence from 2018 to 2019 in Gansu Province were predicted.The distribution of monthly incidence of students tuberculosis in Gansu province in 2018 and 2019 were similar to that of the past 11 years.The 95%confidence interval of the predicted value gradually increases as the increase of the predicted time.Conclusions The overall tuberculosis epidemic in schools in Gansu Province from 2007 to2016 showed a declining trend year by year;the prevalence of tuberculosis among students had differences in the distribution of age,gender and seasonal characteristics.The prevalence in geographical distribution showed imbalance.There was a positive correlation of the reported incidence of tuberculosis between students and teachers.The tuberculosis cases were found mainly by passive discovery ways.ARIMA prediction model had good forecasting effect on tuberculosis epidemic situation,which can be used as a tool for short-term forecasting of tuberculosis epidemic situation at grass-roots level.The policies and measures on tuberculosis prevention and control in schools in Gansu Province should be implemented in a standardized manner according to the epidemic characteristics.The simultaneous prevention and control for tuberculosis of teachers and students in schools should be strengthened.The active detection should be strengthened.Continuous surveillance on the epidemic situation of tuberculosis in schools should be integrated with the emergency measures.Scientific forecasting tools should be used to alert the epidemic effectively and to improve the level of prevention and control practice.