长沙市一起学校耐多药肺结核聚集性疫情流行病学调查

doi:10.20199/j.issn.1672-2302.2025.01.010

摘要/Abstract

摘要：

目的对长沙市一起学校耐多药肺结核聚集性疫情的调查和处置情况进行分析，为今后学校耐多药肺结核疫情的处置提供参考。方法收集聚集性疫情所在学校的基本情况、肺结核指示病例的临床诊疗情况，按照《中国学校结核病防控指南（2020年版）》对指示病例的密切接触者和一般接触者开展肺结核可疑症状筛查、结核菌素皮肤试验（tuberculin skin test, TST）和胸部影像学检查。对指示病例及筛查中发现的肺结核病例进行药敏检测，并进一步开展结核分枝杆菌多位点序列分型（multilocus sequence typing, MLST）分析，构建系统发育树，以判定病例间的流行病学关联并进行疫情的有效处置。结果指示病例被诊断为继发性肺结核后，对46名密切接触者进行首轮肺结核筛查，发现TST中度阳性及以上者5例，新发现2例活动性肺结核病例；扩大筛查与指示病例同层宿舍的一般接触者51例，无新增病例，发现TST中度阳性及以上者4例；对密切接触者和一般接触者进行第二轮筛查，新发现TST中度阳性及以上者9例。药敏检测显示，3例病例均为耐多药病例，根据MLST分析结果绘制进化树分析，推断此次疫情涉及的3名病例存在相关性，指示病例为首发的可能性大，但同一病例治疗前后菌株测序数据分析结果显示异质性。结论该起聚集性疫情为一起耐多药肺结核聚集性疫情，MLST结合药敏和流行病学调查结果为推断病例间关联性提供了参考和证据。

关键词: 耐多药肺结核, 学校, 聚集性疫情, 长沙市

Abstract:

Objective To analyze the epidemiological characteristics and control measures of a clustered outbreak of multidrug-resistant pulmonary tuberculosis in a school campus in Changsha City for reference in following management of such accident. Methods The information, including the school campus settings, the primary case of tuberculosis and clinical diagnosis, was collected, and then we conducted screening on the close and general contacts for suspicious symptoms of pulmonary tuberculosis by tuberculin skin test (TST) and chest X-ray examination according the procedures specified in the Guidelines for Prevention and Control of Tuberculosis in Schools in China (2020). Drug sensitivity testing was performed for the primary case, and for the pulmonary tuberculosis cases found in screening, multilocus sequence typing (MLST) analysis of Mycobacterium tuberculosis was further carried out to construct phylogenetic tree to determine epidemiological association between cases and effective treatment of the epidemic. Results After identification of the index case, 46 close contacts underwent first round of tuberculosis screening, which revealed that 5 subjects were moderate positive or above for TST, and 2 new active cases were found. No new cases were found after expanded screening of 51 general contacts living in the dormitory at the same floor as the index patient. Four cases were moderate positive or above for TST. Subsequent screening of the close and general contacts revealed 9 cases being moderate positive or above for TST. According to the drug sensitivity test results, all three cases were multidrug-resistant tuberculosis, and the MLST analysis results were used to draw an evolutionary tree. The analysis suggested that there was correlation among the 3 cases involved in this epidemic, and the index case was highly likely to be the patient zero. However, analysis results of the strain sequencing data before and after treatment of the same case showed heterogeneity. Conclusion This clustered outbreak is a multi-drug resistant tuberculosis cluster epidemic. MLST or combined it with drug sensitivity and epidemiological investigation results may provide reference and evidence for inferring the correlation between cases.

Key words: Multidrug-resistant pulmonary tuberculosis, School, Clustered epidemic, Changsha City

中图分类号:

R521，R18

宋丽新, 田斌, 谢赐福, 尹鹏亮, 熊姿. 长沙市一起学校耐多药肺结核聚集性疫情流行病学调查[J]. 热带病与寄生虫学, 2025, 23(1): 49-52.

SONG Lixin, TIAN Bin, XIE Cifu, YIN Pengliang, XIONG Zi. Epidemiological investigation and analysis of a clustered outbreak of multidrug-resistant pulmonary tuberculosis in a school in Changsha City[J]. Journal of Tropical Diseases and Parasitology, 2025, 23(1): 49-52.

图/表 1

参考文献 21

[1]	国家卫生和计划生育委员会.结核病分类:WS 196—2017[S]. 北京: 中国标准出版社, 2017.
[2]	黎舒, 邱媛, 何波, 等. 基于SaTScan的2017—2021年南宁市耐多药肺结核疫情时空分析[J]. 公共卫生与预防医学, 2024, 35(2):7-20.
[3]	World Health Organization. Global tuberculosis report 2023[R]. Geneva: World Health Organization,2023:17.
[4]	徐伟, 张秀芝, 张爱洁, 等. 一起学校耐药肺结核聚集性疫情的调查[J]. 中国热带医学, 2020, 20(11):1074-1077. doi: 10.13604/j.cnki.46-1064/r.2020.11.12
[5]	Meehan CJ, Goig GA, Kohl TA, et al. Whole genome sequencing of Mycobacterium tuberculosis: current standards and open issues[J]. Nat Rev Microbiol, 2019, 17(9):533-545. doi: 10.1038/s41579-019-0214-5 pmid: 31209399
[6]	国家卫生健康委员会办公厅,教育部办公厅. 关于印发中国学校结核病防控指南的通知: 国卫办疾控函〔2020〕910 号[A/OL]. (2020-06-23)[2024-07-28]. http://www.nhc.gov.cn/jkj/s7923/202012/5f40b53827ae41c5ab7827507d584cab.shtml.
[7]	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)的通知:国卫办疾控发〔2017〕22号[A/OL]. (2017-06-26) [2024-07-28]. http://www.moe.gov.cn/srcsite/A17/moe_943/s3285/201707/t20170727_310182.html.
[8]	国家卫生和计划生育委员会. 肺结核诊断标准:WS 288—2017[S/OL]. (2017-11-09)[2024-07-28]. http://www.nhc.gov.cn/ewebeditor/uploadfile/2017/12/20171212154852389.pdf.
[9]	赵雁林. 结核病实验室检验规程[M]. 6版. 北京: 人民卫生出版社,2015:67-70.
[10]	李丽, 杨云, 徐丹丹. 洪山区某职业学院一起耐药结核病聚集性疫情分析[J]. 实用预防医学, 2020, 27(7):867-869.
[11]	崔灵绸, 石海萍. 某高校5起肺结核聚集性疫情特征分析[J]. 中国防痨杂志, 2024, 46(11):1388-1394.
[12]	王向柳, 税义超, 罗文, 等. 2016―2022年重庆市青少年肺结核发现延误现状及影响因素[J]. 中华疾病控制杂志, 2025, 29(1):49-54.
[13]	吴继周, 符剑, 王建明, 等. 江苏省某中学一起利福平耐药结核病疫情流行病学调查[J]. 中华疾病控制杂志, 2022, 26(11):1259-1263,1282.
[14]	常俊丽, 张建宏, 章瑛, 等. 一起学校利福平耐药肺结核聚集性疫情的调查分析[J]. 中国防痨杂志, 2021, 43(7):751-754.
[15]	唐嘉, 吴伟强, 韦载娜. 柳州市某重点高中结核病聚集性疫情调查处置分析[J]. 应用预防医学, 2024, 30(1):41-45.
[16]	陈秋奇, 吴超玲, 张培泽, 等. 耐多药结核病患者密切接触者结核分枝杆菌潜伏感染的诊治现状与展望[J]. 结核与肺部疾病杂志, 2022, 3(6):517-520.
[17]	Marks SM, Mase SR, Morris SB. Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis[J]. Clin Infect Dis, 2017, 64(12):1670-1677. doi: 10.1093/cid/cix208 pmid: 28329197
[18]	Kohl TA, Diel R, Harmsen D, et al. Whole-genome-based Mycobacterium tuberculosis surveillance: a standardized, portable, and expandable approach[J]. J Clin Microbiol, 2014, 52(7):2479-2486.
[19]	O’Toole RF. Development of a new genome-wide MLST scheme for high-resolution typing of diverse Mycobacterium tuberculosis complex strains[J]. E Bio Medicine, 2018,34:6-7.
[20]	Kontsevaya I, Lange C, Comella-Del-Barrio P, et al. Perspectives for systems biology in the management of tuberculosis[J]. Eur Respir Rev, 2021, 30(160):200377.
[21]	Jones RC, Harris LG, Morgan S, et al. Phylogenetic analysis of Mycobacterium tuberculosis strains in Wales by use of core genome multilocus sequence typing to analyze whole-genome sequencing data[J]. J Clin Microbiol, 2019, 57(6):e02025-18.