Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Tuberculosis, Tibetan Delek Hospital, Dharamsala, India.
Clin Infect Dis. 2019 Aug 16;69(5):760-768. doi: 10.1093/cid/ciy987.
Tuberculosis (TB) prevalence is high among Tibetan refugees in India, with almost half of cases occurring in congregate facilities, including schools. A comprehensive program of TB case finding and treatment of TB infection (TBI) was undertaken in schools for Tibetan refugee children.
Schoolchildren and staff in Tibetan schools in Himachal Pradesh, India, were screened for TB with an algorithm using symptoms, chest radiography, molecular diagnostics, and tuberculin skin testing. Individuals with active TB were treated and those with TBI were offered isoniazid-rifampicin preventive therapy for 3 months.
From April 2017 to March 2018, we screened 5391 schoolchildren (median age, 13 years) and 786 staff in 11 Tibetan schools. Forty-six TB cases, including 1 with multidrug resistance, were found in schoolchildren, for a prevalence of 853 per 100 000. Extensively drug-resistant TB was diagnosed in 1 staff member. The majority of cases (66%) were subclinical. TBI was detected in 930 of 5234 (18%) schoolchildren and 334 of 634 (53%) staff who completed testing. Children in boarding schools had a higher prevalence of TBI than children in day schools (915/5020 [18%] vs 15/371 [4%]; P < .01). Preventive therapy was provided to 799 of 888 (90%) schoolchildren and 101 of 332 (30%) staff with TBI; 857 (95%) people successfully completed therapy.
TB prevalence is extremely high among Tibetan schoolchildren. Effective active case finding and a high uptake and completion of preventive therapy for children were achieved. With leadership and community mobilization, TB control is implementable on a population level.
在印度的藏难民中，结核病（TB）的患病率很高，几乎有一半的病例发生在集体设施中，包括学校。在藏难民儿童的学校中，开展了一项全面的结核病病例发现和治疗结核感染（TBI）的计划。
在印度喜马偕尔邦的藏学校，使用症状、胸部 X 光、分子诊断和结核菌素皮肤试验的算法对学童和工作人员进行了结核病筛查。对活动性结核病患者进行了治疗，对 TBI 患者提供了为期 3 个月的异烟肼-利福平预防性治疗。
从 2017 年 4 月至 2018 年 3 月，我们筛查了 11 所藏学校的 5391 名学童（中位数年龄 13 岁）和 786 名工作人员。在学童中发现了 46 例结核病病例，包括 1 例耐多药病例，患病率为每 10 万人 853 例。在 1 名工作人员中诊断出广泛耐药结核病。大多数病例（66%）为亚临床病例。在完成检测的 5234 名学童中的 930 名（18%）和 634 名工作人员中的 334 名（53%）中发现了 TBI。寄宿学校的学童比走读学校的学童 TBI 患病率更高（915/5020[18%]比 15/371[4%]；P<.01）。向 888 名（90%）TBI 学童和 332 名（30%）TBI 工作人员中的 101 名提供了预防性治疗；857 人（95%）成功完成了治疗。
藏学童的结核病患病率极高。有效发现活动性病例，以及儿童对预防性治疗的高接受率和完成率都很高。在领导层和社区动员下，结核病控制可以在人群层面上实施。
