Yamaguchi Y, Kishi M
Sirakawa Health Center, Fukushima-ken, Japan.
Kekkaku. 1993 Oct;68(10):637-43.
In a routine PPD skin test among 1st grade pupils in 4 elementary schools, Fukushima prefecture in April 1989, the number of pupils that showed strongly positive was unusually high. Moreover, 2 tuberculosis cases were detected among them. Since those children graduated the same kindergarten, and one of 6 kindergarten teachers had been complaining cough and hoarseness for about 3 to 5 months before being diagnosed as a smear positive patient in the contact survey, she was suspected to be the source of infection. Meanwhile, she had been treated for common cold and chronic bronchitis in several clinics, therefore, the main cause of this epidemic was due to the doctor's delay in detecting the case. With the discovery of 2 additional cases in the contact survey of the kindergarten, there were 5 cases altogether including the index cases. Three of 4 children's cases had been vaccinated with BCG. If the children who showed strong reaction to tuberculin and eventually treated prophylactically with isoniazid were assumed the infected, the rate of development of disease among the infected was 13.6 to 27.3%. Usually, lymph node enlargement of the hilum is said not to be observed among vaccinated, though slightly, it was evident among the cases in this epidemic.
1989年4月，在福岛县4所小学一年级学生的常规结核菌素皮肤试验中，强阳性学生人数异常之多。此外，还在这些学生中检测出2例结核病病例。由于这些孩子毕业于同一所幼儿园，且在接触者调查中，6名幼儿园教师中有1名在被诊断为涂片阳性患者之前约3至5个月一直抱怨咳嗽和声音嘶哑，她被怀疑是传染源。与此同时，她曾在几家诊所因普通感冒和慢性支气管炎接受治疗，因此，此次疫情的主要原因是医生延误了病例的检测。在幼儿园接触者调查中又发现2例病例，包括首例病例在内共有5例。4名儿童病例中有3名接种过卡介苗。如果将对结核菌素反应强烈并最终接受异烟肼预防性治疗的儿童视为感染者，那么感染者中的发病率为13.6%至27.3%。通常，接种过疫苗的人不会出现肺门淋巴结肿大，尽管此次疫情中的病例有轻微的肺门淋巴结肿大现象，但仍较为明显。
