Querol J M, Oltra C, Mínguez J, Moreno R, Sánchez E, Martínez P
Servicio de Medicina Interna, Hospital Lluís Alcanyís, Xàtiva, Valencia.
Enferm Infecc Microbiol Clin. 1993 May;11(5):267-70.
Despite the progressive decrease in the incidence of tuberculosis, this disease continues to be a problem of Public Health Care, maintaining endemic levels which sporadically allow the appearance of epidemic outbreaks, particularly among the young population. A small outbreak of tuberculosis among COU (high school) students is presented.
Following the detection of a case of open, cavitary pulmonary tuberculosis, the authors studied 47 students and 12 teachers who were distributed into two groups according to the number of weekly class hours shared with the index case (group A 4 hours and group B 21 hours).
The index case began with respiratory symptomatology in the month of September 1990 and was not diagnosed of tuberculosis until January 1991, having shared classes with school mates for 3 months. In April 1991 two patients were diagnosed with pleural tuberculosis and it was at this time that the study was initiated. A prevalence rate of positive tuberculin of 59% was detected among the students of group A and 93% among those of group B, with an incidence of tuberculous disease of 12% and 20% in the two groups respectively. No teachers were found to have the disease and the tuberculin test was heavily influenced by previous BCG vaccination.
Both the prevalence of infection and the incidence of tuberculosis was very high in all two groups. The authors consider that the development of this small outbreak in a school was due to deficiencies in primary health care (low index of suspicion and excessive delay), specialized care (delay in declaration of cases) and epidemiologic departments (deficient study of contacts).
尽管结核病发病率呈逐渐下降趋势，但该疾病仍是公共卫生保健领域的一个问题，仍维持在地方病水平，偶尔会出现疫情爆发，尤其是在年轻人群体中。本文介绍了一起在高中生中发生的小规模结核病疫情。
在发现一例开放性空洞型肺结核病例后，作者对47名学生和12名教师进行了研究，根据与索引病例每周共享的课时数将他们分为两组（A组4小时，B组21小时）。
索引病例于1990年9月开始出现呼吸道症状，直到1991年1月才被诊断为结核病，在此期间与同学共班3个月。1991年4月，两名患者被诊断为胸膜结核，此时研究开始。A组学生结核菌素阳性患病率为59%，B组为93%，两组结核病发病率分别为12%和20%。未发现教师患病，结核菌素试验受先前卡介苗接种影响很大。
两组的感染患病率和结核病发病率都非常高。作者认为，这起学校小规模疫情的发生是由于初级卫生保健存在缺陷（怀疑指数低和过度延误）、专科护理（病例报告延误）和流行病学部门（接触者研究不足）。
