Calpe J L, Chiner E, Sánchez E, Armero V, Puigcerver M T, Carbonell C, Vilar A
Seccione de Neumología, Hospital de la Marina Baixa, Alicante.
Arch Bronconeumol. 1997 Dec;33(11):566-71. doi: 10.1016/s0300-2896(15)30514-7.
Schools are settings with high concentrations of young people with little exposure to Mycobacterium tuberculosis and greater risk of developing disease when infection occurs as the result of sporadic localized outbreaks. We studied two outbreaks in two elementary schools (A and B) after two cases of bacilliferous pulmonary tuberculosis were detected in teachers in 1990 and 1994. Contacts were trace din school A by the primary care physician and in school B by the pneumologist and public health authorities. Contacts were classified as belonging to the risk group (RG) or the low risk group (LRG). The RG was composed of 187 contacts in school A and 59 in school B. Individuals in the LRG numbered 429 and 116 respectively. Mantoux positives numbered 108 in the RG and 45 in the LRG in school A (p < 0.001). In school B 50 RG individuals and 29 LRG individuals were positive (p < 0.001). The proportion of Mantoux positives was greater in the RG of school B than in the RG of school A (p < 0.01), probably owing to longer time of evolution of disease and possible laryngeal involvement in the index case. Likewise, tuberculin positives were fewer in the LRG of school A than in the LRG of school B (p < 0.001), owing to the small size of the LRG in school A. Thirteen cases of tuberculosis were seen in school A, six of which called for drug prophylaxis after contacts were traced. The nature of the index case and the conditions of exposure are both important in such outbreaks, demonstrating the need to act appropriately to trace contacts, preferably under the supervision of a pneumologists.
学校是年轻人高度集中的场所，他们很少接触结核分枝杆菌，一旦因偶发性局部暴发而感染，患病风险就更高。1990年和1994年在教师中检测出两例痰菌阳性的肺结核病例后，我们对两所小学（A校和B校）的两次疫情暴发进行了研究。A校的接触者由初级保健医生进行追踪，B校的接触者由肺科医生和公共卫生当局进行追踪。接触者被分为高危组（RG）或低危组（LRG）。A校的高危组有187名接触者，B校有59名。低危组的人数在A校为429人，在B校为116人。A校高危组中结核菌素试验阳性者有108人，低危组有45人（p<0.001）。B校高危组中有50人结核菌素试验阳性，低危组中有29人阳性（p<0.001）。B校高危组中结核菌素试验阳性的比例高于A校高危组（p<0.01），这可能是由于疾病发展时间较长以及首例病例可能累及喉部。同样，A校低危组中结核菌素试验阳性者比B校低危组少（p<0.001），这是因为A校低危组规模较小。A校发现了13例结核病病例，其中6例在追踪接触者后需要进行药物预防。在这类疫情暴发中，首例病例的性质和接触条件都很重要，这表明需要采取适当行动追踪接触者，最好在肺科医生的监督下进行。
