Yamamoto M
Nagoya Medical Examination Center, Postal Life Insurance Welfare Corporation, Japan.
Kekkaku. 1998 Nov;73(11):625-31.
School teachers are regarded as one of the danger groups in contracting tuberculosis infection and are subjected to strict tuberculosis controls, since when they develop tuberculosis, many school children are exposed to infection to the disease. However, the recent decrease in the incidence of tuberculosis in Japan has led to disputes concerning the significance of routine mass health examinations for tuberculosis. In this study, the significance of routine health examinations for tuberculosis in teachers was investigated by the analysis of the results of extraordinary health examinations carried out for tuberculosis in teachers as the index cases. A total of 496 extraordinary health examinations were carried out by Nagoya City from 1975 to 1986 and by Aichi Prefecture from 1980 to 1995. In 49 instances of these examinations, teachers were regarded as index cases, which included 25 teachers of public primary, middle or high schools and 14 teachers of private schools, including private instructors for piano, painting or calligraphy, and teachers for supplementary education. The results of these examinations in both groups were compared, regarding the routes of notification, the disease status of the index cases, and the frequency and the scale of the infections of tuberculosis observed among contacts with the index cases. "Group infections of tuberculosis" was defined as instances the infection in which 20 or more cases were infected by the index case, "small scale group infection" as 5-19 infected cases, and "cases with infection" as 1-4 infected cases. The result obtained were as follows. 1. The response rates to routine health examinations were 99.9% in the teachers of public primary, middle or high schools, and about 20-30% in the teachers of private schools. 2. The proportion of the cases notefied by routine examinations were 68.0% in the former group and 21.4% in the latter group. The cases notefied before the onset of the symptoms in the former group was significantly more frequent than in the latter group. 3. In the former group, no far advanced cases were identified, whereas 2 (14.3%) far advanced cases were identified in the latter group. The cases with amount of tubercle bacilli in sputum exceed 3 on the Gaffky scale were 32.0% in the former group and 61.5% in the latter group. 4. One (4.0%) case of the "group infections of tuberculosis" was observed in the former group, and 2 (14.3%) cases in the latter group. "Small scale group infection" was observed in 4.0% of the former group and in 21.4% of the latter group, and "cases with infection" in 8.0% of the former group and in 35.7% of the latter group. The frequency and the scale of the infections of tuberculosis observed among contacts with the index cases was significantly smaller in the former group than in the latter group. In conclusion, routine health examinations for tuberculosis for teachers seems valuable for the early diagnosis of tuberculosis cases and for the prevension of the infection of tuberculosis in schools.
学校教师被视为感染结核病的高危群体之一，因此受到严格的结核病防控措施，因为一旦他们患上结核病，许多学童就有感染该疾病的风险。然而，近年来日本结核病发病率的下降引发了关于教师常规大规模结核病健康检查意义的争议。在本研究中，以教师作为索引病例进行的非常规健康检查结果分析为基础，对教师结核病常规健康检查的意义进行了调查。名古屋市在1975年至1986年期间以及爱知县在1980年至1995年期间共进行了496次非常规健康检查。在这些检查中，有49例教师被视为索引病例，其中包括25名公立小学、初中或高中教师以及14名私立学校教师，私立学校教师包括钢琴、绘画或书法私人教师以及补习教育教师。比较了两组检查结果，包括报告途径、索引病例的疾病状况以及在与索引病例接触者中观察到的结核病感染频率和规模。“结核病群体感染”定义为索引病例感染导致20例或更多病例被感染的情况，“小规模群体感染”为5 - 19例感染病例，“有感染病例”为1 - 4例感染病例。结果如下：1. 公立小学、初中或高中教师的常规健康检查响应率为99.9%，私立学校教师约为20% - 30%。2. 前一组通过常规检查报告的病例比例为68.0%，后一组为21.4%。前一组在症状出现前报告的病例明显比后一组更频繁。3. 前一组未发现晚期病例，而后一组发现了2例（14.3%）晚期病例。前一组痰中结核杆菌数量在加夫基量表上超过3的病例为32.0%，后一组为61.5%。4. 前一组观察到1例（4.0%）“结核病群体感染”病例，后一组观察到2例（14.3%）。前一组4.0%观察到“小规模群体感染”，后一组为21.4%，前一组8.0%观察到“有感染病例”，后一组为35.7%。在前一组与索引病例接触者中观察到的结核病感染频率和规模明显小于后一组。总之，教师结核病常规健康检查对于结核病病例的早期诊断以及预防学校内结核病感染似乎是有价值的。
