成都市涂阳肺结核病人密切接触者.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,目的：,Objective,通过对涂阳肺结核病人密切接触者进行筛查，以早期发现并治疗结核病人，这是结核病控制的重要措施，同时为政府制定结核病控制政策措施提供科学依据。,To early detection and treatment of tuberculosis of smear-positive close contacts of tuberculosis patients in screening,which is an important TB control measures,as well as the development of TB control for the government to provide the scientific basis of policies and measures.,方法：,Methods,统计结防机构,2007-2008,年登记的涂阳肺结核病人密切接触者，对密切接触者进行痰涂片检查和胸部,X,检查，并分析不同筛查方法对结核病人发现的影响。,Counted contacts in close of smear-positive tuberculosis patients registered by Tuberculosis prevention and control institutions in 2007-2008,carried out sputum smear examination and checked chest X-ray in whom,and analyzed different screening methods for the impact of TB found.,结果：,Result,07-08,年共筛查密切接触者,11357,例，发现肺结核病人,34,例，病人发现率为,299/10,万；家属中筛查病人发现率为,278/10,万，非家属中筛查病人发现率为,729/10,万；用问诊方法筛查病人发现率为,188/10,万，用直接检查方法筛查病人发现率为,729/10,万。,There are 11,357 cases of screening in close contacts,in 2007-2008,and found 34 tuberculosis patients in witch.The rate of patients found is 299/100000.The screening detection rate is 729/100000 in non-family members of patients and 278/100000 in family members of patients.,The screening detection rate is 729/100000 by direct examination,as well as 188/100000 by inquiry,.,背景,2,background2,一个痰涂片阳性的肺结核病人如果得不到正规治疗，一年中可以传染,10-15,个健康人，被感染者一生中发生结核病的可能性约为,5-10%,。有资料显示：涂阳结核病人家庭接触者中，结核病发现率为,2 836/10,万,1,。,A sputum smear-positive tuberculosis patient in the absence of formal treatment,can infect 10-15 health people one year,，,and it is about the 5-10%possibility of TB incidence in his life who has been infected.,There are indications,the detection rate of TB is 2836/100000 in family contacts with smear-positive tuberculosis patients,1.,背景,3 background3,所以，对涂阳肺结核病人的密切接触者进行筛查，以早期发现并治疗结核病人，这是结核病控制的重要措施，同时为政府制定结核病控制政策提供科学依据。,Therefore,the screening in close contacts with smear-positive tuberculosis patients in order to early detection and treatment of tuberculosis,which is an important TB control measures,as well as the development of TB control for the government policy to provide a scientific basis.,对象与方法,objects and methods,1,、对象：成都市,19,个区（市）县结核病防治机构新登记的涂阳肺结核病人的直接接触的家庭成员总数，包括与痰涂片阳性的肺结核病人密切接触的家庭成员、邻居、同事和同学等。,1 objects,：,the total family members in direct contact with newly registered smear-positive tuberculosis patients from 19 TB control and prevention institutions in Chengdu,including those related to sputum smear-positive tuberculosis patients in close contact with family members,neighbors,colleagues and students etc.,对象与方法,objects and methods,2,、方法：大邑县、龙泉驿区、都江堰市这,3,个区县对所有涂阳肺结核病人的密切接触者均进行拍摄,X,线胸片和三次痰涂片检查；其他,16,个区（市）县对密切接触者先进行问诊，对有肺结核可疑症状者再进行,PPD,拍摄,X,线胸片和三次痰涂片检查。,2 Methods All contacts of three districts(Dayi,Longquanyi,Dujiangyan)in close with smear-positive tuberculosis patients were carried out the chest X-ray and smeared sputum three times.Other close contacts of 16 districts were asked by diagnosis first and then examined by vaccination PPD,carrying out the chest X-ray,smearing sputum three times in which there are suspicious symptoms of tuberculosis.,对象与方法,objects and methods,3,、资料来源：,2007-2008,年成都市,19,个区（市）县结防机构核实上报的涂阳肺结核病人密切接触者的调查数据和方法。,3 Source:The survey data and methods of contacts in close with the smear-positive tuberculosis patients from 19 districts TB control and prevention institutions in Chengdu in 2007-2008.,对象与方法,objects and methods,4,、资料质量控制：按,中国结核病防治规划实施指南,和卫生部,关于结核病防治工作“五率”相关技术方案,的要求。,4 Data quality control:According to“The implementation of TB control guide in China and The Ministry of Health The Related technology programs about the five rate of Tuberculosis prevention and control.,结 果,Results,1,、病人发现情况,2007-2008,年涂阳肺结核病人密切接触者,11624,例，共筛查,11357,例，接触者筛查率为,97.7,，发现结核病人,34,例（其中涂阳肺结核病人,11,例，涂阴肺结核病人,23,例），病人发现率为,299/10,万。（见表,1,）,1.Patients found,In 2007-2008 there is 11,624 cases in close contacts of smear-positive tuberculosis patients and screening 11,357 cases.The rate of contacts screening is 97.7%.There are 34 cases of TB were be found(11 cases smear-positive tuberculosis patients and 23 smear-negative tuberculosis patients in which).The rate of TB patients found is 299/100000(table 1),表,1,密切接触者筛查人数和肺结核病人发现结果,年 份,接触者数,筛查人数,接触者筛查率（,%,）,发现结核病人数,病人发现率（,/10,万）,2007,年,5505,5309,96.40%,19,358/10,万,2008,年,6119,6048,98.80%,15,248/10,万,合 计,11624,11357,97.70%,34,299/10,万,Table 1 The number of screening in close contacts of tuberculosis patients and the results of TB cases found.,year,The number of Contacts,The number of Screening,The rate of screening contacts,（,%,）,The number of TB found.,The rate of patients found,（,/100000,）,2007,5505,5309,96.40%,19,358/100000,2008,6119,6048,98.80%,15,248/100000,total,11624,11357,97.70%,34,299/100000,2,、家属与非家属筛查情况,The screening in families and non-families,在非家属中筛查病人发现率为,729,万,/10,万，家属中筛查病人发现率为,278/10,万，特别是,2008,年在非家属中筛查病人发现率为,1118/10,万，远大于在家属中筛查的病人发现率,131/10,万。,The screening detection rate is 729/100000 in non-family members of patients and 278/100000 in family members of patients.In particular,the screening detection rate in non-family members of patients is 1118/100000 in 2008,far greater than that in families of patients is 131/100000.,表,2,涂阳肺结核病人家属与非家属中肺结核病人筛查结果,年 份,家 属,非家属,筛查数,病人数,病人发现率（,%,）,筛查数,病人数,病人发现率（,%,）,2007,年,4001,19,474/10,万,381,0,0,2008,年,5333,7,131/10,万,715,8,1118/10,万,合 计,9334,26,278/10,万,1096,8,729/10,万,Table 2,The screening results,in families and non-families of smear-positive tuberculosis patients,year,families,non-families,the number of Screening,patients,The rate of patients found,（,%,）,the number of Screening,patients,The rate of patients found,（,%,）,2007,4001,19,474/100000,381,0,0,2008,5333,7,131/100000,715,8,1118/100000,Total,9334,26,278/100000,1096,8,729/100000,3,、不同筛查方法对结核病人患病率的影响,3.Different methods of screening for TB prevalence rate,大邑县、龙泉驿区、都江堰市这,3,个区县对所有涂阳肺结核病人的密切接触者直接进行拍摄,X,线胸片和三次痰涂片检查；其他,16,个区（市）县对密切接触者先进行问诊，对有肺结核可疑症状者再进行,PPD,、拍摄,X,线胸片和三次痰涂片检查。,3,个用直接检查方法筛查的区县病人发现率为,729/10,万，,16,个用问诊方法筛查的区县病人发现率为,188/10,万。,All contacts of three districts(Dayi,Longquanyi,Dujiangyan)in close with smear-positive tuberculosis patients were carried out the chest X-ray and smeared sputum three times directly.Other close contacts of 16 districts were asked by diagnosis first and then examined by vaccination PPD,carrying out the chest X-ray,smearing sputum three times in which there are suspicious symptoms of tuberculosis.The screening detection rate is 729/100000 in 3 districts by direct examination,as well as 188/100000 in 16 districts by inquiry.,表,3,不同筛查方法对结核病人发现率的影响,年 份,直 接 筛 查（,3,个区县）,问 诊 筛 查（,16,个区县）,检查人数,病人数,病人发现率（,/10,万）,检查人数,病人数,病人发现率（,/10,万）,2007,年,868,4,460/10,万,4441,15,337/10,万,2008,年（,1-11,月）,1463,13,888/10,万,4585,2,43/10,万,合 计,2331,17,729/10,万,9026,17,188/10,万,Table 3 Different methods of screening for TB prevalence rate,year,by direct examination,（,3,districts,）,by inquiry,（,16 districts,）,The number of check,Patients,The rate of patients found,（,/10,万）,The number of check,Patients,The rate of patients found,（,/10,万）,2007,868,4,460/100000,4441,15,337/100000,2008,（,Jan-Nov,）,1463,13,888/100000,4585,2,43/100000,Total,2331,17,729/100000,9026,17,188/100000,三、讨 论,Discussion,在结核病控制工作中，对涂阳病人密切接触者的诊断和治疗是结核病预防与控制的重要措施之一。两年中，我市对传染性肺结核病人的密切接触者进行感染情况调查，旨在了解成都市传染性肺结核病人密切接触者感染结核的情况，提高结核病人的发现水平，早发现，早治疗，减少传染，减少结核病耐药的发生，控制成都市结核病疫情。,It is an important measure in TB prevention and control to diagnose and treat contacts in close with smear-positive patients.,From two years,the investigation of contacts in close with infectious tuberculosis patients in Chengdu was surveyed.,Aimed at understanding the case of tuberculosis infection in the close contacts of infectious tuberculosis patients and increasing the level of TB case-finding early,reducing infection and the incidence of drug-resistant tuberculosis,controlling tuberculosis epidemic in Chengdu.,传染性肺结核病人的密切接触者是结核病的高危人群，对密切接触者检查是主动发现病人的一种方式，其对病人的发现作用仅次于因症就诊,2 3,。我国的结核病控制项目也强调对密切接触者进行全面调查，,2007,年初，我国卫生部制定了,结核病防治工作“五率”相关技术方案,，将密切接触者检查纳入“五率”技术方案，我市也将密切接触者检查工作纳入了目标考核。,Contacts in close with infectious TB patients are high risk groups of tuberculosis,It is a way to found cases in close contacts of patients by taking examination actively,the role of the discovery of the patients after treatment due to disease,2 3,.,It is also stressing a full-scale investigation in close contacts should be surveyed by Chinas TB control project office.In early 2007,Chinas Ministry of Health set down a“the five rate related technology programs in TB prevention and treatment”,the program of checking close contacts were be included.We will also check the program into the target assessment.,2005,年美国国家结核控制联合会与疾病预防控制中心联合发布了对结核病接触者调查、诊断、评价及治疗指南，他们的资料显示的密切接触者中结核病发现率达到,2 836/10,万,1,。而目前的研究结果显示，我市的密切接触者发现率仅为,299/10,万，明显小于资料显示的数据。,Federation of the U.S.National TB Control and CDC co-released a guide about survey,diagnosis,evaluation and treatment of TB contacts in 2005,as shown by their information the detection rate in close contact with TB is 2836/10000,1,.The current study showed that the detection rate in close contacts in our city is just 299/10 0000,obviously less than the information data.,资料上报道的方法是直接对人群进行,PPD,和拍摄,X,线胸片检查，而我市从,2007,年下半年起，大部分区县的密切接触者检查就用问诊的方法筛查，绝大多数的潜伏结核菌感染者没有被发现出来，这是造成我市密切接触者发现率低的直接原因。,The methods on reports is carried out the chest X-ray and examined by vaccination PPD in crowd directly.But from the second half 2007,most districts of our city used methods of inquiry to screen the close contacts,the vast majority cases of latent TB infection was not found out.This led to the low rate of found in close contacts in our city directly.,涂阳肺结核病人的密切接触者包括病人的家庭成员、邻居、同事和同学等。结防人员在对密切接触者进行筛查时，除了筛查病人家属外，还要对与涂阳病人直接接触的邻居、同事和同学等进行筛查，特别是对农民工和学生，虽然他们的家属在外地，但要对同吃同住的同事和同学进行筛查，我们不能忽视了这个群体。,The contacts in close of smear-positive tuberculosis patients including the patients family members,neighbors,colleagues,students and etc.So the screening of close contacts we can not ignore for this group,who live together as their home is not on the local.,两年来，我市大邑县、龙泉驿区、都江堰市这,3,个区县对密切接触者不论有没有可疑症状，直接进行,PPD,和拍摄,X,线胸片检查；而其他,16,个区县对密切接触者先进行问诊，问诊后再对有可疑症状者进行,PPD,和拍摄,X,线胸片、痰涂片检查，所以这,3,个区县的病人发现率远远大于其他区县。,The past two years,contacts with or without suspicious symptoms of three districts(Dayi,Longquanyi,Dujiangyan)in close with smear-positive tuberculosis patients were carried out the chest X-ray and smeared sputum three times directly.,As well as other close contacts who have suspicious symptoms of 16 districts examined by vaccination PPD,carrying out the chest X-ray,smearing sputum after inquiry.So the rate of patients found in three districts is much larger than other districts.,研究表明：涂阳肺结核病人密切接触者筛查是发现新结核病人的有效方法。在实际工作中值得提倡的做法,:,一是对所有阳性病人的密切接触者不论有没有可疑症状，直接进行,PPD,和拍摄,X,线胸片检查，对胸片异常的再做三次痰涂片检查；二是除了筛查病人家属外，还要对与涂阳病人直接接触的邻居、同事和同学等进行筛查；,Study shows,It is an effective way to detect new tuberculosis patients by screening of close contacts in.patients with smear-positive.These measures should be promoted in practical work.,Firstly,contacts with or without suspicious symptoms in close with smear-positive tuberculosis patients should be carried out the chest X-ray and smeared sputum three times for whose chest X-ray abnormal.,Secondly,in addition to screening the patients family members,but also contacts with smear-positive patients including their family members,neighbors,colleagues and students etc.,三是进一步开展结核病防治知识的宣传，特别是对学校、农民工等人群要加强宣传，及时发现身边的可疑结核病患者。中央财政对密切接触者检查进行专项拨款，成都市财政也对密切接触者检查进行了专项补助，各区县级专业机构要应该充分利用项目经费进行有效率的检查工作，以提高结核病人的发现水平，早发现，早治疗，有效控制结核病疫情。,Thirdly,Further knowledge of tuberculosis prevention and treatment should be promoted,especially to step up publicity for groups such as students,migrant workers,in order to detect suspicious TB patients timely.,The Financial Bureau of Chengdu as well as The central financial authorities established special fund on checking contacts in close with TB patients.,So all professional institutions of districts in Chengdu should make full use of project funds to carry out the screening efficiently,in order to enhance the level of TB found,early detection,early treatment,effective control of tuberculosis epidemic.,