How to prevent the tuberculosis epidemic on campus

　　Many times, people think it has disappeared.

　　It has been entangled with humans for tens of thousands of years.

Archaeologists have found traces of it in ancient Egyptian mummies.

Chopin, Chekhov, Kafka, Lu Xun, and Xiao Hong were all killed by it.

To deal with it, bacteriologists spent 13 years developing a vaccine.

Today, this vaccine is the "first shot after birth" for newborn babies in China.

　　It is an ancient pathogen called Mycobacterium tuberculosis, short for Mycobacterium tuberculosis.

In the impression of many people, it has been effectively controlled.

But in fact, the tuberculosis it brings is still one of the top ten causes of death in the world.

In 2017, 10 million people worldwide suffered from tuberculosis, of which an estimated 1 million children were.

　　Recently, the campus tuberculosis epidemic in the School of Science and Arts of Jiangsu Normal University brought it back to public view.

On October 14, 2020, the school issued a fact sheet stating that in the past year, 22 cases of tuberculosis among school students have been discovered.

Recently, after the school conducted a screening of teachers and students, it was found that 43 students had abnormal chest CT images.

　　On the same day, the World Health Organization released the "Global Tuberculosis Report 2020".

According to estimates, in 2019, there were approximately 833,000 new cases of tuberculosis in China, ranking third in the world, after India and Indonesia.

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　　Tuberculosis was once called the "poor disease" and it is difficult to associate it with young and healthy students.

In fact, the campus is also a key area for tuberculosis prevention and control.

　　In a paper published in March 2020 by Gao Qian, a professor at the School of Basic Medicine of Shanghai Medical College of Fudan University, in 2017, 830,000 cases of tuberculosis were reported in my country, and there were more than 40,000 cases of student tuberculosis. The number of new cases of student cases accounted for the country. 4.87%.

　　Gao Qian explained that from the data point of view, the campus is not a place with a high incidence of tuberculosis, but the outbreak of tuberculosis in schools has a large impact and is likely to constitute a public health incident that attracts social attention. Students are also one of the key populations for tuberculosis prevention and control. Prevention and control is the top priority of my country's tuberculosis prevention and control work.

　　Chu Naihui, chief physician of the Beijing Chest Hospital affiliated to Capital Medical University, explained that in the past, poor patients were often malnourished and weakened their resistance to contract tuberculosis.

However, for young patients such as students and young white-collar workers, they are well-nourished, but they have the habit of staying up late and insomnia.

　　The majority of tuberculosis patients that Chu Naihui contacts are high school and university students and middle-aged and elderly people in their 50s and 60s.

　　She had seen a young tuberculosis patient.

Before the diagnosis, the patient spent time with friends in the Internet cafe, staying up late to play games for several days, until he fainted in the Internet cafe.

　　In 2017, the former National Health and Family Planning Commission and the Ministry of Education jointly issued the "Guidelines for the Prevention and Control of Tuberculosis in Schools (2017 Edition)".

When a school has 10 or more epidemiologically-related tuberculosis cases in the same semester, or a death case of tuberculosis, the county-level health and family planning administrative department where the school is located shall determine whether or not it is based on the results of on-site investigation and public health risk assessment It constitutes a public health emergency.

　　However, from all angles, screening for tuberculosis is not easy.

The main examination items for tuberculosis are sputum smear and chest X-ray examination. Sputum culture examination and drug sensitivity examination can be carried out if necessary.

According to the information on the official website of the Chinese Center for Disease Control and Prevention, currently, sputum smear tuberculosis examination is the main method for detecting infectious pulmonary tuberculosis patients.

If tuberculosis is detected in the sputum, it can be diagnosed as having tuberculosis.

　　According to Wu Lijuan, chief physician of the Department of Respiratory and Critical Care Medicine at the China-Japan Friendship Hospital, compared with other bacteria, it is difficult to capture Mycobacterium tuberculosis by technical means. It has been latent for many years and grows slowly in the human body.

Wu Lijuan believes that some hospitals are weak in diagnosing tuberculosis, and the widely used sputum smear method has low sensitivity and can only screen about 10% of patients.

Due to the limited testing conditions, some non-local patients were misdiagnosed as other diseases, and it took a long time to diagnose tuberculosis.

　　After 22 students had confirmed cases, a teacher from Jiangsu Normal University told reporters that they have not learned the specific information of the confirmed cases from the school so far, and it is difficult to determine whether they belong to the close group.

This teacher is not clear about the number of infections and the number of investigations in the college, and even if the future teaching mode is switched to online, he has not been informed.

　　The dean of the School of Science and Humanities of the school said in an interview with the media, “Although the school has successively received case notifications from the local disease control department and has the exact number of cases and patient status, in accordance with relevant regulations, the school has no right to issue a notification.”

　　Because tuberculosis is difficult to diagnose, Gao Qian believes that when tuberculosis cases appear in a school, how many cases are announced, how many of them are truly confirmed patients, how many are clinically diagnosed patients, and how many are suspected patients or patients in the latent infection period. Needed.

　　Diagnosis of tuberculosis is divided into pathogenic diagnosis and clinical diagnosis.

In clinical diagnosis, no tuberculosis bacterium was found in the patient's body, which is a "negative patient".

Gao Qian believes that, generally speaking, patients with clinically diagnosed bacterium-negative tuberculosis are in an early stage that has not been excreted.

The source of infection of tuberculosis is not "bacterial negative patients", but "bacterial positive patients" who have found Mycobacterium tuberculosis in their bodies, and the latter needs more public health attention.

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　　In order to promote the knowledge of tuberculosis prevention and control, some related lectures will appear on campus from time to time.

Chu Naihui participated in a lecture organized by the Beijing Anti-tuberculosis Association and went to Beijing universities to explain tuberculosis related knowledge.

However, she found that some students were not very enthusiastic about the tuberculosis lecture and were reluctant to participate. "Everyone generally thinks that this has nothing to do with them."

For this reason, Chu Naihui had to ask the counselor to organize more students to participate.

　　Every year on World Tuberculosis Day, many doctors explain tuberculosis knowledge on radio, television, and newspapers.

Most of the feedback that Chu Naihui received from the audience came from tuberculosis patients, their families and colleagues.

　　Tan Shouyong, deputy director of the Tuberculosis Branch of the Chinese Medical Association, remembers that after a school had a tuberculosis case, he followed the disease control department to the school for screening.

The question the school administrator asked the doctor was, will this affect the school’s enrollment rate?

　　In 2017, a cluster of tuberculosis epidemic broke out in Hunan Taojiang Fourth Middle School. The reporter learned on the spot that students infected with tuberculosis had been suspended for as little as 3 months and as long as half a year. After classes were resumed, some students were arranged for special use. The science and technology building that came to do the experiment is far away from the original teaching building, and it is still worried about being "squinted" by students in other classes.

　　The "School Tuberculosis Prevention and Control Work Regulations (2017 Edition)" stipulates that after the full course of treatment is completed for bacteria-positive pulmonary tuberculosis patients and severe bacteria-negative pulmonary tuberculosis patients, the school shall go through the procedures for returning to school on the basis of the resumption diagnosis certificate.

　　This puts pressure on young patients who are under heavy academic pressure.

Chu Naihui met a tuberculosis patient who was in the third year of high school. He was worried that Xiong will miss the college entrance examination. Chu Naihui comforted him. The cure rate of tuberculosis is very high. He must be treated first. Law school".

　　Wu Lijuan once diagnosed and treated a graduate who was about to get a job, and was found to be suffering from tuberculosis during the physical examination.

This young man is more worried about his future than he is treating illness.

　　Gao Qian once published a paper stating that my country's current requirements for tuberculosis management are too strict, especially for senior high school students who are under pressure from the college entrance examination. After being diagnosed with tuberculosis, the pressure on the students has increased.

This may cause the school or the parents of students to be afraid that the suspension of school will affect their studies, and there may be underreporting.

　　He calculated according to my country's regulations that the sick students need to take a leave of absence for at least 5 months, but the current majority of the student cases diagnosed in my country are bacteria-negative patients who are not infectious.

　　In the US Centers for Disease Control and Prevention (CDC) guidelines for tuberculosis, there is no clear stipulation on the time of absence for student tuberculosis patients. After 2-3 weeks for bacteria-positive patients, and 5-7 days for bacteria-negative patients, they will be treated with doctor’s consent You can go back to school.

　　"Eliminating the infectivity of the patient and curing the patient are different concepts." Gao Qian explained that it takes several months to cure tuberculosis patients, including several weeks for the results of bacteriological examination (smear or culture) to turn negative. The patient’s infectivity only takes nearly 2 weeks.

He suggested that the sick students should return to school after the infection is eliminated.

　　Tan Shouyong found that after the students contracted tuberculosis, there was a huge psychological gap, and they were easily reticent, depressed, worried about discrimination, and became irritable and impatient.

Even after returning to school, "we can't simply say that the patient is cured and can return to school (that's it). How to manage it, including relapse and psychological counseling, is very important."

　　He gave an example. A classmate who had dropped out of school due to illness for one year. After returning to school, the original class had changed a group of new classmates. The new classmates talked about his past medical history, which aggravated the boy’s introverted and lonely character, so that he gave up his studies and often went to school. drink.

There are also some students who feel that they have missed too much homework because of their resumption of school.

　　Tan Shouyong believes that school teachers need to learn about tuberculosis, promote tuberculosis prevention and treatment knowledge to students, and reduce the psychological gap between students who are ill and other students, so as to ensure that there is no discrimination.

　　From the perspective of the general environment of tuberculosis, the society still discriminates against tuberculosis patients.

For example, Gao Qian, employees who have jobs do not want to be notified of their illness by their employers in order to prevent being dismissed; similar situations exist for student patients.

He called on the society to have more understanding and sympathy for tuberculosis patients. When a tuberculosis epidemic breaks out on campus, find the bacteria-positive patients and treat them in time to avoid panic.

　　China Youth Daily, China Youth Daily, trainee reporter Wei Xi, reporter Jiang Shan Source: China Youth Daily