ESMPE: A combined strategy for school tuberculosis prevention and control proposed by Dalian, China

Abstract

BackgroundAlthough China has paid more attention on the prevention and control of tuberculosis (TB) in schools, several unsolved questions in this field still threaten the progress of TB control. Therefore, there is an urgent need to develop a systematic and practical strategy for Chinese school TB prevention and control system. In this study, we aimed to assess the feasibility of a combined strategy named ESMPE (examination, screening, monitoring, prevention and education) that adhere to the basic principles of Chinese schools TB control strategy.MethodsThe ESMPE strategy included five sections, namely TB screening during physical examination for the school freshmen entrances, screening of close contacts, monitoring of high-risk schools, preventive treatment and TB education. The effectiveness of ESMPE strategy was evaluated from 2011 to 2016. The original data were provided by the Dalian Tuberculosis Hospital. Descriptive analysis and nonparametric tests were used for comparing statistical differences of results between different years.ResultsThe detection rate of active pulmonary TB in school freshmen was decreased from 2011 to 2016 (χ2 = 41.941, P = 6.0551E-8). 97.22% (17,043/17,530) of close contacts experienced close contacts screening, and the secondary attack rate (SAR) of TB in schools fell by 146.35/105 from 2011 to 2012, and finally reduced to 85.57/105 in 2016. There was a significant correlation between SAR of student TB and the rate of screened close contacts (r = -0.924, P = 0.009). TB incidence of five monitored schools had a substantial decline after receiving monitoring, and this declining trend continued in 2016. Due to the TB education and advanced screening methods, the mean of diagnostic delay time in students with TB was shortened (15.71 days), while still fewer latent TB infection students received preventive treatment (30.38%).ConclusionsThe ESMPE strategy has shown a favorable effect on TB prevention and control in Dalian schools. More systematic evidence is needed on the effect of this strategy in reducing the incidence of TB in schools from other settings prior to its further scaling-up in China.

Tuberculosis-related stigma and its determinants in Dalian, Northeast China: a cross-sectional study

“…Based on the permanent resident population, the per capita gross domestic product (GDP) was 109,644 yuan. In 2016, the incidence of TB in the general population of Dalian was 64.66/100,000 [ 32 ]. Dalian Tuberculosis Hospital is the only specialized hospital for TB control in Dalian.…”

The effects of family, society and national policy support on treatment adherence among newly diagnosed tuberculosis patients: a cross-sectional study

“…Dalian is the best economically developed area in Liaoning province. In 2016, the incidence of TB was 64.66/100,000 in the general population of Dalian [20]. In recent years, although the incidence of TB has been declining slowly, it is still the main killer among infectious diseases.…”

Implications of a school outbreak of multidrug-resistant tuberculosis in Northern China

“…As recommended by the World Health Organisation, the 9-month INH regimen was used for the preventive treatment of students with LTBI [11]. If students with LTBI progressed to active TB cases, they received the standardised first-line treatment regimen of 2 months of IREZ ( I soniazid, R ifampicin, E thambutol, P yrazinamide) plus 4 months of IR in the local TB dispensary.…”

“…Active cases were defined as individuals with positive smear results or clinical findings consistent with active TB, as defined by national guidelines. In addition, students with indurations of ⩾15 mm and normal radiological features were classified as having LTBI and were advised to receive isoniazid preventive therapy (IPT) against TB on a voluntary basis [11].…”