Tuberculosis Outbreak in an Educational Institution in Henan Province, China

The burden and trends of infectious diseases among children aged 14 and below in China from 1990 to 2021: a systematic analysis from the 2021 global burden of disease study

Background

Infectious diseases remain one of the leading causes of death among children worldwide. This study aims to analyze the burden and trends of infectious diseases among children aged 0-14 years in China from 1990 to 2021, and evaluate their gender- and age-specific impacts.

Methods

This study utilizes data from the Global Burden of Disease (GBD) 2021 to analyze mortality, incidence, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), age-standardized incidence rates (ASIR), and age-standardized DALY rates (ASDR) for infectious diseases in Chinese children. Statistical analysis was performed using R and ggplot2.

Results

From 1990 to 2021, China observed substantial declines in pediatric infectious disease burdens. Acute hepatitis mortality decreased from 7,349 deaths (95% UI:5,987-9,059) to 87 (EAPC: -13.78), with a fivefold reduction in ASMR. Enteric infections exhibited the steepest decline: incidence dropped by 86% (EAPC: -6.72), and ASDR fell from 2,257 to 67/100,000. HIV/AIDS deaths rose from 62 to 555 (EAPC:8.28), though post-2018 declines emerged. By 2021, lower respiratory infections remained the leading cause of death (ASMR:5.11/100,000), while upper respiratory infections had the highest incidence. Females showed faster reductions in enteric (EAPC: -7.44 vs. -6.20) and lower respiratory infections (EAPC: -10.39 vs. -9.76). Children under 5 faced the highest burden, particularly for lower respiratory infections (ASMR:13.02/100,000).

Conclusion

The overall burden of infectious diseases among children in China has declined, especially for enteric infections and acute hepatitis. The burden of pediatric HIV/AIDS has also decreased in recent years, though adolescent HIV/AIDS education remains a key area of concern. Children under 5 continue to represent the highest burden group. While China's infectious disease control measures and immunization programs have played a vital role, further strengthening policies to address ongoing challenges is essential for effectively reducing the burden of infectious diseases and achieving the Healthy China 2030 goals.

Epidemiological characteristics and influencing factors of tuberculosis aggregation in schools in Wuhan, China during 2017-2022

Background

Wuhan is located in the hinterland of China, in the east of Hubei Province, at the intersection of the Yangtze River and Hanshui River. It is a national historical and cultural city, an important industrial, scientific, and educational base, and a key transportation hub. There are many schools in Wuhan, with nearly a thousand of all kinds. The number of students is ~2.2 million, accounting for nearly one-fifth of the resident population; college or university students account for ~60% of the total student population. The geographical location of these colleges is relatively concentrated, and the population density is relatively high, making it prone to tuberculosis cluster epidemic.

Objective

This study analyzed the epidemiological characteristics and influencing factors of tuberculosis aggregation in schools in Wuhan, China, during 2017-2022 to provide the basis for the scientific development of tuberculosis prevention and control strategies and measures in schools.

Methods

This study adopted the methods of descriptive epidemiology to analyze the epidemic characteristics of tuberculosis aggregation in schools in Wuhan from January 2017 to December 2022, collecting the relevant data on tuberculosis prevention and control in all kinds of schools in the city using Questionnaire Star, an application of the China network questionnaire survey, and analyze the influencing factors of tuberculosis aggregation by using multifactor logistic regression analysis.

Results

From 2017 to 2022, 54 outbreaks of pulmonary tuberculosis aggregation in schools were reported in Wuhan, which involved 37 different schools, including 32 colleges or universities and five senior high schools; 176 cases were reported, among which 73 were positive for pathogens and 18 were rifampicin or izoniazid resistant. The median duration of a single cluster epidemic was 46 (26,368) days. Universities were more prone to cluster outbreaks than middle schools (χ2 = 105.160, P = 0.001), and the incidence rate among male students was higher than that of female students in cluster epidemics (χ2 = 12.970, P = 0.001). The multivariate logistic regression analysis results showed that boarding in school (OR = 7.60) is the risk factor for a tuberculosis cluster epidemic in schools. The small number of students (OR = 0.50), the location of the school in the city (OR = 0.60), carry out physical examinations for freshmen (OR = 0.44), carry out illness absence and cause tracking (OR = 0.05), dormitories and classrooms are regularly ventilated with open windows (OR = 0.16), strict implement the management of sick student's suspension from school (OR = 0.36), and seeking timely medical consultation (OR = 0.32) were the protective factors for a tuberculosis cluster epidemic in schools.

Conclusion

We successfully identified the epidemiological characteristics and influencing factors of tuberculosis aggregation in schools in Wuhan. The results revealed the influence and status of various factors and indicated ways for schools to improve their TB prevention and control measures in their daily activities. These measures can effectively help curb the cluster epidemic of tuberculosis in schools.

Extreme value analysis of the number of student absences in Jiangsu, China: Based on extreme value theory

Attendance absences have a substantial impact on student's future physical and mental health as well as academic progress. Numerous personal, familial, and social issues are among the causes of student absences. Any kind of absence from school should be minimized. Extremely high rates of student absences may indicate the abrupt commencement of a serious school health crisis or public health crisis, such as the spread of tuberculosis or COVID-19, which provides school health professionals with an early warning. We take the extreme values in absence data as the object and attempt to apply the extreme value theory (EVT) to describe the distribution of extreme values. This study aims to predict extreme instances of student absences. School health professionals can take preventative measures to reduce future excessive absences, according to the predicted results. Five statistical distributions were applied to individually characterize the extreme values. Our findings suggest that EVT is a useful tool for predicting extreme student absences, thereby aiding preventative measures in public health.

The necessity for enhancing awareness of tuberculosis starting from the early college semesters: empirical evidence from a cross-sectional research

Background

College students, especially those in the lower grades, constitute the main high-risk population for tuberculosis (TB). Insufficient knowledge about TB among college students contributes to an increased risk of TB infection. In Zhejiang Province, China, limited research has been conducted recently on the awareness of TB in schools among college students. Therefore, this study aims to gain insight into TB knowledge among low-grade college students in Zhejiang Province and develop effective strategies for TB education targeted at this specific population.

Methods

A cross-sectional survey was conducted between 1st and 20th May 2022 in 20 colleges in Zhejiang Province, southeastern China. The survey aimed to assess the level of TB awareness among 1st and 2nd-year college students. Chi-square tests were performed to compare the rates, while multivariate logistic regression was used to identify the factors influencing the overall awareness level of students' regarding key knowledge about TB.

Results

A total of 4,414 lower-grade students participated in the study. The total awareness rate and entire awareness rate of key TB knowledge were 81.6 and 25.3%, respectively. Participants who demonstrated a relatively poor understanding of the definition were (51.0%), curable outcomes (75.7%), and preventive measures of TB (76.1%). Female participants [adjusted odds ratio (aOR):1.44; 95% confidence interval (CI):1.25-1.65], medical students (aOR:2.00; 95%CI:1.63-2.64), had a high level of monthly expenditures (aOR:2.50; 95%CI:1.49-4.19), had prior TB health education (aOR:1.95; 95%CI:1.68-2.25) and previous exposure to TB patients (aOR:2.13; 95% CI:1.48-3.08) indicating a better level of awareness of key knowledge about TB. Among the students, 58.5% expressed their willingness to acquire TB knowledge through "broadcasting, television, films, and audiovisual materials."

Conclusions

The total awareness rate of key knowledge among low-grade college students in Zhejiang did not meet the national requirements. To effectively prevent TB in schools, it is crucial to develop a comprehensive understanding of the disease among college students. Therefore, it is necessary to enhance TB awareness through theoretical and practical education, starting from the early semesters of college.

Whole-Genome Sequencing and Epidemiological Investigation of Tuberculosis Outbreaks in High Schools in Hunan, China

Background

Tuberculosis (TB) seriously threatens individual and public health. Recently, TB outbreaks in schools have been reported more frequently in China and have attracted widespread attention. We reported three TB outbreaks in high schools in Hunan Province, China.

Methods

When a tuberculosis patient was reported in a school, we carried out field epidemiological investigations, including tuberculin skin testing (TST), chest X-ray (CXR) and laboratory test for all close contacts, and whole-genome sequencing (WGS) analyses to understand the transmission patterns, the causes and the risk factors for the outbreaks, thereby providing a foundation for the control of TB epidemics in schools.

Results

A total of 49 students with TB patients were identified in the three schools where TB outbreaks occurred, including nine patients in School A, 14 patients in School B, and 26 patients in School C. In Schools A, B and C, the putative attack rates in the classes of the index case were 13.8% (8/58), 7.6% (5/66), and 40.4% (21/52), while the putative attack rates of expanding screening in the school were 0.3% (1/361), 0.2% (9/3955), and 0.2% (5/2080), respectively. Thirteen patients had patient delay, with a median delay interval of 69 days (IQR 30.5–113 days). Twelve patients had a healthcare diagnostic delay with a median delay interval of 32 days (IQR 24–82 days). Phylogenetic analysis of culture-positive patients revealed that most of them shared a small genetic distance (≤12 SNPs), with three separate genetic clusters (including one MDR-TB genomic cluster), indicating the recent transmission of Mycobacterium tuberculosis strains.

Conclusion

This combination of field investigation and WGS analysis revealed the transmission of three TB outbreaks in schools. Reinforced implementation is needed to improve timely case finding and reduce diagnosis delay in routine TB control in the school population.

A university-clustered tuberculosis outbreak during the COVID-19 pandemic in eastern China

During the COVID-19 pandemic in 2020, a tuberculosis outbreak occurred in a university in eastern China, with 4,488 students and 421 staff on the campus. A 19-year-old student was diagnosed in August 2019. Later, the first round of screening was initiated among close contacts, but no active cases were found. Till September 2020, four rounds of screening were performed. Four rounds of screening were conducted on September 9, November 8, November 22-25 in 2019 and September 2020, with 0, 5, 0 and 43 cases identified, respectively. A total of 66 active tuberculosis were found in the same university, including 4 sputum culture-positive and 7 sputum smear-positive. The total attack rate of active tuberculosis was 1.34% (66/4909). The whole-genome sequencing showed that the isolates belonged to the same L2 sub-specie and were sensitive to all tested antituberculosis drugs. Delay detection, diagnosis and report of cases were the major cause of this university tuberculosis epidemic. More attention should be paid to the asymptomatic students in the index class. After the occurrence of tuberculosis cases in schools, multiple rounds of screening should be carried out, and preventive therapy should be applied in a timely manner.