In recent years, health departments and education departments have attached great importance to TB control in schools, striving to raise TB detection rates and reduce TB outbreaks in schools. However, there are still many shortcomings in TB control work, which should be recognized, and a series of integrated measures should be implemented and further strengthened (6):
First, schools should be instructed on TB control. Through work meetings and training, schools should be guided to carry out physical examinations with all newly enrolled students, and the frequency of TB screening should be elevated in some areas and schools when necessary (7-8). Morning check-ups and tracing of students with illnesses should be reinforced, and the referral and arrival rates of students with suspected symptoms and suspected patients should be raised. In addition, the environment in schools should be improved, especially for ventilation in classrooms and dormitories.
Second, all areas should establish effective channels for communication among schools, local CDCs, and health facilities within their jurisdictions to facilitate information exchange and standardize case reporting and registration. Capacities in surveillance and early warning systems should be strengthened with enhanced efficiency of data utilization. Early warning information based on individual cases should be thoroughly explored (9), and automated-alert methods and thresholds should be optimized to identify high-risk schools promptly (10).
Third, when a TB outbreak occurs, the principle of simultaneous investigation, management, and improvement should be followed to identify the cause of the outbreak and control and prevent further spread of TB. Once any TB cases are detected in a school, an investigation should be carried out as soon as possible to assess and judge the situation and the possibility of TB spread. All cases should be searched and verified case by case. The time distribution of the cases, case distribution in classes and dormitories, distribution of population characteristics, and the correlation among them should be analyzed. Close contacts should be screened for TB: symptom screening, TST, and chest X-ray should be performed simultaneously for those aged 15 and above; for those under 15 years of age, symptom screening and TST should be performed first, and chest X-ray should then be performed for those being found with suspected symptoms or strong positive TST. According to the situation on the spot and the findings of screening, the scope of screening should be expanded as appropriate. In general, screening should first be performed with teachers and students who were in the same class or dormitory as the patient. If a new TB case is found, screening must be extended to students and teachers on the same teaching building floor and dormitory floor as the case. In addition, it should be noted that family members in close contact with TB cases should also be screened. All active TB cases should be incorporated into the scope of TB control programs for case management and standardized treatment. Those who meet the criteria for suspension of schooling must suspend their schooling for medical treatment. Suspected cases should be isolated from other students before a final diagnosis is made. On the basis of excluding TB and related contraindications, it was recommended that students with strong positive TST alone receive preventive treatment intervention with their informed consent.
Finally, TB health education in schools should be improved in a variety of ways. The awareness of TB identification and prevention among students and their parents should be enhanced. Sound healthcare practices and moral literacy should be developed, including prompt health-seeking upon illness, disclosure of disease diagnosis without concealment, and voluntary suspension of school attendance when necessary.