广西南宁地区5岁以下儿童细菌性脑膜炎的流行病学监测

董柏青; 唐振柱; 林玫; 李翠云; 谭冬梅; 梁大斌; 廖和壮; 刘先知; 权怡; 方锦嵩; 吴兴华; 秦卫文; Kilgore PE; Kennedy WA; 徐志一; Clemens JD

Abstract

董柏青,唐振柱,林玫,李翠云,谭冬梅,梁大斌,廖和壮,刘先知,权怡,方锦嵩,吴兴华,秦卫文,Kilgore PE,Kennedy WA,徐志一,Clemens JD.广西南宁地区5岁以下儿童细菌性脑膜炎的流行病学监测[J].Chinese journal of Epidemiology,2004,25(5):391-395

广西南宁地区5岁以下儿童细菌性脑膜炎的流行病学监测

Epidemiologic surveillance for bacterial meningitis in 140000 children under 5 years of age in Nanning district, Guangxi province

Received:August 14, 2003

DOI：

KeyWord: 流感嗜血杆菌细菌性脑膜炎流行病学监测

English Key Word: Haemophilus influenzae Bacterial meningitis Epidemiology Surveillance

FundProject:国际疫苗研究所(ⅠⅤⅠ)合作项目资助

Author Name	Affiliation	E-mail
Dong Bai-qing	Guangxi Autonomous Region Center for Disease Prevention and Control, Nanning 530021, China	dbq666@163.net
Tang Zhen-zhu	Guangxi Autonomous Region Center for Disease Prevention and Control, Nanning 530021, China
Lin Wen	Guangxi Autonomous Region Center for Disease Prevention and Control, Nanning 530021, China
Li Cui-yun	Guangxi Autonomous Region Center for Disease Prevention and Control, Nanning 530021, China
Tan Dong-mei	Guangxi Autonomous Region Center for Disease Prevention and Control, Nanning 530021, China
Liang Da-bin	Guangxi Autonomous Region Center for Disease Prevention and Control, Nanning 530021, China
Liao He-zhuang	Guangxi Autonomous Region Center for Disease Prevention and Control, Nanning 530021, China
Liu Xian-zhi	广西壮族自治区妇幼保健院
Quan Yi	Guangxi Autonomous Region Center for Disease Prevention and Control, Nanning 530021, China
Fang Jin-song	Guangxi Autonomous Region Center for Disease Prevention and Control, Nanning 530021, China
Wu Xin-hua	Guangxi Autonomous Region Center for Disease Prevention and Control, Nanning 530021, China
Qin Wei-wen	Guangxi Autonomous Region Center for Disease Prevention and Control, Nanning 530021, China
Kilgore PE	International Vaccine Institute, Republic of Korea
Kennedy WA	UCLA Center for Vaccine Research, Torrance, CA, USA
Xu Zhi-yi	International Vaccine Institute, Republic of Korea
Clemens JD	International Vaccine Institute, Republic of Korea

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Abstract:

目的: 分析南宁地区5岁以下儿童细菌性脑膜炎的发病率、流行特征、病原谱、后遗症等的特点。方法: 采取以监测区域所有医院、卫生院及村卫生室为监测单位, 以人口为基数的流行病学监测方法, 以符合筛选标准的病例作为研究病例; 采集脑脊液(CSF)和血液标本, 按照统一规程进行病原学分离和临床诊断。结果: 在26个月的监测期内, 在5岁以下儿童中共收集到符合筛检标准的研究病例1272例, 其中临床诊断病例265例, 临床诊断病例年均发病率为86.36/10万, 病原确诊细菌性脑膜炎病例38例, 年均发病率为12.38/10万。确诊病例的病原谱以葡萄球菌为主, 次为大肠埃希菌和肺炎双球菌(Sp); 年龄分布以1月龄以下年龄组为最高,次为1～12月龄组, 1～24月龄组是Sp和流感嗜血杆菌(Hi)所致脑膜炎的高发年龄组; 并发症和后遗症发生率分别为13.16%和0.00%, 病死率18.42%。实验室分别从1193份血培养标本和1211份CSF培养标本中分离出40株Hi和23株Sp等致病菌, 但均未分离到脑膜炎奈瑟菌(Nm)。结论: 首次证实广西存在Hi所致脑膜炎, 年均发病率为0.98/10万, 处于较低发病水平; 确诊细菌性脑膜炎年均发病率12.38/10万, 是当前危及儿童健康的重要问题; 确诊细菌性脑膜炎的病原谱以葡萄球菌为主。

English Abstract:

Objective: To characterize the incidence, epidemiologic features, etiologic agents and sequelase of bacterial meningitis in children under 5 years of age in Nanning, Guangxi. Methods: A population-based surveillance was conducted to evaluate children with signs and sumptoms of meningitis. All hospitals, township health centers and village clinics in the surveillance area were structured to participate in the case referral and evaluatioon. Cerebrospinal fluid (CSF) and blood specimens were obtained and processed using standardized microbiologic methods. Results: During the 26-month surveillance period, among the children under 5 years old, a total of 1272 cases who met the screening criteria of meningitis were studied. 265 of 1272 cases were identified as clinically diagnosed meningitis, with an incidence rate of 86.36 per 100000 population. The annual incidence rate under the 38 cases of confirmed bacterial meningitis appearsed to be 12.38/100000. Staphylococcus species accounted for the largest proportion of laboratory-confirmed bacterial mengitis, followed by E.coli and S. pneumoniae. The highest attack rate occurred in neonates< 1 month, followed by children aged 1-12 months. All cases of meningitis due to Hi and Sp were children aged 1-24 months. 13.16% and 0.00% of the cases survived with complications and sequelae, and the case-fatality rate was 18.42%. 40 bacterial isolates were identified from 1193 blood cultures and 23 from 1211 cerebrospinal fluid samples, but no Neisseria meningitidis was found. Conclusion: Meningitis due to Hi was first confirmed in Guangxi with the incidence of 0.98 per 100000 population. The annual incidence rate of confirmed bacterial meningitis was 12.38 per 100000, which was considered an important public health problem in children. Staphylococci was the predominant pathogen in conformed bacterial meningitis.

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