Dawson K G, Emerson J C, Burns J L
Department of Pediatrics, University of Washington, Children's Hospital and Regional Medical Center, Seattle 98105, USA.
Pediatr Infect Dis J. 1999 Sep;18(9):816-22. doi: 10.1097/00006454-199909000-00014.
Introduction of Haemophilus influenzae type b (Hib) vaccines has dramatically altered the epidemiology of bacterial meningitis in children. The goal of this study was to describe these changes in a pediatric teaching hospital.
Patient charts at Children's Hospital and Regional Medical Center, Seattle, were identified by diagnosis codes and reviewed retrospectively. The 1981 to 1995 time period was chosen to incorporate three distinct 5-year periods: before the use of unconjugated Hib vaccine; between the unconjugated and conjugate vaccines; and after the conjugate vaccines were available for routine immunization of infants.
Bacterial meningitis was identified in 806 cases. In 13 premature infant cases Escherichia coli was most frequently isolated (6 cases). Group B Streptococcus, E. coli and Listeria monocytogenes were the most common pathogens in 87 neonatal cases. The most common pathogens in 706 cases of childhood meningitis were H. influenzae, Streptococcus pneumoniae and Neisseria meningitidis. H. influenzae was the most common pathogen in the first two time periods (73 and 69% of childhood cases, respectively), but not so in the third period (16%).
A changing pattern in childhood meningitis was observed during the study period. H. influenzae cases dramatically declined, altering the relative proportions of other pathogens, S. pneumoniae and N. meningitidis. However, the number of cases caused by these latter pathogens remained steady.
b型流感嗜血杆菌（Hib）疫苗的引入极大地改变了儿童细菌性脑膜炎的流行病学特征。本研究的目的是描述一家儿科教学医院中的这些变化。
通过诊断编码确定西雅图儿童医院及地区医疗中心的患者病历，并进行回顾性审查。选择1981年至1995年这一时间段，以纳入三个不同的5年时期：未使用非结合型Hib疫苗之前；在非结合型疫苗和结合型疫苗使用之间；以及结合型疫苗可用于婴儿常规免疫之后。
共确定806例细菌性脑膜炎病例。在13例早产婴儿病例中，最常分离出的是大肠杆菌（6例）。B族链球菌、大肠杆菌和单核细胞增生李斯特菌是87例新生儿病例中最常见的病原体。在706例儿童脑膜炎病例中，最常见的病原体是流感嗜血杆菌、肺炎链球菌和脑膜炎奈瑟菌。流感嗜血杆菌在前两个时期是最常见的病原体（分别占儿童病例的73%和69%），但在第三个时期并非如此（16%）。
在研究期间观察到儿童脑膜炎的模式发生了变化。流感嗜血杆菌病例大幅下降，改变了其他病原体（肺炎链球菌和脑膜炎奈瑟菌）的相对比例。然而，后两种病原体导致的病例数保持稳定。
