Dell E, Bedford D, McMahon B, Nicholson A
Department of Paediatrics, Our Lady of Lourdes Hospital, Drogheda, Ireland.
Ir Med J. 2001 Jun;94(6):166, 168-9.
Recent evidence in Ireland highlights an increased incidence of meningococcal disease, with group B the prominent serogroup. However, in developed countries, 'clusters 'are predominantly group C. To retrospectively analyse all patients with meningococcal disease in the North Eastern Health Board (NEHB) Region (circa 300,000 population) from January 1997 to December 1998 inclusively, and to highlight the occurrence of two 'clusters' of Group C meningococcal disease, one in Drogheda and the other in Monaghan (both of whom received national media attention). We studied clinical, laboratory (including PCR) and epidemiological data on all patients in the NEHB with a diagnosis of meningococcal disease. Blood for PCR (Polymerase Chain Reaction) was sent to the National Meningococcal Reference Laboratory on all suspected cases. Details of two 'clusters' were studied in depth from an epidemiological perspective. 131 patients with meningococcal disease were notified, with three deaths of 53 notifications in 1997 (7.5% mortality) and six deaths of 78 notifications in 1998 (9.8% mortality). The rate of meningococcal disease per 100,00 in 1997 was 13.1 and rose to 18.6 in 1998. This contrasts with a national average of 8.5 per 100,00 for the Republic of Ireland in 1997. Age peaks occurred in those under one year old and between 14-16 years old, with seasonal peaks in the winter and spring months. In 1997, 57.5% were group B and 35% were group C, with 7.5% not grouped. In 1998, 60.3% were group B and 39.7% were group C. There were two linked cases in Drogheda, with both attending a local national school. Both were confirmed group C disease. In Monaghan, in January 1998, a cluster of four cases of group C disease occurred over a 48 hour period. All were males, ranging in age from 11-16 years. Of the four, one died and one received intensive care treatment in a children's hospital. The cluster received intense local and national media attention. One week later, a fifth case of group C disease occurred in Monaghan and this 10 year old boy made an uneventful recovery. The high endemic rate of meningococcal disease is striking, with a four fold rise over the past five years. Clusters of serogroup C meningococcal disease will be of historical interest now that new conjugate C vaccines are incorporated into the vaccination program.
爱尔兰最近的证据表明，脑膜炎球菌病的发病率有所上升，其中B群是主要的血清群。然而，在发达国家，“聚集性病例”主要是C群。回顾性分析1997年1月至1998年12月期间（含）东北卫生委员会（NEHB）地区（约30万人口）所有患脑膜炎球菌病的患者，并突出显示两起C群脑膜炎球菌病“聚集性病例”的发生情况，一起发生在德罗赫达，另一起发生在莫纳汉（两起事件均受到全国媒体关注）。我们研究了NEHB所有诊断为脑膜炎球菌病患者的临床、实验室（包括聚合酶链反应）和流行病学数据。所有疑似病例的用于聚合酶链反应（PCR）的血液都被送往国家脑膜炎球菌参考实验室。从流行病学角度深入研究了两起“聚集性病例”的细节。共报告了131例脑膜炎球菌病患者，1997年53例报告中有3例死亡（死亡率7.5%），1998年78例报告中有6例死亡（死亡率9.8%）。1997年每10万人中脑膜炎球菌病发病率为13.1，1998年升至18.6。这与1997年爱尔兰共和国全国平均每10万人8.5的发病率形成对比。年龄高峰出现在1岁以下儿童以及14 - 16岁人群中，季节性高峰出现在冬季和春季月份。1997年，57.5%为B群，35%为C群，7.5%未分型。1998年，60.3%为B群，39.7%为C群。在德罗赫达有两例相关病例，两人都就读于当地一所国立学校。两人均确诊为C群疾病。在莫纳汉，1998年1月，在48小时内发生了4例C群疾病聚集性病例。患者均为男性，年龄在11 - 16岁之间。4人中，1人死亡，1人在儿童医院接受重症监护治疗。这起聚集性病例受到了当地和全国媒体的高度关注。一周后，莫纳汉又出现了第5例C群疾病病例，这名10岁男孩康复过程顺利。脑膜炎球菌病的高流行率令人震惊，在过去五年中上升了四倍。鉴于新的结合C疫苗已纳入疫苗接种计划，C群脑膜炎球菌病的聚集性病例将具有历史意义。
