Shigematsu M, Davison K L, Charlett A, Crowcroft N S
Immunisation Division, Public Health Laboratory Service, Communicable Disease Surveillance Centre, 61 Colindale Avenue London NW9 5EQ, UK.
Epidemiol Infect. 2002 Dec;129(3):459-70. doi: 10.1017/s0950268802007549.
Enhanced surveillance of meningococcal disease (ESMD) was implemented nationally across ten regions of England, Wales and Northern Ireland from 1 January 1999. It aims to deliver more sensitive surveillance than laboratory reporting by including clinically diagnosed but laboratory unconfirmed cases. Consultants in Communicable Disease Control (CsCDC) report all clinically diagnosed cases of meningococcal disease (MD) to the Regional Epidemiologist in the relevant regional unit of the Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC). These reports are reconciled with laboratory data from the PHLS Meningococcal Reference Unit and then forwarded to the national CDSC where further reconciliation with laboratory data takes place. In addition, CsCDC are asked to report any clusters of MD that occur. Between 1 January 1999 and 30 June 2001, 12,074 cases of MD were ascertained through ESMD. The majority (57%) were laboratory confirmed. The estimated incidence of MD fell between 1999 and 2001 from 9.2 to 8.0 per 100,000 population. Of laboratory confirmed cases, the number of cases of serogroups B and W135 increased and of serogroup C and of ungrouped meningococcal infection decreased. Variation between regions was considerable and deserves further investigation. Of 11,522 cases with a reported clinical diagnosis, 53.6% were diagnosed as septicaemia, 32.6% as meningitis, 12.5% as both septicaemia and meningitis, and 13% had other invasive MD. Between 1 January 1999 and 30 June 2001 698 deaths were reported, an overall case fatality rate (CFR) of 5.8%; 567 deaths were in confirmed cases and 131 probable (CFR 8.2% and 2.5%, respectively). CFR was higher in serogroup C (13.5%) than B (5.8%). No peak in serogroup C meningococcal infection occurred in the winter of 2000/1 and no clusters of serogroup C meningococcal infection were reported in the first half of 2001. ESMD provides information about the epidemiology of MD that is more complete than statutory notification and laboratory surveillance and is useful for evaluating the impact of the meningococcal serogroup C vaccination programme and of the other non-vaccine preventable serogroups.
1999年1月1日起，英格兰、威尔士和北爱尔兰的10个地区在全国范围内实施了脑膜炎球菌病强化监测（ESMD）。其目的是通过纳入临床诊断但实验室未确诊的病例，提供比实验室报告更敏感的监测。传染病控制顾问（CsCDC）将所有临床诊断的脑膜炎球菌病（MD）病例报告给公共卫生实验室服务（PHLS）传染病监测中心（CDSC）相关区域单位的区域流行病学家。这些报告与PHLS脑膜炎球菌参考单位的实验室数据进行核对，然后转发给国家CDSC，在那里与实验室数据进行进一步核对。此外，要求CsCDC报告发生的任何MD聚集病例。1999年1月1日至2001年6月30日期间，通过ESMD确诊了12,074例MD病例。大多数（57%）病例经实验室确诊。MD的估计发病率在1999年至2001年间从每10万人9.2例降至8.0例。在实验室确诊病例中，B群和W135群病例数增加，C群和未分组的脑膜炎球菌感染病例数减少。各地区之间的差异相当大，值得进一步调查。在报告有临床诊断的11,522例病例中，53.6%被诊断为败血症，32.6%为脑膜炎，12.5%为败血症和脑膜炎，13%患有其他侵袭性MD。1999年1月1日至2001年6月30日期间报告了698例死亡病例，总体病死率（CFR）为5.8%；确诊病例中有567例死亡，131例可能死亡（CFR分别为8.2%和2.5%）。C群的病死率（13.5%）高于B群（5.8%）。2000/1年冬季未出现C群脑膜炎球菌感染高峰，2001年上半年未报告C群脑膜炎球菌感染聚集病例。ESMD提供了比法定通报和实验室监测更完整的MD流行病学信息，有助于评估脑膜炎球菌C群疫苗接种计划以及其他非疫苗可预防血清群的影响。
