Davison K L, Andrews N, White J M, Ramsay M E, Crowcroft N S, Rushdy A A, Kaczmarski E B, Monk P N, Stuart J M
Immunisation Department, HPA Communicable Disease Surveillance Centre, London NW9 5EQ, UK.
Arch Dis Child. 2004 Mar;89(3):256-60. doi: 10.1136/adc.2003.031369.
To assess the risk of further cases in educational settings in order to inform policy on managing cases and clusters of meningococcal disease.
Between 1 April 1995 and 31 March 2001, surveillance in preschool and school settings in England and Wales identified 114 clusters of meningococcal disease. Twenty clusters were reported in preschool settings, 43 in primary, 46 in secondary, and five in independent schools. Seventy three clusters (64%) consisted of two or more confirmed cases, of which 30 had two or more serogroup C cases. Following the introduction of the national meningococcal serogroup C vaccination programme in 1999, no serogroup C clusters were observed between April 2000 and March 2001.
The relative risk of further cases in the four weeks after a single case compared with the background rate was raised in all settings, ranging from RR 27.6 (95% CI 15.2 to 39.9) in preschool settings to RR 3.6 (95% CI 2.5 to 4.6) in secondary schools. Absolute risk estimates ranged from 70/100 000 in preschool settings to 3.0/100 000 in secondary schools. The relative risk of clustering was similar for serogroup B and C strains. Most (68%) second cases occurred within seven days of the first case.
Although there was a higher risk of further cases of meningococcal disease in schools and especially in preschool settings, it is not known whether widespread antibiotic use after single cases reduces risk of further cases and if there is a real risk of harm. Evidence of risk reduction is needed to inform public health policy.
评估教育机构中出现更多病例的风险，以便为管理脑膜炎球菌病病例和聚集性病例的政策提供依据。
在1995年4月1日至2001年3月31日期间，对英格兰和威尔士的学前和学校机构进行监测，共识别出114个脑膜炎球菌病聚集性病例。其中20个聚集性病例出现在学前机构，43个在小学，46个在中学，5个在私立学校。73个聚集性病例（64%）由两例或更多确诊病例组成，其中30个有两例或更多C群病例。1999年全国C群脑膜炎球菌疫苗接种计划实施后，2000年4月至2001年3月期间未观察到C群聚集性病例。
与背景发病率相比，单个病例出现后四周内所有机构中出现更多病例的相对风险均有所升高，范围从学前机构的RR 27.6（95%可信区间15.2至39.9）到中学的RR 3.6（95%可信区间2.5至4.6）。绝对风险估计范围从学前机构的70/10万到中学的3.0/10万。B群和C群菌株的聚集相对风险相似。大多数（68%）第二例病例发生在第一例病例后的七天内。
尽管学校尤其是学前机构中出现更多脑膜炎球菌病病例的风险较高，但尚不清楚单个病例后广泛使用抗生素是否能降低出现更多病例的风险以及是否存在实际危害风险。需要有降低风险的证据来为公共卫生政策提供依据。
