Smith I, Caugant D A, Høiby E A, Wentzel-Larsen T, Halstensen A
Institute of Medicine, University of Bergen, Bergen, Norway.
Epidemiol Infect. 2006 Dec;134(6):1195-202. doi: 10.1017/S0950268806006248. Epub 2006 May 2.
A total of 293 meningococcal disease (McD) patients from Western Norway hospitalized during 1985-2002 were examined for risk factors related to death. The case-fatality rate (CFR) increased from 4% during 1985-1993 to 17% during 1994-2002. We analysed the phenotypic and genotypic characteristics of the meningococcal patient isolates, with the aim of identifying whether highly virulent meningococcal strains contributed to the increased CFR. The Norwegian epidemic strain B:15:P1.7,16/ST-32 complex was overall the most common phenotype/genotype (n=75) and caused most deaths (n=9; CFR 12.0%). However, fatality was significantly associated with disease caused by serogroup C meningococcal strains; C:15:P1.7,16/ST-32 and C:2a/ST-11 complex strains, which had the highest CFRs of 21.1% and 18.2% respectively. Serogroup B strains of the ST-32 complex differing by serotype and/or serosubtype from the epidemic strain had a CFR of 5.1%, while the CFR of disease caused by other strains (all phenotypes and genotypes pooled) was 2.2%. The distribution of phenotypes/clonal complexes varied significantly between 1985-1993 and 1994-2002 (P<0.001); B:15/ST-32 complex strains decreased whereas both C:15:P1.7,16/ST-32 complex strains and strains with other phenotypes/clonal complexes increased. Our results indicate that C:15:P1.7,16/ST-32 and C:2a/ST-11 complex strains were highly virulent strains and contributed to the high CFR of McD in patients from Western Norway. To reduce fatality, rapid identification of such virulent strains is necessary. In addition, early and specific measures should include public information, vaccination of populations at risk of disease and carriage eradication, when clustering of patients occurs.
对1985年至2002年期间在挪威西部住院的293例脑膜炎球菌病（McD）患者进行了与死亡相关的危险因素检查。病死率（CFR）从1985年至1993年期间的4%上升至1994年至2002年期间的17%。我们分析了脑膜炎球菌患者分离株的表型和基因型特征，目的是确定高毒力脑膜炎球菌菌株是否导致了CFR的增加。挪威流行菌株B:15:P1.7,16/ST-32复合体总体上是最常见的表型/基因型（n = 75），并导致了大多数死亡（n = 9；CFR 12.0%）。然而，死亡与血清群C脑膜炎球菌菌株引起的疾病显著相关；C:15:P1.7,16/ST-32和C:2a/ST-11复合体菌株的CFR最高，分别为21.1%和18.2%。与流行菌株在血清型和/或血清亚型上不同的ST-32复合体血清群B菌株的CFR为5.1%，而其他菌株（所有表型和基因型汇总）引起的疾病的CFR为2.2%。1985年至1993年与1994年至2002年期间表型/克隆复合体的分布有显著差异（P<0.001）；B:15/ST-32复合体菌株减少，而C:15:P1.7,16/ST-32复合体菌株和具有其他表型/克隆复合体的菌株均增加。我们的结果表明，C:15:P1.7,16/ST-32和C:2a/ST-11复合体菌株是高毒力菌株，导致了挪威西部患者中McD的高CFR。为降低死亡率，必须快速鉴定此类毒力菌株。此外，早期和具体措施应包括公众宣传、对疾病高危人群进行疫苗接种以及在出现患者聚集时消除携带情况。
