De Wals Philippe, Deshaies Pierre, De Serres Gaston, Duval Bernard, Goulet Lise, Pouliot Bernard, Ricard Sylvie, Poulin Maurice
Institut national de Santé publique du Québec, Quebec City, Quebec;
Can J Infect Dis. 2004 Mar;15(2):89-93. doi: 10.1155/2004/370415.
The aims of the present study were to review the risk of invasive meningococcal disease (IMD) among education workers, particularly pregnant women, and to evaluate preventive measures, in a context of endemicity, outbreak or epidemic as observed in the province of Quebec. The literature was reviewed and persons in charge of IMD surveillance in France, Quebec, the United Kingdom and the United States were interviewed. Surveys of asymptomatic carriage of Neisseria meningitidis show that transmission among students is higher than transmission between students and teachers. IMD incidence among education workers was analyzed in Cheshire (United Kingdom) in the period from 1997 to 1999, and the results indicated a risk six times higher than that in the general population. Overestimation of the magnitude of the risk is possible because the analysis focused on a cluster. None of the population-based studies of IMD mentioned a risk of secondary cases among education workers. Six IMD cases in education workers were identified in five clusters in schools in the United Kingdom, but not in the other countries. There is no epidemiological study on IMD risk among pregnant women, and this factor was not mentioned in any published review of IMD. Immunization of education workers at the beginning of their employment, using serogroup C glycoconjugate vaccine or a combined A, C, W-135, and Y conjugate vaccine (still under development), could reduce IMD risk, but the cost effectiveness of this measure should be evaluated. The societal benefit of excluding pregnant women from the work place during an outbreak seems to be very low, even if disease risk could be decreased for this specific group. When chemoprophylaxis is indicated for the control of an outbreak in an educational setting, treatment should be offered both to students and teachers in the group at risk.
本研究的目的是，在魁北克省观察到的地方性流行、暴发或流行的背景下，回顾教育工作者尤其是孕妇中侵袭性脑膜炎球菌病（IMD）的风险，并评估预防措施。我们查阅了文献，并采访了法国、魁北克、英国和美国负责IMD监测的人员。对脑膜炎奈瑟菌无症状携带情况的调查表明，学生之间的传播高于学生与教师之间的传播。1997年至1999年期间，在柴郡（英国）分析了教育工作者中的IMD发病率，结果显示其风险比普通人群高六倍。由于分析集中在一个聚集性病例上，可能高估了风险的程度。没有一项基于人群的IMD研究提到教育工作者中有二代病例的风险。在英国学校的五个聚集性病例中发现了6例教育工作者的IMD病例，但其他国家未发现。没有关于孕妇IMD风险的流行病学研究，并且在任何已发表的IMD综述中都未提及这一因素。在教育工作者入职之初，使用C群糖缀合物疫苗或联合A、C、W-135和Y群缀合物疫苗（仍在研发中）进行免疫接种，可降低IMD风险，但应评估该措施的成本效益。在暴发期间将孕妇排除在工作场所之外，其社会效益似乎非常低，即使该特定群体的疾病风险可能降低。当在教育环境中需要进行化学预防以控制暴发时，应向有风险的群体中的学生和教师都提供治疗。
