1998-2007 年美国脑膜炎奈瑟菌病流行病学变化：对预防脑膜炎球菌病的启示。
Changes in Neisseria meningitidis disease epidemiology in the United States, 1998-2007: implications for prevention of meningococcal disease.
机构信息
Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta Georgia 30333, USA.
出版信息
Clin Infect Dis. 2010 Jan 15;50(2):184-91. doi: 10.1086/649209.
BACKGROUND
In January 2005, a quadrivalent (serogroups A, C , Y, and W-135) meningococcal conjugate vaccine was licensed for use in adolescents. This report describes the epidemiologic features of meningococcal disease in the United States from January 1998 through December 2007, before and during implementation of adolescent quadrivalent meningococcal conjugate vaccination.
METHODS
Data were collected from active surveillance for invasive Neisseria meningitidis conducted through the Active Bacterial Core surveillance (ABCs) sites during 1998-2007. Isolates from cases were serogrouped at the ABCs site and confirmed at the Centers for Disease Control and Prevention. Estimates of the incidence and number of cases in the 50 states were calculated, standardizing for race and age group.
RESULTS
In the period 1998-2007, a total of 2262 cases of meningococcal disease were reported from ABCs sites; 11.3% of these cases were fatal. The estimated United States average annual incidence of meningococcal disease was 0.53 cases per 100,000 population (95% confidence interval, 0.51-0.55), and an estimated 1525 (95% confidence interval, 1470-1598) cases occurred annually. The annual incidence decreased 64.1%, from 0.92 cases per 100,000 population in 1998 to 0.33 cases per 100,000 population in 2007. Infants aged <1 year have the highest incidence of meningococcal disease (5.38 cases per 100,000 population). After introduction of the quadrivalent meningococcal conjugate vaccine, no significant decrease in serogroup C or Y meningococcal disease was seen among those aged 11-19 years in 2006-2007, compared with 2004-2005.
CONCLUSIONS
Before the introduction of the quadrivalent meningococcal conjugate vaccine, the incidence of meningococcal disease in the United States decreased to a historic low. However, meningococcal disease still causes a substantial burden of disease among all age groups. Future vaccination strategies may include targeting infants and preventing serogroup B meningococcal disease.
背景
2005 年 1 月，一种四价（血清群 A、C、Y 和 W-135）脑膜炎球菌结合疫苗获得许可，可用于青少年。本报告描述了美国 1998 年 1 月至 2007 年 12 月在实施青少年四价脑膜炎球菌结合疫苗接种之前和期间，脑膜炎奈瑟菌疾病的流行病学特征。
方法
通过 1998-2007 年期间主动细菌核心监测（ABCs）站点进行的侵袭性奈瑟氏脑膜炎球菌主动监测收集数据。病例分离株在 ABCs 站点进行血清群分类，并在疾病控制与预防中心进行确认。计算了 50 个州的发病率和病例数，并按种族和年龄组进行了标准化。
结果
在 1998-2007 年期间，从 ABCs 站点共报告了 2262 例脑膜炎球菌病病例；其中 11.3%的病例为致命性的。估计美国脑膜炎球菌病的年平均发病率为每 10 万人 0.53 例（95%置信区间，0.51-0.55），每年估计有 1525 例（95%置信区间，1470-1598 例）发生。发病率下降了 64.1%，从 1998 年每 10 万人 0.92 例降至 2007 年每 10 万人 0.33 例。年龄<1 岁的婴儿发病率最高（每 10 万人 5.38 例）。四价脑膜炎球菌结合疫苗推出后，2006-2007 年，11-19 岁人群中血清群 C 或 Y 脑膜炎球菌病未见明显下降，而 2004-2005 年则有所下降。
结论
在四价脑膜炎球菌结合疫苗推出之前，美国脑膜炎球菌病的发病率已降至历史最低水平。然而，脑膜炎球菌病仍然给所有年龄段的人带来了相当大的疾病负担。未来的疫苗接种策略可能包括针对婴儿和预防血清群 B 脑膜炎球菌病。
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