美国 1998-2007 年细菌性脑膜炎流行情况。

Bacterial meningitis in the United States, 1998-2007.

机构信息

Centers for Disease Control and Prevention, Atlanta, USA.

出版信息

N Engl J Med. 2011 May 26;364(21):2016-25. doi: 10.1056/NEJMoa1005384.

DOI:10.1056/NEJMoa1005384

PMID:21612470

Abstract

BACKGROUND

The rate of bacterial meningitis declined by 55% in the United States in the early 1990s, when the Haemophilus influenzae type b (Hib) conjugate vaccine for infants was introduced. More recent prevention measures such as the pneumococcal conjugate vaccine and universal screening of pregnant women for group B streptococcus (GBS) have further changed the epidemiology of bacterial meningitis.

METHODS

We analyzed data on cases of bacterial meningitis reported among residents in eight surveillance areas of the Emerging Infections Programs Network, consisting of approximately 17.4 million persons, during 1998-2007. We defined bacterial meningitis as the presence of H. influenzae, Streptococcus pneumoniae, GBS, Listeria monocytogenes, or Neisseria meningitidis in cerebrospinal fluid or other normally sterile site in association with a clinical diagnosis of meningitis.

RESULTS

We identified 3188 patients with bacterial meningitis; of 3155 patients for whom outcome data were available, 466 (14.8%) died. The incidence of meningitis changed by -31% (95% confidence interval [CI], -33 to -29) during the surveillance period, from 2.00 cases per 100,000 population (95% CI, 1.85 to 2.15) in 1998-1999 to 1.38 cases per 100,000 population (95% CI 1.27 to 1.50) in 2006-2007. The median age of patients increased from 30.3 years in 1998-1999 to 41.9 years in 2006-2007 (P<0.001 by the Wilcoxon rank-sum test). The case fatality rate did not change significantly: it was 15.7% in 1998-1999 and 14.3% in 2006-2007 (P=0.50). Of the 1670 cases reported during 2003-2007, S. pneumoniae was the predominant infective species (58.0%), followed by GBS (18.1%), N. meningitidis (13.9%), H. influenzae (6.7%), and L. monocytogenes (3.4%). An estimated 4100 cases and 500 deaths from bacterial meningitis occurred annually in the United States during 2003-2007.

CONCLUSIONS

The rates of bacterial meningitis have decreased since 1998, but the disease still often results in death. With the success of pneumococcal and Hib conjugate vaccines in reducing the risk of meningitis among young children, the burden of bacterial meningitis is now borne more by older adults. (Funded by the Emerging Infections Programs, Centers for Disease Control and Prevention.).

摘要

背景

20 世纪 90 年代初，在美国引入婴幼儿流感嗜血杆菌 b 型（Hib）结合疫苗后，细菌性脑膜炎的发病率下降了 55%。最近的预防措施，如肺炎球菌结合疫苗和对孕妇进行 B 型链球菌（GBS）的普遍筛查，进一步改变了细菌性脑膜炎的流行病学。

方法

我们分析了在包括约 1740 万人的八个新兴感染项目网络监测区报告的细菌性脑膜炎病例数据，这些数据来自 1998-2007 年。我们将细菌性脑膜炎定义为在脑脊液或其他正常无菌部位存在流感嗜血杆菌、肺炎链球菌、GBS、李斯特菌属或脑膜炎奈瑟菌，并伴有脑膜炎的临床诊断。

结果

我们确定了 3188 例细菌性脑膜炎患者；在可获得结局数据的 3155 例患者中，466 例（14.8%）死亡。在监测期间，脑膜炎的发病率下降了 31%（95%置信区间[CI]，-33 至-29），从 1998-1999 年的每 100,000 人 2.00 例（95%CI，1.85 至 2.15）降至 2006-2007 年的每 100,000 人 1.38 例（95%CI，1.27 至 1.50）。患者的中位年龄从 1998-1999 年的 30.3 岁增加到 2006-2007 年的 41.9 岁（Wilcoxon 秩和检验，P<0.001）。病死率无显著变化：1998-1999 年为 15.7%，2006-2007 年为 14.3%（P=0.50）。在 2003-2007 年报告的 1670 例病例中，肺炎链球菌是主要的感染物种（58.0%），其次是 GBS（18.1%）、脑膜炎奈瑟菌（13.9%）、流感嗜血杆菌（6.7%）和李斯特菌属（3.4%）。估计在 2003-2007 年期间，美国每年有 4100 例和 500 例细菌性脑膜炎死亡。