Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Clin Epidemiol. 2012;4:237-45. doi: 10.2147/CLEP.S28410. Epub 2012 Sep 19.
The human bacterial pathogen Neisseria meningitidis remains a serious worldwide health threat, but progress is being made toward the control of meningococcal infections. This review summarizes current knowledge of the global epidemiology and the pathophysiology of meningococcal disease, as well as recent advances in prevention by new vaccines. Meningococcal disease patterns and incidence can vary dramatically, both geographically and over time in populations, influenced by differences in invasive meningococcal capsular serogroups and specific genotypes designated as ST clonal complexes. Serogroup A (ST-5, ST-7), B (ST-41/44, ST-32, ST-18, ST-269, ST-8, ST-35), C (ST-11), Y (ST-23, ST-167), W-135 (ST-11) and X (ST-181) meningococci currently cause almost all invasive disease. Serogroups B, C, and Y are responsible for the majority of cases in Europe, the Americas, and Oceania; serogroup A has been associated with the highest incidence (up to 1000 per 100,000 cases) and large outbreaks of meningococcal disease in sub-Saharan Africa and previously Asia; and serogroups W-135 and X have emerged to cause major disease outbreaks in sub-Saharan Africa. Significant declines in meningococcal disease have occurred in the last decade in many developed countries. In part, the decline is related to the introduction of new meningococcal vaccines. Serogroup C polysaccharide-protein conjugate vaccines were introduced over a decade ago, first in the UK in a mass vaccination campaign, and are now widely used; multivalent meningococcal conjugate vaccines containing serogroups A, C, W-135, and/or Y were first used for adolescents in the US in 2005 and have now expanded indications for infants and young children, and a new serogroup A conjugate vaccine has recently been introduced in sub-Saharan Africa. The effectiveness of these conjugate vaccines has been enhanced by the prevention of person-to-person transmission and herd immunity. In addition, progress has been made in serogroup B-specific vaccines based on conserved proteins and outer membrane vesicles. However, continued global surveillance is essential in understanding and predicting the dynamic changes in the epidemiology and biological basis of meningococcal disease and to influence the recommendations for current and future vaccines or other prevention strategies.
人类细菌病原体脑膜炎奈瑟菌仍然是全世界严重的健康威胁，但在控制脑膜炎球菌感染方面正在取得进展。本综述总结了脑膜炎奈瑟菌病的全球流行病学和病理生理学的最新知识，以及新疫苗在预防方面的最新进展。脑膜炎球菌病的模式和发病率在地理和时间上在人群中差异很大，这受到侵袭性脑膜炎奈瑟菌荚膜血清群和特定基因型（指定为 ST 克隆复合体）的差异影响。血清组 A（ST-5、ST-7）、B（ST-41/44、ST-32、ST-18、ST-269、ST-8、ST-35）、C（ST-11）、Y（ST-23、ST-167）、W-135（ST-11）和 X（ST-181）脑膜炎球菌目前几乎导致所有侵袭性疾病。血清组 B、C 和 Y 是欧洲、美洲和大洋洲大多数病例的原因；血清组 A 与发病率最高（高达每 100,000 例 1000 例）和撒哈拉以南非洲和亚洲以前的脑膜炎球菌病大爆发有关；血清组 W-135 和 X 已出现导致撒哈拉以南非洲重大疾病爆发。在过去十年中，许多发达国家的脑膜炎球菌病发病率显著下降。在某种程度上，这种下降与新的脑膜炎球菌疫苗的引入有关。血清组 C 多糖-蛋白结合疫苗在十多年前首次在英国大规模疫苗接种运动中引入，现在已广泛使用；含有血清组 A、C、W-135 和/或 Y 的多价脑膜炎球菌结合疫苗于 2005 年首次在美国用于青少年，现在已扩大用于婴儿和幼儿的适应症，最近在撒哈拉以南非洲引入了一种新的血清组 A 结合疫苗。这些结合疫苗通过预防人与人之间的传播和群体免疫，提高了疫苗的有效性。此外，基于保守蛋白和外膜囊泡的血清组 B 特异性疫苗也取得了进展。然而，继续进行全球监测对于了解和预测脑膜炎球菌病的流行病学和生物学基础的动态变化以及影响当前和未来疫苗或其他预防策略的建议至关重要。
