墨西哥蒂华纳市发生C群（ST-11型）脑膜炎球菌病疫情。
An outbreak of serogroup C (ST-11) meningococcal disease in Tijuana, Mexico.
作者信息
Chacon-Cruz Enrique, Espinosa-De Los Monteros Luz Elena, Navarro-Alvarez Samuel, Aranda-Lozano Jose Luis, Volker-Soberanes Maria Luisa, Rivas-Landeros Rosa Maria, Alvelais-Arzamendi Ariadna Annete, Vazquez Julio Alberto
机构信息
Hospital General de Tijuana, Paseo Centario S/N, Zona del Rio, Tijuana, 22010, Mexico.
Hospital Dr Manuel Gea Gonzalez, Mexico City, Mexico.
出版信息
Ther Adv Vaccines. 2014 May;2(3):71-6. doi: 10.1177/2051013614526592.
BACKGROUND
Invasive meningococcal disease (IMD) has been reported to be endemic in children from Tijuana, Mexico and the risk of an outbreak was always a threat.
OBJECTIVES
To describe all clinical, epidemiological and microbiological features of a meningococcal outbreak that occurred in Tijuana, Mexico.
METHODS
All cases with IMD were admitted at different emergency departments within the city and diagnosed by culture and agglutination tests. Further restriction fragment length polymorphism pulse field gel electrophoresis (RFLP-PFGE) and multi locus sequence typing (MLST) were performed. All clinical and epidemiological characteristics and interventions were evaluated, as well as risk factors associated with mortality.
RESULTS
From 30 January 2013 to 30 March 2013 there were 19 cases of IMD all caused by Neisseria meningitidis serogroup C. The median age was 16 years (2-47), with higher frequency among individuals at least 13 years old (73.7%). At admission, meningitis was the main clinical presentation (94.7%), followed by purpura (78.9%), septic shock (42.1%) and disseminated intravascular coagulation (DIC, 36.8%). Overall mortality was seven (36.8%). Variables associated with higher mortality were, at admission, presence of septic shock, DIC and thrombocytopenia less than 70,000. All 19 cases had no identifiable site or cluster as the source of the outbreak. RFLP-PFGE showed a discriminatory power for only one profile on all N. meningitidis strains analyzed and a clone ST-11 was identified in all strains. Public health interventions were continuous case reporting of all suspected cases of IMD, an increase in active surveillance in all hospitals, training of medical and laboratory personnel, massive and rapid chemoprophylaxis to all close contacts as indicated, and promotion of good health habits.
CONCLUSIONS
An outbreak with high mortality of IMD occurred in Tijuana, Mexico. This event and evidence of endemicity should encourage health authorities to evaluate meningococcal vaccination in the region.
背景
据报道，侵袭性脑膜炎球菌病（IMD）在墨西哥蒂华纳的儿童中呈地方性流行，爆发疫情的风险一直存在威胁。
目的
描述在墨西哥蒂华纳发生的一次脑膜炎球菌疫情的所有临床、流行病学和微生物学特征。
方法
所有IMD病例均在该市不同的急诊科就诊，并通过培养和凝集试验进行诊断。进一步进行了限制性片段长度多态性脉冲场凝胶电泳（RFLP-PFGE）和多位点序列分型（MLST）。评估了所有临床和流行病学特征及干预措施，以及与死亡率相关的危险因素。
结果
2013年1月30日至2013年3月30日，共发生19例IMD病例，均由C群脑膜炎奈瑟菌引起。中位年龄为16岁（2 - 47岁），至少13岁的个体发病率较高（73.7%）。入院时，脑膜炎是主要临床表现（94.7%），其次是紫癜（78.9%）、感染性休克（42.1%）和弥散性血管内凝血（DIC，36.8%）。总体死亡率为7例（36.8%）。与较高死亡率相关的变量在入院时包括感染性休克、DIC和血小板减少症（低于70,000）。所有19例病例均未发现可识别的疫情源头地点或聚集性病例。RFLP-PFGE显示，在所有分析的脑膜炎奈瑟菌菌株中，只有一种图谱具有鉴别力，并且在所有菌株中均鉴定出克隆ST-11。公共卫生干预措施包括持续报告所有疑似IMD病例、加强所有医院的主动监测、培训医疗和实验室人员、对所有密切接触者按指示进行大规模快速化学预防以及推广良好的健康习惯。
结论
墨西哥蒂华纳发生了一次IMD高死亡率疫情。这一事件和地方性流行的证据应促使卫生当局评估该地区的脑膜炎球菌疫苗接种情况。
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