Shinjoh Masayoshi, Yamaguchi Yoshio, Iwata Satoshi
Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Center for Infectious Diseases and Infection Control, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Department of Clinical Research, National Hospital Organization, Tochigi Medical Center, 1-10-37 Nakatomatsuri, Utsunomiya-city, Tochigi, Japan.
J Infect Chemother. 2017 Jul;23(7):427-438. doi: 10.1016/j.jiac.2017.02.014. Epub 2017 Apr 26.
Haemophilus influenzae type b (Hib) vaccine and pneumococcal conjugated vaccine (PCV) have been widely used since 2010 in Japan when both vaccines were supported by the regional governments, and they were covered as routine recommended vaccines in 2013. The incidence of bacterial meningitis due to these organisms decreased in 2011 and 2012, but meningitis due to Streptococcus agalactiae and Escherichia coli remained unchanged.
We planned to confirm whether the incidence also decreased in subsequent years.
We analyzed the epidemiological and clinical data for 2013-2015, and compared the information obtained in the previous nationwide survey database and our previous reports. We also investigated the risk factors for disease outcome.
In the 2013-2015 surveys, 407 patients from 366 hospitals from all prefectures were evaluated. S. agalactiae (33%), Streptococcus pneumoniae (25%), and E. coli (10%) were the main organisms. The total number of patients hospitalized with bacterial meningitis per 1000 admissions decreased from 1.19 in 2009-2010 to 0.37 in 2013-2015 (p < 0.001). The incidence of H. influenzae and S. pneumoniae meningitis significantly decreased from 0.66 in 2009-2010 to 0.01 in 2013-2015, and from 0.30 to 0.09, respectively (p < 0.001). Only 0-2 cases with Neisseria meningitidis were reported each year throughout 2001-2015. The fatality rates for H. influenzae, S. pneumoniae, S. agalactiae, and E. coli in 2013-2015 were 0.0, 4.1, 3.1, and 2.6%, respectively. Risk factors for death and sequelae were consciousness disturbance, convulsion, low CSF glucose, and Staphylococcus sp. as a causative organism (p < 0.01).
Hib vaccine and PCV have decreased the rate of bacterial meningitis. S. agalactiae has subsequently become the most common cause of bacterial meningitis in Japan.
自2010年起，b型流感嗜血杆菌（Hib）疫苗和肺炎球菌结合疫苗（PCV）在日本得到广泛使用，当时这两种疫苗均得到地方政府的支持，并于2013年被列为常规推荐疫苗。2011年和2012年，由这些病原体引起的细菌性脑膜炎发病率有所下降，但无乳链球菌和大肠杆菌引起的脑膜炎发病率保持不变。
我们计划确认在随后几年中发病率是否也有所下降。
我们分析了2013 - 2015年的流行病学和临床数据，并将获得的信息与之前的全国调查数据库及我们之前的报告进行比较。我们还调查了疾病转归的危险因素。
在2013 - 2015年的调查中，对来自所有都道府县366家医院的407例患者进行了评估。无乳链球菌（33%）、肺炎链球菌（25%）和大肠杆菌（10%）是主要病原体。每1000例入院患者中细菌性脑膜炎住院患者总数从2009 - 2010年的1.19例降至2013 - 2015年的0.37例（p < 0.001）。流感嗜血杆菌和肺炎链球菌脑膜炎的发病率分别从2009 - 2010年的0.66例显著降至2013 - 2015年的0.01例和从0.30例降至0.09例（p < 0.001）。在2001 - 2015年期间，每年仅报告0 - 2例脑膜炎奈瑟菌病例。2013 - 2015年，流感嗜血杆菌、肺炎链球菌、无乳链球菌和大肠杆菌的病死率分别为0.0%、4.1%、3.1%和2.6%。死亡和后遗症的危险因素有意识障碍、惊厥、脑脊液葡萄糖水平低以及作为病原体的葡萄球菌属（p < 0.01）。
Hib疫苗和PCV降低了细菌性脑膜炎的发病率。随后，无乳链球菌已成为日本细菌性脑膜炎最常见的病因。
