南亚 1-59 月龄儿童细菌性脑膜炎的发病率和病因学：系统评价和荟萃分析。
Incidence and aetiology of bacterial meningitis among children aged 1-59 months in South Asia: systematic review and meta-analysis.
机构信息
Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA.
Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA; Institute for Next Generation Healthcare, Icahn Institute for Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA.
出版信息
Vaccine. 2018 Sep 18;36(39):5846-5857. doi: 10.1016/j.vaccine.2018.07.037. Epub 2018 Aug 23.
BACKGROUND
Bacterial meningitis is a significant cause of morbidity and mortality worldwide among children aged 1-59 months. We aimed to describe its burden in South Asia, focusing on vaccine-preventable aetiologies.
METHODS
We searched five databases for studies published from January 1, 1990, to April 25, 2017. We estimated incidence and aetiology-specific proportions using random-effects meta-analysis. In secondary analyses, we described vaccine impact and pneumococcal meningitis serotypes.
RESULTS
We included 48 articles cumulatively reporting 20,707 cases from 1987 to 2013. Mean annual incidence was 105 (95% confidence interval [CI], 53-173) cases per 100,000 children. On average, Haemophilus influenzae type b (Hib) accounted for 13% (95% CI, 8-19%) of cases, pneumococcus for 10% (95% CI, 6-15%), and meningococcus for 1% (95% CI, 0-2%). These meta-analyses had substantial between-study heterogeneity (I > 78%, P < 0.0001). Among studies reporting only confirmed cases, these three bacteria caused a median of 78% cases (IQR, 50-87%). Hib meningitis incidence declined by 72-83% at sentinel hospitals in Pakistan and Bangladesh, respectively, within two years of implementing nationwide vaccination. On average, PCV10 covered 49% (95% CI, 39-58%), PCV13 covered 51% (95% CI, 40-61%), and PPSV23 covered 74% (95% CI, 67-80%) of pneumococcal meningitis serotypes. Lower PCV10 and PCV13 serotype coverage in Bangladesh was associated with higher prevalence of serotype 2, compared to India and Pakistan.
CONCLUSIONS
South Asia has relatively high incidence of bacterial meningitis among children aged 1-59 months, with vaccine-preventable bacteria causing a substantial proportion. These estimates are likely underestimates due to multiple epidemiological and microbiological factors. Further research on vaccine impact and distribution of pneumococcal serotypes will inform vaccine policymaking and implementation.
背景
细菌性脑膜炎是全球 1-59 月龄儿童发病率和死亡率的重要原因。我们旨在描述南亚的疾病负担，重点关注可通过疫苗预防的病因。
方法
我们检索了五个数据库，以获取 1990 年 1 月 1 日至 2017 年 4 月 25 日发表的研究。我们使用随机效应荟萃分析来估计发病率和病因特异性比例。在二次分析中，我们描述了疫苗的影响和肺炎球菌性脑膜炎血清型。
结果
我们共纳入 48 篇文章，这些文章累计报告了 1987 年至 2013 年期间的 20707 例病例。平均每年每 10 万名儿童有 105 例（95%置信区间，53-173）病例。平均而言，乙型流感嗜血杆菌（Hib）占 13%（95%置信区间，8-19%），肺炎球菌占 10%（95%置信区间，6-15%），脑膜炎球菌占 1%（95%置信区间，0-2%）。这些荟萃分析存在很大的异质性（I > 78%，P < 0.0001）。在仅报告确诊病例的研究中，这三种细菌导致的病例中位数为 78%（IQR，50-87%）。在巴基斯坦和孟加拉国，全国疫苗接种实施后两年内，哨点医院的 Hib 脑膜炎发病率分别下降了 72-83%。平均而言，PCV10 覆盖了 49%（95%置信区间，39-58%），PCV13 覆盖了 51%（95%置信区间，40-61%），PPSV23 覆盖了 74%（95%置信区间，67-80%）的肺炎球菌性脑膜炎血清型。与印度和巴基斯坦相比，孟加拉国的 PCV10 和 PCV13 血清型覆盖率较低，与血清型 2 的流行率较高有关。
结论
南亚 1-59 月龄儿童细菌性脑膜炎的发病率相对较高，其中可通过疫苗预防的细菌占很大比例。由于多种流行病学和微生物学因素，这些估计数可能偏低。进一步研究疫苗的影响和肺炎球菌血清型的分布将为疫苗政策的制定和实施提供信息。
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