南非侵袭性脑膜炎奈瑟菌病发病率的下降：2003-2016 年。
Declining Incidence of Invasive Meningococcal Disease in South Africa: 2003-2016.
机构信息
Division of Public Health Surveillance and Response, National Institute for Communicable Diseases (NICD), a Division of the National Health Laboratory Service (NHLS), Johannesburg.
School of Public Health, University of the Witwatersrand, Johannesburg.
出版信息
Clin Infect Dis. 2019 Jul 18;69(3):495-504. doi: 10.1093/cid/ciy914.
BACKGROUND
Invasive meningococcal disease (IMD) is endemic to South Africa, where vaccine use is negligible. We describe the epidemiology of IMD in South Africa.
METHODS
IMD cases were identified through a national, laboratory-based surveillance program, GERMS-SA, from 2003-2016. Clinical data on outcomes and human immunodeficiency virus (HIV) statuses were available from 26 sentinel hospital sites. We conducted space-time analyses to detect clusters of serogroup-specific IMD cases.
RESULTS
Over 14 years, 5249 IMD cases were identified. The incidence was 0.97 cases per 100 000 persons in 2003, peaked at 1.4 cases per 100 000 persons in 2006, and declined to 0.23 cases per 100 000 persons in 2016. Serogroups were confirmed in 3917 (75%) cases: serogroup A was present in 4.7% of cases, B in 23.3%, C in 9.4%; W in 49.5%; Y in 12.3%, X in 0.3%; Z in 0.1% and 0.4% of cases were non-groupable. We identified 8 serogroup-specific, geo-temporal clusters of disease. Isolate susceptibility was 100% to ceftriaxone, 95% to penicillin, and 99.9% to ciprofloxacin. The in-hospital case-fatality rate was 17% (247/1479). Of those tested, 36% (337/947) of IMD cases were HIV-coinfected. The IMD incidence in HIV-infected persons was higher for all age categories, with an age-adjusted relative risk ratio (aRRR) of 2.5 (95% confidence interval [CI] 2.2-2.8; P < .001) from 2012-2016. No patients reported previous meningococcal vaccine exposure. Patients with serogroup W were 3 times more likely to present with severe disease than those with serogroup B (aRRR 2.7, 95% CI 1.1-6.3); HIV coinfection was twice as common with W and Y diseases (aRRR W = 1.8, 95% CI 1.1-2.9; aRRR Y = 1.9, 95% CI 1.0-3.4).
CONCLUSIONS
In the absence of significant vaccine use, IMD in South Africa decreased by 76% from 2003-2016. HIV was associated with an increased risk of IMD, especially for serogroup W and Y diseases.
背景
侵袭性脑膜炎奈瑟菌病（IMD）在南非流行，而该国疫苗接种率却极低。我们描述了南非 IMD 的流行病学特征。
方法
2003 年至 2016 年，我们通过基于实验室的国家监测计划 GERMS-SA 来确定 IMD 病例。来自 26 家哨点医院的临床数据可用于评估结局和人类免疫缺陷病毒（HIV）状况。我们进行时空分析，以检测特定血清群 IMD 病例的聚集情况。
结果
14 年来，共确定了 5249 例 IMD 病例。2003 年发病率为每 100000 人 0.97 例，2006 年发病率最高，达到每 100000 人 1.4 例，2016 年下降至每 100000 人 0.23 例。3917 例（75%）病例血清群得到确认：血清群 A 占 4.7%，B 占 23.3%，C 占 9.4%；W 占 49.5%；Y 占 12.3%，X 占 0.3%；Z 占 0.1%，其余 0.4%无法分群。我们确定了 8 个特定血清群、具有地理时间特征的疾病聚集。分离株对头孢曲松的敏感性为 100%，对青霉素的敏感性为 95%，对环丙沙星的敏感性为 99.9%。院内病死率为 17%（247/1479）。在检测的病例中，36%（337/947）的 IMD 病例 HIV 合并感染。所有年龄段的 HIV 感染者 IMD 发病率均较高，2012-2016 年的年龄调整后相对风险比（aRRR）为 2.5（95%置信区间[CI] 2.2-2.8；P<0.001）。无患者报告有脑膜炎球菌疫苗接种史。与血清群 B 相比，血清群 W 患者发生严重疾病的可能性高 3 倍（aRRR 2.7，95%CI 1.1-6.3）；W 和 Y 血清群的 HIV 合并感染更为常见（aRRR W = 1.8，95%CI 1.1-2.9；aRRR Y = 1.9，95%CI 1.0-3.4）。
结论
在没有大量疫苗接种的情况下，2003 年至 2016 年南非 IMD 发病率下降了 76%。HIV 与 IMD 风险增加相关，尤其是血清群 W 和 Y 疾病。
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