Victorian Department of Health and Human Services, Melbourne, Victoria, Australia.
Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.
Intern Med J. 2021 Mar;51(3):390-397. doi: 10.1111/imj.14771.
Historically, Australian cases of invasive meningococcal disease (IMD) have been most frequently caused by Neisseria meningitidis serogroup B, but recently an increase in cases due to serogroup W (MenW) and serogroup Y (MenY) has occurred.
To determine whether clinical manifestations of IMD have changed due to increased incidence of MenW and MenY.
We performed a retrospective review of IMD cases notified to the Department of Health and Human Services in Victoria, Australia. We compared the period between January 2013 and June 2015 (defined as P1) immediately before the increase in MenW and MenY was noted, with the equal time period of July 2015 to December 2017 (P2), when this increase was observed.
IMD was notified more frequently in P2 than P1 (1.24 vs 0.53 per 100 000 person-years, P < 0.001). IMD cases in P2 were older (46 vs 19 years, P < 0.001), and more likely due to MenW (92/187, 49.2% vs 11/80, 13.8%, P < 0.001) or MenY (31/187, 16.6% vs 4/80, 5.0%, P = 0.01). IMD cases from P2 were more likely bacteraemic (151/187, 80.7% vs 55/80, 68.8%, P = 0.04), while meningitis (68/187, 36.4% vs 41/80, 51.3%, P = 0.03) and rash (65/181, 35.9% vs 45/78, 57.7%, P = 0.002) were less frequent. Intensive care unit admission rates and in-hospital mortality were unchanged.
Alongside an increase in IMD in Victoria, the proliferation of cases of MenW and MenY occurred in older patients, and were more often identified through bacteraemia rather than meningitis or purpura fulminans. Clinicians should be aware of these changes to facilitate earlier identification and treatment of IMD.
在历史上，澳大利亚侵袭性脑膜炎球菌病（IMD）的病例主要由脑膜炎奈瑟菌血清群 B 引起，但最近由于血清群 W（MenW）和血清群 Y（MenY）引起的病例有所增加。
确定由于 MenW 和 MenY 发病率的增加，IMD 的临床表现是否发生了变化。
我们对澳大利亚维多利亚州卫生部通报的 IMD 病例进行了回顾性研究。我们比较了 MenW 和 MenY 增加前的 2013 年 1 月至 2015 年 6 月（定义为 P1）和观察到增加后的 2015 年 7 月至 2017 年 12 月（P2）期间的发病率。
P2 期间 IMD 的通报频率高于 P1（每 100000 人年 1.24 比 0.53，P <0.001）。P2 中的 IMD 病例年龄较大（46 岁比 19 岁，P <0.001），且更可能由 MenW（92/187，49.2%比 11/80，13.8%，P <0.001）或 MenY（31/187，16.6%比 4/80，5.0%，P =0.01）引起。P2 中的 IMD 病例更可能有菌血症（151/187，80.7%比 55/80，68.8%，P =0.04），而脑膜炎（68/187，36.4%比 41/80，51.3%，P =0.03）和皮疹（65/181，35.9%比 45/78，57.7%，P =0.002）的发生率较低。重症监护病房的入院率和住院死亡率没有变化。
在维多利亚州 IMD 增加的同时，MenW 和 MenY 病例的发病率也在增加，并且更多地通过菌血症而不是脑膜炎或暴发性紫癜来识别。临床医生应注意这些变化，以便更早地识别和治疗 IMD。
