Middeldorp Marit, Steens Anneke, Lagerweij Giske, van Sorge Nina M, Freudenburg-de Graaf Wieke, A M Sanders Elisabeth, de Melker Hester E, Knol Mirjam J
Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
Vaccine. 2023 Apr 17;41(16):2664-2670. doi: 10.1016/j.vaccine.2023.03.017. Epub 2023 Mar 16.
Representative information on disease course and outcome of invasive meningococcal disease (IMD) is important because of the shift in meningococcal epidemiology that recently occurred in the Netherlands. With this study, we update earlier research on the burden of IMD in the Netherlands.
We performed a retrospective study using Dutch surveillance data on IMD from July 2011 to May 2020. Clinical information was collected from hospital records. The effect of age, serogroup, and clinical manifestation on disease course and outcome was assessed in multivariable logistic regression analyses. Grouping of infecting isolates was performed by Ouchterlony gel diffusion or by PCR.
Clinical information was collected for 278 IMD cases of which the majority had IMD-B (55%), followed by IMD-W (27%), IMD-Y (13%), and IMD-C (5%). Most patients presented with meningitis (32%) or sepsis (30%). Hospitalisation for ≥ 10 days was most frequent among 24-64 year olds (67%). ICU admission was highest among 24-64 year olds (60%), and in case of sepsis (70%), or sepsis plus meningitis (61%). Sequelae at discharge was lower for patients with mild meningococcaemia compared to patients with sepsis plus meningitis (OR: 0.19, 95% CI: 0.07-0.51). The overall case fatality rate was 7%, and was highest for IMD-Y (14%) and IMD-W (13%) patients.
IMD remains a disease with high morbidity and mortality. Sepsis (with or without meningitis) is associated with a more severe disease course and outcome compared to other clinical manifestations. The high disease burden can be partly prevented by meningococcal vaccination.
由于荷兰最近发生的脑膜炎球菌流行病学变化，有关侵袭性脑膜炎球菌病（IMD）病程和结局的代表性信息非常重要。通过本研究，我们更新了荷兰IMD负担的早期研究。
我们利用2011年7月至2020年5月荷兰IMD的监测数据进行了一项回顾性研究。临床信息从医院记录中收集。在多变量逻辑回归分析中评估年龄、血清群和临床表现对病程和结局的影响。通过奥克特洛尼凝胶扩散法或PCR对感染菌株进行分组。
收集了278例IMD病例的临床信息，其中大多数为B群IMD（55%），其次是W群IMD（27%）、Y群IMD（13%）和C群IMD（5%）。大多数患者表现为脑膜炎（32%）或败血症（30%）。24 - 64岁人群中住院≥10天最为常见（67%）。24 - 64岁人群中入住重症监护病房的比例最高（60%），败血症患者（70%）以及败血症合并脑膜炎患者（61%）中入住重症监护病房的比例最高。与败血症合并脑膜炎患者相比，轻度脑膜炎球菌血症患者出院时的后遗症较少（比值比：0.19，95%置信区间：0.07 - 0.51）。总体病死率为7%，Y群IMD（14%）和W群IMD（13%）患者的病死率最高。
IMD仍然是一种发病率和死亡率很高的疾病。与其他临床表现相比，败血症（无论有无脑膜炎）与更严重的病程和结局相关。脑膜炎球菌疫苗接种可部分预防高疾病负担。
