Wang Biying, Lin Wanjing, Qian Chen, Zhang Youyi, Zhao Genming, Wang Weibing, Zhang Tao
Department of Epidemiology, School of Public Health, Fudan University, 130 Dong'an Road, Xuhui District, Shanghai, 200032, People's Republic of China.
Key Laboratory of Public Health Safety, Ministry of Education, 130 Dong'an Road, Xuhui District, Shanghai, 200032, People's Republic of China.
Infect Dis Ther. 2023 Nov;12(11):2567-2580. doi: 10.1007/s40121-023-00878-y. Epub 2023 Oct 14.
Streptococcus pneumoniae is the leading cause of meningitis, with a case fatality of up to about 50%. Children younger than 5 years are at greater risk for pneumococcal meningitis compared with other populations. It is of significant importance to provide a comprehensive understanding of the burden of pneumococcal meningitis among under-fives in the low pneumococcal conjugate vaccine (PCV) coverage period in China.
A systematic review was conducted. We searched both English (PubMed, Ovid-EMBASE, Biosis, Web of Science, and Cochrane) and Chinese (CNKI, Wanfang, and ViP) databases for studies on bacterial meningitis in China published between January 1980 and July 2022. Ineligible studies were excluded based on study design and data integrity. Heterogeneity was assessed with I and estimates of bacterial meningitis morbidity and mortality were pooled using random-effects models. Subgroup analysis was conducted to trace the source of the heterogeneity and summarize average estimates.
A total of 13,082 studies were identified in the literature, and 56 studies were finally included for data analysis. The estimated incidence of pneumococcal meningitis was 2.10 cases per 100,000 children younger than 5 years each year (95% CI: 0.59-7.46), with a pooled case fatality rate of 24.59% (95%CI: 19.35-30.28%) in China. It was estimated that 1617.16 (95% CI: 454.35-5744.78) pneumococcal meningitis cases and 548.86 (95% CI: 474.80-627.62) deaths occurred among under-fives in China in 2020. Streptococcus pneumoniae played an important role in the etiology of confirmed bacterial meningitis cases, with a pooled proportion of 22.05% (95% CI: 17.83-26.27%). The most prevalent serotypes were 6B, 14, 19F, 19A, and 23F, which were preventable with a vaccine.
Pneumococcal meningitis remains one of the most important health problems among children younger than 5 years in China. Immunization programs should be promoted to avoid preventable cases and deaths.
肺炎链球菌是脑膜炎的主要病因，病死率高达约50%。与其他人群相比，5岁以下儿童患肺炎球菌性脑膜炎的风险更高。全面了解中国肺炎球菌结合疫苗（PCV）低覆盖率时期5岁以下儿童肺炎球菌性脑膜炎的负担具有重要意义。
进行了一项系统综述。我们检索了英文数据库（PubMed、Ovid-EMBASE、Biosis、Web of Science和Cochrane）和中文数据库（CNKI、万方和维普），以查找1980年1月至2022年7月间在中国发表的关于细菌性脑膜炎的研究。根据研究设计和数据完整性排除不合格的研究。使用I²评估异质性，并采用随机效应模型汇总细菌性脑膜炎发病率和死亡率的估计值。进行亚组分析以追踪异质性来源并总结平均估计值。
文献中共鉴定出13082项研究，最终纳入56项研究进行数据分析。在中国，5岁以下儿童肺炎球菌性脑膜炎的估计发病率为每年每10万名儿童2.10例（95%CI：0.59 - 7.46），合并病死率为24.59%（95%CI：19.35 - 30.28%）。据估计，2020年中国5岁以下儿童中有1617.16例（95%CI：454.35 - 5744.78）肺炎球菌性脑膜炎病例和548.86例（95%CI：474.80 - 627.62）死亡。肺炎链球菌在确诊的细菌性脑膜炎病例病因中起重要作用，合并比例为22.05%（95%CI：17.83 - 26.27%）。最常见的血清型为6B、14、19F、19A和23F，这些血清型可用疫苗预防。
肺炎球菌性脑膜炎仍然是中国5岁以下儿童最重要的健康问题之一。应推广免疫规划以避免可预防的病例和死亡。
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