Merlin M, Martet G, Debonne J M, Nicolas P, Bailly C, Yazipo D, Bougère J, Todesco A, Laroche R
Mission Bioforce, Institut de médecine tropicale du Service de santé des Armées, Le Pharo, Marseille Armées, France.
Sante. 1996 Mar-Apr;6(2):87-95.
A severe epidemic of group A meningococcal disease occurred in the northwest part of the Central African Republic from January to March 1992. The outbreak affected a large and densely populated area, with a poor road network, located 400 kilometers south of the classical meningitis belt. An initial selective vaccination campaign was carried out by the national health care service. As the epidemic was continuing, the national authorities asked for international assistance. The French participated by sending Bioforce, a medical task force designed by the Ministry of Defense, with the financial support of the Ministry of Cooperation. Neisseria meningitidis strains were isolated and identified within 36 hours by the Bioforce field laboratory. Strains from 24 patients were sent to the Pasteur Institute in Paris (Neisseria Unit) for serotyping, testing of antibiotic susceptibility, and multilocus enzyme electrophoresis. With one exception, all strains had formula A:4:P1.9. By an initial rapid assessment, the limits of the affected area and populations were determined. The weekly incidence rates observed in different areas varied within a range of 3 to 10 cases per 1,000, with fatality rates from 20 to 30 cases per 100. The spread of the epidemic was stopped by a mass vaccination campaign, which targeted the entire population (200,000 immunizations) of the affected area. The case fatality rate could not be reduced below 15%, despite antimicrobial treatments implemented as soon as possible. The optimal treatment was the standard single intramuscular injection of oily chloramphenicol. The predictive values of clinical symptoms were calculated. The efficacy of vaccination was estimated by comparison of the percentage of people immunized and the proportion of those vaccinated people who developed meningitis identified during the 3 weeks following the mass vaccination campaign. The efficacy varied between 93 to 95% according to the place. The typical weekly incidence rate of 1 case per 1,000 is not a relevant threshold to sufficiently and immediately detect a meningitis outbreak and needs to be reconsidered.
1992年1月至3月，中非共和国西北部发生了A群脑膜炎球菌病的严重疫情。此次疫情影响了一个面积大且人口密集、道路网络状况不佳的地区，该地区位于传统脑膜炎带以南400公里处。国家医疗服务机构开展了初步的选择性疫苗接种运动。由于疫情仍在持续，国家当局请求国际援助。法国派遣了“生物力量”参与援助，这是一支由国防部组建的医疗特遣部队，得到了合作部的资金支持。“生物力量”的现场实验室在36小时内分离并鉴定出了脑膜炎奈瑟菌菌株。来自24名患者的菌株被送往巴黎巴斯德研究所（奈瑟菌研究室）进行血清分型、抗生素敏感性测试和多位点酶电泳分析。除1株外，所有菌株的血清型均为A:4:P1.9。通过初步快速评估，确定了受影响地区和人群的范围。不同地区观察到的每周发病率在每1000人3至10例之间，病死率为每100例20至30例。通过针对受影响地区全体人口（20万次免疫接种）的大规模疫苗接种运动，疫情蔓延得以遏制。尽管尽快实施了抗菌治疗，但病死率仍无法降至15%以下。最佳治疗方法是标准的单次肌内注射油性氯霉素。计算了临床症状的预测价值。通过比较接种疫苗的人数百分比与大规模疫苗接种运动后3周内接种人群中患脑膜炎的比例，估计了疫苗接种的效果。根据地点不同，效果在93%至95%之间。每1000人中有1例的典型每周发病率并非充分且立即检测脑膜炎疫情的相关阈值，需要重新考虑。
