Zangwill K M, Schuchat A, Riedo F X, Pinner R W, Koo D T, Reeves M W, Wenger J D
Childhood and Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA.
JAMA. 1997 Feb 5;277(5):389-95.
To evaluate the epidemiologic features and risk factors for multiple cases of meningococcal disease in schools.
Population-based prospective evaluation and case-control study of clusters of meningococcal disease that occurred in schools from January 1989 to June 1994.
Surveillance conducted through state health departments in the United States.
Descriptive epidemiology of school-based clusters of meningococcal disease and determinants of their occurrence.
We identified 22 clusters of meningococcal disease in 15 states. The estimated incidence of secondary meningococcal disease among schoolchildren aged 5 to 18 years was 2.5 per 100000 population, a relative risk of 2.3 (95% confidence interval [CI], 1.6-3.3). The median number of students per cluster was 2 (range, 2-4). Of 30 subsequent cases, 10 (33%) occurred 2 or fewer days after the index case, and 22 (73%) occurred 14 or fewer days after the index case. Among the 8 schools with 2 or more cases, 50% of the additional cases occurred 2 or more days after the second case. Secondary schools (grades 7 through 12) accounted for 15 (75%) of 20 cluster schools compared with 9 (45%) of 20 matched control schools (P<.05). In 16 (73%) of 22 clusters, interaction between case patients was noted. The index patient in cluster schools was more likely than the controls to have participated in a school-based group activity 14 or fewer days before illness (matched odds ratio, 7.0; 95% CI, 0.9-57).
Three quarters of the school clusters occurred in secondary schools, with over 70% of subsequent cases occurring within 2 weeks of the index case. Rapid initiation of a chemoprophylaxis program after 2 cases of meningococcal disease in a school would have potentially prevented 50% of subsequent cases in the clusters described.
评估学校中多例脑膜炎球菌病的流行病学特征及危险因素。
对1989年1月至1994年6月期间学校中发生的脑膜炎球菌病聚集病例进行基于人群的前瞻性评估和病例对照研究。
通过美国各州卫生部门开展监测。
以学校为基础的脑膜炎球菌病聚集病例的描述性流行病学及其发生的决定因素。
我们在15个州识别出22个脑膜炎球菌病聚集病例。5至18岁学龄儿童中继发性脑膜炎球菌病的估计发病率为每10万人2.5例，相对危险度为2.3（95%置信区间[CI]，1.6 - 3.3）。每个聚集病例中学生的中位数为2名（范围为2 - 4名）。在随后的30例病例中，10例（33%）在首例病例后2天或更短时间内发生，22例（73%）在首例病例后14天或更短时间内发生。在8所出现2例或更多病例的学校中，50%的额外病例在第二例病例后2天或更长时间内发生。与20所匹配对照学校中的9所（45%）相比，中学（7至12年级）占20所聚集病例学校中的15所（75%）（P<0.05）。在22个聚集病例中的16个（73%）中，观察到病例患者之间存在相互作用。聚集病例学校中的首例患者比对照更有可能在发病前14天或更短时间内参加过学校组织的集体活动（匹配优势比，7.0；95%CI，0.9 - 57）。
四分之三的学校聚集病例发生在中学，超过70%的后续病例在首例病例后2周内发生。学校出现2例脑膜炎球菌病后迅速启动化学预防计划可能会预防所描述聚集病例中50%的后续病例。
