河北省C群流行性脑脊髓膜炎监测分析

Monitoring of Epidemic Cerebrospinal Meningitis of Serogroup C Cases in Hebei Province

目的分析河北省C群流行性脑脊髓膜炎(流脑)病例和菌株特征,为预防控制(防控)流脑和临床诊治提供参考。方法采用描述方法,从流行病学、临床表现、分子生物学分型和耐药性方面,分析病例和菌株的特征。结果2005～2012年,河北省共报告C群流脑21例,占全部报告流脑病例的5.13%,其中2012年报告l4例,占全部C群流脑病例的66.67%。病例分布在6个设区市的13个县(区、市,下同),占全省县总数的7.56%。除1个县发生9例外,其余县仅发生1例。病例年龄中位数为13.2岁(6日龄～72.7岁),其中<15岁儿童16例,占76.19%。男女性别比为1.33‥1;学生发病15例,占71.43%。冬春为高发季节。病例均无明确的C群脑膜炎球菌疫苗(Group C Meningococca1 Vaccine,MenV-C)接种史。多数病例起病急,并伴有头痛、恶心、呕吐症状;高热占28.57%;>50%病例出现颈项强直和意识障碍,>60%病例皮肤出现瘀点或瘀斑。病例全部住院,其中2例<1岁病例在发病2～3d死亡。对2012年5例C群流脑病例标本进行多位点序列分型(Multi1ocus Sequence Typing,MLST)分析,全部为ST-4821克隆群。对3株菌株做耐药性检测显示,对磺胺类和喹诺酮类抗菌药物全部耐药,对青霉素类敏感性降低。结论河北省C群流脑病例以散发为主,但己出现局部爆发;冬春季节高发,中小学生为高危人群;流行菌株为高致病性ST-4821克隆群,且对部分抗菌药物产生了耐药。提示应加强对C群流脑的监测,特别在冬春季节,重点加强寄宿制中小学流脑防控工作,防止出现爆发疫情;加强MenV接种,提高人群抗体水平;临床上选用敏感性抗菌药物对病例进行治疗。

Objective To analyze the characteristic of epidemic cerebrospinal meningitis （ECM）of serogroup C cases and strains in Hebei province, and to conduct control and prevention on ECM and improve the cases diagnosis and treatment. Methods Use the description epidemiology methods, respectively from the cases distribution,clinical symptoms and signs,molecular biological credit type and antibiotics resistance to analyse the characteristics of cases and strains. ResuIts In the year of 2005-2012, there were 21 cases of Neisseria meningitidis （Nm）serogrou C patients in Hebei province, accounting for 5.13%of all reported cases, including the 14 cases in 2012 which accounting for 66.67% of all Nm serogroup C cases. Cases distribution in 6 district, 13 counties, the county accounted for 7.56% of the. One county occurred 9 cases, the rest county occurs 1 cases of each county. Cases ot median age was l3.2 years （6 days to72.7 years old）, and〈15 years old children were 16 cases （76.19%）;Male and female sex ratio were 13.3 ： 1 ： The students were 15 cases （71.43 % ）. Winter and spring were the high- risk season ; All cases were no clear Nm serogroup C Vaccination history. Most cases have disease onseturgently, and with headache, nausea, vomiting, and 28.57%cases were high fever symptoms ; more than 50%of cases were stiff neck and disturbance of consciousness,more than 60% cases appeared skin appear petechiae or ecchymosis ; all cases in hospital, and 2 cases of〈l years old were death in 2-3 days onset. Used multilocussequence typing（MLST）method, we analyze the 5 Nm serogroup C cases specimens in 2012 year, all for ST-4821 cloning group ;For 3 Nm serogroup C strains drug sensiti retest showed that, the sulfa and quinolones were antibiotic resistance. And to penicillins, all antibiotic sensitivity were reduced. ConcIusion The ECM of serogroup C cases in Hebei provinc were sporadic in priority, but already appeared outbreak, in winter and spring season were peak season and the elementary and middle school students were high-risk groups ; The main Nm serogroup C strain were highly pathogenic ST-4821 cloning group and the strain were resistance for some kinds of antibiotics. In all province,we should strengthen the monitoring of EMC serogroup C, and in winter and spring season, strengthening the prevention and control of ECM in boarding middle and primary school and prevention the outbreak were particularly important ; Strengthening the Nm serogroup C vaccine vaccination to improve the crowd antibody level and selecting antibiotic sensitivity drug for cases treatment were important strategy as well.