2006-2012年山东省急性细菌性脑膜炎哨点监测及病原学监测结果分析

Sentinel surveillance and etiological analysis of acute bacterial meningitis in Shandong,2006-2012

目的分析急性细菌性脑膜炎（Acute Bacterial Meningitis，ABM）哨点监测及病原学监测结果，了解山东省ABM流行特征。方法对6所哨点医院监测的ABM病例开展流行病学调查，采用细菌培养、乳胶凝集、实时荧光定量-聚合酶链反应等方法对病例标本进行常见病原菌检测，并通过Epi Info 2003、SPSS13．0等软件对数据进行分析。结果2006—2012年共报告ABM病例309例，男女性别比为1．81：1，以儿童、学生和农民为主。其中实验室确诊病例61例，脑膜炎奈瑟菌（Neisseria meningitidis，Nm）感染32例（B群2例，C群19例，W135群2例，不可分群9例），患者年龄主要为7～44岁（24例，75．00％），职业以学生和农民居多，4、5月为发病高峰期（15例，46．88％）；肺炎链球菌（Streptococcus pneumoniae，Sp）感染29例，以婴幼儿和老年人为主（18例，62．07％）；未检出流感嗜血杆菌（Haemophilus influenzae，Hi）。病例转归总体良好，痊愈或好转者占87．05％，实验室确诊ABM病例疗程显著低于非实验室确诊病例（t：2．762，P=0．006）。结论山东省哨点监测发现的ABM首要致病原是Nm，Sp次之，建议根据疾病的流行特征及病原谱分布，对ABM的防控策略做相应调整。病原体的检出对疾病治疗具有促进作用，需要进一步加强病原学监测。

Objective To understand the epidemiological characteristics of acute bacterial meningitis （ ABM） in Shandong province. through sentinel surveillance system and by etiological analysis Methods Epidemiological survey was conducted among the ABM cases in sentinel hospitals from 2006 to 2012. Serum and cerebrospinal fluid （ CSF） specimens were collected from the cases for bacterial culture, latex agglutination and real-time fluorescent quantitative polymerase chain reaction（real-time PCR）. Data were analyzed with software EPI Info 2003 and SPSS 13. O. Results A total 309 ABM cases were reported from 2006 to 2012. The male to female ratio of the cases was 1. 81： 1. Most ABM cases were children, students and farmers. Sixty-one ABM cases were laboratory confirmed, 32 were infections of Neisseria meningitides （ Nm） including 2 serogroup B infections, 19 serogroup C infections, 2 serogroup W135 infections and 9 unspecified infections, 29 were infections of Streptococcus pneumoniae （ Sp）. Twenty four Nm cases （75. 00% ） were aged 7 - 14 years. The incidence peak. was during April-May. The majority of Sp cases were infants and aged people （ 18, 62.07% ）. No cases infected with Haemophilus influenzae were detected. Up to 87. 05 % of the ABM cases were cured or had good prognosis. The disease courses of laboratory confirmed ABM cases were shorter than those of non-laboratory confirmed cases. Conclusion Neisseria meningitidis was the major pathogen causing ABM in sentinel hospitals in Shandong, followed by Streptococcus pneumoniae. According to surveillance data, it is necessary to revise the strategy of ABM prevention and control and further strengthen pathogen detection.