济南市2011年急性脑膜炎/脑炎症候群病例哨点监测分析

Surveillance and Analysis of Acute Meningitis /Encephalitis Syndrome in Jinan City in 2011

目的了解济南市2011年急性脑膜炎/脑炎症候群（Acute Meningitis/Encephalitis Syndrome,AMES）哨点监测病例的主要病毒性病原及其流行病学特征。方法在济南市选取省、市、县级各2所医院作为哨点医院,收集2011年AMES病例血清和脑脊液（Cerebrospinal Fluid,CSF）标本,采用酶联免疫吸附试验对4种病毒特异性免疫球蛋白（Immunoglobilin,Ig）M进行血清学诊断。结果济南市2011年报告的AMES病例集中在5-9月,高峰出现在6-8月,峰值出现在7月,但≥15岁的病例数无季节性高峰。所有病例的血清和CSF标本均检测了流行性乙型脑炎病毒（Japanese Encephalitis Virus,JEV）IgM,阳性率为7.1%（46/647例）,比2008-2010年明显下降,其差异有统计学意义（χ2=12.6,P〈0.05）。其余血清标本IgM检测结果为：人类肠道病毒（Human Enterovirus,HEV）阳性率为18.5%（61/330例）,流行性腮腺炎病毒（Mumps Virus,MuV）阳性率为13.9%（46/330例）,单纯疱疹病毒（Herpes Simplex Virus,HSV）阳性率为13.0%（43/330例）。不同年龄组病例的主要病原存在差异,〈5岁以HEV感染为主,而≥15岁则以HSV为主。与其他3种病毒的季节分布不同,MuV感染全年无明显差异（χ2=5.4,P=0.36）。4种病毒中,仅HSV感染有明显的性别差异（χ2=5.1,P=0.02）,女性感染较多。结论济南市2011年6所哨点医院AMES病例的主要病毒性病原体依次为HEV、MuV、HSV、JEV。由于不同病毒的流行病学特征不同,需针对病毒的特性制定个性化监测方案,并加强实验室检测。

Objective Determine viral pathogens and epidemiological characters of acute meningitis /encephalitis syndrome（ AMES） cases in Jinan city.Methods We selected 6 sentinel surveillance hospitals,2-each from provincial,prefectural,and county levels in Jinan city.Samples of serum and cerebrospinal fluid（ CSF） were collected from AMES cases during 2011.Serological diagnoses were made by enzyme-linked immunosorbent assays for the specific immunoglobin（ IgM） to 4 different viruses.Results In 2011,reported AMES cases clustered between May and September,and showed a peak in July and August.Cases over 15 years old showed no seasonal trends.Positivity rates for Japanese encephalitis virus（ JEV）,human enterovirus（ HEV）,mumps virus（ MuV）,and herpes simplex virus（ HSV） were7.1%,18.4%,13.9% and 13.3%,respectively.The positivity rates for JEV were decreased compared with rates from 2008- 2010（ χ2= 12.6 P 〈0.05）.The main pathogens of AMES differed by age group.Children less than 5 years old were mainly infected by HEV,while HSV cases were more common among those over 15 years of age.In contrast to the other 3 virus,MuV infection showed no seasonal trend（ χ2= 5.4,P = 0.36）.The only differences by sex were seen in individuals infected by HSV,with more female cases.Conclusion Cases collected from the 6 sentinel surveillance hospitals in 2011 showed that the main viral pathogens of AMES were HEV,MuV,HSV,JEV.Because the epidemiological characteristics of the causative viruses differ,prevention strategies should be specific to the given pathogen.