2009—2014年广西2市2县脑膜炎症状监测

Syndromic surveillance for meningitis in 2 cities and 2 counties of Guangxi, 2009-2014

目的了解广西脑膜炎症状监测病例的临床特点、就诊情况及病原谱,为制定防控策略提供科学依据.方法在广西2市2县建立脑膜炎症状监测系统,对符合筛查标准的病例进行调查,采集脑脊液、血液进行常规及细菌病原学检查.结果2009年2月-2014年12月共监测1661例脑膜炎症候群病例,其中临床诊断病例占16.98%（282例）,实验室确诊病例占4.58%（76例）.358例确诊及临床诊断病例的年龄中位数是26岁（5天～86岁）,成人及儿童分别占40.22%（144例） 及59.78%（214例）;脑脊液蛋白质及葡萄糖指标检出异常的比例成人组均高于儿童组（P 均小于0.05）.发病-就诊间隔天数中位数（P25-P75） 为0.00天（0.00-3.00天）.儿童组及成人组检出较多的病原菌分别为肺炎链球菌（21.88%） 及新型隐球菌（38.64%）.此外,还检出较为少见的脑膜炎奈瑟菌B群2例,伤寒沙门菌和非伤寒沙门菌各1例.结论症状监测有利于及时发现脑膜炎病例.成人脑膜炎病例有增多趋势,应引起重视.对不同人群的防控措施及临床治疗应有针对性.

Objectives To understand the clinical features, health seryices-seeking and bacterial spectrum in cases with meningitis syndromes,and to provide scientific evidence for development of control strategies. Methods A syndromic surveillance system for meningitis was set up to evaluate cases meeting the screening criteria in 2 cities and 2 counties of Guangxi.The cerebrospinal fluid (CSF) and blood specimens were collected for routine tests and bacterial culture to elucidate bacterial etiology. Results During February 2009 to December 2014, a total of 1661 cases with meningitis syndrome were evaluated, of those, 282 (16.98%) were clinical diagnosis cases and 76(4.58%) were laboratory-confirmed cases. The median age of 358 clinical diagnosis and confirmed cases was 26 years (5d-86y). Adult cases accounted for 40.22%(144) and children cases for 59.78%(214). Abnormal CSF protein and glucose were observed more frequently in adults than children (P<0.05) .The median intervals (P25-P75) between onset of illness and seeing a doctor were 0 days (0-3) in cases enrolled. Streptococcus pneumonia (7 cases, 21.88% ) and Crytococcus neoformans(17cases, 38.64% )were the most common pathogens causing meningitis in children and adults, respectively. And rarely detected pathogens such as Neisseria meningitidesgroup B(2) Salmonella typhi(1), and non-typhi salmonella(1)were isolated in this surveillance. Conclusions Syndromic surveillance is helpful for timely detecting cases with meningitis. Increased cases of meningitis were observed in adults, which should gain more at tention. Effective control and treatment strategies should be taken according to different population.