广西壮族自治区贵港市<15岁儿童急性脑炎和脑膜炎症候群监测分析

Syndromic Surveillance of Acute Meningitis and Encephalitis among Children Aged <15 Years in Guigang,Guangxi Zhuang Autonomous Region

目的了解广西贵港市〈15岁儿童急性脑炎和脑膜炎（Acute Meningitis and Encephalitis,AME）的发病情况、主要病原及分布特征,为疾病防控和临床诊治提供依据。方法对符合监测病例定义的病例进行流行病学个案调查,采集血液和/或脑脊液（Cerebrospinal Fluid,CSF）标本进行流行性乙型脑炎（Japanese Encephalitis,JE）、常见病毒性脑炎病原、细菌学培养和聚合酶链反应（PCR）检测。结果 2007年5月~2012年6月共监测到〈15岁AME病例1 814例,死亡63例;总AME、JE、其他病毒性AME和细菌/真菌性AME年均发病率分别为46.31/10万、2.76/10万、16.58/10万和1.68/10万。病例以病毒感染为主,肠道病毒、腮腺炎病毒和JE病毒为前三位致病原。各种病原病例均为男性多于女性,〈5岁儿童占多数;细菌/真菌感染较病毒感染临床症状重且病死率高;CSF白细胞是鉴别细菌性和病毒性脑炎的独立相关因素。结论 〈15岁儿童AME以病毒性感染更为多见,医疗机构有必要开展常见的致病原检测。

Objective To determine incidence rates, most common pathogens, and epidemiological char- acteristics of acute meningitis and encephalitis （AME） among children, age 〈 15 years. Methods Children who met the case definition were studied, and blood and/or cerebrospinal fluid （CSF） speci- mens were collected from these subjects. Presence of Japanese Encephalitis （JE） and other common vi- ral, bacteriological pathogens was tested through culture and polymerase chain reaction （PCR）. Results From May 2007 to June 2012, 1 814 AME cases, age 〈 15 years, were identified; 63 cases died The inci- dence rates of total AME, JE, other viral AME and bacteriab/fungal AME were 46. 31, 2. 76, 16. 58 and 1.68 per 100,000 population, respectively. Viral infection caused most AME cases, and among viral ca- ses, enterovirus, mumps virus, and JE virus were the top three pathogens. AME cases among males were more common than among females; most cases were among children aged 〈 5 years. Bacterial and funsal infections had more severe clinical manifestations and higher fatality rates than viral infections. CSF leuko- cyte count was an independent factor to differentiate viral from bacterial/fungal infection. Conclusions AME among children aged 〈 15 years were mainly caused by viral pathogens. Hospitals should enhance the etiologic testing for common pathogens.