2011-2016年河北省B群和C群流行性脑脊髓膜炎流行病学与病原学特征

Epidemiology and etiology of serogroup B and C meningococcal meningitis in Hebei province during 2011-2016

目的分析201l2016年河北省B群和C群流行性脑脊髓膜炎（Meningococcal meningitis，MM）病例和菌株特征。方法采用描述性方法分析B群和C群MM病例的流行特征，对B群和C群脑膜炎奈瑟菌（Neisseria menin-gitidis，Nm）菌株进行多位点序列分型（Multi-locus sequencetyping，MLST）分析和抗菌药物敏感性试验。结果2011-2016年河北省分别报告B群、C群MM病例14例、27例；B群病例集中在邯郸和石家庄地区（10例，71．43％）、散居儿童（9例，64．29％），C群病例集中在邯郸地区（23例，85．19％）、中小学生（25例，92．59％）；冬春为高发季节（33例，80．49％）。MLST分析发现，CC4821为2012-2013年B群、C群Nm的优势克隆群（14／15）。首次在河北省发现B群Nm对头孢类药物不敏感，同时C群Nm对青霉素类药物敏感性降低。结论河北省B群和C群MM病例分别以婴幼儿、中小学生发病为主，且南部地区高发。建议适时引进B群脑膜炎球菌疫苗、开展中小学生A群C群脑膜炎球菌疫苗强化免疫、临床用药参考药敏试验。

Objective To analyze the epidemiology and etiology of serogroup B and C meningococcal meningitis （MM） in Hebei province during 2011-2016. Methods We used descriptive methods to char- acterize group B and C MM cases and conducted multi-locus sequence typing （MLST） analyses and anti- microbial susceptibility tests of serogroup B and C Neisseria meningitidis （Nm） strains. Results Four- teen serogroup B MM cases and 27 serogroup C MM cases were reported in Hebei during 2011-2016. Most serogroup B cases occurred in Shijiazhuang and Handan prefectures （10 cases, 71.43% ） or among scattered children （9 cases, 64.29% ）, while most serogroup C cases occurred in Handan prefecture （23 cases, 85.19% ） or in primary and secondary school students （25 cases, 92.59% ）. Winter and spring were high-incidence seasons （33 cases, 80. 49% ）. MLST analysis showed that CC4821 was the predom- inant clone of serogroup B and C Nm strains （14/15） during 2012-2013. Serogroup B Nm strains were not sensitive to cephalosporins in Hebei, and serogroup C Nm strains were less sensitive to penicillin. Conclusions Serogroup B and C MM cases occurred predominately among young children and students and were most common in the southern region of Hebei. We suggest introduction of serogroup B meningo- coccal vaccine if available, supplementary immunization with serogroup A and C meningococcal vaccines for students, and antimicrobial susceptibility testing to guide clinical care.