1例B群流脑死亡病例周围人群脑膜炎奈瑟菌的携带状况调查
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摘要
目的了解贵州省1例流行性脑脊髓膜炎(流脑)死亡病例周围人群脑膜炎奈瑟菌(Nesseria meningtides, Nm)的携带状况,为流脑防控提供科学依据。方法采集死亡病例所在学校及居住地人群咽后壁分泌物,现场接种双抗巧克力平板作脑膜炎奈瑟菌分离培养;采用实时荧光聚合酶链反应(Real-time PCR)技术对培养后获得的可疑菌株及原始咽拭子标本进行Nm种特异基因(ctrA、sodC)及血清群特异基因(sacB、synD、synE、synG、xcbB、synF)检测,完成Nm鉴定和分群。结果调查109人,中位数年龄为15.92岁;男女比例1∶0.88;职业以学生为主(96.33%,105/109)。109份咽拭子标本中Nm的检出率为38.53%(42/109);其中B群占92.86%(39/42),W135群占2.38%(1/42),其他群及不可分群(Non-sero-groupable, NG)Nm占4.76%(2/42)。不同性别和来自家庭内外的周围人群检测结果差异均无统计学意义;直接法的阳性检出率(36.70%)高于培养法的阳性检出率(16.51%)(X~2=16.962,P<0.001)。结论调查群体中存在较高的流脑病原携带率,且以B群为主,提示相关部门应关注该群体健康卫生状况,加强流脑防控工作。
Objective The carrying status of Neisseria meningitides(Nm) in a population surrounding a death case of epidemic cerebrospinal meningitis was investigated to provide scientific basis for the prevention and control of meningitis in Guizhou Province. Methods The secretions of the posterior pharyngeal wall in the population from the school where the death case was studied, or the places of residence where the death case lived were collected and the Nm was isolated by using double anti-chocolate plates immediately. The suspicious Nm isolates and original pharynx swab samples were identified by using real-time PCR to detect the specific genes(ctrA, sodC) and serogroup-specific genes(sacB, synD, synE, synG, xcbB,synF) of Nm. Results A total of 109 people were surveyed around the case, with a median age of 15.92 years; a ratio of 1:0.88 for men and women; and a predominantly occupational of student(96.33%, 105/109). The detection rate of Nm in 109 throat swab specimens was 38.53%(42/109); B group accounted for 92.86%(39/42), W135 group accounted for 2.38%(1/42), others and Non-sero-groupable(NG) Nm accounted for 4.76%(2/42). There was no significant difference in the detection results of the surrounding populations of different genders. The difference between people in and out of family also was not significant. The positive detection rate of direct method(36.70%) was higher than the positive detection rate of culture method(16.51%)(X~2=16.962, P<0.001). Conclusion There is a high carrier rate of the pathogen of epidemic cerebrospinal meningitis in the survey population, and dominated by B group. It suggests that relevant departments should pay attention to the health and hygiene status of the group, and strengthen prevention and control of epidemic cerebrospinal meningitis.
Objective The carrying status of Neisseria meningitides(Nm) in a population surrounding a death case of epidemic cerebrospinal meningitis was investigated to provide scientific basis for the prevention and control of meningitis in Guizhou Province. Methods The secretions of the posterior pharyngeal wall in the population from the school where the death case was studied, or the places of residence where the death case lived were collected and the Nm was isolated by using double anti-chocolate plates immediately. The suspicious Nm isolates and original pharynx swab samples were identified by using real-time PCR to detect the specific genes(ctrA, sodC) and serogroup-specific genes(sacB, synD, synE, synG, xcbB,synF) of Nm. Results A total of 109 people were surveyed around the case, with a median age of 15.92 years; a ratio of 1:0.88 for men and women; and a predominantly occupational of student(96.33%, 105/109). The detection rate of Nm in 109 throat swab specimens was 38.53%(42/109); B group accounted for 92.86%(39/42), W135 group accounted for 2.38%(1/42), others and Non-sero-groupable(NG) Nm accounted for 4.76%(2/42). There was no significant difference in the detection results of the surrounding populations of different genders. The difference between people in and out of family also was not significant. The positive detection rate of direct method(36.70%) was higher than the positive detection rate of culture method(16.51%)(X~2=16.962, P<0.001). Conclusion There is a high carrier rate of the pathogen of epidemic cerebrospinal meningitis in the survey population, and dominated by B group. It suggests that relevant departments should pay attention to the health and hygiene status of the group, and strengthen prevention and control of epidemic cerebrospinal meningitis.
引文
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[13]闫永飞,赵丽萍,郭娜娜,等.2009-2015年邯郸市健康人群流行性脑脊髓膜炎带菌率调查及分子分型研究[J].实用预防医学,2018,25(2):209-211.
[14]薛伟华,庞志钊,张云,等.2015年平山县健康人群流行性脑脊髓膜炎监测结果分析[J].中国卫生检验杂志,2016,26(7):1020-1021, 1024.
[15]刘美真,杜志明,陈经雕,等.广东省2002~2003年流脑监测结果分析[J].华南预防医学,2004,30(4):31-32.
[16]李军宏,李艺星,吴丹,等.中国2006~2014年流行性脑脊髓膜炎病例菌群分布特征及变迁趋势[J].中国疫苗和免疫,2015,21(5):481-485.
[17]蒋凤,刘铭,张丽,等.1951~2010年贵州省流行性脑脊髓膜炎流行趋势分析[J].应用预防医学,2012,18(3):147-149.
[18]张丽,周晖,周朝霞,等.贵州省首例C群流行性脑脊髓膜炎的发现及处理[J].中国疫苗和免疫,2008,14(2):130-132.
[19] Lancellotti M, Guiyoule A, Ruckly C, et al. Conserved virulence of C to B capsule switched Neisseria meningitidis clinical isolates belonging to ET-37/ST-11 clonal complex[J]. Microbes and Infection,2006, 8(1):191-196.
[20]陈涛,谢娜,符文慧,等.基于实时荧光定量PCR技术检测阿克苏市健康人群脑膜炎奈瑟菌携带状况[J].疾病监测,2018,33(1):59-62.
[21]刘海涛,庄国良,王志越,等.2013-2015年北京市门头沟区健康人群脑膜炎奈瑟氏球菌带菌率分析[J].首都公共卫生,2016,10(2):78-79.
[22]杨红梅,吕静,邹文菁,等.应用荧光定量PCR检测细菌性脑膜炎病原体DNA的研究[J].中国病原生物学杂志,2012,7(8):582-585.
[23]王颖童,孙印旗,贾肇一,等.细菌分离培养与实时荧光定量-聚合酶链反应用于健康人群脑膜炎奈瑟菌携带率研究[J].疾病监测,2013,28(6):443-446.
[2]王萌.流行性脑脊髓膜炎疾病负担研究综述[J].中国热带医学,2012,12(6):770-772.
[3] Bilukha OO, Rosenstein N. Prevention and control of meningococcal disease:Recommendations of the Advisory Committee on Immunization Practices(ACIP)[J]. MMWR. Morbidity and Mortality Weekly Report, 2005, 54(RR07):1-21.
[4]蒋凤,张丽,管庆虎,等.贵州省2008-2010年流行性脑脊髓膜炎经济负担分析[J].现代预防医学,2014,41(10):1800-1802,1813.
[5]彭文伟.传染病学[M].6版.北京:人民卫生出版社,2006.
[6]中华人民共和国卫生部.WS295-2008流行性脑脊髓膜炎诊断标准[S].北京:人民卫生出版社,2008.
[7] World Health Organization. Laboratory methods for the diagnosis of meningitis caused by neisseria meningitides, streptococcus pneumonia, and haemophilus influenza[M]. 2nd ed. Geneva:WHO, 2011.
[8]朱兵清,徐丽,李马超,等.Taq Man荧光定量PCR检测和鉴别不同血清群脑膜炎奈瑟菌方法的建立及应用[J].中华流行病学杂志,2008,29(4):360-364.
[9]游旅,田克诚,姚光海,等.2005年贵州省健康人群和病例密切接触者流脑病原菌带菌状况调查[J].疾病监测,2006,21(3):120-122.
[10]刘振武,王晓萍,钱玉春,等.合肥市2011年流脑流行前期健康人群流脑带菌率及免疫水平调查[J].安徽预防医学杂志,2013,19(6):408-409, 413.
[11]刘尊玉,聂伟,刘岚铮,等.济南市2008年-2015年健康人群脑膜炎奈瑟菌带菌状况监测结果分析[J].中国卫生检验杂志,2016,26(23):3436-3437, 3440.
[12]蓝荣伟,刘民哲,邓丽丽,等.健康人群脑膜炎奈瑟菌带菌率以及血清群分布特征研究[J].中国疫苗和免疫,2014,20(5):438-441.
[13]闫永飞,赵丽萍,郭娜娜,等.2009-2015年邯郸市健康人群流行性脑脊髓膜炎带菌率调查及分子分型研究[J].实用预防医学,2018,25(2):209-211.
[14]薛伟华,庞志钊,张云,等.2015年平山县健康人群流行性脑脊髓膜炎监测结果分析[J].中国卫生检验杂志,2016,26(7):1020-1021, 1024.
[15]刘美真,杜志明,陈经雕,等.广东省2002~2003年流脑监测结果分析[J].华南预防医学,2004,30(4):31-32.
[16]李军宏,李艺星,吴丹,等.中国2006~2014年流行性脑脊髓膜炎病例菌群分布特征及变迁趋势[J].中国疫苗和免疫,2015,21(5):481-485.
[17]蒋凤,刘铭,张丽,等.1951~2010年贵州省流行性脑脊髓膜炎流行趋势分析[J].应用预防医学,2012,18(3):147-149.
[18]张丽,周晖,周朝霞,等.贵州省首例C群流行性脑脊髓膜炎的发现及处理[J].中国疫苗和免疫,2008,14(2):130-132.
[19] Lancellotti M, Guiyoule A, Ruckly C, et al. Conserved virulence of C to B capsule switched Neisseria meningitidis clinical isolates belonging to ET-37/ST-11 clonal complex[J]. Microbes and Infection,2006, 8(1):191-196.
[20]陈涛,谢娜,符文慧,等.基于实时荧光定量PCR技术检测阿克苏市健康人群脑膜炎奈瑟菌携带状况[J].疾病监测,2018,33(1):59-62.
[21]刘海涛,庄国良,王志越,等.2013-2015年北京市门头沟区健康人群脑膜炎奈瑟氏球菌带菌率分析[J].首都公共卫生,2016,10(2):78-79.
[22]杨红梅,吕静,邹文菁,等.应用荧光定量PCR检测细菌性脑膜炎病原体DNA的研究[J].中国病原生物学杂志,2012,7(8):582-585.
[23]王颖童,孙印旗,贾肇一,等.细菌分离培养与实时荧光定量-聚合酶链反应用于健康人群脑膜炎奈瑟菌携带率研究[J].疾病监测,2013,28(6):443-446.