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
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摘要
目的分析2011-2016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 meningitidis,Nm)菌株进行多位点序列分型(Multi-locus sequence typing,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 characterize group B and C MM cases and conducted multi-locus sequence typing( MLST) analyses and antimicrobial susceptibility tests of serogroup B and C Neisseria meningitidis( Nm) strains. Results Fourteen 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 predominant 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 meningococcal vaccine if available,supplementary immunization with serogroup A and C meningococcal vaccines for students,and antimicrobial susceptibility testing to guide clinical care.
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 characterize group B and C MM cases and conducted multi-locus sequence typing( MLST) analyses and antimicrobial susceptibility tests of serogroup B and C Neisseria meningitidis( Nm) strains. Results Fourteen 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 predominant 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 meningococcal vaccine if available,supplementary immunization with serogroup A and C meningococcal vaccines for students,and antimicrobial susceptibility testing to guide clinical care.
引文
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[12]徐丽,邵祝军,李马超,等.脑膜炎奈瑟菌对12种抗菌药物体外敏感检测[J].中国计划免疫,2006,12(1):53-55.XU Li,SHAO Zhujun,LI Machao,et al.Test on susceptibility of Neisseria meningitidis to 12 antimicrobial agents[J].Chinese Journal of Vaccines and Immunization,2006,12(1):53-55.
[13]李马超,徐丽,黄鑫,等.49株脑膜炎奈瑟菌体外抗菌药物敏感性检测[J].疾病监测,2008,23(2):76-79.LI Machao,XU Li,HUANG Xin,et al.Drug susceptibility testing in vitro of 49 strains of Neisseria meningitides[J].Disease Surveillance,2008,23(2):76-79.
[14]王颖童.河北省健康人群脑膜炎奈瑟菌、流感嗜`血杆菌、肺炎链球菌带菌情况调查研究[D].北京:中国疾病预防控制中心,2013.WANG Yingtong.Survey on carriage of Neisseria meningitidis,Haemophilus influenzae,Streptococcus pneumoniae among healthy population in Hebei province[D].Beijing:Chinese Center for Disease Control and Prevention,2013.
[2]魏承毓.流行性脑脊髓膜炎[J].预防医学论坛,2004,10(6):764-768.WEI Chengyu.Meningococcal meningitis[J].Prevention Medicine Tribune,2004,10(6):764-768.
[3]Zhu P,Hu X,Xu L.Typing neisseria meningitidis by analysis of restriction fragment length polymorphisms in the gene encoding the class 1 outer membrane protein:application to assessment of epidemics throughout the last 4 decades in China[J].J Clin Microbiol,1995,33(2):458-462.
[4]胡绪敬.流行性脑脊髓膜炎的流行病学监测与预防[J].中国计划免疫,2001,7(5):300-303.HU Xujing.Monitoring and prevention of meningococcal meningitis[J].Chinese Journal of Vaccines and Immunization,2001,7(5):300-303.
[5]宁桂军,李艺星.流行性脑脊髓膜炎流行概况与预防控制[J].疾病监测,2009,24(3):155-159.NING Guijun,LI Yixing.Epidemic situation and prevention and control of epidemic cerebrospinal meningitis[J].Disease Surveillance,2009,24(3):155-159.
[6]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.LI Junhong,LI Yixing,WU Dan,et al.Epidemiological characteristics of meningococcal meningitis and switching trend of serogroups of neisseria meningitidis in China,2006-2014[J].Chinese Journal of Vaccines and Immunization,2015,21(5):481-485.
[7]孙印旗,马洪生,贾肇一,等.河北省流行性脑脊髓膜炎发病特征与菌群变迁分析[J].医学动物防制,2012,28(11):1184-1187.SUN Yinqi,MA Hongsheng,JIA Zhaoyi,et al.Analysis on characteristic and flora change of epidemic cerebrospinal meningitis in Hebei province[J].Journal of Medical Pest Control,2012,28(11):1184-1187.
[8]潘静,赵瑞芹.6个月以下婴儿B群流行性脑脊髓膜炎2例[J].临床荟萃,2008,23(18):1359-1360.PAN Jing,ZHAO Ruiqin.Two Neisseria meningitidis serogroup B cases of the infants under 6 months[J].Clinical Focus,2008,23(18):1359-1360.
[9]马洪生,孙印旗,贾肇一,等.河北省C群流行性脑脊髓膜炎监测分析[J].中国疫苗和免疫,2013,19(5):455-459.MA Hongsheng,SUN Yinqi,JIA Zhaoyi,et al.Monitoring of epidemic cerebrospinal meningitis of serogroup C cases in Hebei province[J].Chinese Journal of Vaccines and Immunization,2013,19(5):455-459.
[10]郑春早,孙伯超,蔡加平.一起C群流行性脑脊髓膜炎暴发疫情的调查与处理[J].江苏预防医学,2005,16(4):33-34.ZHENG Chunzan,SUN Bochao,CAI Jiaping.Investigation and control on an outbreak of serogroup C epidemic cerebrospinal meningitis[J].Jiangsu Journal of Preventive Medicine,2005,16(4):33-34.
[11]Shao Z,Li W,Ren J,et al.Identification of a new Neisseria meningitidis serogroup C clone from Anhui province,China[J].The Lancet,2006,367(9508):419-423.
[12]徐丽,邵祝军,李马超,等.脑膜炎奈瑟菌对12种抗菌药物体外敏感检测[J].中国计划免疫,2006,12(1):53-55.XU Li,SHAO Zhujun,LI Machao,et al.Test on susceptibility of Neisseria meningitidis to 12 antimicrobial agents[J].Chinese Journal of Vaccines and Immunization,2006,12(1):53-55.
[13]李马超,徐丽,黄鑫,等.49株脑膜炎奈瑟菌体外抗菌药物敏感性检测[J].疾病监测,2008,23(2):76-79.LI Machao,XU Li,HUANG Xin,et al.Drug susceptibility testing in vitro of 49 strains of Neisseria meningitides[J].Disease Surveillance,2008,23(2):76-79.
[14]王颖童.河北省健康人群脑膜炎奈瑟菌、流感嗜`血杆菌、肺炎链球菌带菌情况调查研究[D].北京:中国疾病预防控制中心,2013.WANG Yingtong.Survey on carriage of Neisseria meningitidis,Haemophilus influenzae,Streptococcus pneumoniae among healthy population in Hebei province[D].Beijing:Chinese Center for Disease Control and Prevention,2013.