摘要目的 了解中国4个城市由脑膜炎奈瑟菌( Nm ) 、肺炎链球菌( Sp ) 、b型流感嗜血杆菌(Hib)和乙脑病毒(JEV)引起脑膜炎脑炎的发病率和流行病学特征,为相关疾病的防控提供依据.方法 于2006年9月在山东省济南市和湖北省宜昌市,2007年4月在河北省石家庄市13个区县和广西壮族自治区贵港市开展了急性脑膜炎脑炎症状(AMES)监测,每市选择6所医院为监测试点医院,对AMES监测病例开展个案调查,并采集病例血液和(或)脑脊液标本进行实验室检测;对标本进行JEV IgM抗体ELISA检测,Nm 、Sp和Hib培养及PCR检测等.当地其他医院作为非监测试点医院,只进行病例报告.按照年龄组分层,计算各市本地居民细菌性脑膜炎及乙脑发病率.结果 2006—2013年,共报告AMES监测病例19 423例,其中,监测试点医院报告11 071例(57.00%);11 071病例中, 5 315例开展了细菌学检测,9 180例开展了JEV IgM抗体检测.细菌学实验室检测176例为阳性,包括Nm 75例,Sp 91例和Hib 10例.<5岁病例Nm 、Sp和Hib脑膜炎估算发病率分别为0.46/10万~0.71/10万、0.34/10万~0.83/10万和0.32/10万~0.57/10万;5~9岁病例Nm 、Sp脑膜炎估计发病率分别为0.59/10万~1.14/10万和0.50/10万~1.66/10万.JEV IgM抗体阳性者为732例,即乙脑实验室确诊病例,<5、40~49和≥50岁人群的阳性检出率分别为9.51%(95/999)、28.09%(66/235)和33.85%(130/384),乙脑年发病率为0.12~0.79/10万.结论 中小学生是Nm脑膜炎的重点人群,提示需探索脑膜炎球菌疫苗在此部分人群中的加强免疫研究;Sp在各年龄组均存在发病可能;<5岁儿童是Hib脑膜炎发病主要人群.

abstractsObjectives To explore acute meningitis and encephalitis syndrome (AMES) surveillance in 4 China prefectures, to understand the epidemiological features and disease burden of neisseria meningitides (Nm) meningitis, streptococcus pneumoniae (Sp) meningitis, haemophilus influenza type b (Hib) meningitis and Japanese encephalitis and provide evidence for related disease prevention and control. Methods AMES surveillance were conducted in Jinan, Shandong Province and Yichang, Hubei Province in September 2006, and in 13 districts of Shijiazhuang, Hebei Province and Guigang City, Guangxi Zhuang Autonomous Region in April 2007. Six hospitals in each city were selected as monitoring pilot hospitals to carry out reports of suspected cases of acute meningitis and encephalitis, case investigation, blood specimens and cerebrospinal fluid specimen collection, anti?JEV IgM antibody enzyme?linked immunosorbent assay, Nm, Sp and Hib culture and polymerase chain reaction detection, etc. According to the age group, the incidence of bacterial meningitis and Japanese encephalitis in local residents<20 years old was estimated. Results From 2006 to 2013, a total of 19 423 surveillance cases were reported in four cities, of which 11 071 (56.99%) were reported in the pilot hospitals. Of the 11 071 cases, 5 315 were tested for bacteriology and 9 180 were tested for anti?JEV IgM antibodies. Among the bacteriological tests, 176 cases were positive, including 75 cases of Nm positive, 91 cases of Sp positive and 10 cases of Hib positive. The incidence of three bacterial meningitis is estimated for people under 20 years old, with estimated incidence of Nm, Sp and Hib meningitis in children <5 years old was 0.46/100 000-0.71/100 000, 0.34/100 000-0.83/100 000 and 0.32/100 000-0.57/100 000 respectively; the estimated incidence of Nm and Sp meningitis in children aged 5-9 years was 0.59/100 000-1.14/100 000 and 0.50/100 000-1.66/100 000 respectively. In 732 cases of positive JE cases, the positive detection rates of<5 years old, 40-49 years old and ≥50 years old were 9.51% (95/999), 28.09% (66/235) and 33.85% (130/384), respectively. The estimated annual incidence rate of JE was 0.12/100 000-0.79/100 000.ratio of cases 1.19∶1. Most of cases (27.30%) were children and adolescents aged 5-14 years and those (26.84%) aged over 45 year. Conclusion The study found that primary and secondary school students are the key population of Nm meningitis, suggesting that it is necessary to explore the enhanced immunization study of meningococcal vaccine in this population; Sp has the possibility of occurrence in all age groups;<5 years old children are the main population of Hib meningitis.