2006－2017年浙江省流行性脑脊髓膜炎流行病学特征及菌群变迁趋势分析

邓璇; 姚苹苹; 何寒青; 严睿; 唐学雯; 周洋; 符剑; 谢淑云

doi:10.3784/j.issn.1003-9961.2018.07.005

2006－2017年浙江省流行性脑脊髓膜炎流行病学特征及菌群变迁趋势分析

Epidemiological characteristics of meningococcal meningitis and changing trend of serogroups of Neisseria meningitidis in Zhejiang, 2006–2017

摘要

摘要:
目的分析浙江省流行性脑脊髓膜炎（流脑）流行病学特征及脑膜炎奈瑟菌菌群分布及变迁趋势，为流脑防控提供依据。

方法利用2006 — 2017年全国法定传染病报告系统资料、流脑监测报告信息管理系统数据和2010 — 2016年浙江省流脑监测获取的健康人群带菌率资料，采用Excel 2010软件处理数据，运用描述流行病学方法进行统—计分析。采用SAS 9.2软件进行Cochran-Armitage趋势检验分析。

结果 2006 — 2017年浙江省累计报告流脑病例212例，死亡28例，病死率为13.21%，年均发病率为0.034 8/10万，年均死亡率为0.004 6/10万。发病率和死亡率均随着年份的增长而下降（ Z＝–13.420、–6.090，均P＜0.001）。流脑冬春季高发，占全年病例总数的91.98%。发病数累计前3位的年龄组分别为0 ~ 4岁（32.08%）、10 ~ 14岁（16.04%）和15 ~ 19岁组（13.21%）。≥15岁年龄组的流脑病例所占比例从2006 — 2011年间的42.13%上升至2012 — 2017年间的50%。2006 — 2017年浙江省共分离到病例菌株71株，包括A群、B群、C群、X群和W135群，分别有31、12、22、1和5株。2010年以来未再检出A群流脑菌，C群流脑病例构成比在20%左右上下浮动，而B群和W135群呈逐年上升趋势。A群、B群、C群和W135群均对青霉素、头孢类药物、氧氟沙星和环丙沙星敏感。

结论浙江省流脑疫情维持在较低水平，优势流行菌群由以A群、B群、C群为主向B群、C群和W135群转变，流脑防控呈现新局面。

Abstract:
Objective To analyze the epidemiological characteristics of meningococcal meningitis caused by Neisseria meningitidis, the distribution of the serogroups of N. meningitidis and their changing trend in Zhejiang province from 2006 to 2017 and provide evidence for meningococcal meningitis prevention and control.

Methods The incidence data of meningococcal meningitis in Zhejiang from 2006 to 2017 were collected from national notifiable diseases registry system and meningococcal meningitis surveillance system and the N. meningitidis carriage data in local healthy population during 2006 to 2017 were collected from Zhejiang meningococcal meningitis surveillance system for descriptive epidemiological analysis, Microsoft Office Excel 2010 and Statistical Analysis System 9.2 were used for data process and statistical analysis.

Results From 2006 to 2017, a total of 212 cases of meningococcal meningitis, including 28 deaths, were reported in Zhejiang. The case fatality was 13.21%, the average annual morbidity rate was 0.034 8/100 000 and the average annual mortality rate was 0.004 6/100 000. Both the morbidity rate and the mortality rate showed a significant decreasing trend (Z＝–13.420, –6.090,P＜0.001). The incidence peak of meningococcal meningitis was during w₁＝inter-spring (91.98%). The top three age groups of meningococcal meningitis cases were 0–4 years (32.08%), 10–14 years (16.04%) and 15–19 years (13.21%) respectively. The constituent ratio for cases ≥15 years old increased from 42.13% during 2006–2011 to 50% during 2012–2017. A total of 71N. meningitidis strains were isolated, among which the number of serogroup A, B, C, X and W135 strains were 31, 12, 22, 1 and 5 respectively. No serogroup A strain had been detected since 2010. The constituent ratio of serogroup C strain fluctuated around 20% and the constituent ratios of serogroup B and W135 strains showed increasing trends. Drug susceptibility test showed that serogroup A, B, C and W135 were all sensitive to penicillin, cephalosporins, ofloxacin and ciprofloxacin.

Conclusion The prevalence of meningococcal meningitis in Zhejiang is at a low level. The predominant strains of N. meningitidis is changing from serogroup A, B and C to serogroup B, C and W135.

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