Bacterial Meningitis in the United States, 1998-2007
Bacterial Meningitis in the United States, 1998-2007
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DOI：
10.1056/nejmoa1005384
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发表时间：
2011-05-26
影响因子：
158.5
通讯作者：
Schuchat, Anne
中科院分区：
文献类型：
--
作者：
Thigpen, Michael C.;Whitney, Cynthia G.;Schuchat, Anne
背景20世纪90年代初，随着b型流感嗜血杆菌(Hib)结合疫苗的问世，细菌性脑膜炎在美国的发病率下降了55%。最近的预防措施，如肺炎球菌结合疫苗和对孕妇进行B群链球菌(GBS)普遍筛查，进一步改变了细菌性脑膜炎的流行病学。方法我们分析了1998-2007年间新发感染规划网络的八个监测区居民报告的细菌性脑膜炎病例的数据，这些监测区约有1740万人。我们根据脑膜炎的临床诊断将细菌性脑膜炎定义为脑脊液或其他正常无菌部位存在流感嗜血杆菌、肺炎链球菌、GBS、单核细胞增多性李斯特菌或脑膜炎奈瑟菌。结果我们发现了3188例细菌性脑膜炎患者，在3155例有预后数据的患者中，466例(14.8%)死亡。在监测期间，脑膜炎发病率变化了-31%(95%可信区间[CI]，-33至-29)，从1998-1999年的每10万人2.00例(95%可信区间，1.85至2.15)到2006-2007年的每10万人口1.38例(95%可信区间1.27至1.50)。患者的中位年龄从1998-1999年的30.3岁上升到2006-2007年的41.9岁(P
BACKGROUNDThe rate of bacterial meningitis declined by 55% in the United States in the early 1990s, when the Haemophilus influenzae type b (Hib) conjugate vaccine for infants was introduced. More recent prevention measures such as the pneumococcal conjugate vaccine and universal screening of pregnant women for group B streptococcus (GBS) have further changed the epidemiology of bacterial meningitis.METHODSWe analyzed data on cases of bacterial meningitis reported among residents in eight surveillance areas of the Emerging Infections Programs Network, consisting of approximately 17.4 million persons, during 1998-2007. We defined bacterial meningitis as the presence of H. influenzae, Streptococcus pneumoniae, GBS, Listeria monocytogenes, or Neisseria meningitidis in cerebrospinal fluid or other normally sterile site in association with a clinical diagnosis of meningitis.RESULTSWe identified 3188 patients with bacterial meningitis; of 3155 patients for whom outcome data were available, 466 (14.8%) died. The incidence of meningitis changed by -31% (95% confidence interval [CI], -33 to -29) during the surveillance period, from 2.00 cases per 100,000 population (95% CI, 1.85 to 2.15) in 1998-1999 to 1.38 cases per 100,000 population (95% CI 1.27 to 1.50) in 2006-2007. The median age of patients increased from 30.3 years in 1998-1999 to 41.9 years in 2006-2007 (P