THE OUTCOME OF CHILDHOOD HAEMOPHILUS-INFLUENZAE MENINGITIS - A POPULATION-BASED STUDY
THE OUTCOME OF CHILDHOOD HAEMOPHILUS-INFLUENZAE MENINGITIS - A POPULATION-BASED STUDY
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DOI：
10.5694/j.1326-5377.1993.tb141344.x
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发表时间：
1993-12-06
影响因子：
11.4
通讯作者：
IRWIG, L
中科院分区：
文献类型：
--
作者：
MCINTYRE, P;JEPSON, R;IRWIG, L
目的：了解该病的发病率和病死率。明确定义人群中的儿童b型流感嗜血杆菌脑膜炎。设计：1985-1987年进行回顾性调查，1989-1990年对医院实验室进行前瞻性监测。关于脑膜炎结局的信息来自医院记录和主治医生，以及1989-1990年对儿童父母的调查。单位：悉尼统计局，1986年为229 165名0-4岁儿童，1990年为263 758名。患者：符合条件的儿童年龄从1个月到4岁，根据标准有肋状脑膜炎的临床和微生物学证据。结果：符合条件的儿童229名。12人被排除在外(7人死亡，5人有既往神经功能障碍)。45名患者(21%)在出院时检测到神经功能障碍，29名患者(13%)持续12个月或更长时间。有165名(96%)出院时正常的儿童可获得随访信息，其中12名(7%)记录有持续性缺陷。41名儿童(19%)有容易识别的神经或听力问题：9名(4%)有持续性的严重神经缺陷，7名(3%)有严重听力损失，需要助听器或人工耳蜗植入。年龄对结果有显著影响。最小的孩子更有可能进入重症监护病房。重度神经功能缺失随年龄增长呈显著负相关趋势(P=0.03)。严重的单侧或双侧感觉神经缺失(优势比(OR)8.0，95%可信区间[CI]1.5~81)和出院时共济失调(OR 13.3，95%CI 2.8~128)在2岁以上儿童中明显增多，且随着年龄的增长有显著的积极趋势(P<0.001)。需要重症监护的患者更有可能出现不良结果，特别是在需要正压通气的情况下。结论：这些数据提供了基于人群的估计，即在有良好医疗服务的城市社区，Hib脑膜炎的不良后果发生率最低。这对于评估肋骨疫苗接种的影响很重要，因为脑膜炎是儿童侵袭性肋骨疾病长期发病率的主要原因。确定发病率和年龄之间的关系对于评估替代疫苗策略很重要。
Objective: To determine the morbidity and mortality from. childhood Haemophilus influenzae type b (Hib) meningitis in a well defined population. Design: Retrospective survey 1985-1987 and prospective surveillance of hospital laboratories 1989-1990. Information on outcome of meningitis was obtained from hospital records and attending physicians and, in 1989-1990, from a survey of the children's parents. Setting: Sydney Statistical Division, which had a population of children aged 0-4 years of 229 165 in 1986 and 263 758 in 1990. Patients: Eligible children were aged from one month to four years and had clinical and microbiological evidence of Rib meningitis on standard criteria. Results: There were 229 eligible children. Twelve were excluded (seven died and five had pre-existing neurological deficits). A neurological deficit was detected at the time of hospital discharge in 45 patients (21%) and persisted for 12 months or longer in 29 patients (13%). Follow-up information was available for 165 (96%) children who were normal at the time of hospital discharge and persistent deficits were recorded in 12 (7%) of these children. Forty-one children (19%) had readily recognisable neurological or hearing problems: nine (4%) had persistent severe neurological deficits and seven (3%) had severe hearing loss requiring hearing aids or a cochlear implant. Age had a significant influence on outcome. The youngest children were significantly more likely to be admitted to intensive care. Severe neurological deficits showed a significant negative trend with increasing age (P = 0.03). Severe unilateral or bilateral sensorineural loss (odds ratio [OR] 8.0, 95% confidence interval [CI] 1.5-81) and ataxia at discharge (OR 13.3, 95% CI 2.8-128) were noticeably more common in children over two years of age, with a significant positive trend (P less than or equal to 0.001) with increasing age. Patients requiring intensive care were much more likely to have an adverse outcome, particularly if positive pressure ventilation was needed. Conclusions: These data provide population-based estimates of the minimum incidence of adverse outcomes from Hib meningitis in an urban community with good access to medical services. This is important in assessing the impact of Rib vaccination, as meningitis is responsible for most of the long-term morbidity from childhood invasive Rib disease. Determination of the relationship between morbidity and age is important for assessing alternative vaccine strategies.