Etiological and epidemiological features of acute meningitis or encephalitis in China: a nationwide active surveillance study.
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Wang Li-Ping, Yuan Yang, Liu Ying-Le, Lu Qing-Bin, Shi Lu-Sha, Ren Xiang, Zhou Shi-Xia, Zhang Hai-Yang, Zhang Xiao-Ai, Wang Xin, Wang Yi-Fei, Lin Sheng-Hong, Zhang Cui-Hong, Geng Meng-Jie, Li Jun, Zhao Shi-Wen, Yi Zhi-Gang, Chen Xiao, Yang Zuo-Sen, Meng Lei, Wang Xin-Hua, Cui Ai-Li, Lai Sheng-Jie, Liu Meng-Yang, Zhu Yu-Liang, Xu Wen-Bo, Chen Yu, Yuan Zheng-Hong, Li Meng-Feng, Huang Liu-Yu, Jing Huai-Qi, Li Zhong-Jie, Liu Wei, Fang Li-Qun, Wu Jian-Guo, Hay Simon I, Yang Wei-Zhong, Gao George F, Chinese Centers for Disease Control and Prevention (CDC) Etiology of Acute Meningitis and Encephalitis Surveillance Study Team
Аннотация
METHODS: Nation-wide surveillance of all-age patients with AME syndromes was conducted in 144 sentinel hospitals of 29 provinces in China. Eleven AME-causative viral and bacterial pathogens were tested with multiple diagnostic methods.
FINDINGS: Between 2009 and 2018, 20,454 AME patients were recruited for tests. Based on 9,079 patients with all-four-virus tested, 28.43% (95% CI: 27.50%‒29.36%) of them had at least one virus-positive detection. Enterovirus was the most frequently determined virus in children <18 years, herpes simplex virus and Japanese encephalitis virus were the most frequently determined in 18-59 and ≥60 years age groups, respectively. Based on 6,802 patients with all-seven-bacteria tested, 4.43% (95% CI: 3.94%‒4.91%) had at least one bacteria-positive detection, Streptococcus pneumoniae and Neisseria meningitidis were the leading bacterium in children aged <5 years and 5-17 years, respectively. Staphylococcus aureus was the most frequently detected in adults aged 18-59 and ≥60 years. The pathogen spectrum also differed statistically significantly between northern and southern China. Joinpoint analysis revealed age-specific positive rates, with enterovirus, herpes simplex virus and mumps virus peaking at 3-6 years old, while Japanese encephalitis virus peaked in the ≥60 years old. As age increased, the positive rate for Streptococcus pneumoniae and Escherichia coli statistically significantly decreased, while for Staphylococcus aureus and Streptococcus suis it increased.
INTERPRETATION: The current findings allow enhanced identification of the predominant AME-related pathogen candidates for diagnosis in clinical practice and more targeted application of prevention and control measures in China, and a possible reassessment of vaccination strategy.
FUNDING: China Mega-Project on Infectious Disease Prevention and the National Natural Science Funds.