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Pneumococcal Meningitis Outbreaks in Africa, 2000–2018: Systematic Literature Review and Meningitis Surveillance Database Analyses
The Journal of Infectious Diseases ( IF 6.4 ) Pub Date : 2021-02-18 , DOI: 10.1093/infdis/jiab105
Kat Franklin 1 , Brenda Kwambana-Adams 2 , Fernanda C Lessa 3 , Heidi M Soeters 3 , Laura Cooper 4 , Matthew E Coldiron 5 , Jason Mwenda 6 , Martin Antonio 7 , Tomoka Nakamura 8 , Ryan Novak 3 , Adam L Cohen 8
Affiliation  

Background The meningitis belt of sub-Saharan Africa has traditionally experienced large outbreaks of meningitis mainly caused by Neisseria meningitidis. More recently, Streptococcus pneumoniae has been recognized as a cause of meningitis outbreaks in the region. Little is known about the natural history and epidemiology of these outbreaks, and, in contrast to meningococcal meningitis, there is no agreed definition for a pneumococcal meningitis epidemic. The aim of this analysis was to systematically review and understand pneumococcal meningitis outbreaks in Africa between 2000 and 2018. Methods Meningitis outbreaks were identified using a systematic literature review and analyses of meningitis surveillance databases. Potential outbreaks were included in the final analysis if they reported at least 10 laboratory-confirmed meningitis cases above baseline per week with ≥50% of cases confirmed as pneumococcus. Results A total of 10 potential pneumococcal meningitis outbreaks were identified in Africa between 2000 and 2018. Of these, 2 were classified as confirmed, 7 were classified as possible, and 1 was classified as unlikely. Three outbreaks spanned more than 1 year. In general, the outbreaks demonstrated lower peak attack rates than meningococcal meningitis outbreaks and had a predominance of serotype 1. Patients with pneumococcal meningitis tended to be older and had higher case fatality rates than meningococcal meningitis cases. An outbreak definition, which includes a weekly district-level incidence of at least 10 suspected cases per 100 000 population per week, with >10 cumulative confirmed cases of pneumococcus per year, would have identified all 10 potential outbreaks. Conclusions Given the frequency of and high case fatality from pneumococcal meningitis outbreaks, public health recommendations on vaccination strategies and the management of outbreaks are needed. Improved laboratory testing for S. pneumoniae is critical for early outbreak identification.

中文翻译:

2000-2018 年非洲肺炎球菌脑膜炎疫情:系统文献回顾和脑膜炎监测数据库分析

背景 撒哈拉以南非洲的脑膜炎地带传统上经历了主要由脑膜炎奈瑟菌引起的大规模脑膜炎暴发。最近,肺炎链球菌被认为是该地区脑膜炎暴发的一个原因。对这些暴发的自然史和流行病学知之甚少,而且与脑膜炎球菌性脑膜炎相比,对于肺炎球菌性脑膜炎流行没有一致的定义。本分析的目的是系统回顾和了解 2000 年至 2018 年期间非洲肺炎球菌脑膜炎的暴发情况。方法通过系统文献回顾和脑膜炎监测数据库分析确定脑膜炎暴发。如果他们每周报告至少 10 例实验室确诊脑膜炎病例高于基线且≥50% 的病例确诊为肺炎球菌,则将潜在暴发纳入最终分析。结果 2000 年至 2018 年期间,非洲共发现 10 起潜在肺炎球菌脑膜炎疫情,其中 2 起确诊,7 起可能,1 起不太可能。3 次爆发跨越 1 年多。一般来说,与脑膜炎球菌性脑膜炎暴发相比,暴发的峰值发病率较低,并且以血清型 1 为主。与脑膜炎球菌性脑膜炎病例相比,肺炎球菌性脑膜炎患者的年龄往往更大,病死率更高。爆发定义,其中包括每周每 10 万人口中至少 10 例疑似病例的地区级发病率,每年累计确诊肺炎球菌病例超过 10 例,将确定所有 10 次潜在暴发。结论 鉴于肺炎球菌脑膜炎暴发的频率和高病死率,需要就疫苗接种策略和暴发管理提出公共卫生建议。改进对肺炎链球菌的实验室检测对于早期发现暴发至关重要。
更新日期:2021-02-18
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