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Population-based Surveillance for Bacterial Meningitis in China, September 2006–December 2009 - Volume 20, Number 1—January 2014 - Emerging Infectious Disease journal - CDC

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Population-based Surveillance for Bacterial Meningitis in China, September 2006–December 2009 - Volume 20, Number 1—January 2014 - Emerging Infectious Disease journal - CDC

link to Volume 20, Number 1—January 2014

Volume 20, Number 1—January 2014


Population-based Surveillance for Bacterial Meningitis in China, September 2006–December 2009

Yixing Li1, Zundong Yin1, Zhujun Shao1, Manshi Li, Xiaofeng Liang, Hardeep S. Sandhu, Stephen C. Hadler, Junhong Li, Yinqi Sun, Jing Li, Wenjing Zou, Mei Lin, Shuyan Zuo, Leonard W. Mayer, Ryan T. Novak, Bingqing Zhu, Li Xu, Huiming LuoComments to Author , and the Acute Meningitis and Encephalitis Syndrome Study Group
Author affiliations: Chinese Center for Disease Control and Prevention, Beijing, China (Y. Li, Z. Yin, X. Liang, J. Li, H. Luo );National Institute for Communicable Disease Control and Prevention, Beijing (Z. Shao)Shandong Provincial Center for Disease Control and Prevention, Jinan, China (M. Li)Centers for Disease Control and Prevention, Atlanta, Georgia, USA (H.S. Sandhu, S.C. Hadler, L.W. Mayer, R.T. Novak)Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China (Y. Sun, J. Li)Hubei Provincial Center for Disease Control and Prevention, Wuhan, China (W. Zou)Guangxi Zhuang Autonomous Regional Center for Disease Control and Prevention, Nanning, China (M. Lin)World Health Organization China Office, Beijing (S. Zuo)State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China (B. Zhu, L. Xu )


During September 2006–December 2009, we conducted active population and sentinel laboratory–based surveillance for bacterial meningitis pathogens, including Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b, in 4 China prefectures. We identified 7,876 acute meningitis and encephalitis syndrome cases, including 6,388 among prefecture residents. A total of 833 resident cases from sentinel hospitals met the World Health Organization case definition for probable bacterial meningitis; 339 of these cases were among children < 5 years of age. Laboratory testing confirmed bacterial meningitis in 74 of 3,391 tested cases. The estimated annual incidence (per 100,000 population) of probable bacterial meningitis ranged from 1.84 to 2.93 for the entire population and from 6.95 to 22.30 for children < 5 years old. Active surveillance with laboratory confirmation has provided a population-based estimate of the number of probable bacterial meningitis cases in China, but more complete laboratory testing is needed to better define the epidemiology of the disease in this country.

Bacterial meningitis continues to be a major cause of illness and death in neonates and children throughout the world (1). The leading vaccine-preventable causes of this disease areStreptococcus pneumoniaeNeisseria meningitidis, and Haemophilus influenzae type b (Hib). The increasing availability of vaccines has made public health initiatives to control bacterial meningitis disease feasible; however, the incidence of this disease and associated deaths in resource-limited countries continue to exceed those for developed countries (2). Accurate pathogen-specific estimates of the number of bacterial meningitis cases are needed to monitor and refine vaccination programs, but such estimates are challenging to obtain in many countries because of limited laboratory-based surveillance capacity.
Thirty-nine infectious diseases are currently routinely reportable in China. However, among the common bacterial meningitis pathogens, only epidemic meningitis caused by N. meningitidis is reportable (3,4). Most reported cases of epidemic meningitis represent clinical diagnoses that lack laboratory confirmation because of the low culture rate for N. meningitidis.
In population-based studies, the incidence of acute bacterial meningitis in China ranges from 12.4 to 19.2 cases/100,000 children < 5 years of age (5,6). Available studies suggest that the main causal pathogens of bacterial meningitis in China are N. meningitidis, Hib, and S. pneumoniae (79). In population-based studies in Hefei and Nanning, China, the incidence of meningitis caused by Hib was 10.66 and 0.98 cases/100, 000 children < 5 years of age, respectively (6,10), and the incidence of S. pneumoniae meningitis was 1.5 and 1.3 cases/100,000 children < 5 years of age, respectively (6,11).
In 2006, the Acute Meningitis and Encephalitis Syndrome Project was initiated in China (12,13) to determine the incidence and epidemiology of vaccine-preventable causes of meningitis and encephalitis and to improve the laboratory capacity for diagnosis of these diseases. Using data from the project’s active surveillance system, we report the etiology, epidemiology, and estimated incidence of bacterial meningitis in 4 Chinese prefectures during September 2006–December 2009.


We thank Steve McLaughlin, Lisa Lee, Daxin Ni, and Junfeng Yang. We are grateful for the contributions of the staff at the Chinese CDC; the Shandong, Hubei, Hebei, and Guangxi provincial CDCs; the Jinan, Yichang, Shijiazhuang, and Guigang Prefecture CDCs; the county CDCs, and the clinical doctors and patients whose support and participation made this project successful.
Financial support was provided by the Acute Meningitis–Encephalitis Syndrome Surveillance project of US Centers for Disease Control and Prevention’s Global Disease Detection and Response Initiative.
Dr Yixing Li is a professor at National Immunization Programme, Chinese CDC, and her research interests include meningitis and encephalitis disease epidemiology and the use of vaccines.


  1. Kim KSAcute bacterial meningitis in infants and children. Lancet Infect Dis.2010;10:3242 .DOIExternal Web Site IconPubMedExternal Web Site Icon
  2. Molyneux ERiordan FAWalsh AAcute bacterial meningitis in children presenting to the Royal Liverpool Children’s Hospital, Liverpool, UK and the Queen Elizabeth Central Hospital in Blantyre, Malawi: a world of difference. Ann Trop Paediatr2006;26:2937 .DOIExternal Web Site IconPubMedExternal Web Site Icon
  3. Li JLi YYin ZNing GLuo HLiang XAnalysis of epidemiologic characteristics of fatal meningococcal meningitis disease cases in China during 2004–2006 [in Chinese].Chinese Journal of Vaccines and Immunization. 2008;14:23846.
  4. Ze WDiao LXu A. Planed Immunology [in Chinese]. 2nd ed. Shanghai (China): Shanghai Scientific and Technological Literature Publishing House Co, Ltd; 2002. p. 461–74.
  5. Yang YLeng ZShen XLu DJiang ZRao JAcute bacterial meningitis in children in Hefei, China 1990–1992. Chin Med J (Engl)1996;109:3858 .PubMedExternal Web Site Icon
  6. Dong BQTang ZZLin MLi CYTan DMLiang DBEpidemiologic surveillance for bacterial meningitis in 140,000 children under 5 years of age in Nanning District, Guangxi Province[in Chinese]Zhonghua Liu Xing Bing Xue Za Zhi2004;25:3915 .PubMedExternal Web Site Icon
  7. Shen XYang YZhang GBai HXu SLi YEtiologic analysis of 128 bacterial meningitis cases [in Chinese]Chinese Journal of Infectious Diseases. 1991;9:2302.
  8. Shen XLi YTong YGao WYang YWang YEtiologic analyses for 60 cases of purulent meningitis [in Chinese]National Medical Journal of China. 1998;78:466.
  9. Yi WChuanqing WXiaohong W. Etiology and antimicrobial susceptibility of children with bacterial meningitis [in Chinese]. Journal of Applied Clinical Pediatrics. 2006;21:355–6, 366.
  10. Yang YLeng ZLu DRao JLiu ZHu YPediatric Haemophilus influenzae type b meningitis in Hefei city: an epidemiologic study [in Chinese]. National Medical Journal of China. 1998;78:251–3.
  11. Yao KHYang YHStreptococcus pneumoniae diseases in Chinese children: past, present and future. Vaccine2008;26:442533 .DOIExternal Web Site IconPubMedExternal Web Site Icon
  12. Yin ZWang HYang JLuo HLi YHadler SCJapanese encephalitis disease burden and clinical features of Japanese encephalitis in four cities in the People’s Republic of China.Am J Trop Med Hyg2010;83:76673 .DOIExternal Web Site IconPubMedExternal Web Site Icon
  13. Centers for Disease Control and PreventionExpanding poliomyelitis and measles surveillance networks to establish surveillance for acute meningitis and encephalitis syndromes—Bangladesh, China, and India, 2006–2008. MMWR Morb Mortal Wkly Rep.2012;61:100811 .PubMedExternal Web Site Icon
  14. World Health Organization. WHO-recommended standards for surveillance of selected vaccine-preventable diseases; 2003 May. WHO/V&B/03.01 [cited 2013 Nov 5]. Adobe PDF fileExternal Web Site Icon
  15. Mothershed EASacchi CTWhitney AMBarnett GAAjello GWSchmink SUse of real-time PCR to resolve slide agglutination discrepancies in serogroup identification ofNeisseria meningitidis. J Clin Microbiol2004;42:3208 .DOIExternal Web Site IconPubMedExternal Web Site Icon
  16. Corless CEGuiver MBorrow REdwards-Jones VFox AJKaczmarski EBSimultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniaein suspected cases of meningitis and septicemia using real-time PCR. J Clin Microbiol.2001;39:15538 .DOIExternal Web Site IconPubMedExternal Web Site Icon
  17. Implementation plan for national expanded immunization programs. Gazette of the Ministry of Health of People’s Republic of China. 2008;3:1721.
  18. Zieliński ATomaszunas-Blaszczyk JKuklińska DEpidemiology of childhood bacterial meningitis in Poland. Incidence of bacterial meningitis with special reference toHaemophilus influenzae type b among children 0–59 months old in the former Kielce and Bydgoszcz districts in Poland in 1998–1999. Eur J Epidemiol2001;17:77982 .DOIExternal Web Site IconPubMedExternal Web Site Icon
  19. Kojouharova MGatcheva NSetchanova LRobertson SEWenger JDEpidemiology of meningitis due to Haemophilus influenzae type b in children in Bulgaria: a prospective, population-based surveillance study. Bull World Health Organ2002;80:6905 .PubMedExternal Web Site Icon
  20. Mendsaikhan JWatt JPMansoor OSuvdmaa NEdmond KLitt DJChildhood bacterial meningitis in Ulaanbaatar, Mongolia, 2002–2004. Clin Infect Dis2009;48(Suppl 2):S1416 .DOIExternal Web Site IconPubMedExternal Web Site Icon
  21. Kim JSJang YTKim JDPark THPark JMKilgore PEIncidence of Haemophilus influenzaetype b and other invasive diseases in South Korean children. Vaccine2004;22:395262.DOIExternal Web Site IconPubMedExternal Web Site Icon
  22. Rerks-Ngarm STreleaven SCChunsuttiwat SMuangchana CJolley DBrooks A,Prospective population-based incidence of Haemophilus influenzae type b meningitis in Thailand. Vaccine2004;22:97583 .DOIExternal Web Site IconPubMedExternal Web Site Icon
  23. Heymann DL. Control of communicable diseases manual. 18th ed. Washington (DC): American Public Health Association; 2004. p. 391–402.
  24. Gurley ESHossain MJMontgomery SPPetersen LRSejvar JJMayer LWEtiologies of bacterial meningitis in Bangladesh: results from a hospital-based study. Am J Trop Med Hyg2009;81:47583 .PubMedExternal Web Site Icon
  25. Abdulrab AAlgobaty FSalem AKMohammed YAAcute bacterial meningitis in adults: a hospital based study in Yemen. Jpn J Infect Dis2010;63:12831 .PubMedExternal Web Site Icon



Suggested citation for this article: Li Y, Yin Z, Shao Z, Li M, Liang X, Sandhu HS, et al.; the Acute Meningitis and Encephalitis Syndrome Study Group. Population-based surveillance for bacterial meningitis in China, September 2006–December 2009. Emerg Infect Dis [Internet]. 2014 Jan [date cited]. Web Site Icon
DOI: 10.3201/eid2001.120375
1These authors contributed equally to this article.
2Members of the Acute Meningitis and Encephalitis Syndrome Study Group are listed at the end of this article.

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