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

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

Volume 20, Number 1—January 2014

Research

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

Article Contents

• Materials and Methods
• Results
• Discussion
• Acknowledgments
• References
• Figure 1
• Figure 2
• Table 1
• Table 2
• Table 3
• Table 4
• Table 5
• Suggested Citation

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 Luo , 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 )

Suggested citation for this article

Abstract

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 pneumoniae, Neisseria 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 (7–9). 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.

Acknowledgments

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.

References

1. Kim KS. Acute bacterial meningitis in infants and children. Lancet Infect Dis.2010;10:32–42 .DOIPubMed
2. Molyneux E, Riordan FA, Walsh A. Acute 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 Paediatr. 2006;26:29–37 .DOIPubMed
3. Li J, Li Y, Yin Z, Ning G, Luo H, Liang X. Analysis of epidemiologic characteristics of fatal meningococcal meningitis disease cases in China during 2004–2006 [in Chinese].Chinese Journal of Vaccines and Immunization. 2008;14:238–46.
4. Ze W, Diao L, Xu A. Planed Immunology [in Chinese]. 2nd ed. Shanghai (China): Shanghai Scientific and Technological Literature Publishing House Co, Ltd; 2002. p. 461–74.
5. Yang Y, Leng Z, Shen X, Lu D, Jiang Z, Rao J, Acute bacterial meningitis in children in Hefei, China 1990–1992. Chin Med J (Engl). 1996;109:385–8 .PubMed
6. Dong BQ, Tang ZZ, Lin M, Li CY, Tan DM, Liang DB, Epidemiologic 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 Zhi. 2004;25:391–5 .PubMed
7. Shen X, Yang Y, Zhang G, Bai H, Xu S, Li Y, Etiologic analysis of 128 bacterial meningitis cases [in Chinese]. Chinese Journal of Infectious Diseases. 1991;9:230–2.
8. Shen X, Li Y, Tong Y, Gao W, Yang Y, Wang Y. Etiologic analyses for 60 cases of purulent meningitis [in Chinese]. National Medical Journal of China. 1998;78:466.
9. Yi W, Chuanqing W, Xiaohong W. Etiology and antimicrobial susceptibility of children with bacterial meningitis [in Chinese]. Journal of Applied Clinical Pediatrics. 2006;21:355–6, 366.
10. Yang Y, Leng Z, Lu D, Rao J, Liu Z, Hu Y, Pediatric Haemophilus influenzae type b meningitis in Hefei city: an epidemiologic study [in Chinese]. National Medical Journal of China. 1998;78:251–3.
11. Yao KH, Yang YH. Streptococcus pneumoniae diseases in Chinese children: past, present and future. Vaccine. 2008;26:4425–33 .DOIPubMed
12. Yin Z, Wang H, Yang J, Luo H, Li Y, Hadler SC, Japanese encephalitis disease burden and clinical features of Japanese encephalitis in four cities in the People’s Republic of China.Am J Trop Med Hyg. 2010;83:766–73 .DOIPubMed
13. Centers for Disease Control and Prevention. Expanding 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;61:1008–11 .PubMed
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].http://www.measlesrubellainitiative.org/wp-content/uploads/2013/06/WHO-surveillance-standard.pdf 
15. Mothershed EA, Sacchi CT, Whitney AM, Barnett GA, Ajello GW, Schmink S, Use of real-time PCR to resolve slide agglutination discrepancies in serogroup identification ofNeisseria meningitidis. J Clin Microbiol. 2004;42:320–8 .DOIPubMed
16. Corless CE, Guiver M, Borrow R, Edwards-Jones V, Fox AJ, Kaczmarski EB. Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniaein suspected cases of meningitis and septicemia using real-time PCR. J Clin Microbiol.2001;39:1553–8 .DOIPubMed
17. Implementation plan for national expanded immunization programs. Gazette of the Ministry of Health of People’s Republic of China. 2008;3:17–21.
18. Zieliński A, Tomaszunas-Blaszczyk J, Kuklińska D. Epidemiology 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 Epidemiol. 2001;17:779–82 .DOIPubMed
19. Kojouharova M, Gatcheva N, Setchanova L, Robertson SE, Wenger JD. Epidemiology of meningitis due to Haemophilus influenzae type b in children in Bulgaria: a prospective, population-based surveillance study. Bull World Health Organ. 2002;80:690–5 .PubMed
20. Mendsaikhan J, Watt JP, Mansoor O, Suvdmaa N, Edmond K, Litt DJ, Childhood bacterial meningitis in Ulaanbaatar, Mongolia, 2002–2004. Clin Infect Dis. 2009;48(Suppl 2):S141–6 .DOIPubMed
21. Kim JS, Jang YT, Kim JD, Park TH, Park JM, Kilgore PE, Incidence of Haemophilus influenzaetype b and other invasive diseases in South Korean children. Vaccine. 2004;22:3952–62.DOIPubMed
22. Rerks-Ngarm S, Treleaven SC, Chunsuttiwat S, Muangchana C, Jolley D, Brooks A,Prospective population-based incidence of Haemophilus influenzae type b meningitis in Thailand. Vaccine. 2004;22:975–83 .DOIPubMed
23. Heymann DL. Control of communicable diseases manual. 18th ed. Washington (DC): American Public Health Association; 2004. p. 391–402.
24. Gurley ES, Hossain MJ, Montgomery SP, Petersen LR, Sejvar JJ, Mayer LW, Etiologies of bacterial meningitis in Bangladesh: results from a hospital-based study. Am J Trop Med Hyg. 2009;81:475–83 .PubMed
25. Abdulrab A, Algobaty F, Salem AK, Mohammed YA. Acute bacterial meningitis in adults: a hospital based study in Yemen. Jpn J Infect Dis. 2010;63:128–31 .PubMed

Figures

• Figure 1. [[caption]]
• Figure 2. [[caption]]

Tables

• Table 1. Surveillance for AMES cases in 4 China prefectures, September 2006–December 2009
• Table 2. Demographic features and bacterial laboratory testing for AMES case-patients in sentinel hospitals in 4 China prefectures, September 2006–December 2009
• Table 3. Demographic information for AMES case-patients meeting the World Health Organization definition for probable bacterial meningitis, China, September 2006–December 2009
• Table 4. Bacterial testing results for specimens from AMES case-patients, China, September 2006–December 2009
• Table 5. Initial clinical diagnoses of AMES and probable bacterial meningitis cases in sentinel hospitals in 4 China prefectures, September 2006–December 2009

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]. http://dx.doi.org/10.3201/eid2001.120375

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.