This article is more than 5 years old. Information may no longer be current.
Areas of improvement identified in meningitis surveillance in China
Researchers have identified several ways to enhance surveillance of bacterial meningitis in China, which may lead to better recommendations for vaccines.
“Bacterial meningitis continues to be a major cause of illness and death in neonates and children throughout the world …” the researchers wrote in Emerging Infectious Diseases. “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.”
The researchers used data from the Acute Meningitis and Encephalitis Syndrome Project to determine the incidence and epidemiology of bacterial meningitis in four prefectures in China from September 2006 to December 2009. The active surveillance component of the project relied on six hospitals in each prefecture that represented the largest general infectious disease and children’s hospitals, known as sentinel sites, where serum and cerebrospinal fluid samples were collected from cases of acute meningitis and encephalitis syndrome (AMES). All other hospitals reported epidemiologic data on AMES cases but did not supply diagnostic specimens. All AMES case information was relayed to public health personnel at the China CDC, who investigated reports from sentinel sites within 48 hours.
Overall, 7,876 AMES cases were reported from the four prefectures — 4,712 cases from sentinel and 3,164 from non-sentinel hospitals. A total of 833 AMES cases from sentinel sites met WHO criteria for probable bacterial meningitis, with 40% of infections occurring in children younger than 5 years. Of the 3,391 AMES cases with specimens tested by any method, 74 (2.2%) were laboratory confirmed as bacterial meningitis; 26 of those cases were caused by Neisseria meningitides, nine cases caused by Haemophilus influenza type b, and 39 cases were caused by Streptococcus pneumonia.
The crude incidence rates of probable bacterial meningitis ranged from 1.84 to 2.93 cases/100,000 population for the entire population and from 6.95 to 22.3 cases/100,000 population for children younger than 5 years.
Based on these findings, the researchers suggest the following measures to enhance surveillance in China:
- Increase specimen collection and handling and laboratory testing to confirm pathogens, especially in pediatric cases.
- Collect diagnostic samples for free.
- Train physicians and hospital staff to properly collect diagnostic samples and enforce better quality control regarding specimen collection.
- PCR testing should be used at all sentinel sites because it is the most sensitive bacterial testing method.
“These efforts will help to improve active surveillance so that disease incidence and pathogen-specific etiologies for bacterial meningitis can be more accurately determined by age group and used to develop recommendations for the use of meningococcal conjugate vaccines and to determine the need for routine Hib and S. pneumonia vaccinations for young children in China.”
Disclosure: The researchers report no relevant financial disclosures.