The Lancet Regional Health. Western Pacific (Mar 2022)

Etiological and epidemiological features of acute meningitis or encephalitis in China: a nationwide active surveillance study

  • Li-Ping Wang,
  • Yang Yuan,
  • Ying-Le Liu,
  • Qing-Bin Lu,
  • Lu-Sha Shi,
  • Xiang Ren,
  • Shi-Xia Zhou,
  • Hai-Yang Zhang,
  • Xiao-Ai Zhang,
  • Xin Wang,
  • Yi-Fei Wang,
  • Sheng-Hong Lin,
  • Cui-Hong Zhang,
  • Meng-Jie Geng,
  • Jun Li,
  • Shi-Wen Zhao,
  • Zhi-Gang Yi,
  • Xiao Chen,
  • Zuo-Sen Yang,
  • Lei Meng,
  • Xin-Hua Wang,
  • Ai-Li Cui,
  • Sheng-Jie Lai,
  • Meng-Yang Liu,
  • Yu-Liang Zhu,
  • Wen-Bo Xu,
  • Yu Chen,
  • Zheng-Hong Yuan,
  • Meng-Feng Li,
  • Liu-Yu Huang,
  • Huai-Qi Jing,
  • Zhong-Jie Li,
  • Wei Liu,
  • Li-Qun Fang,
  • Jian-Guo Wu,
  • Simon I. Hay,
  • Wei-Zhong Yang,
  • George F. Gao

Journal volume & issue
Vol. 20
p. 100361

Abstract

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Summary: Background: Acute meningitis or encephalitis (AME) results from a neurological infection causing high case fatality and severe sequelae. AME lacked comprehensive surveillance in China. 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

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