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

Abstract

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.

• Authors: 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, Chinese Centers for Disease Control and Prevention (CDC) Etiology of Acute Meningitis and Encephalitis Surveillance Study Team
• Journal: The Lancet regional health. Western Pacific (Lancet Reg Health West Pac) Vol. 20 Pg. 100361 (Mar 2022) ISSN: 2666-6065 [Electronic] England
• PMID: 35036977 (Publication Type: Journal Article)
• Copyright: © 2021 The Author(s).