Epidemiological and Clinical Features of Meningococcal Meningitis in Infants - China, 2006-2023
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Qian Zhang1, Jiajia Zhou1, Mingshuang Li1
1National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease (NITFID), National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.
Introduction:
Infants have the highest incidence of meningococcal meningitis (MM) among all age groups in China. Infants receive their first and second doses of serogroup A meningococcal polysaccharide vaccine at 6 and 9 months of age.
Methods:
We extracted data on MM cases among 0-11-month-old children reported during 2006-2023 from the National Notifiable Diseases Registry System and the National Meningococcal Disease Surveillance System and conducted an epidemiological and clinical analysis.
Results:
During the study period, 721 infant MM cases were reported. Incidence decreased from 7.31 cases per million to 2.74 per million, while the all-age incidence declined from 1.27 cases per million to 0.06 per million. Among 210 cases with serogrouping results, five serogroups (A, B, C, W, Y) and non-groupable strains were detected. Serogroup A cases decreased from 36.36% to 1.87% during the study period, while serogroup B increased from 14.55% to 67.29%. Fever, nausea, and/or vomiting were common symptoms across all serogroups. The frequencies of petechiae and/or purpura in serogroup A (73%) and C (92%) were substantially higher than in other serogroups. Among serogroup B cases, 26.42% developed petechiae and/or purpura, 26.42% exhibited neck stiffness, and 13.21% had positive Kernig's and/or Brudzinski's signs.
Conclusions:
The incidence of MM in infants has significantly decreased but remains higher than incidence across all age groups. Serogroup B cases were the most common. Atypical symptoms in infant cases challenge timely diagnosis. We suggest eligible infants receive meningococcal vaccination timely, and the development of serogroup B meningococcal vaccines should be accelerated.
Insights
Meningococcal meningitis (MM) incidence in Chinese infants has decreased but remains high. Serogroup B is now the most common cause, highlighting the need for timely infant vaccination and development of serogroup B vaccines.
Area of Science:
- Pediatrics
- Epidemiology
- Infectious Diseases
Background:
- Infants in China face the highest risk of meningococcal meningitis (MM).
- Current vaccination schedules include serogroup A meningococcal polysaccharide vaccine at 6 and 9 months.
Purpose of the Study:
- To analyze epidemiological and clinical trends of infant MM in China from 2006-2023.
- To identify changes in serogroup distribution and clinical presentation.
Main Methods:
- Data on infant MM cases (0-11 months) were extracted from national surveillance systems (2006-2023).
- Epidemiological and clinical analyses were conducted.
Main Results:
- Infant MM incidence decreased significantly, yet remains higher than the general population.
- Serogroup B became the predominant strain, replacing serogroup A.
- Clinical presentations varied, with atypical symptoms challenging diagnosis in infants.
Conclusions:
- Despite reduced incidence, infant MM remains a concern in China.
- Timely vaccination for eligible infants is crucial.
- Accelerated development of serogroup B meningococcal vaccines is recommended.
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