ACUTE BACTERIAL-MENINGITIS IN CHILDREN IN HEFEI, CHINA 1990-1992

Objective. To obtain etiologic and epidemiologic information about bac terial meningitis, especially the H influenza type B (Hib), from a med ium-sized city, Hefei, China. Methods. Data were collected prospective ly over 3 years, from 1990 to 1992 by a well-organized group including 13 hospitals. All children with a clinical diagnosis of acute bacteri al meningitis were enrolled and the specimens were taken for the etiol ogic studies. CSF and blood were tested by standard bacteriologic tech nique. CSF, blood and concentrated urine were tested directly for dete ction of antigen by countercurrent immuno-electrophoresis (CIE). Data were analyzed by epidemiologic methods. Results. Bacterial culture and CSF Gram's staining were positive only in 13.3% and 11.7%, respective ly. Bacterial antigen detection was positive in up to 90% by CIE which was more sensitive than bacterial culture (X(2)=67.7, P<0.005). The a nnual incidence of acute bacterial meningitis in the city is calculate d as 9.3 cases/100 000 children from 1 month to 15 years of age and 19 .2 cases/100 000 children from 1 month to 5 years of age. Hib meningit is accounted for 51.7%, N. meningitis (Nm) for 38.3%, and S. pneumonia e (Sp) for 8.3%. There was no significant seasonal variation. Of the p atients, 76.7% were children under 5 years of age, and 51.7% under 1 y ear of age. The case fatality rate was 11.7% for all bacterial meningi tis, 9.7% for Hib, 17.4% for Nm and 20% for Sp. A total of 22.6% of su rvivors suffered from neurological or psychological problems. Conclusi ons. Using antigen detection combined with bacterial culture, we could make an etiologic diagnosis in up to 90% of the patients in this grou p. Hib, Nm and Sp were the predominant pathogens, which was similar to the findings in other countries. Hib was the most common cause of bac terial meningitis, but the incidence was much lower than in most parts of the world.