目的：探討台灣地區腦膜炎流行病學以評估其造成的疾病負擔，提供相關單位作為腦膜炎防治的參考。

方法：採用1996年至2003年，國家衛生研究院全民健康保險研究資料庫，利用資料庫內的住院醫療費用清單明細檔（DD檔）、及醫事機構基本資料檔（HOSB檔）合併進行分析，以國際疾病分類第九版挑選出主診斷代碼符合腦膜炎診斷的病患列入研究樣本。

結果：於1996年至2003年，剔除條件不符者，台灣地區共有30,200人次因罹患腦膜炎而住院，北部地區有10,773人次為最多，其次為南部（10,243人次）、中部（6,903人次）、東部地區（2,281人次），男女比約為1.6比1。致病原方面，病毒所引起的佔54.3%為最高，細菌佔17.9%，未知原因佔27.5%，其它原因佔0.4%。因腦膜炎住院的平均年齡，細菌性腦膜炎為35.9歲，病毒性為11.6歲，其它原因為31.6歲，未知原因為20.1歲。院內死亡方面，致死率以細菌性腦膜炎的5.0%為最高，未知原因（1.6%）、其它原因（0.9%）、病毒性（0.1%）次之。在不同的醫療層級的致病原檢出率方面，醫學中心未知原因所造成的腦膜炎僅佔19.7%，區域醫院及地區醫院則分別佔32.8%及38.6%。

病毒性腦膜炎中，在不考慮無法辨識病原的情況下，主要是由腸病毒（35.6%）所引起；成人細菌性腦膜炎，主要是由結核桿菌（83.2%）所引起。幼童細菌性腦膜炎主要是由鏈球菌（35.9%）、嗜血桿菌（20.2%）及肺炎雙球菌（17.3%）感染發生。在不同醫療層級的特定細菌性致病原檢出率方面，以醫學中心的40.7%為最高，區域醫院為35.3%，地區醫院為33.6%。

醫學中心細菌性腦膜炎的總致死率為5%，在1,575人次中有78人死亡。北部地區的致死率為6.4%，中部地區為5.4%，南部地區為3.2%，東部地區為0%。致病原以肺炎雙球菌所造成的細菌性腦膜炎致死率最高（15.7%），其次為腦膜炎雙球菌7.5%，嗜血桿菌5.2%，葡萄球菌4.9%，肺結核桿菌3.7%，鏈球菌3.4%。醫學中心的年齡別致死率方面，在「未滿1個月」致死率為3.7%、「1-6個月」為4.3%、「7-23個月」為19.5%、「2-15歲」為7.1%、「16-29歲」為2.0%、「30-59歲」為3.2%、「60歲以上」為5.1%。

醫療經濟負擔方面，在1996年至2003年，健保平均每年支付腦膜炎住院治療的費用約為一億五千萬元（新台幣），平均每人次腦膜炎住院醫療費用為40,835元。依致病原分類，平均每人次腦膜炎住院醫療費用，細菌性為109,452元、病毒性為17,253元，其中又以肺炎雙球菌的131,527元為最高。

結論：細菌性腦膜炎是台灣地區15歲以下幼童因腦膜炎死亡的主要原因，可考慮推動疫苗注射來預防細菌性腦膜炎的發生及減少死亡。

Objectives:
The objective of this study is to examine the epidemiology profile of meningitis and disease burden in Taiwan.

Material and methods:
Adopt the National Health Insurance database from 1996-2003 of the National Health Research Institute, and merge the DD shelf and HOSB shelf to analyze data. From the nationwide inpatient database, creating a subsample that included hospitalizes with International Classification of Diseases, ninth revision, principal diagnosis code for meningitis.

Result:
In 1996 to 2003, there are 30,200 episodes of meningitis in Taiwan, including 10,773 episodes in the North, 10,243 episodes in the South, 6,903 in the Center, and 2,281 in the East. The male to female ratio is around 1.6. The proportion of aetiology leading to meningitis is: Virus 54.3%, Bacteria 17.9%, Unknown 27.5%, and Others 0.4%. The mean age of meningitis inpatients is: 35.9 years due to Bacteria, 11.6 years due to Virus, 31.6 years due to Others, and 20.1 years due to Unknown. The proportion of meningitis due to Unknown in the Medical Center, Regional Hospital, and Local Hospital are 19.7%, 32.8% and 38.6 respectively.
About the pathogen, viral meningitis is mainly caused by enterovirus（35.6%）. Adult bacterial meningitis is chiefly caused by Mycobacterium tuberculosis（83.2%）, and children meningitis are mainly caused by Streptococcus（35.9%）, Hemophilus（20.2%）, and Streptococcus pneumoniae（17.3%）. The proportion of knowing the specific bacteria leading to bacterial meningitis in the Medical Center, Regional Hospital, and Local Hospital are 40.7%, 35.3%, and 33.6% respectively.
In the Medical Center, the case fatality ratio of meningitis is 5% and it is 6.4% in the North, 5.4% in Center, 3.2% in the South, and 0% in the East. The case fatality ratio of meningitis due to Streptococcus pneumoniae, Neisseria meningitides, Hemophilus, Staphylococcus, Mycobacterium tuberculosis, Streptococcus are 15.7%, 7.5%, 5.2%, 4.9%, 3.7%, and 3.4% respectively. The case fatality ratio by age group are: 「＜1 month」3.7%, 「1-6 months」4.3%, 「7-23 months」19.5%, 「2-15 years」7.1%, 「16-29 years」2.0%, 「30-59 years」3.2%, and 「＞60years」5.1%.
In the aspect of medical cost, it takes 40,835 NTD to treat a patient with hospitalization in average. It takes 109,452 NTD to treat a bacterial meningitis patient with hospitalization in average and 17,253 in a viral meningitis patient.

Conclusions:
Bacterial meningitis is the main cause leading to death from meningitis of children under 15 years in Taiwan. We should consider putting recommended vaccination for children in practice to reduce hospitalizations and deaths due to bacterial meningitis.

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