Childhood meningitis in the conjugate vaccine era: a prospective cohort study

Abstract

Bacterial conjugate vaccines have dramatically changed the epidemiology of childhood meningitis; viral causes are increasingly predominant, but the current UK epidemiology is unknown. This prospective study recruited children under 16 years of age admitted to 3 UK hospitals with suspected meningitis. 70/388 children had meningitis-13 bacterial, 26 viral and 29 with no pathogen identified. Group B Streptococcus was the most common bacterial pathogen. Infants under 3 months of age with bacterial meningitis were more likely to have a reduced Glasgow Coma Score and respiratory distress than those with viral meningitis or other infections. There were no discriminatory clinical features in older children. Cerebrospinal fluid (CSF) white blood cell count and plasma C-reactive protein at all ages, and CSF protein in infants <3 months of age, distinguished between bacterial meningitis and viral meningitis or other infections. Improved diagnosis of non-bacterial meningitis is urgently needed to reduce antibiotic use and hospital stay.

Management of suspected paediatric meningitis: a multicentre prospective cohort study

“…UK guidelines recommend LP for all febrile infants aged <1 month and all febrile infants aged 1–3 months who appear unwell or have abnormal white cell count,14 whereas in older children the decision is based on clinical assessment 13. In our study, the rate of meningitis in infants aged <3 months undergoing LP (16%) was similar to the rate in children aged ≥3 months undergoing LP (19%) 5. However, the older group experienced significantly longer time to LP, probably because of time taken for evaluation.…”

“…Median age was 2 months (range 0 days to 15.7 years). Aetiology and clinical features have been described 5. Mean follow-up was 6.8 days (n=386/388).…”

“…Each child was followed up until discharge and data collected during hospital admission. The study population, data collection and definition of meningitis have been described previously 5. Preadmission review was defined as face-to-face or telephone assessment by a healthcare professional prehospitalisation.…”

“…Although most childhood meningitis in the UK is now caused by viruses, failure to confidently exclude bacterial disease may lead to unnecessary hospitalisation and antibiotic treatment 5. When lumbar puncture (LP) is delayed until after antibiotic initiation, diagnostic yield from cerebrospinal fluid (CSF) culture rapidly decreases, increasing the uncertainty of aetiology 15 16…”

Fifteen-minute consultation: enterovirus meningitis and encephalitis—when can we stop the antibiotics?

“…A recent UK study identified 70 children admitted to hospital with a final diagnosis of meningitis. Of these, 39 had a proven aetiology (13 bacterial and 26 viral) with 20/26 (77%) viral cases being due to EV infections 5. EV is the most common pathogen causing meningitis in children 6.…”