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

Manish Sadarangani1, Louise Willis1, Seilesh Kadambari2

  • 1Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.

Archives of Disease in Childhood
|September 27, 2014
PubMed

Insights

Viral meningitis is now more common than bacterial meningitis in UK children. Early diagnosis using cerebrospinal fluid (CSF) and C-reactive protein (CRP) levels is crucial for effective treatment and reducing antibiotic use.

Area of Science:

  • Pediatric infectious diseases
  • Epidemiology of meningitis
  • Clinical diagnostics

Background:

  • Bacterial conjugate vaccines have significantly altered childhood meningitis epidemiology.
  • Viral meningitis is increasingly prevalent, yet current UK epidemiology remains unclear.
  • Understanding contemporary meningitis causes in children is essential for public health.

Purpose of the Study:

  • To determine the current epidemiology of meningitis in children under 16 in the UK.
  • To identify causative pathogens and compare clinical features and diagnostic markers.
  • To highlight the need for improved diagnostics for non-bacterial meningitis.

Main Methods:

  • Prospective study involving children under 16 with suspected meningitis across 3 UK hospitals.
  • Pathogen identification in cerebrospinal fluid (CSF) and clinical data collection.
  • Analysis of clinical features, CSF white blood cell count, plasma C-reactive protein (CRP), and CSF protein levels.

Main Results:

  • Of 388 children, 70 had meningitis: 13 bacterial, 26 viral, and 29 with unidentified pathogens.
  • Group B Streptococcus was the most frequent bacterial cause.
  • CSF white blood cell count, plasma CRP, and CSF protein (in infants <3 months) differentiated bacterial from viral meningitis.

Conclusions:

  • Viral meningitis is now predominant in the studied UK pediatric population.
  • Clinical features were only distinct in infants (<3 months) with bacterial meningitis.
  • Enhanced diagnostic methods for non-bacterial meningitis are critical to optimize antibiotic stewardship and reduce hospital stays.

Keywords:
Group B StreptococcusNeisseria meningitidisStreptococcus penumoniaeenterovirusmeningitis

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