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Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011–2014

Hasbun, Rodrigo, MD*; Wootton, Susan H., MD; Rosenthal, Ning, MD; Balada-Llasat, Joan Miquel, PharmD§; Chung, Jessica, PhD; Duff, Steve, MS; Bozzette, Samuel, MD‡,‖; Zimmer, Louise**; Ginocchio, Christine C., PhD**,††

The Pediatric Infectious Disease Journal: January 2019 - Volume 38 - Issue 1 - p 37–41
doi: 10.1097/INF.0000000000002081
Original Studies
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Background: Large epidemiologic studies evaluating the etiologies, management decisions and outcomes of infants and children with meningitis and encephalitis in the United States are lacking.

Methods: Children 0–17 years of age with meningitis or encephalitis as assessed by International Classification of Diseases, Ninth Revision, codes available in the Premier Healthcare Database during 2011–2014 were analyzed.

Results: Six thousand six hundred sixty-five patients with meningitis or encephalitis were identified; 3030 (45.5%) were younger than 1 year of age, 295 (4.4%) were 1–2 years of age, 1460 (21.9%) were 3–9 years of age, and 1880 (28.2%) were 10–17 years of age. Etiologies included enterovirus (58.4%), unknown (23.7%), bacterial (13.0%), noninfectious (3.1%), herpes simplex virus (1.5%), other viruses (0.7%), arboviruses (0.5%) and fungal (0.04%). The majority of patients were male [3847 (57.7%)] and healthy [6094 (91.4%)] with no reported underlying conditions. Most underwent a lumbar puncture in the emergency department [5363 (80%)] and were admitted to the hospital [5363 (83.1%)]. Antibiotic therapy was frequent (92.2%) with children younger than 1 year of age with the highest rates (97.7%). Antiviral therapy was less common (31.1%). Only 539 (8.1%) of 6665 of patients received steroids. Early administration of adjunctive steroids was not associated with a reduction in mortality (P = 0.266). The overall median length of stay was 2 days. Overall mortality rate (0.5%) and readmission rates (<1%) was low for both groups.

Conclusion: Meningitis and encephalitis in infants and children in the United States are more commonly caused by viruses and are treated empirically with antibiotic therapy and antiviral therapy in a significant proportion of cases. Adjunctive steroids are used infrequently and are not associated with a benefit in mortality.

From the *Department of Internal Medicine

Department of Pediatrics, McGovern Medical School at UTHealth

Premier Applied Sciences, Premier Inc., Charlotte, North Carolina

§Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH

Veritas Health Economics Consulting, Carlsbad, CA

School of Global Policy, University of California, San Diego, CA

**bioMérieux, Durham, NC

††Department of Pathology and Laboratory Medicine, Hofstra North Shore-LIJ/School of Medicine, Hempstead, NY.

Accepted for publication February 9, 2018.

This project was supported by bioMerieux (Durham, NC) R.H. is speaker for Pfizer, Medicine’s company, Merck, Biofire and consultant to bioMérieux; C.C.G. is an employee of bioMérieux and owns stock in bioMérieux. bioMérieux paid for the Premier database analysis and paid S.D., R.H. and J.M.B.-L. as consultants on the project. C.C.G. is an employee of bioMérieux. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Rodrigo Hasbun, MD, MPH, Department of Internal Medicine, UT Health McGovern Medical School, 6431 Fannin St. MSB 2.112, Houston, TX 77030. E-mail: rodrigo.hasbun@uth.tmc.edu.

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