Epidemiological trends in viral meningitis in England: Prospective national surveillance, 2013-2023

Seilesh Kadambari; Fariyo Abdullahi; Cristina Celma; Shamez Ladhani

doi:10.1016/j.jinf.2024.106223

Epidemiological trends in viral meningitis in England: Prospective national surveillance, 2013-2023

J Infect. 2024 Sep;89(3):106223. doi: 10.1016/j.jinf.2024.106223. Epub 2024 Jul 8.

Authors

Seilesh Kadambari¹, Fariyo Abdullahi², Cristina Celma³, Shamez Ladhani⁴

Affiliations

¹ Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; UCL Great Ormond Street Institute of Child Health, London, UK. Electronic address: Seilesh.kadambari@gosh.nhs.uk.
² Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK.
³ Enteric Virus Unit, UK Health Security Agency, Colindale, London, UK.
⁴ Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK; Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, UK.

PMID: 38986749
DOI: 10.1016/j.jinf.2024.106223

Abstract

Background: In the conjugate vaccine era, viruses are the most common cause of meningitis. Here, we evaluated epidemiological trends in laboratory-confirmed viral meningitis across all age-groups over an 11-year period in England.

Methods: In England, hospital laboratories routinely report laboratory-confirmed infections electronically to the UK Health Security Agency. Records of positive viral detections in cerebrospinal fluid during 2013-2023 were extracted. Incidence rates with confidence intervals were calculated using mid-year resident population estimates.

Results: There were 22,114 laboratory-confirmed viral meningitis cases, including 15,299 cases during 2013-19 (pre COVID-19), with a gradual increase in incidence from 3.5/100,00 (95%CI: 3.3-3.6) to 3.9/100,000 (95%CI: 3.6-4.1). During 2020-21 when pandemic restrictions were in place, there were 2061 cases (1.8/100,000; 1.7-1.9), which increased to 4754 (4.2/100,000; 4.0-4.3) during 2022-23 (post pandemic restrictions). Infants aged <3 months accounted for 39.4% (8702/22,048) of all cases, with a stable incidence 2013-19 (504/100,000, 95%CI: 491-517), followed by a significant decline during 2020-21 (204/100,000; 188-221) and then an increase during 2022-23 (780/100,000; 749-812), with enteroviruses being the commonest cause (84.9%, 7387/8702; 424.74/100,000; 95%CI: 415.12-434.51), followed by parechoviruses (9.1%, 792/8702; 45.54/100,000; 95%CI: 42.42-48.82) and herpes simplex virus (4.4%, 380/8702; 21.85/100,000; 95%CI: 19.71-24.16). Pandemic restrictions were associated with significant declines in the incidence of enterovirus (77.7%) and parechoviruses (64% lower), with rebounds after societal restrictions were lifted.

Conclusions: Rates of viral meningitis have returned to pre-pandemic levels since societal restrictions were lifted. The highest incidence of viral meningitis remains in infants aged <3 months and most commonly due to enteroviral infection.

Keywords: Enterovirus; Epidemiology; Herpes simplex virus; Meningitis; Parechovirus; Viral.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
COVID-19 / epidemiology
Child
Child, Preschool
England / epidemiology
Epidemiological Monitoring
Female
Humans
Incidence
Infant
Infant, Newborn
Male
Meningitis, Viral* / epidemiology
Meningitis, Viral* / virology
Middle Aged
Prospective Studies
Young Adult