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

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Large epidemiological studies evaluating the etiologies, management decisions and outcomes of infants and children with meningitis and encephalitis in the United States (US) are lacking.


Children age 0-17 years with meningitis or encephalitis by ICD-9 codes available in the Premier Healthcare Database during 2011-2014 were analyzed.


6,665 patients with meningitis or encephalitis were identified; 3030 (45.5%) age < 1 year, 295 (4.4%) age 1 – 2 years, 1460 (21.9%) age 3 – 9 years, and 1880 (28.2%) age 10-17 years. Etiologies included enterovirus (58.4%); unknown (23.7%), bacterial (13.0%), non-infectious (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 [6,094 (91.4%)] with no reported underlying conditions. Most underwent an LP in the ED [5,363 (80%)] and were admitted to the hospital [5,363 (83.1%)]. Antibiotic therapy was frequent (92.2%) with children age < 1 year with the highest rates (97.7%). Antiviral therapy was less common (31.1%). Only 539 (8.1%) of 6,665 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.


Meningitis and encephalitis in infants and children in the US 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 is not associated with a benefit in mortality.

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