Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011-2014
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.Methods:
Children age 0-17 years with meningitis or encephalitis by ICD-9 codes available in the Premier Healthcare Database during 2011-2014 were analyzed.Results:
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.Conclusion:
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.