Enterovirus and parechovirus meningitis in infants younger than 90 days old in the UK and Republic of Ireland: a British Paediatric Surveillance Unit study

Abstract

ObjectivesThis study aimed to prospectively collect detailed clinical information for all enterovirus (EV) and human parechovirus (HPeV) meningitis cases in infants aged <90 days in the UK and Ireland.Participants, design and settingProspective, active national surveillance during July 2014 to July 2015 through the British Paediatric Surveillance Unit. Reporting paediatricians completed questionnaires requesting information on clinical presentation, investigations, management and outcomes at hospital discharge and after 12 months.Main outcome measuresTo describe the clinical burden of EV and HPeV meningitis in infants aged <90 days.ResultsDuring the 13-month surveillance period, 703 cases (668 EV, incidence0.79/1,000 live- births; 35 HPeV, 0.04/1,000 live-births) were identified. The most common clinical presentations were fever (EV: 570/668(85%); HPeV: 28/35(80%)), irritability (EV: 441/668(66%); HPeV: 23/35(66%)) and reduced feeding (EV: 363/668(54%); HPeV 23/35(66%)). Features of circulatory shock were present in 27% (182/668) of EV and 43% (15/35) of HPeV cases. Overall, 11% (76/668) of EV and 23% (8/35) of HPeV cases required intensive care support. Nearly all cases (678/703, 96%) were confirmed by cerebrospinal fluid (CSF) PCR, with 52% (309/600) having normal CSF white cell count for age. Two infants with EV meningitis died (2/668, 0.3%) and four survivors (4/666, 0.6%) had long-term complications at 12 months’ follow-up. Infants with HPeV meningitis survived without sequelae. Overall 189 infants had a formal hearing test and none had sensorineural hearing loss.ConclusionThe incidence of laboratory-confirmed EV/HPeV meningitis in young infants is more than twice that for bacterial meningitis. Less than 1% will develop severe neurological complications or die of their infection. Further studies are required to formally assess long-term neurodevelopmental sequelae.

Outcomes beyond hospital discharge in infants and children with viral meningitis: A systematic review

“…In the United Kingdom, the largest follow‐up study of EV meningitis included 668 cases in infants less than 3 months old and followed up till 12 months of life . No infants had hearing loss.…”

“…In the United Kingdom, a prospective national study using questionnaires completed by paediatricians managing 35 HPeV cases less than 3 months old showed that none had SNHL or neurodevelopmental delay at 12‐month follow‐up . In England during 2016, a retrospective study using a similar questionnaire‐based methodology showed that 5% (5/106) of cases had seizures beyond hospital discharge, but again, there was no evidence of SNHL or neurodevelopmental delay…”

“…As a consequence of limited clinical and epidemiological data, management of viral meningitis beyond discharge from hospital may be inconsistent. A British Paediatric Surveillance Unit (BPSU) study showed that only 38% (254/668) of infants with EV meningitis and 46% (16/35) of infants with human parechovirus (HPeV) meningitis were reviewed by the clinical team on at least one occasion within 12 months of hospital discharge …”

Screening for enteroviral meningitis in infants and children—Is it useful in clinical practice?

“…Another recent study from the UK showed that testing CSF samples from viral PCR without any screening criteria in children under aged < 5 years who presented with sepsis‐like illness or meningitis increased the detection of EV and/or HPeV from 3.1% to 26.4% . A recent BPSU study with 703 cases of EV and HPeV related meningitis demonstrated that >50% of the infants (aged <3 months) had absent CSF pleocytosis and low inflammatory markers . Consequently, we now recommend PCR testing locally on all infants <6 months old, irrespective of CSF WCC count (adjusted or unadjusted) where viral meningitis is suspected.…”

“…2 is more than double that for bacterial meningitis in this age group. 3 The same study showed that <1% of infants in the EV meningitis group developed significant complications (n = 4) or died of their infection (n = 2). 3 All infants with HPeV meningitis survived without any sequelae.…”