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

Kadambari, S; Braccio, S; Ribeiro, S; Allen, DJ; Pebody, R; Brown, D; Cunney, R; Sharland, M; Ladhani, S (2019) Enterovirus and parechovirus meningitis in infants younger than 90 days old in the UK and Republic of Ireland: a British Paediatric Surveillance Unit study. Arch Dis Child, 104 (6). pp. 552-557. ISSN 1468-2044 https://doi.org/10.1136/archdischild-2018-315643
SGUL Authors: Ladhani, Shamez Nizarali

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Abstract

OBJECTIVES: This 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 SETTING: Prospective, 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 MEASURES: To describe the clinical burden of EV and HPeV meningitis in infants aged <90 days. RESULTS: During 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. CONCLUSION: The 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.

Item Type: Article
Additional Information: This article has been accepted for publication in Archives of Disease in Childhood, 2018 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/archdischild-2018-315643. © Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: infectious diseases, microbiology, virology, 1103 Clinical Sciences, 1114 Paediatrics And Reproductive Medicine, 1117 Public Health And Health Services, Pediatrics
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Arch Dis Child
ISSN: 1468-2044
Language: eng
Dates:
DateEvent
17 May 2019Published
8 December 2018Published Online
7 November 2018Accepted
Publisher License: Publisher's own licence
PubMed ID: 30530486
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/110544
Publisher's version: https://doi.org/10.1136/archdischild-2018-315643

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