Paediatric meningitis in the conjugate vaccine era and a novel clinical decision model to predict bacterial aetiology - 30/04/24

Doi : 10.1016/j.jinf.2024.106145

N.G. Martin ^a,^b, S. Defres ^c, L. Willis ^a, R. Beckley ^a, H. Hardwick ^c, A. Coxon ^a, S. Kadambari ^d,^e, L.-M. Yu ^f, X. Liu ^a, U. Galal ^a, K. Conlin ^a, M.J. Griffiths ^c,^g, R. Kneen ^g, S. Nadel ^h, P.T. Heath ⁱ, D.E. Kelly ^a, T. Solomon ^c,^j, M. Sadarangani ^k,^l,^⁎,^{^{1
Joint senior authors.}} , A.J. Pollard ^a,^{^{1
Joint senior authors.}}
on behalf of the UK-ChiMES and ENCEPH-UK study groups^²
Full list of authors included in the group is included in Supplementary Table 13.
^a Department of Paediatrics, University of Oxford and the Oxford University Hospitals NHS Foundation Trust, Level 2, Children’s Hospital, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
^b Department of Paediatrics, University of Otago Christchurch, 2 Riccarton Avenue, Christchurch Central City, Christchurch 8011, New Zealand
^c Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK
^d Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
^e Infection, Immunity & Inflammation Department, University College London, Great Ormond Street Institute of Child Health, 30 Guilford St, London WC1N 1EH, UK
^f Nuffield Department of Primary Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, UK
^g Department of Neurology, Alder Hey Children's NHS Trust, E Prescot Rd, Liverpool L14 5AB, UK
^h Department of Paediatrics, St. Mary’s Hospital, Praed St, London W2 1NY, UK
ⁱ Centre for Neonatal and Paediatric Infection & Vaccine Institute, St. George’s, University of London, Cranmer Terrace, London SW17 0RE, UK
^j Department of Neurology, Walton Centre NHS Foundation Trust, Lower Ln, Fazakerley, Liverpool L9 7LJ, UK
^k Vaccine Evaluation Center, BC Children’s Hospital Research Institute, 950 West 28th Ave, Vancouver, BC V5Z 4H4, Canada
^l Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC V5Z 4H4, Canada

^⁎Corresponding author at: Vaccine Evaluation Center, BC Children’s Hospital Research Institute, 950 West 28th Ave, Vancouver, BC V5Z 4H4, Canada.Vaccine Evaluation Center, BC Children’s Hospital Research Institute950 West 28th AveVancouverBCV5Z 4H4Canada

Summary

Objectives

The aims of this study were to assess aetiology and clinical characteristics in childhood meningitis, and develop clinical decision rules to distinguish bacterial meningitis from other similar clinical syndromes.

Methods

Children aged <16 years hospitalised with suspected meningitis/encephalitis were included, and prospectively recruited at 31 UK hospitals. Meningitis was defined as identification of bacteria/viruses from cerebrospinal fluid (CSF) and/or a raised CSF white blood cell count. New clinical decision rules were developed to distinguish bacterial from viral meningitis and those of alternative aetiology.

Results

The cohort included 3002 children (median age 2·4 months); 1101/3002 (36·7%) had meningitis, including 180 bacterial, 423 viral and 280 with no pathogen identified. Enterovirus was the most common pathogen in those aged <6 months and 10–16 years, with Neisseria meningitidis and/or Streptococcus pneumoniae commonest at age 6 months to 9 years. The Bacterial Meningitis Score had a negative predictive value of 95·3%. We developed two clinical decision rules, that could be used either before (sensitivity 82%, specificity 71%) or after lumbar puncture (sensitivity 84%, specificity 93%), to determine risk of bacterial meningitis.

Conclusions

Bacterial meningitis comprised 6% of children with suspected meningitis/encephalitis. Our clinical decision rules provide potential novel approaches to assist with identifying children with bacterial meningitis.

Funding

This study was funded by the Meningitis Research Foundation, Pfizer and the NIHR Programme Grants for Applied Research.

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Highlights

•	First study to describe childhood meningitis in the UK in the conjugate vaccine era.
•	37% had meningitis; 26% with aseptic meningitis, and 6% with bacterial meningitis.
•	Most meningitis cases were caused by enterovirus.
•	The Bacterial Meningitis Score had a high negative predictive value of 95%.
•	We developed two clinical decision rules to determine risk of bacterial meningitis.

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Keywords : Meningitis, Children, Cerebrospinal fluid, Diagnostics, Bacteria

Plan

Introduction

Methods

Participant recruitment

Clinical data collection

Definitions

Outcomes

Statistical analysis

Evaluation of the ‘Bacterial Meningitis Score’

Development of a new multivariable rule to predict probability of bacterial meningitis

Ethics

Results

Description of study population

Meningitis aetiology

Clinical and laboratory characteristics (; )

Validation of the ‘Bacterial Meningitis Score’

Development of new multivariable rules to predict the probability of bacterial meningitis

Discussion

Source of Funding

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Vol 88 - N° 5

Article 106145- mai 2024 Retour au numéro

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Paediatric meningitis in the conjugate vaccine era and a novel clinical decision model to predict bacterial aetiology - 30/04/24

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