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Trends in Laboratory-Confirmed Bacterial Meningitis (2012-2019): National Observational Study, England

21 Pages Posted: 20 Dec 2021

See all articles by Sathyavani Subbarao

Sathyavani Subbarao

St. George Hospital; Government of the United Kingdom - Immunisation and Countermeasures Division

Sonia Ribeiro

Government of the United Kingdom - Immunisation and Countermeasures Division

Helen Campbell

Government of the United Kingdom - Immunisation and Countermeasures Division

Ifeanichukwu Okike

Derbyshire Healthcare NHS Foundation Trust

Mary E. Ramsay

Public Health England - Immunisation, Hepatitis, and Blood Safety Department

Shamez Ladhani

Public Health England - Immunisation and Countermeasures Division; University of London, St. George's, Paediatric Infectious Diseases Research Group

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Abstract

Background: Bacterial meningitis is associated with significant morbidity and mortality worldwide. We aimed to describe the epidemiology, aetiology, trends over time and outcomes of laboratory-confirmed bacterial meningitis in England during 2012-2019.

Methods: Public Health England routinely receives electronic notifications of confirmed infections from National Health Service hospital laboratories in England. Data were extracted for positive bacterial cultures, PCR-positive results for Neisseria meningitidis or Streptococcus pneumoniae from cerebrospinal fluid and positive blood cultures in patients with clinical meningitis.

Findings: During 2012-19, there were 6,554 laboratory-confirmed cases. Mean annual incidence was 1.49/100,000, which remained stable throughout the surveillance period (p=0.745). There were 155 different bacterial species identified, including 68.4% (106/1550) Gram-negative and 31.6% (49/155) Gram-positive bacteria. After excluding coagulase-negative staphylococci (2481/6554, 37.9%), the main pathogens causing meningitis were Streptococcus pneumoniae (811/4073, 19.9%), Neisseria meningitidis (497/4073, 12.2%), Staphylococcus aureus (467/4073, 11.5%), Escherichia coli (314/4073, 7.7%) and Group B Streptococcus (268/4073, 6.6%). Pneumococcal meningitis incidence increased significantly during 2012-9, while meningococcal, group A streptococcal and tuberculous meningitis declined. Infants aged <3 months had the highest mean incidence (55.6/100,000; 95%CI, 47.7-63.5) driven mainly by group B streptococci, followed by 3-11 month-olds (8.1/100,000; 95%CI 7.1-9.0), where pneumococcal and meningitis predominated. The 30-day case-fatality rate (CFR) was 10.0% (71/6554). Group A streptococcal meningitis had the highest CFR (47/85, 55.3%). The probability of surviving at 30 days was 95.3% (95%CI, 93.4-97.3%) for infants and 80.0% for older adults (77-84%).

Interpretation: The incidence of bacterial meningitis has remained stable. The high CFR highlights a need for prevention through vaccination.

Funding Information: PHE

Declaration of Interests: The authors declare no conflicts of interest.

Ethics Approval Statement: PHE has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002, to process patient confidential information for national surveillance of communicable diseases and as such, individual patient consent is not required.

Keywords: Bacterial meningitis, group B streptococci, meningococcal meningitis, pneumococcal meningitis, surveillance

Suggested Citation

Subbarao, Sathyavani and Subbarao, Sathyavani and Ribeiro, Sonia and Campbell, Helen and Okike, Ifeanichukwu and Ramsay, Mary E. and Ladhani, Shamez, Trends in Laboratory-Confirmed Bacterial Meningitis (2012-2019): National Observational Study, England. Available at SSRN: https://ssrn.com/abstract=3989846 or http://dx.doi.org/10.2139/ssrn.3989846

Sathyavani Subbarao (Contact Author)

St. George Hospital

Hamburg
Germany

Government of the United Kingdom - Immunisation and Countermeasures Division ( email )

United Kingdom

Sonia Ribeiro

Government of the United Kingdom - Immunisation and Countermeasures Division

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Helen Campbell

Government of the United Kingdom - Immunisation and Countermeasures Division ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Ifeanichukwu Okike

Derbyshire Healthcare NHS Foundation Trust ( email )

Mary E. Ramsay

Public Health England - Immunisation, Hepatitis, and Blood Safety Department ( email )

United Kingdom

Shamez Ladhani

Public Health England - Immunisation and Countermeasures Division ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

University of London, St. George's, Paediatric Infectious Diseases Research Group

United Kingdom

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