title: Incidence, etiology, and outcome of bacterial meningitis in infants aged <90 days in the United kingdom and Republic of Ireland: prospective, enhanced, national population-based surveillance.
abstract: BACKGROUND
  Bacterial meningitis remains a major cause of morbidity and mortality in young infants. Understanding the epidemiology and burden of disease is important.
  
  
  METHODS
  Prospective, enhanced, national population-based active surveillance was undertaken to determine the incidence, etiology, and outcome of bacterial meningitis in infants aged <90 days in the United Kingdom and Ireland.
  
  
  RESULTS
  During July 2010-July 2011, 364 cases were identified (annual incidence, 0.38/1000 live births; 95% confidence interval [CI], .35-.42). In England and Wales, the incidence of confirmed neonatal bacterial meningitis was 0.21 (n = 167; 95% CI, .18-.25). A total of 302 bacteria were isolated in 298 (82%) of the cases. The pathogens responsible varied by route of admission, gestation at birth, and age at infection. Group B Streptococcus (GBS) (150/302 [50%]; incidence, 0.16/1000 live births; 95% CI, .13-.18) and Escherichia coli (41/302 [14%]; incidence, 0.04/1000; 95% CI, .03-.06) were responsible for approximately two-thirds of identified bacteria. Pneumococcal (28/302 [9%]) and meningococcal (23/302 [8%]) meningitis were rare in the first month, whereas Listeria meningitis was seen only in the first month of life (11/302 [4%]). In hospitalized preterm infants, the etiology of both early- and late-onset meningitis was more varied. Overall case fatality was 8% (25/329) and was higher for pneumococcal meningitis (5/26 [19%]) than GBS meningitis (7/135 [5%]; P = .04) and for preterm (15/90 [17%]) compared with term (10/235 [4%]; P = .0002) infants.
  
  
  CONCLUSIONS
  The incidence of bacterial meningitis in young infants remains unchanged since the 1980s and is associated with significant case fatality. Prevention strategies and guidelines to improve the early management of cases should be prioritized.
authors.forename: Ifeanyichukwu O
authors.initials: IO
authors.lastname: Okike
authors.forename: Alan P
authors.initials: AP
authors.lastname: Johnson
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Henderson
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Blackburn
authors.forename: Berit
authors.initials: B
authors.lastname: Muller-Pebody
authors.forename: Shamez N
authors.initials: SN
authors.lastname: Ladhani
authors.forename: Mark
authors.initials: M
authors.lastname: Anthony
authors.forename: Nelly
authors.initials: N
authors.lastname: Ninis
authors.forename: Paul T
authors.initials: PT
authors.lastname: Heath
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007494:Ireland / Q000453:epidemiology; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology; D009026:Mortality; D063868:Patient Outcome Assessment; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: BPSU; bacterial; meningitis; neonatal; surveillance