title: Childhood meningitis in the conjugate vaccine era: a prospective cohort study.
abstract: Bacterial conjugate vaccines have dramatically changed the epidemiology of childhood meningitis; viral causes are increasingly predominant, but the current UK epidemiology is unknown. This prospective study recruited children under 16 years of age admitted to 3 UK hospitals with suspected meningitis. 70/388 children had meningitis-13 bacterial, 26 viral and 29 with no pathogen identified. Group B Streptococcus was the most common bacterial pathogen. Infants under 3 months of age with bacterial meningitis were more likely to have a reduced Glasgow Coma Score and respiratory distress than those with viral meningitis or other infections. There were no discriminatory clinical features in older children. Cerebrospinal fluid (CSF) white blood cell count and plasma C-reactive protein at all ages, and CSF protein in infants <3 months of age, distinguished between bacterial meningitis and viral meningitis or other infections. Improved diagnosis of non-bacterial meningitis is urgently needed to reduce antibiotic use and hospital stay.
authors.affiliation: Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.
authors.forename: Manish
authors.initials: M
authors.lastname: Sadarangani
authors.affiliation: Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Willis
authors.affiliation: Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.
authors.forename: Seilesh
authors.initials: S
authors.lastname: Kadambari
authors.affiliation: Department of Paediatrics, St Mary's Hospital, London, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Gormley
authors.affiliation: Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Young
authors.affiliation: Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Beckley
authors.affiliation: Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Gantlett
authors.affiliation: University of Oxford Medical School, John Radcliffe Hospital, Oxford, UK.
authors.forename: Katharine
authors.initials: K
authors.lastname: Orf
authors.affiliation: University of Oxford Medical School, John Radcliffe Hospital, Oxford, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Blakey
authors.affiliation: Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.
authors.forename: Natalie G
authors.initials: NG
authors.lastname: Martin
authors.affiliation: Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.
authors.forename: Dominic F
authors.initials: DF
authors.lastname: Kelly
authors.affiliation: Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Heath
authors.affiliation: Department of Paediatrics, St Mary's Hospital, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Nadel
authors.affiliation: Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Pollard
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000382:microbiology / Q000517:prevention & control; D008587:Meningitis, Viral / Q000175:diagnosis* / Q000517:prevention & control / Q000821:virology; D011446:Prospective Studies; D006113:United Kingdom; D018074:Vaccines, Conjugate / Q000008:administration & dosage
chemical_list: D018074:Vaccines, Conjugate
keywords: Group B Streptococcus; Neisseria meningitidis; Streptococcus penumoniae; enterovirus; meningitis