title: Hospital admissions for viral meningitis in children in England over five decades: a population-based observational study.
abstract: BACKGROUND
  A substantial reduction in bacterial meningitis has occurred in the UK following successful implementation of immunisation programmes. Most childhood meningitis in developed countries is now caused by viruses. Long-term trends in paediatric viral meningitis in England have not previously been reported. The objective of this study is to report on epidemiological trends over time in childhood viral meningitis in England.
  
  
  METHODS
  In this population-based observational study, we used routinely collected hospital discharge records from English National Health Service hospitals from 1968-2011 to analyse annual age-specific admission rates for viral meningitis, including specific viral aetiologies, in children younger than 15 years.
  
  
  RESULTS
  We analysed hospital discharge records from Jan 1, 1968, to Dec 31, 2011. Hospital admission rates for viral meningitis from Jan 1, 1968, to Dec 31, 1985, varied annually, with a mean of 13·5 admissions per 100 000 children aged less than 15 years, per year (95% CI 13·0-14·0). Admission rates declined during the late 1980s, and the mean number of admissions from 1989-2011 was 5·2 per 100 000 per year (5·1-5·3). This decrease was entirely in children aged 1-14 years. Admission rates for infants aged less than 1 year increased since 2005, to 70·0 per 100 000 (63·7-76·2) in 2011, which was driven by an increase in admission of infants aged 90 days or less. In 1968-85, the majority of cases in children were in those aged 1-14 years (22 150 [89%] of 24 920 admissions). In 2007-11, 1716 (72%) of 2382 cases were in infants. Admissions for mumps-related meningitis almost disappeared following introduction of the measles-mumps-rubella (MMR) vaccine in 1988. Admissions with a specified viral aetiology have increased since 2000.
  
  
  CONCLUSIONS
  Trends in viral meningitis admissions have changed substantially over the past 50 years, and probably reflect the impact of the MMR vaccine programme and the use of more sensitive diagnostic techniques.
  
  
  BACKGROUND
  None.
authors.affiliation: Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Department of Paediatrics, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand. Electronic address: natalie.martin@otago.ac.nz.
authors.forename: Natalie G
authors.initials: NG
authors.lastname: Martin
authors.affiliation: Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK.
authors.forename: Mildred A
authors.initials: MA
authors.lastname: Iro
authors.affiliation: Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK.
authors.forename: Manish
authors.initials: M
authors.lastname: Sadarangani
authors.affiliation: Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Raphael
authors.initials: R
authors.lastname: Goldacre
authors.affiliation: Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Pollard
authors.affiliation: Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goldacre
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004739:England; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007231:Infant, Newborn; D016920:Meningitis, Bacterial / Q000517:prevention & control; D008587:Meningitis, Viral / Q000453:epidemiology*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011159:Population Surveillance