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Enterovirus and parechovirus meningitis in infants younger than 90 days old in the UK and Republic of Ireland: a British Paediatric Surveillance Unit study
  1. Seilesh Kadambari1,2,
  2. Serena Braccio1,
  3. Sonia Ribeiro3,
  4. David J Allen4,
  5. Richard Pebody5,
  6. David Brown4,
  7. Robert Cunney6,
  8. Mike Sharland1,
  9. Shamez Ladhani1,3
  1. 1 Paediatric Infectious Diseases Research Group, St George’s University of London, London, UK
  2. 2 Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
  3. 3 Immunisation, Hepatitis and Blood Safety Department, Public Health England, Colindale, London, UK
  4. 4 Virology Reference Department, Public Health England, London, UK
  5. 5 Influenza and other Respiratory Viruses Section, Public Health England, London, UK
  6. 6 Department of Microbiology, Temple Street Children’s University Hospital, Dublin, Ireland
  1. Correspondence to Dr Seilesh Kadambari, Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK; seilesh.kadambari{at}


Objectives This study aimed to prospectively collect detailed clinical information for all enterovirus (EV) and human parechovirus (HPeV) meningitis cases in infants aged <90 days in the UK and Ireland.

Participants, design and setting Prospective, active national surveillance during July 2014 to July 2015 through the British Paediatric Surveillance Unit. Reporting paediatricians completed questionnaires requesting information on clinical presentation, investigations, management and outcomes at hospital discharge and after 12 months.

Main outcome measures To describe the clinical burden of EV and HPeV meningitis in infants aged <90 days.

Results During the 13-month surveillance period, 703 cases (668 EV, incidence0.79/1,000 live- births; 35 HPeV, 0.04/1,000 live-births) were identified. The most common clinical presentations were fever (EV: 570/668(85%); HPeV: 28/35(80%)), irritability (EV: 441/668(66%); HPeV: 23/35(66%)) and reduced feeding (EV: 363/668(54%); HPeV 23/35(66%)). Features of circulatory shock were present in 27% (182/668) of EV and 43% (15/35) of HPeV cases. Overall, 11% (76/668) of EV and 23% (8/35) of HPeV cases required intensive care support. Nearly all cases (678/703, 96%) were confirmed by cerebrospinal fluid (CSF) PCR, with 52% (309/600) having normal CSF white cell count for age. Two infants with EV meningitis died (2/668, 0.3%) and four survivors (4/666, 0.6%) had long-term complications at 12 months’ follow-up. Infants with HPeV meningitis survived without sequelae. Overall 189 infants had a formal hearing test and none had sensorineural hearing loss.

Conclusion The incidence of laboratory-confirmed EV/HPeV meningitis in young infants is more than twice that for bacterial meningitis. Less than 1% will develop severe neurological complications or die of their infection. Further studies are required to formally assess long-term neurodevelopmental sequelae.

  • infectious diseases
  • microbiology
  • virology

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  • Contributors SK and SL conceptualised and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. SB and SR designed the data collection instruments, collected the data and reviewed and revised the manuscript. DJA, RC, RP, DB and MS conceptualised and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval London Queen Square Research Ethics Committee (Ref: 14/LO/0229).

  • Provenance and peer review Not commissioned; externally peer reviewed.