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Childhood meningitis in the conjugate vaccine era: a prospective cohort study
  1. Manish Sadarangani1,
  2. Louise Willis1,
  3. Seilesh Kadambari2,
  4. Stuart Gormley3,
  5. Zoe Young1,
  6. Rebecca Beckley1,
  7. Katherine Gantlett1,
  8. Katharine Orf4,
  9. Sarah Blakey4,
  10. Natalie G Martin1,
  11. Dominic F Kelly1,
  12. Paul T Heath2,
  13. Simon Nadel3,
  14. Andrew J Pollard1
  1. 1Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
  2. 2Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
  3. 3Department of Paediatrics, St Mary's Hospital, London, UK
  4. 4University of Oxford Medical School, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Dr Manish Sadarangani, Department of Paediatrics, University of Oxford, Level 2, Children's Hospital, Headley Way, Headington, Oxford OX3 9DU, UK; manish.sadarangani{at}


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.

  • enterovirus
  • Group B Streptococcus
  • meningitis
  • Neisseria meningitidis
  • Streptococcus penumoniae

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