Trends in bacterial, mycobacterial, and fungal meningitis in England and Wales 2004-11: an observational study

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• 作者：Ifeanichukwu O Okike ; MRCPCH^a ; ^b ; Sonia Ribeiro ; BA^b ; Mary E Ramsay ; FFPH^b ; Prof Paul T Heath ; FRCPCH^a ; Prof Mike Sharland ; FRCPCH^a ; Dr Shamez N Ladhani ; PhD^a ; ^b ; ^{shamez.ladhani@phe.gov.uk" class="auth_mail}
• 刊名：The Lancet Infectious Diseases
• 出版年：April, 2014
• 年：2014
• 卷：14
• 期：4
• 页码：301-307
• 全文大小：393 K

文摘

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Summary

Background

Meningitis remains one of the most feared infectious diseases worldwide, yet there are few population-based studies on the epidemiology, causes, or trends over time in meningitis, especially in industrialised countries. Our aim was to do such a study using routinely reported data available in England and Wales.

Methods

In England and Wales, UK National Health Service hospitals routinely report laboratory-confirmed pathogens electronically to Public Health England. Records of all positive bacterial, mycobacterial, and fungal results from cerebrospinal fluid or from blood cultures in patients with clinical meningitis were extracted for analysis. The percentage change in annual incidence was estimated using linear regression analysis of the log of the annual incidence.

Findings

During 2004-11, 7061 cases of meningitis were reported (mean annual incidence 1路62 per 100鈥?00 people, 95% CI 1路58-1路66), including 2594 cases in children (37%). The incidence of bacterial (1路44 per 100鈥?00 people, 1路41-1路48), fungal (0路09, 0路08-0路10), and mycobacterial (0路09, 0路08-0路09) meningitis remained stable overall and across the age groups, apart from significant year-on-year increases in children younger than 3 months (978 cases; incidence 72路2 per 100鈥?00 people; annual increase 7路4%, 5路1-9路8; p<0路0001) driven mainly by group B streptococci (GBS), and in adults aged 65 years or older (752 cases; incidence 1路2 per 100鈥?00 people; annual increase 3路0%, 1路4-4路8; p<0路0001) primarily because of Escherichia coli. By contrast, meningococcal meningitis rates declined steadily, but remained the most common cause of meningitis in children. Overall, five groups of bacteria accounted for 60% (3790/6286) of bacterial meningitis cases: Neisseria meningitidis (1350 cases, 22%), Streptococcus pneumoniae (1143, 18%), Staphylococcus aureus (652, 10%), GBS (326, 5%), and E coli (319, 5%).

Interpretation

In England and Wales, laboratory-based surveillance shows a remarkably stable incidence of bacterial, fungal, and mycobacterial meningitis in recent years, although there were differences in individual trends among the main pathogens causing meningitis in different age groups.

Funding

None.