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Epidemiological trends in viral meningitis in England: prospective national surveillance, 2013-2023
Open accessAbstract
BACKGROUND: In the conjugate vaccine era, viruses are the most common cause of meningitis. Here, we evaluated epidemiological trends in laboratory-confirmed viral meningitis across all age-groups over an 11-year period in England. METHODS: In England, hospital laboratories routinely report laboratory-confirmed infections electronically to the UK Health Security Agency. Records of positive viral detections in cerebrospinal fluid during 2013-2023 were extracted. Incidence rates with confidence intervals were calculated using mid-year resident population estimates. RESULTS: There were 22,114 laboratory-confirmed viral meningitis cases, including 15,299 cases during 2013-19 (pre COVID-19), with a gradual increase in incidence from 3.5/100,00 (95%CI: 3.3-3.6) to 3.9/100,000 (95%CI: 3.6-4.1). During 2020-21 when pandemic restrictions were in place, there were 2061 cases (1.8/100,000; 1.7-1.9), which increased to 4754 (4.2/100,000; 4.0-4.3) during 2022-23 (post pandemic restrictions). Infants aged <3 months accounted for 39.4% (8702/22,048) of all cases, with a stable incidence 2013-19 (504/100,000, 95%CI: 491-517), followed by a significant decline during 2020-21 (204/100,000; 188-221) and then an increase during 2022-23 (780/100,000; 749-812), with enteroviruses being the commonest cause (84.9%, 7387/8702; 424.74/100,000; 95%CI: 415.12-434.51), followed by parechoviruses (9.1%, 792/8702; 45.54/100,000; 95%CI: 42.42-48.82) and herpes simplex virus (4.4%, 380/8702; 21.85/100,000; 95%CI: 19.71-24.16). Pandemic restrictions were associated with significant declines in the incidence of enterovirus (77.7%) and parechoviruses (64% lower), with rebounds after societal restrictions were lifted. CONCLUSIONS: Rates of viral meningitis have returned to pre-pandemic levels since societal restrictions were lifted. The highest incidence of viral meningitis remains in infants aged <3 months and most commonly due to enteroviral infection.
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In Türkiye, Ayhan et al. reported a bacterial detection rate of 20.6%, and Bal et al. reported a rate of 36.3%.
“In Türkiye, Ayhan et al.12 reported a bacterial detection rate of 20.6%, and Bal et al.14 reported a rate of 36.3%.”
From Clinical Impact of Cerebrospinal Fluid Multiplex Polymerase Chain Reaction (PCR) Testing in Children with Suspected Central Nervous System Infection (2025) · cites this paper as [14]
The Abstract describes surveillance of viral meningitis in England, and the Discussion says the study included only cases with a confirmed virus in cerebrospinal fluid. Searches for Ayhan, Bal, Türkiye, and the 20.6% and 36.3% bacterial detection rates found no passage addressing those reported results. (LLM, conf=0.75)
Experimental — accuracy not yet measuredIn pediatric studies using PCR for etiologic diagnosis of meningoencephalitis, viral pathogens were detected in 79.7% of cases in Ayhan et al., 84.5% in Mizuno et al., and 53.7% in Bal et al.
“In pediatric studies using PCR for the etiologic diagnosis of meningoencephalitis, viral pathogens were detected in 79.7% of cases in the study by Ayhan et al.12, 84.5% in the study by Mizuno et al.13, and 53.7% in the study by Bal et al.14”
From Clinical Impact of Cerebrospinal Fluid Multiplex Polymerase Chain Reaction (PCR) Testing in Children with Suspected Central Nervous System Infection (2025) · cites this paper as [14]
The Results report pathogen proportions among confirmed viral cases in England, not the proportion of pediatric meningoencephalitis cases in which PCR detected a virus. Searches for Ayhan and 79.7%, as well as Mizuno, Bal, 84.5%, and 53.7%, found no passage reporting those studies or figures. Section pages were not available in our copy. (LLM, conf=0.76)
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Metadata
- Authors
- Kadambari, S., Abdullahi, F., Celma, C., & Ladhani, S.
- Affiliations
- Great Ormond Street Hospital (GB)
- UK Health Security Agency (GB)
- St George's, University of London (GB)
- Corresponding author
- Kadambari, Seilesh
- Venue
- Journal of Infection
- Publisher
- Elsevier BV
- Published
- 2024-09
- Volume
- 89
- Issue
- 3
- Pages
- 106223
- ISSN
- 0163-4453 (ISSN-L)
- OpenAlex
- W4400410505
- Cited by
- 21
- References
- 29
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 1
- FWCI
- 7.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Infection (publishedVersion, cc-by)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Immunology Research
- Keywords
- viral meningitis, incidence trends, enterovirus, parechovirus, enterovirus 70, enterovirus D68, enterovirus 6, enterovirus 30, Enter
- MeSH terms
- COVID-19, Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, England, Female, Humans, Infant, Infant, Newborn, Male, Meningitis, Viral, Middle Aged, Prospective Studies, Incidence, Young Adult, Epidemiological Monitoring
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