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Title: Childhood meningitis : current and previous UK epidemiology, clinical and laboratory characteristics and outcomes
Author: Martin, Natalie G.
ISNI:       0000 0004 6500 6972
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2017
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Introduction: Following reductions in bacterial meningitis which occurred in the UK due to the implementation of vaccine programmes, contemporary knowledge was needed about the current aetiology of childhood meningitis in the context of historical changes in epidemiology, how to reliably distinguish bacterial and aseptic meningitis at presentation to hospital, and outcomes particularly following viral meningitis. Methods: Annual hospital admission rates were analysed for bacterial and viral meningitis in children <15 years in England from the 1960s to 2011. Data from a prospective cohort study performed across 31 UK hospital sites from 2012-2016, recruiting children <16 years with confirmed or suspected meningitis was used to investigate current aetiology, clinical and laboratory features, clinical decision models to distinguish bacterial and aseptic meningitis, short term outcomes at 3 months post-discharge and health-related quality of life until 18 months post-discharge. A study of enteroviral (EV) PCR from non-CSF sites in a subset of participants with suspected or confirmed viral meningitis was also performed. Results: Hospital admissions datasets demonstrated a reduction in bacterial meningitis of different aetiologies after the introduction of different vaccines, a reduction in viral meningitis admissions in children >1 year since the 1980s, but a recent increase in viral meningitis admissions in infants. Of 2754 prospectively recruited children with suspected meningitis, 892 had meningitis, of which 80.7% (720/892) were aseptic, 34.2% (305/892) were caused by enteroviruses and 31.3% (280/892) had no identified aetiology. Following analyses of clinical and laboratory features of meningitis of different aetiologies, a pre-existing bacterial meningitis score was assessed, and a new clinical decision model was developed to distinguish aseptic from bacterial meningitis at hospital presentation. In a subset of children, EV-PCR performed on non-CSF samples demonstrated that in EV meningitis all available stool samples were EV-PCR+, and 35% of children with aseptic meningitis of unknown aetiology had a stool EV-PCR+ result. Analysis of short term outcomes and health related quality of life indicated that although sequelae and lower quality of life scores occurred most often following bacterial meningitis, for enteroviral meningitis parental concern about sequalae and limited lower quality of life scores were reported compared with a control group. Conclusion: These data could inform priorities for prevention and improve the care of children with meningitis.
Supervisor: Kelly, Dominic F. ; Pollard, Andrew J. ; Sadarangani, Manish Sponsor: Meningitis Research Foundation ; University of Oxford ; Royal Australasian College of Physicians ; Canterbury Medical Research Foundation
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available