The epidemiology of acute meningitis in children in England and Wales

A discussion of treatment and prevention options Acute meningitis is a disease that causes high levels of anxiety among parents and the medical profession. Meningitis is often caused, however, by organisms that more commonly result in a mild or asymptomatic infection. Young children are most at risk of meningitis,1,2 but the clinical severity also depends on the causative organism; viral meningitis is rarely severe and children tend to make a complete recovery, whereas bacterial meningitis can have a rapid onset, leading to death and serious neurological sequelae.3 In the past 50 years in England and Wales, many infections that may cause meningitis have been controlled through routine childhood vaccination programmes. In the short to medium term, the wider use of available vaccines has the potential to prevent even more cases and deaths from this disease. In the longer term, options for further prevention by vaccines against new targets seem promising. Routine surveillance of meningitis in England and Wales relies on several sources. Clinically diagnosed cases are notified to Consultants in Communicable Disease Control (CCDCs) and passed on to the Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC). Infections confirmed by isolation from the cerebrospinal fluid (or from a normally sterile site but accompanied by symptoms of meningitis) are also reported by laboratories or referred to the PHLS reference laboratories for further typing. Deaths as a result of meningitis are recorded through the medical certificate of cause of death at the Office of National Statistics (ONS). These routine systems are also used conjointly with enhanced surveillance schemes to monitor meningococcal and pneumococcal meningitis,4,5 and alongside special studies (including the British Paediatric Surveillance Unit “orange card” system (www.bpsu.inopsu.com/)) in the surveillance of neonatal meningitis.6 A further source is Hospital Episode Statistics (HES) (www.doh.gov.uk//hes/). These …

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