Pediatric Enterovirus Meningitis Shows Low Long-Term Risk, Global Burden Remains High
A study finds most children with enterovirus meningitis have favorable long-term outcomes, with only 8.9% experiencing adverse sequelae. Meanwhile, global data shows 259,000 meningitis deaths in 2023, with children under 5 accounting for over one-third of fatalities. Non-polio enteroviruses were the leading cause of meningitis cases worldwide.
Most children with enterovirus meningitis experience favorable long-term outcomes, with adverse sequelae occurring infrequently and primarily among those with underlying risk factors, according to study findings published in Open Forum Infectious Diseases. In 2023, there were 259,000 global deaths and 2.54 million incident cases of meningitis, with more than one-third of deaths accounted for by children younger than 5 years.
The leading cause of viral meningitis in pediatric populations is enteroviruses. A retrospective, multicenter cohort study evaluating outcomes among children with EV meningitis across 4 tertiary care centers in London, England, over a 10-year period (2013-2023) included 243 pediatric patients with polymerase chain reaction-confirmed EV meningitis. Infants predominated the cohort, with 82.3% younger than 3 months at diagnosis and 56.3% boys. Baseline comorbidities were present in 23.0% of patients.
Markers of disease severity varied across the cohort. Overall, 13.6% of patients required admission to the intensive care unit, with the majority of these patients requiring mechanical ventilation. Despite this, most children did not receive targeted antiviral or immunomodulatory therapies, particularly among those without underlying comorbidities.
Among 189 patients with available outcome data, the median follow-up duration reached 16 months among those with documented specialist follow-up. Adverse outcomes occurred in 8.9% of the overall cohort but remained uncommon among otherwise healthy infants younger than 3 months. In this subgroup, nearly all patients achieved full recovery.
Patients with adverse sequelae more frequently presented with comorbid conditions and markers of severe illness. Specifically, 64.7% had baseline comorbidities, and 35.3% required ICU admission. Developmental impairments, particularly persistent motor dysfunction such as hypotonia, represented the most frequently observed sequelae. Other reported outcomes included academic or speech-related difficulties and, less commonly, hearing impairment.
Multivariable analysis identified several factors associated with an increased likelihood of adverse outcomes. Absence of fever at presentation was associated with higher odds of poor recovery, as well as seizures and the presence of comorbidities.
The global burden of meningitis remains substantial. Researchers estimated meningitis mortality using the Cause of Death Ensemble model and morbidity using DisMod-MR 2.1 to examine the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2023 framework. The leading causes of death were Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses, while the most cases were caused by non-polio enteroviruses. The four World Health Organization-defined preventable meningitis pathogens of interest contributed to 98,700 deaths and 594,000 cases. The top factors for meningitis-related mortality were low birthweight, short gestation, and household air pollution.
"Targeted investment in WHO pillars, including expanded vaccination coverage, new vaccine development, antibiotic stewardship, region-specific outbreak preparedness, and advances in treatment access and equity, could help to prevent disability and mortality caused by meningitis," the authors write.