Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study

UK Meningitis Study Investigators

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine the incidence, causes, and sequelae in UK adults to improve the management of patients and assist in health service planning. Methods: We did a multicentre prospective observational cohort study of adults with suspected meningitis at 42 hospitals across England. Nested within this study, in the National Health Service (NHS) northwest region (now part of NHS England North), was an epidemiological study. Patients were eligible if they were aged 16 years or older, had clinically suspected meningitis, and either underwent a lumbar puncture or, if lumbar puncture was contraindicated, had clinically suspected meningitis and an appropriate pathogen identified either in blood culture or on blood PCR. Individuals with ventricular devices were excluded. We calculated the incidence of viral meningitis using data from patients from the northwest region only and used these data to estimate the population-standardised number of cases in the UK. Patients self-reported quality-of-life and neuropsychological outcomes, using the EuroQol EQ-5D-3L, the 36-Item Short Form Health Survey (SF-36), and the Aldenkamp and Baker neuropsychological assessment schedule, for 1 year after admission. Findings: 1126 patients were enrolled between Sept 30, 2011, and Sept 30, 2014. 638 (57%) patients had meningitis: 231 (36%) cases were viral, 99 (16%) were bacterial, and 267 (42%) had an unknown cause. 41 (6%) cases had other causes. The estimated annual incidence of viral meningitis was 2·73 per 100 000 and that of bacterial meningitis was 1·24 per 100 000. The median length of hospital stay for patients with viral meningitis was 4 days (IQR 3–7), increasing to 9 days (6–12) in those treated with antivirals. Earlier lumbar puncture resulted in more patients having a specific cause identified than did those who had a delayed lumbar puncture. Compared with the age-matched UK population, patients with viral meningitis had a mean loss of 0·2 quality-adjusted life-years (SD 0·04) in that first year. Interpretation: Viruses are the most commonly identified cause of meningitis in UK adults, and lead to substantial long-term morbidity. Delays in getting a lumbar puncture and unnecessary treatment with antivirals were associated with longer hospital stays. Rapid diagnostics and rationalising treatments might reduce the burden of meningitis on health services. Funding: Meningitis Research Foundation and UK National Institute for Health Research.

Original languageEnglish (US)
Pages (from-to)992-1003
Number of pages12
JournalThe Lancet Infectious Diseases
Volume18
Issue number9
DOIs
StatePublished - Sep 1 2018

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Viral Meningitis
Observational Studies
Cohort Studies
Meningitis
Spinal Puncture
Incidence
Length of Stay
National Health Programs
England
Health Services
Antiviral Agents
Health Planning
Bacterial Meningitides
Quality-Adjusted Life Years
National Institutes of Health (U.S.)
Health Surveys
Research
Population
Epidemiologic Studies
Appointments and Schedules

All Science Journal Classification (ASJC) codes

  • Infectious Diseases

Cite this

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title = "Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study",
abstract = "Background: Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine the incidence, causes, and sequelae in UK adults to improve the management of patients and assist in health service planning. Methods: We did a multicentre prospective observational cohort study of adults with suspected meningitis at 42 hospitals across England. Nested within this study, in the National Health Service (NHS) northwest region (now part of NHS England North), was an epidemiological study. Patients were eligible if they were aged 16 years or older, had clinically suspected meningitis, and either underwent a lumbar puncture or, if lumbar puncture was contraindicated, had clinically suspected meningitis and an appropriate pathogen identified either in blood culture or on blood PCR. Individuals with ventricular devices were excluded. We calculated the incidence of viral meningitis using data from patients from the northwest region only and used these data to estimate the population-standardised number of cases in the UK. Patients self-reported quality-of-life and neuropsychological outcomes, using the EuroQol EQ-5D-3L, the 36-Item Short Form Health Survey (SF-36), and the Aldenkamp and Baker neuropsychological assessment schedule, for 1 year after admission. Findings: 1126 patients were enrolled between Sept 30, 2011, and Sept 30, 2014. 638 (57{\%}) patients had meningitis: 231 (36{\%}) cases were viral, 99 (16{\%}) were bacterial, and 267 (42{\%}) had an unknown cause. 41 (6{\%}) cases had other causes. The estimated annual incidence of viral meningitis was 2·73 per 100 000 and that of bacterial meningitis was 1·24 per 100 000. The median length of hospital stay for patients with viral meningitis was 4 days (IQR 3–7), increasing to 9 days (6–12) in those treated with antivirals. Earlier lumbar puncture resulted in more patients having a specific cause identified than did those who had a delayed lumbar puncture. Compared with the age-matched UK population, patients with viral meningitis had a mean loss of 0·2 quality-adjusted life-years (SD 0·04) in that first year. Interpretation: Viruses are the most commonly identified cause of meningitis in UK adults, and lead to substantial long-term morbidity. Delays in getting a lumbar puncture and unnecessary treatment with antivirals were associated with longer hospital stays. Rapid diagnostics and rationalising treatments might reduce the burden of meningitis on health services. Funding: Meningitis Research Foundation and UK National Institute for Health Research.",
author = "{UK Meningitis Study Investigators} and Fiona McGill and Griffiths, {Michael J.} and Bonnett, {Laura J.} and Geretti, {Anna Maria} and Michael, {Benedict D.} and Beeching, {Nicholas J.} and David McKee and Paula Scarlett and Hart, {Ian J.} and Mutton, {Kenneth J.} and Agam Jung and Guleed Adan and Alison Gummery and Sulaiman, {Wan Aliaa Wan} and Katherine Ennis and Martin, {Antony P.} and Alan Haycox and Alastair Miller and Tom Solomon and Adekola Adedeji and Ajdukiewicz Katharine and Birkenhead David and Blanchard Thomas and Cadwgan Antony and Chadwick David and Cheesbrough John and Cooke Richard and Croall John and Crossingham Iain and Dunbar James and Ellis Simon and Faris Camelia and Flegg Peter and Graham Clive and Gray Katherine and Hammersley Shirley and Jones Kevin and Jones, {Matthew J.} and Kustos Ildiko and Larkin Susan and Mahawish Karim and Maxwell Sarah and Minton Jane and Mohandas Kavya and Mostert Martin and Moran Ed and Murphy Christopher and Pasztor Monika and Paraiso Hassan and Premchand Nikhil",
year = "2018",
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Incidence, aetiology, and sequelae of viral meningitis in UK adults : a multicentre prospective observational cohort study. / UK Meningitis Study Investigators.

In: The Lancet Infectious Diseases, Vol. 18, No. 9, 01.09.2018, p. 992-1003.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incidence, aetiology, and sequelae of viral meningitis in UK adults

T2 - a multicentre prospective observational cohort study

AU - UK Meningitis Study Investigators

AU - McGill, Fiona

AU - Griffiths, Michael J.

AU - Bonnett, Laura J.

AU - Geretti, Anna Maria

AU - Michael, Benedict D.

AU - Beeching, Nicholas J.

AU - McKee, David

AU - Scarlett, Paula

AU - Hart, Ian J.

AU - Mutton, Kenneth J.

AU - Jung, Agam

AU - Adan, Guleed

AU - Gummery, Alison

AU - Sulaiman, Wan Aliaa Wan

AU - Ennis, Katherine

AU - Martin, Antony P.

AU - Haycox, Alan

AU - Miller, Alastair

AU - Solomon, Tom

AU - Adedeji, Adekola

AU - Katharine, Ajdukiewicz

AU - David, Birkenhead

AU - Thomas, Blanchard

AU - Antony, Cadwgan

AU - David, Chadwick

AU - John, Cheesbrough

AU - Richard, Cooke

AU - John, Croall

AU - Iain, Crossingham

AU - James, Dunbar

AU - Simon, Ellis

AU - Camelia, Faris

AU - Peter, Flegg

AU - Clive, Graham

AU - Katherine, Gray

AU - Shirley, Hammersley

AU - Kevin, Jones

AU - Jones, Matthew J.

AU - Ildiko, Kustos

AU - Susan, Larkin

AU - Karim, Mahawish

AU - Sarah, Maxwell

AU - Jane, Minton

AU - Kavya, Mohandas

AU - Martin, Mostert

AU - Ed, Moran

AU - Christopher, Murphy

AU - Monika, Pasztor

AU - Hassan, Paraiso

AU - Nikhil, Premchand

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine the incidence, causes, and sequelae in UK adults to improve the management of patients and assist in health service planning. Methods: We did a multicentre prospective observational cohort study of adults with suspected meningitis at 42 hospitals across England. Nested within this study, in the National Health Service (NHS) northwest region (now part of NHS England North), was an epidemiological study. Patients were eligible if they were aged 16 years or older, had clinically suspected meningitis, and either underwent a lumbar puncture or, if lumbar puncture was contraindicated, had clinically suspected meningitis and an appropriate pathogen identified either in blood culture or on blood PCR. Individuals with ventricular devices were excluded. We calculated the incidence of viral meningitis using data from patients from the northwest region only and used these data to estimate the population-standardised number of cases in the UK. Patients self-reported quality-of-life and neuropsychological outcomes, using the EuroQol EQ-5D-3L, the 36-Item Short Form Health Survey (SF-36), and the Aldenkamp and Baker neuropsychological assessment schedule, for 1 year after admission. Findings: 1126 patients were enrolled between Sept 30, 2011, and Sept 30, 2014. 638 (57%) patients had meningitis: 231 (36%) cases were viral, 99 (16%) were bacterial, and 267 (42%) had an unknown cause. 41 (6%) cases had other causes. The estimated annual incidence of viral meningitis was 2·73 per 100 000 and that of bacterial meningitis was 1·24 per 100 000. The median length of hospital stay for patients with viral meningitis was 4 days (IQR 3–7), increasing to 9 days (6–12) in those treated with antivirals. Earlier lumbar puncture resulted in more patients having a specific cause identified than did those who had a delayed lumbar puncture. Compared with the age-matched UK population, patients with viral meningitis had a mean loss of 0·2 quality-adjusted life-years (SD 0·04) in that first year. Interpretation: Viruses are the most commonly identified cause of meningitis in UK adults, and lead to substantial long-term morbidity. Delays in getting a lumbar puncture and unnecessary treatment with antivirals were associated with longer hospital stays. Rapid diagnostics and rationalising treatments might reduce the burden of meningitis on health services. Funding: Meningitis Research Foundation and UK National Institute for Health Research.

AB - Background: Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine the incidence, causes, and sequelae in UK adults to improve the management of patients and assist in health service planning. Methods: We did a multicentre prospective observational cohort study of adults with suspected meningitis at 42 hospitals across England. Nested within this study, in the National Health Service (NHS) northwest region (now part of NHS England North), was an epidemiological study. Patients were eligible if they were aged 16 years or older, had clinically suspected meningitis, and either underwent a lumbar puncture or, if lumbar puncture was contraindicated, had clinically suspected meningitis and an appropriate pathogen identified either in blood culture or on blood PCR. Individuals with ventricular devices were excluded. We calculated the incidence of viral meningitis using data from patients from the northwest region only and used these data to estimate the population-standardised number of cases in the UK. Patients self-reported quality-of-life and neuropsychological outcomes, using the EuroQol EQ-5D-3L, the 36-Item Short Form Health Survey (SF-36), and the Aldenkamp and Baker neuropsychological assessment schedule, for 1 year after admission. Findings: 1126 patients were enrolled between Sept 30, 2011, and Sept 30, 2014. 638 (57%) patients had meningitis: 231 (36%) cases were viral, 99 (16%) were bacterial, and 267 (42%) had an unknown cause. 41 (6%) cases had other causes. The estimated annual incidence of viral meningitis was 2·73 per 100 000 and that of bacterial meningitis was 1·24 per 100 000. The median length of hospital stay for patients with viral meningitis was 4 days (IQR 3–7), increasing to 9 days (6–12) in those treated with antivirals. Earlier lumbar puncture resulted in more patients having a specific cause identified than did those who had a delayed lumbar puncture. Compared with the age-matched UK population, patients with viral meningitis had a mean loss of 0·2 quality-adjusted life-years (SD 0·04) in that first year. Interpretation: Viruses are the most commonly identified cause of meningitis in UK adults, and lead to substantial long-term morbidity. Delays in getting a lumbar puncture and unnecessary treatment with antivirals were associated with longer hospital stays. Rapid diagnostics and rationalising treatments might reduce the burden of meningitis on health services. Funding: Meningitis Research Foundation and UK National Institute for Health Research.

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