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

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McGill, FJ ORCID: 0000-0002-0903-9046, Griffiths, Mike, Bonnett, Laura ORCID: 0000-0002-6981-9212, Geretti, Anna ORCID: 0000-0002-3670-6588, Michael, Benedict ORCID: 0000-0002-8693-8926, Beeching, Nicholas ORCID: 0000-0002-7019-8791, McKee, David, Scarlett, Paula, Hart, Ian, Mutton, Kenneth et al (show 9 more authors) , Jung, Agam, Adan, Guleed ORCID: 0000-0001-7340-4207, Gummery, Alison, Sulaiman, Wan Aliaa Wan, Ennis, Katherine, Martin, Anthony ORCID: 0000-0003-4383-6038, Haycox, Alan ORCID: 0000-0001-6659-4866, Miller, Alastair and Solomon, Tom ORCID: 0000-0001-7266-6547 (2018) Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study. Lancet Infectious Diseases, 18 (9). pp. 992-1003.

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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.

Item Type:	Article
Uncontrolled Keywords:	UK Meningitis Study Investigators, Humans, Meningitis, Viral, Population Surveillance, Incidence, Cohort Studies, Prospective Studies, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, United Kingdom
Depositing User:	Symplectic Admin
Date Deposited:	15 Aug 2018 14:53
Last Modified:	19 Jan 2023 01:30
DOI:	10.1016/S1473-3099(18)30245-7
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3024215

Available Versions of this Item

• Viral meningitis in UK adults - a multicentre prospective observational cohort study of incidence, aetiology and sequelae. (deposited 04 Apr 2018 06:58)
  • Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study. (deposited 03 Jul 2018 06:21)
    • Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study. (deposited 15 Aug 2018 14:53) [Currently Displayed]