Defining meningitis in UK children in the conjugate vaccine era

Determining the current causes of childhood meningitis

Scientific version
  • Researchers:
    Dr Dominic Kelly, Dr Manish Sadarangani, Dr Simon Nadel, Professor Andrew Pollard, Professor Paul Heath
  • Start Date:
    01 October 2012
  • Category:
  • Location:
    Oxford University, Oxford, UK
Defining meningitis in UK children in the conjugate vaccine era

What is this project about?

A variety of germs cause childhood meningitis, including different bacteria and viruses. Vaccines against some of the main bacteria – meningococcus C, the most common strains of pneumococcus and Haemophilus influenza type b (Hib) – are now routinely given to children in the UK, so viruses are increasingly predominant. This study will be performed across 16 major UK hospitals and will determine the current causes of childhood meningitis, including a detailed evaluation for viruses, which is not routinely done. Researchers will describe the symptoms, clinical signs and laboratory results of all children with meningitis. They will also audit the treatment these children receive in comparison with the recent NICE guideline, and determine the effects of meningitis on their health in the short- and medium-term. They will also investigate differences between children with bacterial and viral meningitis to determine how to differentiate these two groups.

Why is this important?

There is an urgent need for current data to define the features of meningitis in UK children because an understanding of the current causes, presentation and outcomes will determine whether current diagnostic methods and treatment are appropriate. For example, it is recommended that children with suspected bacterial meningitis be given steroids to prevent deafness and brain damage. However, steroids need to be given within 4 hours of antibiotics and may not be safe in viral meningitis. Since it takes longer than 4 hours to determine if the cause is bacterial or viral, the opportunity to give steroids is often lost. This project will devise a method to give doctors assurance of a bacterial diagnosis in time to treat accordingly.

The after effects of bacterial meningitis have been studied for many years, but there is very little information on the effects of viral meningitis. It is believed that most children make a full recovery, but there may be short-term effects and some small studies have suggested that language and mental development may be delayed following enteroviral meningitis in babies. The increasing proportion of non-bacterial meningitis means it is vital to describe the consequences to aid planning of appropriate follow-up of these children, and explore the potential for use of therapies to improve outcome.

Potential outcomes

The children in this study will enable future studies of long-term outcomes of childhood meningitis. The results of this study will provide a scientific basis on which to determine future priorities for health care, research and education regarding childhood meningitis. It may also identify areas requiring further research, such as treatments for non-bacterial meningitis, new supportive therapies or new vaccine targets.

Collaboration helps recruitment

Professor Pollard has joined forces with an encephalitis study run by the Liverpool Brain Infections Group, in order to help recruit as many people as possible.

The resulting partnership, called UK-ChiMES, will mean that patients eligible for both studies will only have to sign one consent form, making the whole process much quicker and more efficient. Patient samples will also be shared, meaning that children don't have to go through several procedures and costs for both studies are kept down.
Some members of the UK-CHiMES team: (from left to right) Prof Paul Heath, Dr Natalie Martin, Dr Saul Faust, Prof Andrew Pollard, Dr Dominic Kelly, Prof Adam Finn
Some members of the UK-CHiMES team: (from left to right) Prof Paul Heath, Dr Natalie Martin, Dr Saul Faust, Prof Andrew Pollard, Dr Dominic Kelly, Prof Adam Finn

Tilly had amputations as a result of meningococcal septicaemia

MRF Symposium 2014

Dr Manish Sadarangani gave a presentation to a packed MRF Symposium on 11th June, to explain more about the project and why it is so important. 

See his presentation slides here.

Pilot data

Results from a pilot study highlight the challenges around diagnosing meningitis in children and the need for this project to investigate these issues on a nation-wide scale. 

Archives of Disease in Childhood (September 2014)