Defining meningitis in UK children in the conjugate vaccine era

An introduction in to the UK infant immunisation schedule of highly effective conjugate vaccines against Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenza type b has dramatically changed the epidemiology of childhood meningitis such that viral causes are increasingly predominant. There is an urgent need for current data to define meningitis in UK children because an understanding of the current epidemiology, modes of presentations and outcomes will determine whether diagnostic methods and treatment are appropriate. This will identify areas requiring further research, such as interventions for aseptic meningitis, newer adjunctive therapies or new vaccine targets.

This prospective, multi-centre study across 16 major UK centres, driven directly by 2 of the 5 research recommendations in the recent NICE guidelines, will determine the current aetiology of childhood meningitis, including a comprehensive evaluation for viruses. We will describe clinical and laboratory features, clinical management and outcomes of children with meningitis. We will develop a novel and highly specific clinical decision rule to identify children likely to have bacterial meningitis, who may benefit from early, aggressive treatment. These data will result in improved accuracy of diagnosis and enable adjunctive therapies, such as corticosteroids, to be targeted to those most likely to have bacterial meningitis.

This well-characterised cohort will provide an invaluable platform for future studies of long-term outcomes of meningitis. We will also obtain RNA and DNA for use in future genetic association studies. This study will provide a scientific basis on which to determine future priorities for health care, research and education regarding childhood meningitis.