Philip N Britton1,2,3, Russell C Dale1,4, Christopher C Blyth5,6,7, Julia E Clark8,9, Nigel Crawford10,11, Helen Marshall12,13, Elizabeth J Elliott1,14, Kristine Macartney1,3,15, Robert Booy1,2,3,15, Cheryl A Jones2,10,11. 1. Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales. 2. Marie Bashir Institute of Infectious Diseases and Biosecurity Institute, University of Sydney, New South Wales. 3. Departments of Infectious Diseases and Microbiology, New South Wales. 4. Neurology, Children's Hospital at Westmead, New South Wales. 5. Perth Children's Hospital, Nedlands, Perth, Western Australia. 6. Telethon Kids Institute and School of Medicine, University of Western Australia, Nedlands, Perth, Western Australia. 7. PathWest Laboratory Medicine Western Australia and Queen Elizabeth II Medical Centre, Nedlands, Perth, Western Australia. 8. Children's Health Queensland, Brisbane. 9. School of Clinical Medicine, University of Queensland, Brisbane. 10. Murdoch Children's Research Institute and Royal Children's Hospital, Victoria. 11. University of Melbourne, Victoria. 12. Women's and Children's Hospital, South Australia. 13. Robinson Research Institute, University of Adelaide, South Australia, and. 14. Australian Paediatric Surveillance Unit, New South Wales, Australia. 15. National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia.
Abstract
BACKGROUND: We aimed to determine the contemporary causes, clinical features, and short-term outcome of encephalitis in Australian children. METHODS: We prospectively identified children (≤14 years of age) admitted with suspected encephalitis at 5 major pediatric hospitals nationally between May 2013 and December 2016 using the Paediatric Active Enhanced Disease Surveillance (PAEDS) Network. A multidisciplinary expert panel reviewed cases and categorized them using published definitions. Confirmed encephalitis cases were categorized into etiologic subgroups. RESULTS: From 526 cases of suspected encephalitis, 287 children met criteria for confirmed encephalitis: 57% (95% confidence interval [CI], 52%-63%) had infectious causes, 10% enterovirus, 10% parechovirus, 8% bacterial meningoencephalitis, 6% influenza, 6% herpes simplex virus (HSV), and 6% Mycoplasma pneumoniae; 25% (95% CI, 20%-30%) had immune-mediated encephalitis, 18% acute disseminated encephalomyelitis, and 6% anti-N-methyl-d-aspartate receptor encephalitis; and 17% (95% CI, 13%-21%) had an unknown cause. Infectious encephalitis occurred in younger children (median age, 1.7 years [interquartile range {IQR}, 0.1-6.9]) compared with immune-mediated encephalitis (median age, 7.6 years [IQR, 4.6-12.4]). Varicella zoster virus encephalitis was infrequent following high vaccination coverage since 2007. Thirteen children (5%) died: 11 with infectious causes (2 influenza; 2 human herpesvirus 6; 2 group B Streptococcus; 2 Streptococcus pneumoniae; 1 HSV; 1 parechovirus; 1 enterovirus) and 2 with no cause identified. Twenty-seven percent (95% CI, 21%-31%) of children showed moderate to severe neurological sequelae at discharge. CONCLUSIONS: Epidemic viral infections predominated as causes of childhood encephalitis in Australia. The leading causes include vaccine-preventable diseases. There were significant differences in age, clinical features, and outcome among leading causes. Mortality or short-term neurological morbidity occurred in one-third of cases.
BACKGROUND: We aimed to determine the contemporary causes, clinical features, and short-term outcome of encephalitis in Australian children. METHODS: We prospectively identified children (≤14 years of age) admitted with suspected encephalitis at 5 major pediatric hospitals nationally between May 2013 and December 2016 using the Paediatric Active Enhanced Disease Surveillance (PAEDS) Network. A multidisciplinary expert panel reviewed cases and categorized them using published definitions. Confirmed encephalitis cases were categorized into etiologic subgroups. RESULTS: From 526 cases of suspected encephalitis, 287 children met criteria for confirmed encephalitis: 57% (95% confidence interval [CI], 52%-63%) had infectious causes, 10% enterovirus, 10% parechovirus, 8% bacterial meningoencephalitis, 6% influenza, 6% herpes simplex virus (HSV), and 6% Mycoplasma pneumoniae; 25% (95% CI, 20%-30%) had immune-mediated encephalitis, 18% acute disseminated encephalomyelitis, and 6% anti-N-methyl-d-aspartate receptor encephalitis; and 17% (95% CI, 13%-21%) had an unknown cause. Infectious encephalitis occurred in younger children (median age, 1.7 years [interquartile range {IQR}, 0.1-6.9]) compared with immune-mediated encephalitis (median age, 7.6 years [IQR, 4.6-12.4]). Varicella zoster virus encephalitis was infrequent following high vaccination coverage since 2007. Thirteen children (5%) died: 11 with infectious causes (2 influenza; 2 human herpesvirus 6; 2 group B Streptococcus; 2 Streptococcus pneumoniae; 1 HSV; 1 parechovirus; 1 enterovirus) and 2 with no cause identified. Twenty-seven percent (95% CI, 21%-31%) of children showed moderate to severe neurological sequelae at discharge. CONCLUSIONS: Epidemic viral infections predominated as causes of childhood encephalitis in Australia. The leading causes include vaccine-preventable diseases. There were significant differences in age, clinical features, and outcome among leading causes. Mortality or short-term neurological morbidity occurred in one-third of cases.
Authors: Jean David Pommier; Chris Gorman; Yoann Crabol; Kevin Bleakley; Heng Sothy; Ky Santy; Huong Thi Thu Tran; Lam Van Nguyen; Em Bunnakea; Chaw Su Hlaing; Aye Mya Min Aye; Julien Cappelle; Magali Herrant; Patrice Piola; Bruno Rosset; Veronique Chevalier; Arnaud Tarantola; Mey Channa; Jerome Honnorat; Anne Laure Pinto; Sayaphet Rattanavong; Manivanh Vongsouvath; Mayfong Mayxay; Sommanikhone Phangmanixay; Khounthavy Phongsavath; Ommar Swe Tin; Latt Latt Kyaw; Htay Htay Tin; Kyaw Linn; Thi Mai Hung Tran; Philippe Pérot; Nguyen Thi Thu Thuy; Nguyen Hien; Phuc Huu Phan; Philippe Buchy; Philippe Dussart; Denis Laurent; Marc Eloit; Audrey Dubot-Pérès; Olivier Lortholary; Xavier de Lamballerie; Paul N Newton; Marc Lecuit Journal: Lancet Glob Health Date: 2022-07 Impact factor: 38.927
Authors: Nanda Ramchandar; Nicole G Coufal; Anna S Warden; Benjamin Briggs; Toni Schwarz; Rita Stinnett; Heng Xie; Robert Schlaberg; Jennifer Foley; Christina Clarke; Bryce Waldeman; Claudia Enriquez; Stephanie Osborne; Antonio Arrieta; Daria Salyakina; Michelin Janvier; Prithvi Sendi; Balagangadhar R Totapally; David Dimmock; Lauge Farnaes Journal: Open Forum Infect Dis Date: 2021-03-06 Impact factor: 3.835
Authors: Angela Berkhout; Vishal Kapoor; Claire Heney; Cheryl A Jones; Julia E Clark; Philip N Britton; Vikram L Vaska; Melissa M Lai; Clare Nourse Journal: J Paediatr Child Health Date: 2022-05-05 Impact factor: 1.929