Rise in pediatric intracranial infections coincided with spike in respiratory viruses
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Key takeaways:
- States experienced an increase in rare pediatric intracranial infections beginning in the first 2 years of the COVID-19 pandemic.
- Cases spiked during the winter respiratory virus season, particularly in 2022.
There were increases in rare pediatric intracranial infections over the past 3 years that coincided with notable spikes in respiratory viruses, although the infections remained rare, according to two reports published Thursday in MMWR.
According to the CDC, intracranial infections — such as brain abscesses, epidural empyemas and subdural empyemas — are often caused by an infection with multiple bacteria, including Streptococcus bacteria. They can lead to long-term neurological problems, sepsis and death.
A previous report published last September in MMWR noted that pediatric cases had increased during the summer of 2021, peaked in March 2022, and then declined again to baseline levels.
The first of two new reports published Thursday summarized a rise in these types of infections in Clark County, Nevada, during the past few years.
According to the report, from 2015 to 2021, the county reported a median of 0.5 cases of brain abscesses every quarter, but that number increased during the first 2 years of the COVID-19 pandemic to 1.5 cases every quarter and then spiked in 2022 at 5 cases per quarter — 18 cases overall, with no associated deaths.
“Although this investigation did not identify unexpected risk factors for intracranial abscesses, the substantial increase in cases after the mask mandate in Nevada was lifted might be partially attributable to changes in respiratory pathogen transmission,” the authors wrote.
The second new report examined intracranial infections caused by Streptococcus bacteria in 19 states and the District of Columbia using data collected from 37 children’s hospitals from January 2016 to May 2022.
The researchers used data from 2016 to 2019 to calculate a pre-pandemic median baseline of 34 cases per month, with a maximum monthly number of 61 cases.
According to their findings, monthly intracranial infection case counts remained below the baseline median from May 2020 to May 2021, but exceeded the median from August 2021 to March 2023. Cases peaked at 102 in December 2022.
“Although some variability between U.S. Census Bureau regions was observed, overall patterns were generally similar: consistently low case counts after the onset of the pandemic, then a period of increase beginning in mid- to late 2021, followed by a large peak during winter 2022 to 2023,” they wrote, with the large peak coinciding with notable spikes in respiratory virus circulation.
Still, even during the peak, intracranial infections remained rare, the authors wrote.
“These infections are often preceded by viral respiratory infection and sinusitis, and recent trends might be driven by concurrent, heightened pediatric respiratory pathogen transmission,” they wrote. “All persons aged [18 years or younger] should be up to date with recommended vaccinations, including influenza and COVID-19.”
References:
Accorsi EK, et al. MMWR Morb Mortal Wkly Rep. 2023;doi:10.15585/mmwr.mm7137a2.
Accorsi EK, et al. MMWR Morb Mortal Wkly Rep. 2023;doi:10.15585/mmwr.mm7222a5.
CDC. Clinical guidance for children with intracranial infections associated with Streptococcus bacteria. https://www.cdc.gov/ncird/investigation/streptococcus/hcp.html. Last reviewed Sept. 15, 2022. Accessed June 1, 2023.
Penney JA, et al. MMWR Morb Mortal Wkly Rep. 2023;doi:10.15585/mmwr.mm7222a4.
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