Neonatal meningitis in England and Wales: 10 years on

Objectives-To determine the incidence of neonatal meningitis in England and Wales. Design-A national postal survey using the British Paediatric Surveillance Unit (BPSU) card scheme supplemented by information from other sources. Setting-England and Wales 1996-1997. Subjects-A total of 274 babies less than 28 days of age who were treated for meningitis. Results-The incidence of neonatal meningitis in England and Wales has not changed since our previous study in 1985-1987. However, the acute phase mortality has fallen from 19.8% in 1985-1987 to 6.6% in this study. Group B streptococci (42%) and Escherichia coli (16%) remain the most common infecting microorganisms. Eight of 69 (12%) babies with group B streptococci and 4/26 (15%) with E coli died. Antibiotic regimens based on the third generation cephalosporins, notably cefotaxime, were most commonly used (84%). The BPSU scheme identified 72% of cases during the study period. Most cases of viral meningitis were not reported through the BPSU. Less than a third of samples from aseptic meningitis were examined for viruses; 56% of these were positive. Conclusions-Although the incidence of neonatal meningitis remains unchanged, mortality from this infection has fallen significantly, if this improvement is maintained as reflected in the level of sequelae at 5 years of age, then the fear surrounding meningitis during the neonatal period will have been dramatically reduced.