Global Epidemiology of Pediatric Central Nervous System Infection

A Systematic Review and Meta-Analysis

Abstract

Objective

Central nervous system (CNS) infections lead to death and disability in children globally, yet the true burden of the disease is currently unknown. We performed a systematic review and a meta-analysis to provide a global annual incidence of pediatric CNS infection (pCNSi) and estimated pCNSi case burden.

Methods

A comprehensive search of PubMed, Embase, and Scopus was conducted to identify relevant articles. The pCNSi annual incidence was calculated using an estimated bacterial meningitis incidence from a meta-analysis and the estimated BM:pCNSi ratio. The burden of annual cases of pCNSi was then estimated based on World Bank pediatric population data.

Result

Fifty-eight articles were reviewed. The annual pCNSi incidence was estimated at 47.55/100,000  children ≤ 18 years and the projected number of pCNSi worldwide is 1,254,647 yearly. Across WHO regions, the majority of projected cases are found in SEAR (295,737 cases). AFR had the highest pCNSi case consult to neurosurgeon ratio (222.2 per neurosurgeon). About 50% of the total number of projected cases worldwide are located in lower MICs (624,047 cases). LICs had the highest pCNSi case consult to neurosurgeon ratio (211.1 per neurosurgeon). Frequently reported pathogens include Haemophilus influenzae (21.6%), viruses (15.8%), and Streptococcus pneumoniae (14.3%). 41% require neurosurgical intervention.

Conclusion

More than an estimated 1.2 million children suffer from CNS infections yearly, with the vast majority residing in low- and lower middle-income countries with a high case to neurosurgeon ratio. Continued preventive measures, and timely diagnostic and therapeutic support are necessary to curb a common childhood condition worldwide.