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Thirty-year trends in admission rates for childhood encephalitis in England and impact of improved diagnostics and measles and mumps vaccination : a population based observational study Iro, Mildred A.; Sadarangani, Manish; Goldacre, Raphael; Nickless, Alecia; Pollard, Andrew J.; Goldacre, Michael J.

Abstract

Background: Encephalitis is a serious neurological disorder, yet data on admission rates for all-cause childhood encephalitis in England are lacking. We aimed to estimate admission rates for childhood encephalitis in England over 33 years, to describe trends in admission rates and to observe how these have varied with the introduction of vaccines and improved diagnostics. Methods: A retrospective analysis of hospital admission statistics for encephalitis for individuals aged 0-19 years was conducted using the English national Hospital Inpatient Enquiry (HIPE, 1979 -1985) and Hospital Episode Statistics (HES, 1990 -2011). Annual age-specific and age standardised admission rates in single calendar years and admission rate trends for specified aetiologies in relation to introduction of polymerase chain reaction (PCR) testing and measles-mumps-rubella (MMR) vaccination. Results: There were 16571 encephalitis hospital admissions (average hospital admission rate (AR): 5·97/100,000/year (95%CI 5·06-6·82)). Hospital ARs declined from 1979-1994 (annual percentage change, APC, 3·30%; 2·88%-3·66%; p<0·0001) and increased between 1995 and 2011 (APC=3·30%; 2·75%-3·85%; p<0·0001). Admissions for measles and mumps encephalitis decreased by 35- and 60-fold respectively following the introduction of the two-dose MMR vaccine. Hospital ARs for encephalitis of unknown aetiology have increased post-PCR. Interpretation: Hospital admission rates for all-cause childhood encephalitis in England are increasing. Admissions for measles and mumps encephalitis have decreased substantially. The numbers of encephalitis admissions without a specific diagnosis are increasing despite availability of PCR testing, indicating the need for strategies to improve aetiological diagnosis in children with encephalitis.

Item Metadata

Title
Thirty-year trends in admission rates for childhood encephalitis in England and impact of improved diagnostics and measles and mumps vaccination : a population based observational study
Alternate Title
30-year trends in admission rates for encephalitis in children in England and effect of improved diagnostics and measles-mumps-rubella vaccination : a population-based observational study
Creator
Iro, Mildred A.; Sadarangani, Manish; Goldacre, Raphael; Nickless, Alecia; Pollard, Andrew J.; Goldacre, Michael J.
Contributor
Children's Hospital (Vancouver, B.C.). Vaccine Evaluation Center
Date Issued
2017-04
Description
Background: Encephalitis is a serious neurological disorder, yet data on admission rates for all-cause childhood encephalitis in England are lacking. We aimed to estimate admission rates for childhood encephalitis in England over 33 years, to describe trends in admission rates and to observe how these have varied with the introduction of vaccines and improved diagnostics. Methods: A retrospective analysis of hospital admission statistics for encephalitis for individuals aged 0-19 years was conducted using the English national Hospital Inpatient Enquiry (HIPE, 1979 -1985) and Hospital Episode Statistics (HES, 1990 -2011). Annual age-specific and age standardised admission rates in single calendar years and admission rate trends for specified aetiologies in relation to introduction of polymerase chain reaction (PCR) testing and measles-mumps-rubella (MMR) vaccination. Results: There were 16571 encephalitis hospital admissions (average hospital admission rate (AR): 5·97/100,000/year (95%CI 5·06-6·82)). Hospital ARs declined from 1979-1994 (annual percentage change, APC, 3·30%; 2·88%-3·66%; p<0·0001) and increased between 1995 and 2011 (APC=3·30%; 2·75%-3·85%; p<0·0001). Admissions for measles and mumps encephalitis decreased by 35- and 60-fold respectively following the introduction of the two-dose MMR vaccine. Hospital ARs for encephalitis of unknown aetiology have increased post-PCR. Interpretation: Hospital admission rates for all-cause childhood encephalitis in England are increasing. Admissions for measles and mumps encephalitis have decreased substantially. The numbers of encephalitis admissions without a specific diagnosis are increasing despite availability of PCR testing, indicating the need for strategies to improve aetiological diagnosis in children with encephalitis.
Subject
hospital episode statistics; mumps; measles; MMR; herpes simplex virus
Genre
Article; Postprint
Type
Text
Language
eng
Date Available
2018-04-09
Provider
Vancouver : University of British Columbia Library
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International
DOI
10.14288/1.0365267
URI
http://hdl.handle.net/2429/65242
Affiliation
Medicine, Faculty of; Non UBC; Pediatrics, Department of
Citation
Iro, M. A., Sadarangani, M., Goldacre, R., Nickless, A., Pollard, A. J., & Goldacre, M. J. (2017). 30-year trends in admission rates for encephalitis in children in england and effect of improved diagnostics and measles-mumps-rubella vaccination: a population-based observational study. The Lancet Infectious Diseases, 17(4), 422-430.
Publisher DOI
10.1016/S1473-3099(17)30114-7
Peer Review Status
Reviewed
Scholarly Level
Faculty; Graduate
Rights URI
http://creativecommons.org/licenses/by-nc-nd/4.0/
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Attribution-NonCommercial-NoDerivatives 4.0 International