The Impact of the COVID-19 Pandemic on Seasonal Enteroviral Meningitis in Hospitalized Children.

Background: Enterovirus meningitis (EM) is a common central nervous system (CNS) infection with a seasonal peak in summer and fall.

Objectives: To describe the epidemiologic and clinical patterns of EM in children before (2017-2019 years) and during the coronavirus disease 2019 (COVID-19) pandemic (2020-2022).

Methods: This retrospective study included children (age 0-16 years) hospitalized in a pediatric department in Israel diagnosed with EM: January 2017-December 2019 and January 2020-December 2022. The seasonal peak for each period was defined as the maximal incidence in particular months. EM was diagnosed by reverse transcription polymerase chain reaction of cerebrospinal fluid (CSF) for enteroviruses.

Results: During the study period, EM was diagnosed in 134 cases (median age 5 months [1-51], 76 [57%] males); 72 during 2017-2019 and 62 during 2020-2022. The most common presentation was fever. C-reactive protein (CRP) was elevated in 57 cases (43%). CSF profile showed pleocytosis in 130 cases (97%) and elevated protein in 80 (60%). In the 2020-2022 group, fewer patients were febrile, CRP was higher, and CSF profile showed a higher glucose level compared to the 2017-2019 group. Seasonal peaks in 2017-2019 occurred June-August, and in 2020-2022 February-April.

Conclusions: The COVID-19 pandemic altered the clinical characteristics of EM and its seasonal peak. Clinicians should be aware of changes in epidemiological patterns of EM to make appropriate diagnoses in viral infection in order to avoid unnecessary antibiotic treatment.