BPSU study - Enterovirus and parechovirus meningitis

Surveillance of enterovirus and parechovirus meningitis in infants less than 90 days of age concluded in July 2015. The study team hope to understand the clinical burden of the condition. A paper has now been published in Archives of Disease in Childhood - see below link to the abstract.

Lead investigator

Dr Shamez Ladhani
Immunisation, Hepatitis and Blood Safety Department
Public Health England
61 Colindale Avenue
London NW9 5EQ
Email: shamez.ladhani@phe.gov.uk

About the study

Approximately 85% of childhood meningitis in the conjugate vaccine era is due to enteroviruses and Human Parechoviruses (HPeV). Young infants are particularly susceptible to enterovirus and HPeV meningitis and often present with non-specific symptoms which are difficult to differentiate from serious bacterial infections. Real-time PCR is becoming increasingly available and it is anticipated that more cases will be diagnosed in the coming years.

There is, however, very limited data assessing the incidence, clinical features, sequale and outcome of infants with meningitis as a result of these viruses. This study will aim to improve our understanding of enterovirus and parechovirus meningitis, and also the outcomes.

Furthermore, there is no data linking the molecular subtypes of enteroviruses and HPeV currently circulating in the UK and Ireland with clinical severity, laboratory markers or outcomes. No specific antiviral treatments are licenced or in the immediate pipeline to treat these serious viruses. In part the lack of good clinical data defining the burden of disease is a barrier to the development of novel antiviral therapy.

You can download the protocol card, including references, below.


Published papers

Case definition

  • Any infant aged less than 90 days old with clinical symptoms of meningitis* , and
  • Laboratory confirmation of enterovirus or parechovirus from any site**


July 2014 to July 2015 (13 months of surveillance) followed by a 12 month follow-up.


Paediatric Infectious Diseases Research Group, St George’s University of London.


This study has been approved by the NRES Committee London - Queen Square (Ref: 14/LO/0229). Public Health England has approval under Section 251 of the NHS Act 2006 to process confidential patient information for public health purposes. See The Health Service (Control of Patient Information) Regulations 2002.


  • *fever (more than 38 degrees Celsius), coma, seizures, neck stiffness, apnoea, bulging fontanelle, irritability, lethargy, poor feeding
  • **CSF, blood, stool, throat, peri-anal swab