From the Guidelines
Meningitis in children is primarily caused by Streptococcus pneumoniae and Neisseria meningitidis, as Haemophilus influenzae type b (Hib) has become less common due to vaccination. The primary causes of meningitis in children can be broken down into several categories, including bacterial, viral, and fungal pathogens. Bacterial meningitis, the most serious form, is commonly caused by Streptococcus pneumoniae and Neisseria meningitidis, with Group B Streptococcus being a leading cause in newborns 1.
Some key points to consider when evaluating the causes of meningitis in children include:
- The introduction of conjugated vaccines against H. influenzae type b, N. meningitidis serogroup C, and pneumococcal conjugate vaccines has resulted in a dramatic reduction of the incidence of bacterial meningitis in children 1.
- Streptococcus pneumoniae is a leading cause of bacterial meningitis in children, particularly in those under the age of 1 year, with an incidence of approximately 10/100,000 population 1.
- Neisseria meningitidis has become a leading cause of bacterial meningitis in the United States after dramatic reductions in the incidence of Streptococcus pneumoniae and Haemophilus influenzae type b infections have been achieved as a result of using conjugate vaccines 1.
- Viral meningitis, which is generally less severe, is most frequently caused by enteroviruses, herpes simplex virus, and arboviruses.
- Fungal meningitis is rare in healthy children but can occur in immunocompromised patients, with Cryptococcus being the most common fungal agent.
Prevention strategies, such as vaccination against bacterial causes, good hygiene practices, and avoiding close contact with infected individuals, are crucial in reducing the incidence of meningitis in children. Early recognition and treatment are also essential, as bacterial meningitis can progress rapidly and lead to serious complications or death if not promptly addressed 1.
From the Research
Causes of Meningitis in Children
The primary causes of meningitis in children are bacterial infections, with the most common pathogens being:
- Streptococcus pneumoniae
- Neisseria meningitidis
- Haemophilus influenzae
- Streptococcus agalactiae (group B Streptococcus) 2, 3, 4
Bacterial Meningitis Agents
These bacteria have polysaccharide capsules that protect them against the host complement defense, and are typically colonized in the nasopharynx or genito-gastrointestinal tract 2. The incidence of bacterial meningitis has declined since 2008, with a notable low during 2020-2021, followed by a resurgence during 2022-2023 3.
Vaccine-Preventable Bacterial Meningitis
Conjugate vaccines have been developed to prevent disease caused by Haemophilus influenzae type b, Neisseria meningitidis, and Streptococcus pneumoniae, and have been shown to be highly effective in preventing bacteremic disease and reducing asymptomatic carriage 4, 5. These vaccines can induce protective serum antibodies in infants as young as two months old and offer protection to the most vulnerable groups 2.
Diagnosis of Bacterial Meningitis
Rapid and sensitive laboratory assays, such as multiplex real-time PCR, are critical for effective diagnosis and treatment of bacterial meningitis, particularly in countries with low culture positivity rates due to antibiotic use and sample transport delays 6.