Brain Infections in Children Rose After the Pandemic, Peaking in Winter 2022–2023

In May 2022, CDC began investigating a possible rise in intracranial infections in children, particularly those caused by Streptococcus bacteria. Children's hospital data from January 2016 to May 2022 had shown the pattern of these infections shifting after the COVID-19 pandemic began. An update by Emma K. Accorsi of CDC and colleagues extended the data through March 2023.

The data

The analysis counted hospitalizations of patients aged 18 and under with brain abscesses, epidural empyemas or subdural empyemas, reported to the Children's Hospital Association's Pediatric Health Information System by 37 tertiary referral children's hospitals in 19 states and the District of Columbia — every hospital that reported every month from January 1, 2016, to March 31, 2023.

The 2016–2019 data set the pre-pandemic baseline: a median of 34 cases a month (interquartile range 29.75–42.00) and a maximum of 61.

What they found

• Cases ran higher than expected from August 2021.
• A large peak came in winter 2022–2023, both nationally and by region.
• That peak coincided with surges in respiratory viruses. Intracranial infections are a recognized severe complication of viral respiratory infection and sinusitis, and recent trends may reflect heavy spread of respiratory germs among children.
• Even at the peak, these infections remained rare.

Monthly hospitalizations for intracranial infections among children, with the 2016–2019 median and maximum, nationally and by region. Credit: CDC, MMWR.

Because the hospitals included differ slightly from the first analysis, the numbers are not identical. In this analysis, cases fell in May 2022 but not to the median; in the earlier one, they were below the median from April 2020 to June 2021, above it from July 2021 to April 2022, and back at the median in May 2022.

What CDC recommends

CDC continues to track these infections, and recommends that everyone 18 and under stay up to date on recommended vaccines, including flu and COVID-19.

Sources

Based on Accorsi EK, Hall M, Hersh AL, Shah SS, Schrag SJ, Cohen AL, "Notes from the Field: Update on Pediatric Intracranial Infections — 19 States and the District of Columbia, January 2016–March 2023," MMWR, Centers for Disease Control and Prevention; a work of the United States government in the public domain.