Previous estimates of the cause- and age-specific frequency of pediatric meningitis in Korea were mainly derived from single- and multi-center studies. Herein, we used data on the number of cases of bacterial and viral meningitis from the Health Insurance Review and Assessment Service database to examine time- and sex-related trends.
We extracted data on meningitis diagnoses registered in the Health Insurance Review and Assessment Service from 2009 to 2017, using Korean Standard Classification of Disease and Cause of Death codes. Information on 202,254 children aged 0 to 18 years was extracted. Detailed demographic and disease information was available for 84,543 children who underwent hospitalization.
Among all hospitalized patients, 2166, 36,155, and 46,192 children were diagnosed with bacterial, viral, or other types of meningitis, respectively. There were 30 cases of fungal meningitis and another 30 cases of meningitis attributable to other pathogens. The number of cases of bacterial and viral meningitis was highest among infants (1,087 [50.2%]) and patients in their early childhood (12,949 [35.9%]), respectively. Meningitis outbreaks were most likely to occur during the summer, and boys were more susceptible to meningitis than girls. The following pathogens most commonly caused infant meningitis: group B
This study reports the number of pediatric meningitis cases, stratified by age, disease type, and month/year. The present findings contribute to a better understanding of pediatric meningitis in Korea and provide a foundation for future research to identify the risk factors for this disease.
Meningitis is a condition in which the meninges surrounding the brain and spinal cord are inflamed [
Bacterial meningitis requires rapid diagnosis and treatment as it is associated with a high risk of sepsis, which has a mortality rate of 10% [
Previous reports on the cause- and age-stratified frequency of pediatric meningitis in Korea have primarily originated from single- and multi-center studies [
The HIRA database is a data repository, built using information communication technology [
In this study, disease classification was performed according to the Korean Standard Classification of Disease and Cause of Death (KCD-7), which was revised in 2015, based on the World Health Organization's International Classification of Disease and Cause of Death [
Domestic pediatric patients aged 0 to 18 years were included and classified based on their diagnoses (
In general, meningitis is diagnosed and treated in an in-patient setting; thus, this study only included records from certified tertiary hospitals, general hospitals, and other types of hospitals. In addition to the above reasons, in this paper, since the HIRA database was used through the KCD-7 code, we tried to exclude patients who had diagnosed names only by clinical diagnosis. At this stage, the study sample comprised 2,166 cases of bacterial, 36,155 cases of viral, 30 cases of fungal and parasitic, and 46,192 cases of others type of meningitis (
The same method was applied to extract and categorize each diagnosis into subgroups. The HIRA data only classified patients by their respective age, and not according to different age groups. However, in our analyses, we followed the staging system of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which classifies children based on age ranges [
Data were extracted from the HIRA database and examined using SAS Enterprise version 9.2 (SAS Institute, Cary, NC, USA). All statistical analyses were performed using SPSS version 20 for Windows (IBM Co., Armonk, NY, USA). Between-group differences were compared using t-tests, and
The monthly and annual number of pediatric meningitis in South Korea are reported in
Bacterial meningitis was the most common type among infants; the number of cases in early childhood and that in adolescent age groups was similar (
Among bacterial meningitis types, the total numbers of children registered with the disease codes G009 (bacterial, purulent, pyogenic, or suppurative meningitis), G008 (bacterial meningitis associated with
Among the different types of viral meningitis, A879 (viral meningitis, unspecified) was the most commonly reported diagnostic code (16,574 [45.8%]), followed by A870 (enteroviral meningitis, coxsackievirus meningitis, echovirus meningitis; 9,216 [25.5%]), G030 (nonpyogenic meningitis, nonbacterial meningitis; 4,648 [12.9%]), and A878 (other viral meningitis; 3,693 [10.2%]). Although the specific viral species were recorded in a small number of cases, most cases involved adolescents with mumps (B261), zoster (B021), herpes (B003), and enterovirus infections. Among infants, herpesviral meningitis was the most commonly reported type (
Overall, there was a higher frequency of meningitis among boys (1%) than girls (0.70%), based on the ratio of male-to-female patients in the overall sample (51,573 vs. 32,970) and that in the general population of Korea (data for children aged 0 to 17 years in 2010: boy vs. girls, 5,135,542 vs. 4,711,252).
In a large category, classified as bacterial and viral meningitis, there was higher frequency of bacterial meningitis among boys (0.024%) than girls (0.020%) (1,247 vs. 919). Similarly with bacterial meningitis, there was higher frequency of bacterial meningitis among boys (0.43%) than girls (0.30%) (21,904 vs. 14,251).
The present study investigated the data of bacterial and viral meningitis obtained from the Korean HIRA database to identify the temporal- and sex-related trends in the frequency of all-cause meningitis in children. In previous studies analyzing outbreaks from the late 90s to the early 2000s have shown that the most common meningitis-related pathogens were group B
A United States-based report on the etiology of bacterial meningitis during 1998 to2007 revealed that GBS,
A global meta-analysis that investigated meningitis etiology revealed
In the present study, the broadest diagnostic category corresponded to the disease code G009; several other diagnostic entities were included, and G008 included
Many
However, pathogens that belong to the disease code G000 (
Immunization of children is effective for disease prevention worldwide. From 2000 to 2015 in particular, the frequency and mortality rates of meningitis due to
The enterovirus family is the leading cause of viral meningitis, followed by mumps and herpes simplex virus [
The age-dependent frequency rate showed that viral meningitis was equally likely to occur across all age groups; however, bacterial meningitis was most likely to occur in infants [
Owing to the large influence of temperature, infections during summer seemed to occur more vigorously than during winter [
Second, a diagnostic code such as G039 (meningitis, unspecified) corresponding to other diagnostic names may be clearly detected as meningitis in a medical institution, but unspecified diagnostic names may only reflect clinical symptoms. To maximally exclude these errors, only the data of patients who were admitted to the hospital were extracted; however, this error cannot be avoided.
Third, as our data source only included the data of the main diagnosis, cases involving meningitis that progressed to other diseases (e.g., sepsis) might have been missed.
In summary, this study examined meningitis frequency data using population-wide information derived from a medical insurance claims database. Further studies are required to elucidate the relationship between meningitis and other infectious diseases, including ones with analyses that address the current study limitations. Taken together, this evidence will contribute toward a better understanding of childhood meningitis in Korea.
Supplementary materials related to this article can be found online at
Annual and monthly number of meningitis among children in Korea (2009 to 2017)
Meningitis incidence classified by month. VIR, viral; BAC, bacterial.
Number of meningitis types as per diagnostic codes among children in Korea during 2009 to 2017 [18]
No potential conflict of interest relevant to this article was reported.
Conceptualization: SAC. Data curation: JWK. Formal analysis: SAC. Funding acquisition: JWK. Project administration: SAC. Visualization: SAC. Writing-original draft: JWK. Writing-review & editing: JWK, SAC, SYK, NML, DYY, SWY, and ISL.
We wish to thank Editage for English language editing assistance; we also thank the Institutional Review Board for their approval of this study.
Protocol of data extraction for meningitis patients.
(A) Bacterial and (B) viral meningitis by age group.
Distribution of causes of (A) bacterial and (B) viral meningitis by age group.
Meningitis diagnostic codes in the Korean Standard Classification of Disease and Cause of Death (KCD-7)
Diagnostic code | Name |
---|---|
Bacterial | |
A170 | Tuberculous meningitis, tuberculous leptomeningitis |
A321 | Listerial meningitis and meningoencephalitis, listerial meningitis |
A390 | Meningococcal meningitis |
G00 | Bacterial meningitis, bacterial leptomeningitis, bacterial meningitis, bacterial pachymeningitis |
G000 | Haemophilus meningitis, meningitis due to |
G001 | Pneumococcal meningitis |
G002 | Streptococcal meningitis |
G003 | Staphylococcal meningitis |
G008 | Bacterial meningitis associated with |
G009 | Bacterial, purulent, pyogenic, or suppurative meningitis |
G01 | Meningitis due to bacterial diseases classified elsewhere, including anthrax-, gonococcal-, and leptospirosis-related disease, among others |
Viral | |
A87 | Viral meningitis |
A870 | Enteroviral meningitis, coxsackievirus meningitis, echovirus meningitis |
A871 | Adenoviral meningitis |
A872 | Lymphocytic choriomeningitis |
A878 | Other viral meningitis |
A879 | Viral meningitis, unspecified |
B003 | Herpesviral meningitis |
B010 | Varicella meningitis |
B021 | Zoster meningitis |
B051 | Measles complicated by meningitis, post-measles meningitis |
B060 | Rubella meningitis |
B261 | Mumps meningitis |
G020 | Meningitis associated with viral diseases classified elsewhere (adenoviral, enteroviral, herpesviral, infectious mono, measles, mumps, rubella, varicella, zoster) |
G030 | Nonpyogenic meningitis, nonbacterial meningitis |
Fungal and parasitic | |
B375 | Candidal meningitis |
B384 | Coccidioidomycosis meningitis |
B451 | Cryptococcal meningitis |
G021 | Meningitis in mycoses, candidal, coccidioidomycosis, cryptococcal |
G028 | Meningitis associated with another infectious or parasitic diseases, including African trypanosomiasis and Chagas disease |
Other | |
G03 | Meningitis due to unspecified cause, leptomeningitis due to other and unspecified causes, etc. |
G031 | Chronic meningitis |
G032 | Benign recurrent meningitis (Mollaret’s meningitis) |
G038 | Meningitis due to other specified causes |
G039 | Meningitis, unspecified |