Decline in the number of patients with meningitis in German hospitals during the COVID-19 pandemic
Stefanie Völk, Markus Pfirrmann, Uwe Koedel, Hans‐Walter Pfister, Thomas Lang, Franziska Scheibe, Farid Salih, Julia Herzig-Nichtweiß, Julian Zimmermann, Angelika Alonso, Matthias Wittstock, Andreas Totzeck, Patrick Schramm, Ingo Schirotzek, Oezguer A. Onur, Johann Pelz, Caroline Ottomeyer, Sebastian Luger, Kristian Barlinn, Tobias Binder, Gabriele Wöbker, Gernot Reimann, Christian Urbanek, Jan Heckelmann, Piergiorgio Lochner, Martin Berghoff, Silvia Schönenberger, Bernhard Neumann, Wolf‐Dirk Niesen, Christian Dohmen, Hagen B. Huttner, Albrecht Günther, Matthias Klein
Abstract
BACKGROUND AND OBJECTIVES: In 2020, a wide range of hygiene measures was implemented to mitigate infections caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In consequence, pulmonary infections due to other respiratory pathogens also decreased. Here, we evaluated the number of bacterial and viral meningitis and encephalitis cases during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: In a multicentre retrospective analysis of data from January 2016 until December 2020, numbers of patients diagnosed with bacterial meningitis and other types of CNS infections (such as viral meningitis and encephalitis) at 26 German hospitals were studied. Furthermore, the number of common meningitis-preceding ear-nose-throat infections (sinusitis, mastoiditis and otitis media) was evaluated. RESULTS: Compared to the previous years, the total number of patients diagnosed with pneumococcal meningitis was reduced (n = 64 patients/year in 2020 vs. n = 87 to 120 patients/year between 2016 and 2019, all p < 0.05). Additionally, the total number of patients diagnosed with otolaryngological infections was significantly lower (n = 1181 patients/year in 2020 vs. n = 1525 to 1754 patients/year between 2016 and 2019, all p < 0.001). We also observed a decline in viral meningitis and especially enterovirus meningitis (n = 25 patients/year in 2020 vs. n = 97 to 181 patients/year between 2016 and 2019, all p < 0.001). DISCUSSION: This multicentre retrospective analysis demonstrates a decline in the number of patients treated for viral and pneumococcal meningitis as well as otolaryngological infections in 2020 compared to previous years. Since the latter often precedes pneumococcal meningitis, this may point to the significance of the direct spread of pneumococci from an otolaryngological focus such as mastoiditis to the brain as one important pathophysiological route in the development of pneumococcal meningitis.