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A CDC report found no evidence for any unusual uptick in brain-related complications of bacterial infection among children across the country recently.

Hospitalization for brain abscesses and empyemas declined after the beginning of the COVID-19 pandemic in March 2020, rebounded in the summer of 2021, and then peaked in March 2022. Since then, it has fallen back to baseline levels, according to epidemiologist Emma Accorsi, PhD, of the CDC National Center for Immunization and Respiratory Diseases, and colleagues.

The peak in March 2022 was consistent with historical seasonal fluctuations that have been observed since 2016 and a redistribution of cases over time during the pandemic, the investigators reported in .

Early on in the pandemic, concerns had been raised about a in pediatric brain infections caused by Streptococcus bacteria due to the potential contributing role of SARS-CoV-2 infection. In May 2022, the CDC learned of three children who were hospitalized concurrently for brain abscess, epidural empyema, or subdural empyema caused by Streptococcus.

"After clinicians raised concerns about a possible increase in pediatric intracranial infections, analyses of hospitalizations from 40 children's hospitals across the United States found that the number of pediatric intracranial infections in 2021 was within normal historical limits and measures of disease severity remained stable over time," the CDC said in a press release.

"After a comparative increase in cases from previous years that began in summer 2021, no evidence of increased case severity, genetic relatedness of streptococcal isolates from different cases, or antimicrobial resistance beyond what is typical for streptococcal species was identified," Accorsi and colleagues added.

Moreover, they posited that the decrease in cases at the beginning of the pandemic may reflect changes in respiratory pathogen transmission during that time.

For the study, Accorsi's group asked clinicians and health departments nationwide to report pediatric cases of brain abscesses, epidural empyemas, and subdural empyemas. Data were also collected from from the Pediatric Health Information System (PHIS) consisting of hospitalization data from 40 tertiary children's hospitals across the U.S.

If Streptococcus specimens were isolated from the patient, they were sent to the CDC for antimicrobial susceptibility testing and whole-genome sequencing.

The CDC's national call collected 81 cases, in which patients had a median age of 11 years and were 54.5% white. Approximately 45% reported an underlying health condition, and 61% had been diagnosed with at least one respiratory infection within the 6 weeks leading up to hospitalization.

The PHIS database provided 3,078 cases of brain abscesses, epidural empyemas, or subdural empyemas from January 2016 to May 2022, with a median age of 8 years and 65.1% being boys. By race, 46.5% were non-Hispanic white, 21.3% non-Hispanic Black, and 20.8% Hispanic or Latino.

While the 382 total cases in 2020 was lower compared with 2016 to 2019, the 471 cases in 2021 was within that historical range (443-538 cases). Cases ranged from 20 to 68 per month over the 6-year period (median 38).

Study authors acknowledged that the PHIS data lacked information on microbiologic etiology and case rates over time. Additionally, PHIS data from tertiary children's hospitals might not reflect all hospitals admitting children.

There was also potential selection bias from relying on cases voluntarily reported for the national call. The level of completeness of case reports from the CDC's call for cases also varied, the investigators warned.

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