Children with Intracranial Infections Associated with Streptococcus Bacteria
- CDC investigated a possible increase in intracranial (within the head) infections in children in the United States.
- There was a large peak in intracranial infections during winter 2022–2023 compared to what was usually seen before the COVID-19 pandemic.
- High levels of respiratory viruses spreading among children during that time may have contributed to the increase.
- Despite this increase, intracranial infections remain rare in children in the United States.
Intracranial infections increased during winter 2022–2023
A new report looked at hospitalization data from January 2016 through March 2023 and found
- The number of intracranial infections in children varies month to month, but usually stays within a limited range.
- During winter 2022–2023, there was a large peak in intracranial infections in children. There was also a high number of respiratory viruses spreading among children during this time.
- Similar increases were seen across all regions of the United States.
- While there were more infections, the infections were not more serious or deadly than normal.
- The number of infections was and still is low.
CDC will continue to track trends in intracranial infections in children in the United States.
January 2016 through December 2019 (pre-COVID-19 pandemic)
- Up to 61 infections each month (middle of range was 34)
- These numbers were used to define what is considered usual or expected
March 2020 through May 2021 (early COVID-19 pandemic)
- Less than 34 infections each month
- This is on the low end of what is usually seen
August 2021 through November 2022 (late COVID-19 pandemic)
- Between 34 and 61 infections each month
- This is on the high end of what is usually seen
December 2022 through March 2023
- Between 62 and 102 infections each month
- This is above what is usually seen
*Data source: Pediatric Health Information System, through a collaboration with the Children’s Hospital Association
Early findings were reassuring
An earlier analysis showed the number of infections from mid-2021 through March 2022 did not go above previously observed peaks.
That report also described CDC lab findings showing that several types of Streptococcus bacteria were causing the infections. These bacteria were not more resistant to antibiotics than what was seen in the past.
Experts know intracranial infections caused by Streptococcus bacteria can be a rare but serious complication from sinus infections and other respiratory infections.
Why CDC started this investigation
In May 2022, CDC learned about three children with intracranial infections caused by Streptococcus intermedius. The children received care for their infections at the same California hospital and were similar in several ways:
- All were healthy before their infection.
- All were between 11 and 13 years old when they entered the hospital.
- None appeared to have had significant underlying medical conditions or previous surgeries on their brain, head, or neck.
The children were from different parts of the state. Investigators did not find any known contact or common exposures among the children.
These cases and information from other children’s doctors across the country led investigators to question if intracranial infections were increasing.
What CDC did
Intracranial infections are not routinely reported to public health in the United States. CDC worked with state and local health departments, academic partners, and clinicians to see how common these infections were.
Health officials examined:
- Medical records of children who had these infections in the past
- National data sources to look at trends in intracranial infections in children, including before the COVID-19 pandemic
- Bacterial isolates from some patients