Long-Term Survival, Health, Social Functioning, and Education in Patients With an Enterovirus Central Nervous System Infection, Denmark, 1997–2016

• Published in: The Journal of infectious diseases 2020-07, Vol.222 (4), p.619-627
• Main Authors: Omland, Lars H, Holm-Hansen, Charlotte, Lebech, Anne-Mette, Dessau, Ram B, Bodilsen, Jacob, Andersen, Nanna S, Roed, Casper, Christiansen, Claus B, Ellermann-Eriksen, Svend, Midgley, Sofie, Nielsen, Lene, Benfield, Thomas, Hansen, Ann-Brit E, Andersen, Christian Ø, Rothman, Kenneth J, Sørensen, Henrik T, Fischer, Thea K, Obel, Niels
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Central nervous system; Central Nervous System Infections - epidemiology; Central Nervous System Infections - virology; Child; Child, Preschool; Cohort Studies; Dementia disorders; Denmark - epidemiology; Disability pensions; Disabled Persons - psychology; Disabled Persons - statistics & numerical data; Educational Status; Employment - statistics & numerical data; Enterovirus - isolation & purification; Enterovirus Infections - epidemiology; Enterovirus Infections - virology; Epilepsy; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Mortality; Nervous system; Neurological complications; Nursing homes; Patients; Population studies; Sentinel Surveillance; Sick leave; Survival; Survivors - psychology; Survivors - statistics & numerical data; Young Adult
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiaa151

Abstract Background The long-term clinical course of patients with an enterovirus central nervous system infection (ECI) is poorly understood. Methods We performed a nationwide population-based cohort study of all Danish patients with ECI diagnosed 1997–2016 (n = 1745) and a comparison cohort from the general population individually matched on date of birth and sex (n = 17 450). Outcomes were categorized into mortality and risk of cancer and likely measures of neurological sequelae: neuropsychiatric morbidities, educational landmarks, use of hospital services, employment, receipt of disability pension, income, number of sick leave days, and nursing home residency. Results Mortality in the first year was higher among patients with ECI (mortality rate ratio [MRR] = 10.0; 95% confidence interval [CI], 4.17–24.1), but thereafter mortality was not higher (MMR = 0.94; 95% CI, 0.47–1.86). Long-term outcomes for patients with ECI were not inferior to those of the comparison cohort for risk of cancer, epilepsy, mental and behavioral disorders, dementia, depression, school start, school marks, high school education, use of hospital services, employment, receipt of disability pension, income, days of sick leave, or nursing home residency. Conclusions Diagnosis of an ECI had no substantial impact on long-term survival, health, or social/educational functioning. In this nationwide, population-based cohort study, enterovirus CNS infection was associated with an increased short-term mortality but not with long-term survival, health, or social/educational functioning. This finding is important for patients, their caregivers, and physicians.