{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T13:54:11Z","timestamp":1773410051266,"version":"3.50.1"},"reference-count":44,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fogarty International Center of the National Institutes of Health","award":["K43TW011006"],"award-info":[{"award-number":["K43TW011006"]}]},{"name":"South African Research Chairs initiative (SARCHi) grant","award":["K43TW011006"],"award-info":[{"award-number":["K43TW011006"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Tuberculous meningitis (TBM) is a very severe form of childhood tuberculosis (TB), requiring hospitalisation for diagnosis. We investigated trends in admission, disease spectrum, outcomes, and healthcare system factors in children with TBM managed at a tertiary referral hospital in Cape Town, South Africa. We conducted a retrospective cohort study of children (&lt;13 years) with TBM admitted from 2017 to 2021. An innovative surveillance algorithm was used to identify all possible TBM episodes using integrated electronic health data. Episodes were clinically verified and data were extracted using medical records. A total of 263 children (median age 2.2 years; IQR: 1.1\u20135.1), 17 (6.5%) living with HIV were admitted with TBM during 2017 to 2021. There was a significant reduction in TBM admissions during the COVID-19 pandemic (IRR: 0.57, 95% CI:0.39\u20130.84), particularly in children &lt; 2 years (IRR: 0.31, 95% CI: 0.15\u20130.62). BCG vaccination was documented in 137\/263 (52.1%) and 10\/87 (11.5%) eligible children who initiated TB preventive therapy. During the pandemic, children with TBM were significantly more likely to be living with HIV (aOR: 4.01, 95% CI: 1.39\u201311.62). COVID-19 was associated with a significant reduction in the number of young children admitted with TBM. Many missed opportunities to prevent TBM were identified regardless of COVID-19. Paediatric TBM surveillance is a useful marker to monitor epidemiological trends.<\/jats:p>","DOI":"10.3390\/tropicalmed10050127","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T11:46:19Z","timestamp":1746618379000},"page":"127","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Incidence, Disease Spectrum, and Outcomes of Tuberculous Meningitis in South African Children: The Initial Impact of COVID-19"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7767-6529","authenticated-orcid":false,"given":"Victoria E.","family":"Namukuta","sequence":"first","affiliation":[{"name":"Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town 7505, South Africa"},{"name":"Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8613-6328","authenticated-orcid":false,"given":"Mariette","family":"Smith","sequence":"additional","affiliation":[{"name":"Health Intelligence, Western Cape Government Health and Wellness, Cape Town 8000, South Africa"},{"name":"Center for Integrated Data and Epidemiological Research, School of Public Health, University of Cape Town, Cape Town 7701, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danite","family":"Bester","sequence":"additional","affiliation":[{"name":"Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magriet","family":"van Niekerk","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5607-8443","authenticated-orcid":false,"given":"Regan","family":"Solomons","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2689-065X","authenticated-orcid":false,"given":"Ronald","family":"van Toorn","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5755-4133","authenticated-orcid":false,"given":"Hendrik Simon","family":"Schaaf","sequence":"additional","affiliation":[{"name":"Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2296-2302","authenticated-orcid":false,"given":"James A.","family":"Seddon","sequence":"additional","affiliation":[{"name":"Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa"},{"name":"Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helena","family":"Rabie","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary-Ann","family":"Davies","sequence":"additional","affiliation":[{"name":"Health Intelligence, Western Cape Government Health and Wellness, Cape Town 8000, South Africa"},{"name":"Center for Integrated Data and Epidemiological Research, School of Public Health, University of Cape Town, Cape Town 7701, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anneke C.","family":"Hesseling","sequence":"additional","affiliation":[{"name":"Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5279-475X","authenticated-orcid":false,"given":"Karen","family":"du Preez","sequence":"additional","affiliation":[{"name":"Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1016\/S1473-3099(14)70852-7","article-title":"Treatment outcomes of childhood tuberculous meningitis: A systematic review and meta-analysis","volume":"14","author":"Chiang","year":"2014","journal-title":"Lancet Infect. 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