Enterovirus-related central nervous system infections in Queensland, Australia: A 23-year spatiotemporal analysis (2000–2022)

BACKGROUND: To describe the epidemiology and spatiotemporal distribution of enterovirus-related central nervous system (CNS) infections in Queensland over 23 years, focusing on age-specific burden, cerebrospinal fluid (CSF) profiles, and area incidence. METHODS: Retrospective, state-wide observational study using laboratory-confirmed cases from public hospitals and laboratory/pathology services throughout Queensland, Australia, from 1 January 2000 to 31 December 2022. RESULTS: After removing duplicate person identifiers and records with missing essential data, 3390 unique patients were included, where 57.3% were male. The median age was 2.97 years (IQR 0.1-25.8). Newborns (<28 days) and infants and young children (one month to 4 years old) accounted for 20.2% and 32.5% of cases, respectively. The average annual incidence rate was 3.5 per 100,000 inhabitants per year. CSF analyses showed mononuclear-predominant pleocytosis (median white blood cell count, 83 cells/μL, IQR 13.7-300), elevated protein (median, 580 mg/L, IQR 410-800), and preserved glucose (median, 3.0 mmol/L, IQR 2.7-3.4). The one-year case fatality rate was low (five deaths; 1.4 per 1000 cases). 3278 with valid Queensland postcodes contributed to spatial analyses. Spatial analysis revealed widespread geographic distribution, especially in coastal areas. The time series showed an increasing trend during the study period, particularly among newborns. CONCLUSIONS: In the last 2 decades, enterovirus-related CNS infections in Queensland have mainly affected newborns and young infants, with high one-year survival. The burden is widespread, with occasional high-incidence clusters in sparsely populated coastal areas, highlighting the importance of ongoing neurologic diagnostic capacity and locally responsive surveillance.