Pediatric Brain Abscesses, Epidural Empyemas, and Subdural Empyemas Associated With Streptococcus Species

United States, January 2016-August 2022

Emma K. Accorsi, PhD; Sopio Chochua, MD, PhD; Heidi L. Moline, MD; Matt Hall, PhD; Adam L. Hersh, MD, PhD; Samir S. Shah, MD; Amadea Britton, MD; Paulina A. Hawkins, MPH; Wei Xing, MSTAT; Jennifer Onukwube Okaro, MPH; Lindsay Zielinski, DO; Lesley McGee, PhD; Stephanie Schrag, DPhil; Adam L. Cohen, MD


Morbidity and Mortality Weekly Report. 2022;71(37):1169-1173. 

In This Article

Cases Identified Through CHA's PHIS Database

During January 2016–May 2022, a total of 3,078 cases of pediatric brain abscesses, epidural empyemas, or subdural empyemas were identified from the PHIS database, ranging from 20 to 68 cases per month (median = 38; IQR = 32–48) (Figure). Beginning in April 2020, case counts were below the median for 15 months, the longest such interval during the analysis period. Starting in summer 2021, cases increased and peaked in March 2022, representing the longest interval with case counts above the median, before declining in April 2022. During these two periods, 184 fewer and 177 more cases occurred, respectively, than would have, if each month had had the median number of cases. Since 2016, peaks in cases have often occurred around March, with similarly sized peaks observed in March 2017 and March 2019. Although the total number of cases in 2020 (382) was lower than that during 2016–2019 (range = 443–538), the total in 2021 (471) was within this historical range.


Cases of brain abscess, epidural empyema, or subdural empyema in persons aged ≤18 years — Pediatric Health Information System, United States, January 2016–May 2022*
*Data from 40 children's hospitals.

The median patient age was 8 years (IQR = 1–13 years). Most cases (65.1%) occurred in males; 46.5% of cases were in non-Hispanic White (White), 21.3% in non-Hispanic Black, 20.8% in Hispanic or Latino (Hispanic), 3.3% in non-Hispanic Asian children, and 8.1% in non-Hispanic children of another race. The demographic characteristics of patients remained largely consistent over time, as did markers of severity (e.g., length of hospitalization, in-hospital mortality, and ICU admission) and the percentage of patients with a complex chronic condition (Supplementary Figure 1; (Supplementary Figure 2; (Supplementary Figure 3; The percentage of patients with concurrent COVID-19 varied from 1.3% to 10.9% across quarters (Supplementary Figure 2; paralleling known COVID-19 waves.§