Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology · 2026
Discordant trends in enteroviral infections and meningitis in the post-COVID-19 era: Contributions of type distribution and type-specific risk.
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Lee Sanghoon, Cho Sun Ju, Gang Gyung-Li, Kang You Min, Song Eun Song, Kim Young Ok
Аннотация
BACKGROUND: After the COVID-19 pandemic, enterovirus circulation rebounded, but enteroviral meningitis remained low in South Korea, suggesting that viral activity alone may not reflect disease burden.
METHODS: We analyzed hospital-based and national surveillance data from 2015 to 2025 across the pre-pandemic period (2015-2019), pandemic period (2020-2021), and post-pandemic period (2022-2025). A Kitagawa-type decomposition was applied to quantify the relative contributions of changes in circulating type distribution and type-specific risk.
RESULTS: In the post-pandemic period, despite partial recovery in enterovirus activity (IRR 0.379-0.637), meningitis incidence remained markedly low (IRR 0.060-0.077). The proportion of enteroviral meningitis among aseptic meningitis declined from 72.3% to 24.4%. This discordance was accompanied by a shift in circulating types, with echoviruses declining from 40.3% to 1.3% and coxsackievirus A increasing from 34.2% to 93.8% (P < 0.001). The overall decline in meningitis (-60.7 %age points) was explained by changes in type distribution (-27.9 %age points) and type-specific risk (-32.8 %age points), with echoviruses contributing the largest share (58.8%).
CONCLUSIONS: In South Korea, post-pandemic enterovirus epidemiology showed a discordance between overall enterovirus incidence and meningitis burden. This pattern was driven by shifts in circulating type distribution and type-specific risk, indicating that meningitis burden cannot be inferred from overall enterovirus incidence alone.
METHODS: We analyzed hospital-based and national surveillance data from 2015 to 2025 across the pre-pandemic period (2015-2019), pandemic period (2020-2021), and post-pandemic period (2022-2025). A Kitagawa-type decomposition was applied to quantify the relative contributions of changes in circulating type distribution and type-specific risk.
RESULTS: In the post-pandemic period, despite partial recovery in enterovirus activity (IRR 0.379-0.637), meningitis incidence remained markedly low (IRR 0.060-0.077). The proportion of enteroviral meningitis among aseptic meningitis declined from 72.3% to 24.4%. This discordance was accompanied by a shift in circulating types, with echoviruses declining from 40.3% to 1.3% and coxsackievirus A increasing from 34.2% to 93.8% (P < 0.001). The overall decline in meningitis (-60.7 %age points) was explained by changes in type distribution (-27.9 %age points) and type-specific risk (-32.8 %age points), with echoviruses contributing the largest share (58.8%).
CONCLUSIONS: In South Korea, post-pandemic enterovirus epidemiology showed a discordance between overall enterovirus incidence and meningitis burden. This pattern was driven by shifts in circulating type distribution and type-specific risk, indicating that meningitis burden cannot be inferred from overall enterovirus incidence alone.