Long-term outcomes of childhood encephalitis in Australia: burden and predictors from the Australian childhood encephalitis (ACE) prospective multicentre cohort
In brief
Over half of children with encephalitis retain neurological deficits after 12 months
In a prospective Australian cohort of 408 confirmed pediatric encephalitis cases, 58% showed incomplete recovery at one year. Worse outcomes were linked to longer hospital or ICU stays, persistent personality or behavioral changes, motor weakness, and MRI evidence of encephalitis. The findings highlight a substantial long-term burden and the need for at least a year of close follow-up.
- Journal
- The Lancet regional health. Western Pacific (Q1)
- Published
- 8 August 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Gautam J Rao, Russell C Dale, Rebecca Burrell, Luis Furuya-Kanamori, Katherine Phan, Christopher C Blyth, et al.
- PMID
- 42604174
- DOI
- 10.1016/j.lanwpc.2026.101951
Why clinicians should know about it
- Picked for Pediatrics and Child Health (paper of the day, 18 August 2026): Long‑term outcomes of childhood encephalitis inform care
Abstract
BACKGROUND: Encephalitis is inflammation of the brain parenchyma with heterogenous aetiology and presentation. In children, it often leads to short-term residual neurological deficits, however clinical predictors of adverse long-term outcome are not fully understood. METHODS: Cases of suspected encephalitis, in children aged 0 to <15 years, were actively identified from five paediatric hospitals in Australia, from March 2014 to June 2018. An expert panel categorised them into aetiological subgroups. Follow-up was conducted at discharge and 12 months using the Liverpool outcome score as the primary outcome. Potential clinical predictors of adverse outcome were determined using univariate logistic regression. FINDINGS: Of 724 suspected cases identified, 408 were confirmed as having encephalitis (58% infectious, 23% immune mediated, 19% of unknown aetiology). Recovery was incomplete in 58% of children at 12 months. Children with infectious encephalitis presented younger (median age 1.4 years) and showed divergent trajectories of outcome progression from discharge to 12 months. Immune mediated encephalitis affected mainly older children (median age 7.5 years) and overall showed trajectory to improved neurological outcome at 12 months relative to discharge. Hospital length of stay (OR = 1.02, 95% CI [1.01, 1.03]; p = 0.001), ICU length of stay (OR = 1.07, CI 1.01, 1.13]; p = 0.004), personality/behavioural change >24 h (OR = 1.91, 95% CI [1.01, 3.61]; p = 0.045), motor weakness (OR = 2.05, 95% CI [1.16, 3.64]; p = 0.013), and MRI consistent with encephalitis (OR = 2.22, 95% CI [1.19, 4.13]; p = 0.012), were significantly associated with worse neurological outcomes at 12 months. INTERPRETATION: Encephalitis in children results in a considerable ongoing disease burden with clinical features and outcome differing based on disease aetiology. Neurological deficits may manifest over time and close monitoring of children for at least 12 months is warranted. FUNDING: National Health and Medical Research Council (NHMRC) centres for research excellence (CRE) in critical infections (APP1001021) to CJ, RB. NHMRC post-graduate scholarship (GNT1074547) and early career fellowship (GNT1145817) to PB.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.