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Abstract

BACKGROUND

The Meningitis and Encephalitis Registry in Lower Saxony (MERIN), introduced in 2003, monitors circulating neurotropic pathogens in Lower Saxony and Bremen and offers free laboratory diagnostics for patients hospitalised with aseptic meningitis, encephalitis and polio-like symptoms.

AIM

We aimed to present set-up and operation of MERIN in detail and provide results of the collected data.

METHODS

Data (work-flow, demographics, sample materials, detected pathogens including non-polio enterovirus (NPEV) genotypes), collected between 2003 and 2023 were extracted from the MERIN database and presented descriptively. Seasonal patterns of detected pathogens were analysed using a Poisson regression model.

RESULTS

During 21 years of MERIN’s operation, 34,688 samples from 13,813 patients were analysed, 54.6% (7,548/13,813) of which were male. The majority of patients were children, with 58.8% (8,127/13,813) under the age of 10 years. Twenty different pathogens were identified; NPEV infections constituted 56.9% (2,372/4,172) of all diagnoses and were found in 17.2% of patients (2,372/13,813). , adenovirus and varicella-zoster virus were identified in 7.3% (1,004/13,813), 2.1% (286/13,813) and 1.4% (190/13,813) of patients, respectively. Most frequently occurring NPEV genotypes were echovirus 30 (n = 437), echovirus 6 (n = 223) and coxsackie B virus (n = 103). Polioviruses were not detected. Increased numbers of patients and detected pathogens during summer months resulted in seasonal peaks.

CONCLUSION

MERIN elucidates the spectrum of circulating pathogens, mostly NPEV, causing symptoms of aseptic meningitis, encephalitis and polio-like symptoms and demonstrates seasonal occurrence of pathogens. MERIN contributes to the German national enterovirus surveillance and documents the polio-free status of Lower-Saxony and Bremen.

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2026-03-15
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References

  1. Kohil A, Jemmieh S, Smatti MK, Yassine HM. Viral meningitis: an overview. Arch Virol. 2021;166(2):335-45.  https://doi.org/10.1007/s00705-020-04891-1  PMID: 33392820 
  2. Wunrow HY, Bender RG, Vongpradith A, Sirota SB, Swetschinski LR, Novotney A, et al. Global, regional, and national burden of meningitis and its aetiologies, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2023;22(8):685-711.  https://doi.org/10.1016/S1474-4422(23)00195-3  PMID: 37479374 
  3. Rudolph H, Porto L, Tenenbaum T. Schwer verlaufende Meningitis und Enzephalitis bei Kindern und Jugendlichen. [Severe courses of meningitis and encephalitis in children and adolescents]. Monatsschr Kinderheilkd. 2022;170(11):986-96.  https://doi.org/10.1007/s00112-022-01610-9  PMID: 36188234 
  4. Donoso Mantke O, Vaheri A, Ambrose H, Koopmans M, de Ory F, Zeller H, et al. Analysis of the surveillance situation for viral encephalitis and meningitis in Europe. Euro Surveill. 2008;13(3):8017.  https://doi.org/10.2807/ese.13.03.08017-en  PMID: 18445392 
  5. Martin NG, Iro MA, Sadarangani M, Goldacre R, Pollard AJ, Goldacre MJ. Hospital admissions for viral meningitis in children in England over five decades: a population-based observational study. Lancet Infect Dis. 2016;16(11):1279-87.  https://doi.org/10.1016/S1473-3099(16)30201-8  PMID: 27527749 
  6. Hviid A, Melbye M. The epidemiology of viral meningitis hospitalization in childhood. Epidemiology. 2007;18(6):695-701.  https://doi.org/10.1097/EDE.0b013e3181567d31  PMID: 18062062 
  7. Boucher A, Herrmann JL, Morand P, Buzelé R, Crabol Y, Stahl JP, et al. Epidemiology of infectious encephalitis causes in 2016. Med Mal Infect. 2017;47(3):221-35.  https://doi.org/10.1016/j.medmal.2017.02.003  PMID: 28341533 
  8. Federal Ministry of Justice and Consumer Protection (BMJV). Gesetz zur Verhütung und Bekämpfung von Infektionskrankheiten beim Menschen (Infektionsschutzgesetz - IfSG). [Act on the Prevention and Control of Infectious Diseases in Humans (Infection Protection Act), Germany]. Berlin: BMJV; 2000. German. Available from: https://www.gesetze-im-internet.de/ifsg/IfSG.pdf
  9. Menon S, Meyding-Lamadé U. Virale Enzephalitis/Meningitis. [Viral encephalitis/meningitis]. Intensivmedizin up2date. 2008;(2):133-43. German.
  10. Wilske B, Fingerle V, Schulte-Spechtel U. Microbiological and serological diagnosis of Lyme borreliosis. FEMS Immunol Med Microbiol. 2007;49(1):13-21.  https://doi.org/10.1111/j.1574-695X.2006.00139.x  PMID: 17266710 
  11. Kennedy PGE, Quan P-L, Lipkin WI. Viral Encephalitis of Unknown Cause: Current Perspective and Recent Advances. Viruses. 2017;9(6):138.  https://doi.org/10.3390/v9060138  PMID: 28587310 
  12. Wang H, Zhao S, Wang S, Zheng Y, Wang S, Chen H, et al. Global magnitude of encephalitis burden and its evolving pattern over the past 30 years. J Infect. 2022;84(6):777-87.  https://doi.org/10.1016/j.jinf.2022.04.026  PMID: 35452715 
  13. Beyrer K, Baillot A, Heckler R, Monazahian M, Scharlach H, Pulz M, et al. Meningitis- und Enzephalitisregister in Niedersachsen (MERIN): Erfahrungen und erste Ergebnisse der Pilotphase. Gesundheitswesen. 2004;66(04).  https://doi.org/10.1055/s-2004-825205 
  14. Łuczyńska A, Beyrer K, Holle I, Baillot A, Monazahian M, Dreesman J, et al. Evaluation of 17 years of MERIN (Meningitis and Encephalitis register in Lower Saxony, Germany) surveillance system: participants acceptability survey, completeness and timeliness of data. BMC Health Serv Res. 2024;24(1):59.  https://doi.org/10.1186/s12913-023-10482-y  PMID: 38212779 
  15. World Health Organization (WHO) Regional Office for Europe and Centers for Disease Control and Prevention. (CDC). Enterovirus surveillance guidelines. Guidelines for enterovirus surveillance in support of the Polio Eradication Initiative. Copenhagen: WHO/Europe; 2015. Available from: https://iris.who.int/server/api/core/bitstreams/0ab25b7a-27dc-49ce-946d-dd5d17f53922/content
  16. Melnick JL, Wimberly IL. Lyophilized combination pools of enterovirus equine antisera: new LBM pools prepared from reserves of antisera stored frozen for two decades. Bull World Health Organ. 1985;63(3):543-50. PMID: 2994900 
  17. van der Sanden SMG, Koopmans MPG, van der Avoort HGAM. Detection of human enteroviruses and parechoviruses as part of the national enterovirus surveillance in the Netherlands, 1996-2011. Eur J Clin Microbiol Infect Dis. 2013;32(12):1525-31.  https://doi.org/10.1007/s10096-013-1906-9  PMID: 23780695 
  18. Keeren K, Böttcher S, Diedrich S. Enterovirus Surveillance (EVSurv) in Germany. Microorganisms. 2021;9(10):2005.  https://doi.org/10.3390/microorganisms9102005  PMID: 34683328 
  19. R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical computing; 2025. Available from: https://www.R-project.org/
  20. Böttcher S, Panning M. Enterovirus-Infektionen: Epidemiologie, Klinik und Diagnostik. [Enterovirus infections: Epidemiology, clinical picture and diagnostics]. Pädiatrie up2date. 2019;14(1):59-68. German.
  21. Chen B-S, Lee H-C, Lee K-M, Gong Y-N, Shih SR. Enterovirus and Encephalitis. Front Microbiol. 2020;11(261):261.  https://doi.org/10.3389/fmicb.2020.00261  PMID: 32153545 
  22. Peer V, Schwartz N, Green MS. Consistent, Excess Viral Meningitis Incidence Rates in Young Males: A Multi-country, Multi-year, Meta-analysis of National Data. The Importance of Sex as a Biological Variable. EClinicalMedicine. 2019;15:62-71.  https://doi.org/10.1016/j.eclinm.2019.08.006  PMID: 31709415 
  23. Kim MJ, Lee J-E, Kim KG, Park DW, Cho SJ, Kim TS, et al. Long-term sentinel surveillance of enteroviruses in Gwangju, South Korea, 2011-2020. Sci Rep. 2023;13(1):2798.  https://doi.org/10.1038/s41598-023-29461-8  PMID: 36797345 
  24. Beyrer K, Korn K, Raab K, Schaffer A, Windorfer A. Echovirus-30-bedingte Meningitiden: Potenzial für regionale Erkrankungshäufungen. [Echovirus 30 related meningitis: Potential for regional disease clusters]. Pädiatrie Monatsschr Kinderheilkd. 2010;158(3):273-80.  https://doi.org/10.1007/s00112-009-2134-3 
  25. Benschop KS, Albert J, Anton A, Andrés C, Aranzamendi M, Armannsdóttir B, et al. Re-emergence of enterovirus D68 in Europe after easing the COVID-19 lockdown, September 2021. Euro Surveill. 2021;26(45):2100998.  https://doi.org/10.2807/1560-7917.ES.2021.26.45.2100998  PMID: 34763750 
  26. Graf J, Hartmann CJ, Lehmann HC, Otto C, Adams O, Karenfort M, et al. Meningitis gone viral: description of the echovirus wave 2013 in Germany. BMC Infect Dis. 2019;19(1):1010.  https://doi.org/10.1186/s12879-019-4635-6  PMID: 31783807 
  27. Klein SL, Flanagan KL. Sex differences in immune responses. Nat Rev Immunol. 2016;16(10):626-38.  https://doi.org/10.1038/nri.2016.90  PMID: 27546235 
  28. Muenchhoff M, Goulder PJR. Sex differences in pediatric infectious diseases. J Infect Dis. 2014;209(Suppl 3) Suppl 3;S120-6. PMID: 24966192 
  29. Harvala H, Broberg E, Benschop K, Berginc N, Ladhani S, Susi P, et al. Recommendations for enterovirus diagnostics and characterisation within and beyond Europe. J Clin Virol. 2018;101:11-7.  https://doi.org/10.1016/j.jcv.2018.01.008  PMID: 29414181 
  30. Condell O, Midgley S, Christiansen CB, Chen M, Chen Nielsen X, Ellermann-Eriksen S, et al. Evaluation of the enterovirus laboratory surveillance system in Denmark, 2010 to 2013. Euro Surveill. 2016;21(18).  https://doi.org/10.2807/1560-7917.ES.2016.21.18.30218  PMID: 27173593 
  31. Robert Koch Institut (RKI). Frühsommer-Meningoenzephalitis (FSME) und verwandte Virusenzephalitiden (TBE, tick-borne encephalitis). [Early summer meningoencephalitis and related viral encephalitis (TBE, tick-borne encephalitis)]. Berlin: RKI. [Accessed: 9 Jul 2024]. German. Available from: https://www.rki.de/DE/Aktuelles/Publikationen/RKI-Ratgeber/Ratgeber/Ratgeber_FSME.html
  32. Enkelmann J, Böhmer M, Fingerle V, Siffczyk C, Werber D, Littmann M, et al. Incidence of notified Lyme borreliosis in Germany, 2013-2017. Sci Rep. 2018;8(1):14976.  https://doi.org/10.1038/s41598-018-33136-0  PMID: 30297731 
  33. Gutierrez Sanchez LH, Shiau H, Baker JM, Saaybi S, Buchfellner M, Britt W, et al. A Case Series of Children with Acute Hepatitis and Human Adenovirus Infection. N Engl J Med. 2022;387(7):620-30.  https://doi.org/10.1056/NEJMoa2206294  PMID: 35830653 
  34. Bubba L, Broberg EK, Jasir A, Simmonds P, Harvala H, Redlberger-Fritz M, et al. Circulation of non-polio enteroviruses in 24 EU and EEA countries between 2015 and 2017: a retrospective surveillance study. Lancet Infect Dis. 2020;20(3):350-61.  https://doi.org/10.1016/S1473-3099(19)30566-3  PMID: 31870905 
  35. Broberg EK, Simone B, Jansa J, EU/EEA Member State contributors. Upsurge in echovirus 30 detections in five EU/EEA countries, April to September, 2018. Euro Surveill. 2018;23(44):1800537.  https://doi.org/10.2807/1560-7917.ES.2018.23.44.1800537  PMID: 30401013 
  36. European Centre for Disease Prevention and Control (ECDC). Rapid Risk Assessment. Enterovirus detections associated with severe neurological symptoms in children and adults in European countries. Stockholm: ECDC; 2016. Available from: https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/01-08-2016-RRA-Enterovirus%2071-Spain%2C%20France%2C%20Netherlands.pdf
  37. Baertl S, Pietsch C, Maier M, Hönemann M, Bergs S, Liebert UG. Enteroviruses in Respiratory Samples from Paediatric Patients of a Tertiary Care Hospital in Germany. Viruses. 2021;13(5):882.  https://doi.org/10.3390/v13050882  PMID: 34064852 
  38. Böttcher S, Prifert C, Weißbrich B, Adams O, Aldabbagh S, Eis-Hübinger AM, et al. Detection of enterovirus D68 in patients hospitalised in three tertiary university hospitals in Germany, 2013 to 2014. Euro Surveill. 2016;21(19):30227.  https://doi.org/10.2807/1560-7917.ES.2016.21.19.30227  PMID: 27195917 
  39. Völk S, Pfirrmann M, Koedel U, Pfister H-W, Lang T, Scheibe F, et al. Decline in the number of patients with meningitis in German hospitals during the COVID-19 pandemic. J Neurol. 2022;269(7):3389-99.  https://doi.org/10.1007/s00415-022-11034-w  PMID: 35316388 
  40. Tang JW, Bialasiewicz S, Dwyer DE, Dilcher M, Tellier R, Taylor J, et al. Where have all the viruses gone? Disappearance of seasonal respiratory viruses during the COVID-19 pandemic. J Med Virol. 2021;93(7):4099-101.  https://doi.org/10.1002/jmv.26964  PMID: 33760278 
  41. Bundesministerium für Gesundheit (BMG). Coronavirus-Pandemie: Was geschah wann? Chronik aller Entwicklungen im Kampf gegen COVID-19 (Coronavirus SARS-CoV-2) und der dazugehörigen Maßnahmen des Bundesgesundheitsministeriums. [The coronavirus pandemic: What happened when? The chronicle of all developments battling COVID-19 (coronavirus SARS-CoV-2) and the associated measures of the Federal Ministry of Health]. Berlin: BMG; 2023. [Accessed: 4 Aug 2024]. German. Available from: https://www.bundesgesundheitsministerium.de/coronavirus/chronik-coronavirus
  42. Fisman D. Seasonality of viral infections: mechanisms and unknowns. Clin Microbiol Infect. 2012;18(10):946-54.  https://doi.org/10.1111/j.1469-0691.2012.03968.x  PMID: 22817528 
The Meningitis and Encephalitis Registry of Lower Saxony, Germany (MERIN) – design and main results of circulating neurotropic pathogen surveillance, 2003 to 2023
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Mareike+L+Wollenweber&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wollenweber Mareike L</a>, <a href="/search?value1=Konrad+Beyrer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Beyrer Konrad</a>, <a href="/search?value1=Armin+Baillot&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Baillot Armin</a>, <a href="/search?value1=Masyar+Monazahian&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Monazahian Masyar</a>, <a href="/search?value1=Elke+Mertens&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mertens Elke</a>, <a href="/search?value1=Sophie+Rettenbacher-Riefler&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rettenbacher-Riefler Sophie</a></span>. The Meningitis and Encephalitis Registry of Lower Saxony, Germany (MERIN) – design and main results of circulating neurotropic pathogen surveillance, 2003 to 2023. <a href="/content/ecdc">Euro Surveill.</a> 2026;31(6):pii=2500625. <a href="https://doi.org/10.2807/1560-7917.ES.2026.31.6.2500625" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2026.31.6.2500625</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 11 Aug 2025;&nbsp;&nbsp; <span class="generated">Accepted</span>: 29 Nov 2025 </span> </p>
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