Top 5 Takeaways

  1. Case Trends: A comparative increase in pediatric brain abscesses, epidural empyemas, and subdural empyemas associated with Streptococcus species was observed in the United States from January 2016 to August 2022. After an initial decline at the onset of the COVID-19 pandemic, cases rose in summer 2021, peaking in March 2022 before returning to baseline.
  2. Clinical and Microbiological Stability: Despite fluctuations in case numbers, the clinical presentation and microbiological features remained stable. No increase in case severity, genetic relatedness of Streptococcus isolates, or antimicrobial resistance was detected.
  3. Public Health Implications: The trends align with seasonal fluctuations and a redistribution of cases during the COVID-19 pandemic. Continuous epidemiologic monitoring is in place to track these infections.
  4. Data Sources and Analysis: The CDC, in collaboration with the Children’s Hospital Association and state health departments, analyzed data from pediatric hospitalizations and a national call for cases. Analysis included clinical and microbiological features, with genomic sequencing for deeper insights.
  5. Conclusion: The findings suggest that the increase in cases was consistent with historical seasonal patterns, without evidence of heightened severity or resistance. The CDC remains committed to ongoing surveillance and research in this area.

Original Article Author and Citation

Corresponding Author

Emma K. Accorsi, ,

Suggested Citation

Accorsi EK, Chochua S, Moline HL, et al. Pediatric Brain Abscesses, Epidural Empyemas, and Subdural Empyemas Associated with Streptococcus Species — United States, January 2016–August 2022. MMWR Morb Mortal Wkly Rep 2022;71:1169–1173 DOI: .


The report investigates the trend in pediatric intracranial infections, specifically brain abscesses, epidural empyemas, and subdural empyemas associated with Streptococcus species, in the United States from January 2016 to August 2022. Notably, there was a significant increase in these cases in summer 2021, which peaked in March 2022 and then returned to baseline levels. The clinical presentation and microbiological characteristics of these cases remained consistent throughout the period.


The study involved analyzing pediatric hospitalization data from the Pediatric Health Information System and responding to a national call for cases by the CDC. Data analysis included identifying microbiological features and performing genomic sequencing on Streptococcus specimens.


The increase in cases is thought to reflect seasonal fluctuations and a redistribution during the COVID-19 pandemic. Notably, the clinical severity and genetic profiles of the Streptococcus isolates remained consistent, with no observed increase in antimicrobial resistance.


The study concludes that the increase in pediatric brain abscesses and empyemas was consistent with historical seasonal trends and did not represent a new public health concern in terms of severity or antimicrobial resistance. The CDC will continue monitoring these trends to ensure public health safety.



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