Panda PK, Panda P, Sharawat IK, Rana DP, Ranjan A, Govekar S, Kodamana H, Kumar D, Panda K. Etiological spectrum of acute encephalitis syndrome in children in India: A systematic review and meta-analysis. World J Clin Pediatr 2026; 15(4): 121910 [DOI: 10.5409/wjcp.121910]
Corresponding Author of This Article
Kalpana Panda, Associate Professor, Department of Pediatrics, Institute of Medical Sciences and SUM Hospital, Kalinga Nagar, Bhubaneshwar 751003, Odisha, India. drkalpanapanda@gmail.com
Research Domain of This Article
Pediatrics
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research-article
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Panda PK, Panda P, Sharawat IK, Rana DP, Ranjan A, Govekar S, Kodamana H, Kumar D, Panda K. Etiological spectrum of acute encephalitis syndrome in children in India: A systematic review and meta-analysis. World J Clin Pediatr 2026; 15(4): 121910 [DOI: 10.5409/wjcp.121910]
Prateek Kumar Panda, Indar Kumar Sharawat, Dibya Prasanna Rana, Arnav Ranjan, Siddhant Govekar, Harikrishnan Kodamana, Deepak Kumar, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh 249203, Uttarākhand, India
Pragnya Panda, Department of Neurology, Himalayan Institute of Medical Sciences, Dehra Dun 248016, Uttarākhand, India
Kalpana Panda, Department of Pediatrics, Institute of Medical Sciences and SUM Hospital, Bhubaneshwar 751003, Odisha, India
Co-first authors: Prateek Kumar Panda and Pragnya Panda.
Author contributions: Panda PK, Panda P, and Sharawat IK conceptualized the meta-analysis and developed the study protocol; Panda PK, Rana DP, Ranjan A, Govekar S, Kodamana H, and Kumar D performed the literature search, study selection, data extraction, and quality assessment; Panda PK and Panda P performed the statistical analysis; Panda PK and Sharawat IK drafted the manuscript; Panda P and Panda K provided the necessary intellectual inputs; Panda K is the corresponding author and guarantor of the manuscript; and all authors have critically revised and approved the final version of the manuscript.
AI contribution statement: A generative AI tool was used solely to assist with language refinement and improvement of grammar. No AI tool was used for data analysis, result interpretation, generation of scientific conclusions, or creation of references. All content was critically reviewed and verified by the authors, who take full responsibility for the manuscript.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Kalpana Panda, Associate Professor, Department of Pediatrics, Institute of Medical Sciences and SUM Hospital, Kalinga Nagar, Bhubaneshwar 751003, Odisha, India. drkalpanapanda@gmail.com
Received: April 7, 2026 Revised: May 12, 2026 Accepted: June 1, 2026 Published online: December 9, 2026 Processing time: 167 Days and 19.7 Hours
Abstract
BACKGROUND
Acute encephalitis syndrome (AES) continues to be an important cause of illness and death among children in India. While Japanese encephalitis (JE) virus has traditionally been regarded as the leading cause, recent studies indicate that the range of causative organisms has widened considerably.
AIM
To estimate the pooled proportion of AES cases attributable to various common infectious etiologies among children aged 18 years or younger in India.
METHODS
A comprehensive search of PubMed/MEDLINE, EMBASE, and Scopus was conducted for studies published between January 2000 and December 2025. Studies conducted in India that included at least 25 children (≤ 18 years) with AES and reported laboratory-confirmed etiologies were considered eligible. Case reports and small case series were excluded. Quality assessment of included studies was performed using the Joanna Briggs Institute checklist. A random-effects model was used to obtain pooled estimates and their corresponding 95% confidence intervals (CI).
RESULTS
A total of 69 studies were included in the final analysis. Scrub typhus emerged as the most common cause, accounting for 20% (95%CI: 13%-27%) of AES cases, followed by JE at 13% (95%CI: 11%-15%). Enterovirus accounted for 6% of the cases (95%CI: 3%-9%). Dengue, herpes simplex virus and Epstein-Barr virus accounted for 5% of the cases each (95%CI: 3%-8%, 2%-9%, and 1%-11%, respectively). Mumps and chikungunya virus accounted for 4% each (95%CI: 1%-8%, and 2%-5%, respectively).
CONCLUSION
Scrub typhus and JE are the leading identifiable etiology of pediatric AES in India. Broader diagnostic methods, including molecular techniques, may improve the diagnostic yield and facilitate early targeted therapy in children with AES.
Core Tip: This meta-analysis of 69 studies shows that scrub typhus and Japanese encephalitis are the leading identifiable etiologies of pediatric acute encephalitis syndrome (AES) in India. Enterovirus, dengue virus, herpes simplex virus, and Epstein-Barr virus are other etiological agents detected in the AES cases. These findings underline the need to consider a wider range of infectious etiologies in children presenting with AES. Broader diagnostic methods, including molecular techniques, may improve diagnostic yield and facilitate early targeted therapy in children with AES.
