Abstract
BackgroundAn outbreak of aseptic meningitis occurred in Tianshui city of Gansu Province, the People's Republic of China, from March to June 2005. A total of 85 patients were clinical confirmed as aseptic meningitis in this outbreak.ResultsCVA9 was mainly responsible for this outbreak supported by the clinical manifestations of the patients, epidemiological data of the outbreak, the results of RT-PCR and complete VP1 sequence determination, conventional neutralization assays, IgM serological assays, viral isolation and phylogenetics analysis. Through phylogenetic analysis and homogeneity analysis for partial VP1 gene, the nucleotide and amino acid homologies between Gansu isolates and former Chinese CVA9 strains were 88.2%-96.1% and 97.2%-99.2%, respectively. Multiple transmission chains of CVA9 occurred in different provinces or years in China. Moreover, in order to clarify the genotype of CVA9, Gansu CVA9 strains isolated in this outbreak were compared with other CVA9 isolates based on VP1/2A junction regions (genotyping region) and they might belong to a new genotype of CVA9, which could be assigned for genotype XIII,ConclusionsCVA9 was confirmed as the pathogen responsible for this outbreak. The phylogenetic analysis indicated that the CVA9 strains isolated in this outbreak might belong to a new genotype.
Highlights
An outbreak of aseptic meningitis occurred in Tianshui city of Gansu Province, the People’s Republic of China, from March to June 2005
Viral RNA extraction, direct reverse transcriptionpolymerase chain reaction and sequences determination Viral RNA was directly extracted from the clinical specimens using a QIAamp Mini Vial RNA Extraction Kit (Qiagen, Valencia, CA, USA). 10 cerebrospinal fluids (CSF) specimens and 22 stool samples from 22 patients was performed with direct reverse transcription-polymerase chain reaction (RT-PCR) by the pan-enterovirus primer pair including primer PE1 and PE2 as previously described [9]
Up to 29 June 2005, a total of 85 cases, which concentrated in Maiji district of Tianshui city of Gansu province, were clinical confirmed as aseptic meningitis by Tianshui City People’s Hospital in this outbreak (Figure 1)
Summary
An outbreak of aseptic meningitis occurred in Tianshui city of Gansu Province, the People’s Republic of China, from March to June 2005. A total of 85 patients were clinical confirmed as aseptic meningitis in this outbreak. Human Enteroviruses (HEV) comprise more than 80 distinct serotypes within the Picornaviridae family, and are currently classified into five species: Poliovirus and HEV-A, HEV-B, HEV-C, and HEV-D [1]. But enteroviruses can cause a wide variety of clinical diseases, the most common of the potentially severe enterovirus disease in pediatric patients remains aseptic meningitis. Serotypes of the HEV-B species including CVB1-6, ECHO, CVA9, HEV69 and HEV73 are the most frequently implicated [2,3,4,5,6], which could cause sporadic cases, outbreaks or epidemics of aseptic meningitis worldwide including China [6].
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