Abstract
BackgroundHuman enteroviruses (HEVs) are common causal agents of aseptic meningitis in young children. Laboratory and syndromic surveillance during December 2015 and January 2016 noted an unusually high number of paediatric aseptic meningitis cases at a hospital in Mossel Bay, Western Cape Province, South Africa. HEV was detected in clinical samples, prompting an outbreak investigation.MethodsEpidemiological investigations were conducted to ascertain possible linkage between cases. Amplification, sequencing and phylogenetic analysis of the 5’UTR and VP1 regions was undertaken to determine the HEV serotype associated with the outbreak as well as other cases of aseptic meningitis in the area in the preceding 6 weeks.ResultsOver the 2-month period, 63 CSF samples were available for testing. A total of 43 outbreak cases (68.3%) were observed, and the 26 (60.5%) that could be typed were coxsackie virus A9 (CVA9). Children attending three crèche facilities were epidemiologically linked, accounting for 60.5% (26/43) of the CVA9 cases. The majority of patients were under 10 years of age (55/63, 87.3%) and there was a male predominance (66%). Nucleotide sequence analysis of the 5’UTR and VP1 regions identified 2 lineages of CVA9 co-circulating during the outbreak, although the VP1 capsid protein sequence was identical as all nucleotide differences were synonymous. There was a unique isoleucine at position 64 and all outbreak viruses had a valine to threonine change in the hypervariable BC loop of VP1. Other HEV types circulating in the preceding period were echovirus 30 (n = 4), echovirus 5 (n = 3) and 1 each of echovirus 6, echovirus 9 and echovirus 15.ConclusionCVA9 was identified as the pathogen responsible for the large outbreak of aseptic meningitis, with 2 distinct co-circulating lineages.
Highlights
Human enteroviruses (HEVs) are common causal agents of aseptic meningitis in young children
This study reports the epidemiology of a large outbreak of aseptic meningitis associated with enteroviruses in Mossel Bay, Western Cape Province, South Africa from December 2015–January 2016
The objective of this study was to determine the molecular epidemiology of HEVs in the Cerebrospinal fluid (CSF) of patients presenting with aseptic meningitis in Mossel Bay, South Africa, over a 2-month period
Summary
Human enteroviruses (HEVs) are common causal agents of aseptic meningitis in young children. HEV was detected in clinical samples, prompting an outbreak investigation. Human enteroviruses (HEVs) are ubiquitous and cause an array of clinical syndromes ranging from asymptomatic infections, in about 80% of cases, to more severe illnesses including respiratory infection, acute haemorrhagic conjunctivitis, hand- foot-and-mouth disease, neonatal sepsis, Most HEV infections occur in the summer/autumn months in temperate climates and throughout the year in tropical regions [4, 6]. Laboratory diagnosis using molecular technologies enables rapid detection of HEV and has largely replaced the more labour intensive virus culture and isolation methods. Reverse transcription PCR (RT-PCR) diagnostic methodologies target the most conserved region of the HEV genome, 5′ untranslated region (5’UTR), while typing for the investigation of outbreak and clinical disease associations usually targets the VP1 gene
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