Abstract
BackgroundHuman enteroviruses (HEVs) are common causes of acute meningitis. However, there is limited information about HEV associated with aseptic meningitis in mainland China because it has not been classified as a notifiable disease.ObjectivesTo characterize the HEVs associated with sporadic aseptic meningitis in China and to analyze their genetic features.Study DesignCerebrospinal fluid, throat swab and feces specimens were collected from patients with aseptic meningitis in 5 sentinel hospitals in Shandong Province, China between 2006 and 2012. Virological investigation (viral isolation and molecular identification) and phylogenetic analysis were performed.ResultsA total of 437 hospitalized patients were reported, and enteroviruses were detected in the specimens from 84 patients (19.2%) and were identified into 17 serotypes. The nine main serotypes were echovirus (E) 30 (27.4%), EV71 (13.1%), coxsackievirus (CV) B1 (9.5%), CVB3 (7.1%), CVB5 (7.1%), E6 (7.1%), E9 (7.1%), CVA9 (6.0%), and CVA10 (3.6%). Monthly distribution of isolated enteroviruses revealed a major peak in summer-fall season and a small second peak in winter constituted totally by EV71. Sequence analysis on VP1 coding region suggested Shandong strains had great genetic divergence with isolates from other countries.ConclusionsMultiple serotypes were responsible for enterovirus meningitis in mainland China. Aseptic meningitis caused by EV71 and coxsackie A viruses–the predominant pathogens for the hand, foot, and mouth disease–is currently an important concern in mainland China.
Highlights
Human Enteroviruses (HEVs) belong to family Picornaviridae
Distribution of isolated enteroviruses revealed a major peak in summer-fall season and a small second peak in winter constituted totally by EV71
Multiple serotypes were responsible for enterovirus meningitis in mainland China
Summary
Human Enteroviruses (HEVs) belong to family Picornaviridae. They are common pathogens associated with various clinical syndromes, from minor febrile illness to severe, potentially fatal diseases such as aseptic meningitis, encephalitis, paralysis, myocarditis, and neonatal enteroviral sepsis [1]. In China, several investigation on HEV associated aseptic meningitis outbreaks have been reported, such as echovirus (E) 30 in Jiangsu Province in 2003 [3], E6 in Anhui in 2005 [4], coxsackievirus (CV) A9 in Gansu in 2005 [5], E30, CVB3 and CVB5 in Shandong in 2003, 2008 and 2009, respectively [6,7,8] These investigations were triggered by the huge number of hospitalized children and the attention of public health officials, not by surveillance data because aseptic meningitis has not been classified as a notifiable disease in China, and there has been to date no specific enterovirus surveillance system. There is limited information about HEV associated with aseptic meningitis in mainland China because it has not been classified as a notifiable disease
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