Outbreaks of aseptic meningitis ass...

Outbreaks of aseptic meningitis associated with echovirus 9 (E9) and echovirus 30 (E30) have been reported in at least seven states this year, according to a report from the Center for Disease have charge of and Prevention (CDC). The glutted report is available online at http://wwwcdc gov/mmwr/preview/mmwrhtml/mm5232a1.htm.

During March 2003 several state public health departments noted increased reports of aseptic meningitis, and by way of early August, seven states (i.e., Arizona, California, Georgia, Idaho, Oregon, southward Carolina, Texas) had reported outbreaks associated with E9 or E30 The CDC report summarizes the outbreaks in Arizona, California, Georgia, Idaho, and southward Carolina.

In Arizona, 465 cases of aseptic meningitis (rate, 86 cases for 100,000 persons) were reported by the agency of July 31, compared with 104 cases (19 cases by 100,000 persons) reported for the same period in 2002 The highest rate was reported in Maricopa shire (12.7, compared with 2.7 during the same period in 2002) As of July 31 the Arizona State Health Laboratory had reported 62 enterovirus isolates, the majority (66 percent) from cerebrospinal fluid (CSF) specimens. E30 accounted for 47 isolates (76 percent) and E9 for single isolate (2 percent).

In California, 1753 cases of aseptic meningitis (rate, 80 cases for 100,000 persons) had been reported by the agency of August 5, compared with annual rates of 45 to 73 from 1999 to 2003 Specimens from 148 patients from 24 counties were submitted for diagnostic testing, and 82 patients (55 percent) had evidence of enterovirus infection through polymerase chain reaction (PCR) testing or civilization E30 was identified from 29 culture-positive cases (85 percent) and E9 was identified from four cases (12 percent)

In Georgia, 320 cases of aseptic meningitis were reported from 50 counties from March 10 to July 23 compared with 227 cases reported statewide during 2002 E9 was isolated from CSF throat swab, or rectal swab specimens of 24 patients. Enteroviruses were isolated from an additional 24 CSF specimens, and 52 CSF specimens criterioned positive for enteroviruses by PCR Patients commonly reported headache, flush nausea or vomiting, stiff neck and photophobia.

In Idaho, 38 cases from three adjacent north-central counties were reported from May 21 to July 17 compared with four cases statewide during 2002 Of the 32 patients for whom clinical information was available, 17 (53 percent) were hospitalized with clinical signs and symptoms consistent with aseptic meningitis. E30 was isolated from sum of two units of four patients who underwent virologic investigation.

In southern Carolina, 82 cases of viral meningitis were identified in Aiken shire from April 6 to July 31 The outbreak peaked during May, when 38 cases were reported. E9 was isolated from the CSF of brace patients. In June, cases began to appear in multiple counties. by way of the end of July, 130 cases of aseptic meningitis had been reported. E9 was isolated from 20 specimens (18 CSF and brace throat washings); no other enteroviruses were identified. Viral meningitis is not a notifiable disease in southerly Carolina, so comparative data are not available for previous years.

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