Echovirus 30 Outbreak Associated With a High Meningitis Attack Rate in Thrace, Greece

BackgroundIn recent decades, Echovirus 30 (E30) and Japanese encephalitis virus (JEV) have been reported to be the common causative agents of acute meningitis among patients in South East Asia. An E30 outbreak in Vietnam in 2001–2002 gained our interest because the initial clinical diagnosis of infected patients was due to JEV infection. There are few clinical insights regarding E30 cases, and there are no reports comparing E30 and JEV acute meningitis/encephalitis cases based on clinical symptoms and case histories. We therefore aimed to identify reliable clinical methods to differentiate E30 and JEV acute meningitis/encephalitis.MethodsA retrospective, cross-sectional study was conducted to compare E30 and JEV acute meningitis/encephalitis cases. We collected and analyzed the clinical records of 43 E30 confirmed cases (E30 group) and 60 JEV confirmed cases (JEV group). Clinical data were compared between the E30 and the JEV groups. Differences of clinical parameters were analyzed by certain statistical tests.ResultsFever, headache, and vomiting were the most common symptoms in both the E30 and the JEV groups. Combined symptoms of headache and vomiting and the triad of symptoms of fever, headache, and vomiting were observed in more patients in the E30 group (E30 vs. JEV: 19% vs. 0%, p < 0.001; 74% vs. 27%, p < 0.001, respectively). On the other hand, strong neurological symptoms such as seizure (5% vs. 73%, p < 0.001) and altered consciousness (12% vs. 97%, p < 0.001) were manifested primarily in the JEV group. CSF leukocytosis was observed predominantly in the E30 group (80 vs. 18 cells/μL, p = 0.003), whereas decreasing CSF sugar level was observed predominantly in the JEV group (58.7 vs. 46.9 mg/dL, p < 0.001).ConclusionFever, headache, vomiting, absence of neurological symptoms (seizure, altered consciousness), and presence of CSF leukocytosis are important parameters to consider in differentiating E30 from JEV cases during early infection. Then, proper measures can be adopted immediately to prevent the spread of the disease in the affected areas.

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“…A higher ratio was also shown in previous reports [34,35]. Boys usually prefer to play outside of their house compared with girls.…”

Section: Discussionsupporting

confidence: 80%

An approach for differentiating echovirus 30 and Japanese encephalitis virus infections in acute meningitis/encephalitis: a retrospective study of 103 cases in Vietnam

Takamatsu

Uchida

Nga

et al. 2013

Virol J

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“…A single strain of CV-B5 was detected while two strains could not be typed. The predominance of echoviruses in this study was not an unusual finding as in recent years echoviruses have been implicated in numerous outbreaks of aseptic meningitis worldwide [18][19][20][21][22][23][24][25], including SA [10], with E-30, and to a lesser extent E-6 and E-9,being the most frequent EV serotypes identified in outbreaks, including Brazil [20], France [22], Greece [26], India [19], Italy [27,28], Kuwait [23] and Panama [25], and E-4 considered to be a "rare" serotype [21]. The occurrence of E-4 however appears to be a localized rather than global phenomenon as E-4 has been identified as the predominant serotype in outbreaks of aseptic meningitis in Australia [24], Argentina [29], India [19], Italy [27], and in a travel-associated outbreak imported from India to Italy [28].…”

Section: Discussionmentioning

confidence: 99%

Molecular characterisation of enteroviruses and clinical findings from a cluster of paediatric viral meningitis cases in Tshwane, South Africa 2010–2011

Wolfaardt

Büchner

Myburgh

et al. 2014

Journal of Clinical Virology

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“…However, the majority of viruses at that time belonged to serotypes Echo30 (33.3%) and CVA6 (18.1%), which were almost absent from the Roma and immigrant populations but also from environmental samples (unpublished data). In a healthy Roma child from the prefecture of Evros in 2012, supplementary EV surveillance revealed only an Echo30 strain which was genetically similar to other Echo30 virus strains identified at the same time and in the same region of an Echo30 outbreak that resulted in a high meningitis attack rate in children (16). In the rest of the country, Echo30 virus strains that circulated in 2013 through 2014 formed four clusters which were different from the one mentioned above, suggesting a separate introduction and evolution of the virus (data not published).…”

Section: Discussionmentioning

confidence: 99%

“…2A through C). Interestingly, the Echo30 strain isolated from a Roma child in 2012 in the prefecture of Evros was genetically related to other Echo30 viruses identified during a meningitis outbreak in children in the same prefecture during 2012 (16).…”

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confidence: 99%

Laboratory Surveillance of Polio and Other Enteroviruses in High-Risk Populations and Environmental Samples

Pogka

Labropoulou

Emmanouil

et al. 2017

Appl Environ Microbiol

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In the context of poliomyelitis eradication, a reinforced supplementary laboratory surveillance of enteroviruses was implemented in Greece. Between 2008 and 2014, the Hellenic Polioviruses/Enteroviruses Reference Laboratory performed detailed supplementary surveillance of circulating enteroviruses among healthy individuals in high-risk population groups, among immigrants from countries in which poliovirus is endemic, and in environmental samples. In total, 722 stool samples and 179 sewage water samples were included in the study. No wild-type polioviruses were isolated during these 7 years of surveillance, although two imported vaccine polioviruses were detected. Enterovirus presence was recorded in 25.3 and 25.1% of stool and sewage water samples, respectively. Nonpolio enteroviruses isolated from stool samples belonged to species A, B, or C; coxsackievirus A24 was the most frequently identified serotype. Only enteroviruses of species B were identified in sewage water samples, including four serotypes of echoviruses and four serotypes of coxsackie B viruses. Phylogenetic analysis revealed close genetic relationships among virus isolates from sewage water samples and stool samples, which in most cases fell into the same cluster. To the best of our knowledge, this is the first study to compare enterovirus serotypes circulating in fecal specimens of healthy individuals and environmental samples, emphasizing the burden of enterovirus circulation in asymptomatic individuals at high risk. Given that Greece continues to receive a large number of short-term arrivals, students, migrants, and refugees from countries in which poliovirus is endemic, it is important to guarantee high-quality surveillance in order to maintain its polio-free status until global eradication is achieved. IMPORTANCE This article summarizes the results of supplementary poliovirus surveillance in Greece and the subsequent characterization of enteroviral circulation in human feces and the environment. The examination of stool samples from healthy refugees and other individuals in "high-risk" groups for poliovirus enables the identification of enterovirus cases and forms the basis for further investigation of the community-level risk of viral transmission. In addition, the examination of composite human fecal samples through environmental surveillance links poliovirus and nonpoliovirus isolates from unknown individuals to populations served by the sewage or wastewater system. Supplementary surveillance is necessary to comply with the prerequisites imposed by the World Health Organization for monitoring the emergence of vaccine-derived polioviruses, reemergence of wild polioviruses, or disappearance of all vaccine-related strains in order for countries such as Greece to maintain their polio-free status and contribute to global poliovirus eradication.

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Echovirus 30 Outbreak Associated With a High Meningitis Attack Rate in Thrace, Greece

Cited by 24 publications

References 10 publications

An approach for differentiating echovirus 30 and Japanese encephalitis virus infections in acute meningitis/encephalitis: a retrospective study of 103 cases in Vietnam

An approach for differentiating echovirus 30 and Japanese encephalitis virus infections in acute meningitis/encephalitis: a retrospective study of 103 cases in Vietnam

Molecular characterisation of enteroviruses and clinical findings from a cluster of paediatric viral meningitis cases in Tshwane, South Africa 2010–2011

Laboratory Surveillance of Polio and Other Enteroviruses in High-Risk Populations and Environmental Samples

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