Epidemics of viral meningitis caused by echovirus 6 and 30 in Korea in 2008

Abstract

BackgroundEnteroviruses (EVs) are the leading cause of aseptic meningitis, which is the most frequent central nervous system infection worldwide. We aimed to characterize the EVs involved in an aseptic meningitis outbreak in Korea in 2008. In Korea, Echovirus type 30 (E30) and E6 have been associated with outbreaks and frequent meningitis.MethodsDuring 2008, through nationwide surveillance, we collected specimens from 758 patients with aseptic meningitis-related clinical manifestations. The detection of EVs from specimens was subjected to a diagnostic real-time RT-PCR in the 5' NCR. A semi-nested polymerase chain reaction (PCR) to amplify sequences from the VP1 region and sequence comparison with reference strains registered in Genbank was performed for the genotype determination.ResultsMost patients (98%) in this outbreak were children < 15 years of age. The temporal distribution of the E6 and E30 epidemics showed an obvious seasonal pattern during the short period from June to July. A large majority of the EV-positive patients experienced fever, headache, vomiting, and neck stiffness. Some patients also showed cold symptoms, sore throat, altered mental status, and seizures. We did not observe a higher fatality rate in children with E6 or E30 infection. Most of the patients recovered uneventfully. In most cases, the cerebrospinal fluid (CSF) profile was studied, and generally showed a higher than normal white blood cell count (≥ 5/mm3). We detected EVs from 513 patients (67.68%) and identified the EV genotype in 287 patients. E30 (n = 155, 50.4%) and E6 (n = 95, 33.1%) were the predominant genotypes. E9, E1, E7, E16, coxsackievirus A3, 4, 6, coxsackievirus B1, 3, and 10 were also identified. According to phylogenetic analysis, E30 belonged to subgroup 4b, and E6, to the C4 subgroup.ConclusionsConclusively, aseptic meningitis was the most common manifestation in children with either echovirus 30 or 6 infection. Identification of E6 and E30 as the prominent EVs in the 2008 outbreak in South Korea shows the potential of EVs to cause a serious disease in an unpredictable (fashion. Our findings provide new) insights into the clinical and virological features of the aseptic meningitis outbreak caused by E30 and E6.

Accuracy of Diagnostic Methods and Surveillance Sensitivity for Human Enterovirus, South Korea, 1999–2011

“…We described 4 EV outbreaks in South Korea during 1999–2011: aseptic meningitis caused by EV71 in 2000, by E13 in 2002, by CB5 in 2005, and by E30 in 2008 ( 25 – 27 ). EV detection rates in 2002, 2005, and 2008 were relatively higher than those in other years, and the dominant genotypes found during these years were outbreak-associated genotypes.…”

Is a multivalent hand, foot, and mouth disease vaccine feasible?

“…[84][85][86] Echovirus E-30 is a major neurotropic pathogen responsible for worldwide outbreaks of aseptic meningitis and encephalitis. 2,87 Neonates and infants are specifically at risk for disseminated CV-B3, CV-B5 and E-30 infections and these 3 enteroviruses have been directly implicated in the pathogenesis of type I diabetes as a result of direct cell damage and autoimmune mimicry. 2,88 Herpangina is the most frequent clinical manifestation of CV-A4 and CV-A5 infections.…”

Prevalence of Nonpolio Enteroviruses in the Sewage of Guangzhou City, China, from 2009 to 2012

“…However, in France and Spain, ECHO11 and ECHO6 are the most frequently detected agents in human-EV-positive adults with acute respiratory tract infections (14,15). The high incidence of aseptic meningitis that occurred in Alberta, Canada, in 2010 was caused by CVA9, and an aseptic meningitis outbreak in Korea in 2008 was mainly caused by ECHO6 and ECHO30 infections (16,17). For this reason, determining the temporal and geographic patterns of EV circulation, especially the dynamics of EV serotype shifts, is critical.…”