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 Centers for Disease Control and Prevention (CDC). The full report is available online at http://www.cdc. gov/mmwr/preview/mmwrhtml/mm5232a1.htm.
During March 2003, several state public health departments noted increased reports of aseptic meningitis, and by early August, seven states (i.e., Arizona, California, Georgia, Idaho, Oregon, South Carolina, Texas) had reported outbreaks associated with E9 or E30. The CDC report summarizes the outbreaks in Arizona, California, Georgia, Idaho, and South Carolina.
In Arizona, 465 cases of aseptic meningitis (rate, 8.6 cases per 100,000 persons) were reported through July 31, compared with 104 cases (1.9 cases per 100,000 persons) reported for the same period in 2002. The highest rate was reported in Maricopa County (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 one isolate (2 percent).
In California, 1,753 cases of aseptic meningitis (rate, 8.0 cases per 100,000 persons) had been reported through August 5, compared with annual rates of 4.5 to 7.3 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 by polymerase chain reaction (PCR) testing or culture. 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 tested positive for enteroviruses by PCR. Patients commonly reported headache, fever, 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 two of four patients who underwent virologic investigation.
In South Carolina, 82 cases of viral meningitis were identified in Aiken County from April 6 to July 31. The outbreak peaked during May, when 38 cases were reported. E9 was isolated from the CSF of two patients. In June, cases began to appear in multiple counties. By the end of July, 130 cases of aseptic meningitis had been reported. E9 was isolated from 20 specimens (18 CSF and two throat washings); no other enteroviruses were identified. Viral meningitis is not a notifiable disease in South Carolina, so comparative data are not available for previous years.
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