Clinical and virological features of an aseptic meningitis outbreak in North-Eastern France, 2005

Background: Enteroviruses (EVs) are considered as a major viral etiological cause of aseptic meningitis in children. Objectives: We assessed the clinical and virological features of an aseptic meningitis outbreak in North-East of France, 2005. Study design: Classical bacteriological analysis, Herpesviridae and EV PCR assays had been prospectively performed on cerebrospinal fluid (CSF) samples taken from 80 children hospitalized for aseptic meningitis. For each EV strain identified as etiological agent, a phylogenetic comparison of partial EV VP1 capsid protein coding gene was performed. Results: The children older than 12 months (n = 75) presented a typical aseptic meningitis syndrome, whereas the children aged less than 1 year (n = 5) demonstrated only fever and hypotonia. Among the 80 studied children, EV was identified as the etiological cause of aseptic meningitis in 73 (91%) cases. Echovirus 30 (E30) was the most common isolated serotype (84% of 51 EV strains). VP1 phylogenetic analysis revealed that E30 strains were genetically closer to those isolated during 2000 aseptic meningitis outbreak comparatively to those identified during 2003 and 2006 non-epidemic years. Moreover, the genetic study demonstrated the co-circulation of four distinct lineages without any difference in temporal distribution or clinical features during the 2005 outbreak. Conclusions: The present report demonstrates the co-circulation of distinct E30 lineages during the same aseptic meningitis outbreak season. This E30 genetic diversity may be a prerequisite for the emergence of new strains potentially responsible for further aseptic meningitis outbreaks. (c) 2008 Elsevier B.V. All rights reserved.