Investigation into a school enterovirus outbreak using PCR detection and serotype identification based on the 5′ non-coding region

Abstract

A summer camp was followed by an outbreak of illness involving around 90 children. Investigations included individual questionnaires, inspection of the camp facilities, and laboratory analysis of water and clinical samples. Contamination of drinking and swimming water was demonstrated. An enterovirus was detected by polymerase chain reaction (PCR) and/or culture in 4/4 cerebrospinal fluid samples, 9/15 (60%) stool samples from symptomatic children and 2/9 (22%) stool samples from asymptomatic children. The virus was identified as an echovirus 3 by sequencing and phylogenetic analysis of a short 5' non-coding region (NCR) PCR product. Viruses from the outbreak clustered closely and an echovirus 3 from a temporally associated non-outbreak case could be readily distinguished. Despite the lack of a standardized approach, direct molecular detection and identification of enteroviruses is an efficient epidemiological tool. Here the 5'-NCR was successfully used for both detection and 'serotyping', and the close genetic relatedness of isolates was proven.

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

“…Interestingly the E-4 strains from this study were most closely related to E-4 strains from India [34], but no relevant travel history was reported for the patients. The age distribution of patients and seasonality of this cluster of aseptic meningitis cases correlates with findings from other studies in SA [10,33] and other temperate regions [20,25,29,35]. However in temperate regions outbreaks of HEV-associated meningitis can occur in other seasons, especially in closed settings, as was noted in Cape Town [31].…”

“…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].…”

“…Various RT-PCR formats are available and assays targeting the 5' non-translated region (NTR) of the HEV genome, which is the most conserved genomic region among EVs, are essential for diagnostic use [7,9,10]. Typing of HEVs during outbreak investigations is important as HEVs can be associated with specific disease manifestations [7,9].…”

Chapter 9 The Detection of Waterborne Viruses

“…Many (RT-)PCR-based analyses relate to outbreak investigations. Yeats et al (2002) described an outbreak of illness in about 90 children followed by their attendance at a summer camp. Analysis by RT-PCR of stool specimens and drinking and swimming pool water samples revealed the presence of an enterovirus, later typed as echovirus 3 (EV3), in several of each kind of sample.…”

Detection of Noroviruses in Foods: A Study on Virus Extraction Procedures in Foods Implicated in Outbreaks of Human Gastroenteritis

“…To a lesser extent, rotaviruses, enteroviruses, astroviruses, and hepatitis E virus also are important (33,(44)(45)(46)52). Noroviruses, previously known as Norwalk-like viruses, are a genetically diverse group of RNA viruses belonging to the family Caliciviridae.…”