Meningitis gone viral: description of the echovirus wave 2013 in Germany

Abstract

BackgroundAseptic meningitis epidemics may pose various health care challenges.MethodsWe describe the German enterovirus meningitis epidemics in the university hospital centers of Düsseldorf, Cologne and Berlin between January 1st and December 31st, 2013 in order to scrutinize clinical differences from other aseptic meningitis cases.ResultsA total of 72 enterovirus (EV-positive) meningitis cases were detected in our multicenter cohort, corresponding to 5.8% of all EV-positive cases which were voluntarily reported within the National Enterovirus surveillance (EVSurv, based on investigation of patients with suspected aseptic meningitis/encephalitis and/or acute flaccid paralysis) by physicians within this period of time. Among these 72 patients, 38 (52.8%) were enterovirus positive and typed as echovirus (18 pediatric and 20 adult cases, median age 18.5 years; echovirus 18 (1), echovirus 2 (1), echovirus 30 (31), echovirus 33 (1), echovirus 9 (4)). At the same time, 45 aseptic meningitis cases in our cohort were excluded to be due to enteroviral infection (EV-negative). Three EV-negative patients were tested positive for varicella zoster virus (VZV) and 1 EV-negative patient for herpes simplex virus 2. Hospitalization was significantly longer in EV-negative cases. Cerebrospinal fluid analysis did not reveal significant differences between the two groups. After discharge, EV-meningitis resulted in significant burden of sick leave in our pediatric cohort as parents had to care for the children at home.ConclusionsVoluntary syndromic surveillance, such as provided by the EVSurv in our study may be a valuable tool for epidemiological research. Our analyses suggest that EV-positive meningitis predominantly affects younger patients and may be associated with a rather benign clinical course, compared to EV-negative cases.

Molecular Epidemiology of Enterovirus in Children with Central Nervous System Infections

“…Echovirus meningitis outbreaks have been reported to occur worldwide every 3 to 5 years [ 38 , 39 , 40 ]. The most recent EV meningitis epidemics in Europe occurred in Germany (Echovirus 30), in northern European countries in 2013–2014 (Echovirus 4) and in 2018 (Echovirus 30) [ 11 , 41 , 42 ]. However, sequencing data from other studies have suggested that there are genetic exchanges between different isolates, and multiple genotypes could circulate simultaneously in the same outbreak [ 43 ].…”

“…Single or multiplex PCR platforms including EV detection increased the diagnostic yield and our knowledge regarding enteroviral involvement in pediatric central nervous system (CNS) infections [ 7 , 8 , 9 ]. Further characterization of EV species with molecular sequence data, comparative genomics and phylogenetic analysis is important to identify the circulating and emerging EVs causing CNS infection or neurologic manifestations and elucidate epidemic outbreaks on time [ 10 , 11 ].…”

Analysis of enterovirus genotypes in the cerebrospinal fluid of children associated with aseptic meningitis in Liaocheng, China, from 2018 to 2019

“…Phylogenetic analyses of the VP1 gene, as conducted in the present study, have been widely used for typing EVs and in molecular epidemiological investigations. Some EV serotypes (e.g., E6, E11, E18, E30 and CVB5) are still causing global epidemic outbreaks, while others (e.g., CVA9, E5 and E20) are primarily associated with endemic infections [ 18 , 41 – 45 ]. E18 has caused many aseptic meningitis outbreaks in Germany, the United States, Japan, Korea, and other countries or regions [ 44 , 46 – 50 ].…”

Neurologic complications of coronavirus and other respiratory viral infections

“…Influenza virus types A and B are responsible for more than half of all community-acquired viral pneumonia cases, particularly during influenza outbreaks ( Davis et al, 2014 ). Moreover, enteroviruses account for occasional respiratory illnesses during the summer months ( Graf et al, 2019 ). Interestingly, in 2020 and 2021, the stringent public health measures imposed to control the COVID-19 pandemic have suppressed most seasonal respiratory viruses; the notable exception is human rhinovirus/enterovirus ( Champredon et al, 2021 ; Rodgers et al, 2021 ).…”