What is the clinical evidence from this study?

Study design: Observational. Population: Aseptic meningitis (n=437). Intervention: Human enterovirus infection. Primary outcome: Detection and serotyping of enteroviruses in clinical specimens.

February 21, 2014Open Access

Molecular Epidemiology of Human Enterovirus Associated with Aseptic Meningitis in Shandong Province, China, 2006–2012

ZTZexin TaoJinan Infectious Disease Hospital HWHaiyan WangQingdao University YLYan LiUnion Hospital

Key Result

Enteroviruses were detected in 19.2% of pediatric aseptic meningitis cases in Shandong, China, with echovirus 30 (27.4%) and enterovirus 71 (13.1%) being the predominant serotypes.

Study Design

Type

Observational (n=437)

Multicenter

Yes

Structured PICO

Population

437 children aged 4 months to 12 years hospitalized with aseptic meningitis in 5 sentinel hospitals in Shandong Province, China, between 2006 and 2012.

Outcome

Detection and characterization of human enteroviruses (HEVs) and their genetic features

Multiple enterovirus serotypes, notably echovirus 30 and EV71, are responsible for aseptic meningitis in mainland China, with significant genetic divergence from international strains.

Limitations

Lack of a specific enterovirus surveillance system in China meant specimens could not be obtained for all cases, underestimating the true burden.
A few enterovirus serotypes may not be recovered by the RD and HEp-2 cell lines used for virus isolation.

Abstract

BACKGROUND: Human enteroviruses (HEVs) are common causes of acute meningitis. However, there is limited information about HEV associated with aseptic meningitis in mainland China because it has not been classified as a notifiable disease. OBJECTIVES: To characterize the HEVs associated with sporadic aseptic meningitis in China and to analyze their genetic features. STUDY DESIGN: Cerebrospinal fluid, throat swab and feces specimens were collected from patients with aseptic meningitis in 5 sentinel hospitals in Shandong Province, China between 2006 and 2012. Virological investigation (viral isolation and molecular identification) and phylogenetic analysis were performed. RESULTS: A total of 437 hospitalized patients were reported, and enteroviruses were detected in the specimens from 84 patients (19.2%) and were identified into 17 serotypes. The nine main serotypes were echovirus (E) 30 (27.4%), EV71 (13.1%), coxsackievirus (CV) B1 (9.5%), CVB3 (7.1%), CVB5 (7.1%), E6 (7.1%), E9 (7.1%), CVA9 (6.0%), and CVA10 (3.6%). Monthly distribution of isolated enteroviruses revealed a major peak in summer-fall season and a small second peak in winter constituted totally by EV71. Sequence analysis on VP1 coding region suggested Shandong strains had great genetic divergence with isolates from other countries. CONCLUSIONS: Multiple serotypes were responsible for enterovirus meningitis in mainland China. Aseptic meningitis caused by EV71 and coxsackie A viruses-the predominant pathogens for the hand, foot, and mouth disease-is currently an important concern in mainland China.

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