Epidemic outbreak of meningitis due to Echovirus type 13 on the island of Gran Canaria (Spain)

INTRODUCTION. Since the implementation of routine vaccination against mumps, enteroviruses have become the commonest cause of viral meningitis. In Spain the most frequently isolated echoviruses are serotypes 30, 9, 6 and 4. OBJECTIVES. Determine the clinical-epidemiological characteristics of a meningitis outbreak due to echovirus type 13. METHODS. We studied 152 cases of enteroviral meningitis diagnosed in the year 2000. Viral isolation was performed on fibroblast MRC-5 and human rhabdomyosarcoma cells. The viruses were identified with monoclonal antibodies and serotyped by neutralization. RESULTS. Echovirus was isolated in 131 out of 152 CSF samples (86.2%). In 21 patients with negative CSF culture, the diagnosis was made by echovirus isolation from upper respiratory tract and/or feces samples. The cytopathic effect was seen in all cases in monolayers of rhabdomyosarcoma cells. The average age of the patients was 67 months (range: 1-350) and the male:female ratio was 2:1. Most of the patients had fever, headache and other signs of meningitis. Hospitalization was required in 52.6%. All patients were discharged without sequelae. The highest incidence was recorded from April to June. CONCLUSIONS. There had been no record of the presence of echovirus 13 in Spain in recent years until the emergence of this outbreak. Isolation of the virus from sites other than CSF is often helpful in establishing the diagnosis and patient management. Enterovirus isolates must be specifically serotyped to determine enteroviral activity in the population, which can be sporadic or epidemic.