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Meningitis and a febrile vomiting illness caused by echovirus type 4, Northern Territory, Australia

Peter G Markey1, Joshua S Davis, Gerry B Harnett

  • 1Centre for Disease Control, PO Box 40596, Casuarina, 0811, Northern Territory, Australia. peter.markey@nt.gov.au

Emerging Infectious Diseases
|December 25, 2009
PubMed

Insights

An echovirus 4 outbreak caused meningitis and fever in Australia. Genetic analysis confirmed the virus and linked it to a 1996 China outbreak.

Area of Science:

  • Virology
  • Epidemiology
  • Public Health

Background:

  • A cluster of meningitis cases caused by echovirus 4 occurred in indigenous communities in Australia's Northern Territory in July 2007.
  • The outbreak expanded over four months to include other communities and the urban center of Darwin, causing meningitis and a fever and vomiting syndrome.

Purpose of the Study:

  • To describe the epidemiology of the echovirus 4 outbreak.
  • To confirm the causative agent of the meningitis and fever/vomiting syndrome.

Main Methods:

  • Epidemiological investigation of 95 laboratory-confirmed meningitis cases.
  • Whole-genome nucleotide sequencing of the identified enterovirus (AUS250G).
  • Viral protein 1 nucleotide sequencing for homology analysis.

Main Results:

  • The outbreak involved 95 laboratory-confirmed meningitis cases and an epidemic fever and vomiting syndrome.
  • Whole-genome sequencing identified the causative agent as a strain of echovirus 4 (AUS250G).
  • Viral protein 1 sequencing showed 96% homology with an echovirus 4 strain from a 1996 China outbreak.

Conclusions:

  • The epidemic fever and vomiting syndrome was caused by the same echovirus 4 strain responsible for meningitis.
  • The identified echovirus 4 strain (AUS250G) is genetically similar to a strain that caused a large outbreak in China.
  • This highlights the potential for enterovirus 4 to cause widespread outbreaks of neurological and gastrointestinal illness.

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