Abstract:
BACKGROUND : Enteroviruses are amongst the most common causes of aseptic meningitis. Between November 2018
and May 2019, an outbreak of enterovirus-associated aseptic meningitis cases was noted in the Western and
Eastern Cape Provinces, South Africa.
OBJECTIVES : To describe the epidemiology and phylogeography of enterovirus infections during an aseptic meningitis
outbreak in the Western and Eastern Cape Provinces of South Africa.
METHODS : Cerebrospinal fluid samples from suspected cases were screened using a polymerase chain reaction
targeting the 5’UTR. Confirmed enterovirus-associated meningitis samples underwent molecular typing through
species–specific VP1/VP2 primers and pan-species VP1 primers.
RESULTS : Between November 2018 and May 2019, 3497 suspected cases of aseptic meningitis were documented in
the Western and Eastern Cape Provinces. Median age was 8 years (range 0–61), interquartile range (IQR=4–13
years), 405/735 (55%) male. 742/3497 (21%) cases were laboratory – confirmed enterovirus positive by routine
diagnostic PCR targeting the 5’UTR. 128/742 (17%) underwent molecular typing by VP1 gene sequencing.
Echovirus 4 (E4) was detected in 102/128 (80%) cases. Echovirus 9 was found in 7%, Coxsackievirus A13 in 3%.
10 genotypes contributed to the remaining 10% of cases. Synonymous mutations were found in most cases, with
sporadic amino acid changes in 13 (12.7%) cases.
CONCLUSION : The aseptic meningitis outbreak was associated with echovirus 4. Stool samples are valuable for
molecular typing in CSF confirmed EV-associated aseptic meningitis.
