Nkosi, NokwaziPreiser, WolfgangVan Zyl, GertClaassen, MathildaCronje, NadineMaritz, JeanNewman, HowardMcCarthy, KerriganNtshoe, Genevie M.Essel, VivienKorsman, StephenHardie, DianaSmuts, Heidi2022-04-282022-04-282021-06Nkosi, N., Preiser, W., Van Zyl, G. et al. 2021, 'Molecular characterisation and epidemiology of enterovirus-associated aseptic meningitis in the Western and Eastern Cape Provinces, South Africa 2018–2019', Journal of Clinical Virology, vol. 139, art. 104845, pp. 1-6.1386-6532 (print)1873-5967 (online)10.1016/j.jcv.2021.104845https://repository.up.ac.za/handle/2263/84926BACKGROUND : 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.en© 2021 The Authors. This is an open access article under the CC BY-NC-ND license.Aseptic meningitisEnterovirusEchovirus 4Molecular epidemiologyWestern Cape ProvinceEastern Cape ProvinceSouth Africa (SA)Article