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Rare Virus Causing Meningitis in Kids

CDC seeing resurgence of echovirus 13 in South

THURSDAY, Sept. 13, 2001 (HealthDayNews) -- Health officials say they're seeing a spike this year in a rare form of virus that can cause meningitis, particularly in children.

A new report from the Centers for Disease Control and Prevention says at least 13 states, mostly in the South, have reported confirmed cases of echovirus type 13, a so-called enterovirus related to polio.

In all, officials say, through the middle of August 50 people have developed meningitis from infection with the virus, including 45 in just four states, and more than two dozen others have tested positive for the microbe.

Like other echoviruses, strain 13 is almost always benign and causes no symptoms. But in about one in every 100 patients it can lead to meningitis, a potentially serious infection of the membranes around the brain and spinal column. Increased activity of the pathogen was first reported last year in Europe, when disease officials in Germany, England and Wales recorded outbreaks of viral meningitis linked to the strain.

"It has definitely increased in prevalence this year compared to the previous period [last year]," says Dr. Nino Khetsuriani, a medical epidemiologist at the National Center for Infectious Diseases and a co-author of the new report. "It was first isolated in [the] late [19]50s, but since then it has been seen very rarely."

In addition to meningitis, which leads to fever, headache, vomiting, and sensitivity to light, echoviruses can also cause a wide range of other symptoms, including respiratory trouble, rashes and diarrhea. The virus spreads through the oral-fecal route, meaning it's present in both saliva and stool.

But Khetsuriani says scientists don't have a good handle on the kinds of illnesses echovirus 13 can cause. "So far [symptoms] look typical and self-limiting," she says, yet only through surveillance will that be certain.

There are no treatments for viruses like echovirus 13. But some drug makers are working on compounds they hope will fight the infection. Encouraging state labs to collect samples of the virus could help when it comes time to test these medications.

Viral meningitis is no longer a reportable disease in many states. But Dr. Raoult Ratard, Louisiana's state epidemiologist who has been tracking echovirus 13, says an outbreak of the infection last June that sickened as many as 27 people prompted officials there to recommend reinstating the illness on its list of reported conditions.

"When you have an outbreak, you want to be able to look at previous years" for comparison, says Ratard, who helped prepare the latest report. What's more, he adds, some cases of apparent viral meningitis may in fact be encephalitis caused by another pathogen, called an arborvirus, and "we want to be able to distinguish them."

Large outbreaks of viral meningitis in other states, including one that struck 250 people in Tennessee and one in Mississippi that involved 56 patients, are believed to be at least partly due to echovirus 13.

In the Mississippi cases, almost three-quarters of the patients lived in a county adjacent to one of three parishes in Louisiana affected by that state's outbreak, officials say. In all three states, the median age of the patients was either 6 or 7.

What To Do

There's no way to prevent or treat echovirus 13 infection, experts say, although doing so wouldn't generally be important anyway. However, practicing good hygiene, including regular and thorough hand washing, can help stop the spread of all enteroviruses.

There are so far more than 60 types of enteroviruses, of which echoviruses make up one of the biggest branches in the family. To learn more about the pathogens, check out the Centers for Disease Control and Prevention.

For more on viral meningitis, try the New York State Department of Health or the Meningitis Foundation of America.

SOURCES: Interviews with Nino Khetsuriani, M.D., Ph.D., medical epidemiologist, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta; Raoult Ratard, M.D., state epidemiologist, Louisiana Office of Public Health, New Orleans; Sept. 14, 2001 , Morbidity and Mortality Weekly Report
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