Aseptic Meningitis -- New York State and United States, Weeks 1-36, 1991

During April-October 1991, several state health departments noted increased reports of aseptic meningitis.* This report summarizes findings from epidemiologic investigations of and surveillance efforts for aseptic meningitis in New York state and elsewhere in the United States. New York

In New York, information on cases is collected by local health units and forwarded to the New York State Department of Health (NYSDOH), using the Council of State and Territorial Epidemiologists' (CSTE) case definition for surveillance (1). From January through August 1991, 636 cases of aseptic meningitis were reported to the NYSDOH (excluding New York City), a 153% increase over the average number of cases reported during the same 8-month period for 1987-1990 (Figure 1).

From January through August 1991, the statewide incidence rate was 8.9 cases per 100,000 population, compared with 3.9 cases per 100,000 for the same period in 1990. The increase in reporting occurred statewide.

Preliminary data from 11 state laboratories, which perform viral isolation, showed increased isolations of coxsackieviruses, echovirus 30, and enteroviruses not yet typed. During June-July 1991, the Nassau County Medical Center detected echovirus 30 in 12 (67%) of 18 patient specimens from which nonpolio enteroviruses were isolated; during 1990, echovirus 30 was isolated from one (2%) of 57 patient specimens. United States

From the reporting period ending August 24, 1991, through the period ending October 12, 1991, reports of aseptic meningitis nationally have exceeded historical limits for each 4-week reporting period. Cases of aseptic meningitis are not reportable in five states (Connecticut, Idaho, New Jersey, Oregon, and Washington); however, among states with reporting requirements, 8415 cases were reported during the first 36 weeks of 1991, compared with an average of 2992 cases reported during weeks 1-36 of 1986-1990. The highest rates were reported from Vermont and Rhode Island (34.3 and 29.1 cases per 100,000 persons, respectively) (Figure 2). In Vermont, reported cases increased 10-fold over baseline from April through July. States reporting elevated rates of aseptic meningitis were concentrated in the eastern United States, particularly in New England and among the mid-Atlantic states.

Outbreaks were reported in Massachusetts, Ohio, and other states. For example, in Massachusetts, echovirus 30 was isolated from specimens from seven patients involved in a communitywide outbreak. In Ohio, a middle school football coach, a student manager, and three members of the team developed aseptic meningitis during an 8-day period in September; in this outbreak, an enterovirus (not yet identified) was isolated from two patients. The local health department initiated an educational campaign that promoted handwashing and discouraged the shared use of drinking vessels and open ice buckets. Reported by: G Beckett, MPH, KF Gensheimer, MD, State Epidemiologist, Bur of Health, Maine Dept of Human Svcs. J Silva, MD, Lawrence Board of Health, Lawrence; B Werner, PhD, RJ Timperi, MPH, D Lazorik, MS, S Lett, MD, A DeMaria, Jr, MD, State Epidemiologist, Massachusetts Dept of Public Health. J Woodberry, MG Smith, MD, State Epidemiologist, Div of Public Health Svcs, New Hampshire State Dept of Health and Human Svcs. A Greenberg, MD, G Leonardi, PhD, Nassau County; GS Birkhead, MD, H Chang, MS, L Grady, PhD, S Kondraki, DL Morse, MD, State Epidemiologist, New York State Dept of Health. D Wertman, MPA, Health Commission, Seneca County; ED Peterson, JM Moser, MD, GD Davidson, DrPH, TJ Halpin, MD, State Epidemiologist, Ohio Dept of Health. M Rittmann, D DiOrio, MEd, J Feldman, MD, Acting State Epidemiologist, Rhode Island Dept of Health. C Greene, MPH, S Choenfeld, MSPH, J Zingeser, DVM, RF Spengler, ScD, Acting State Epidemiologist, Vermont Dept of Health. Respiratory and Enteric Viruses Br, Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Div of Field Epidemiology and Div of Surveillance and Epidemiology, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Most cases of aseptic meningitis are caused by nonpolio enteroviruses (NPEV), a group of 63 common agents. For an individual case of aseptic meningitis, identification of the causative agent requires laboratory isolation and serotyping, which may take 6-8 weeks. Laboratory reports of NPEV isolations during 1991 suggest that the regional increase in aseptic meningitis may have been associated with circulation of echovirus 30; this agent also was the most frequently isolated enterovirus during 1990. Of the 720 isolates reported to CDC through October 15, 145 (20.1%) were echovirus 30--the most frequently identified NPEV through October 15. Of these 145 echovirus 30 isolates, 90 (62.0%) have been reported from New England, middle Atlantic, and south Atlantic states.

In the United States, aseptic meningitis is a nationally notifiable disease and is reportable through state health departments on a weekly basis. In response to reports of local outbreaks and statewide increases in aseptic meningitis, local and state health departments may initiate epidemiologic investigations, assure that appropriate laboratory specimens are obtained, and provide information to the public and clinicians about transmission of viral agents and the hygienic measures that reduce their spread.

Virology laboratories are encouraged to report identified enteroviruses through state virology laboratories to CDC.

Reference

1. CDC. Case definitions for public health surveillance. MMWR 1990;39(no. RR-13):6.

*The CDC case definition for aseptic meningitis is a syndrome characterized by acute onset of meningeal symptoms, fever, and cerebrospinal fluid pleocytosis, with bacteriologically sterile cultures (1).

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