title: [Analysis of an outbreak of viral meningitis in the province of Tucuman, Argentina].
abstract: OBJECTIVE
  To confirm the occurrence of an outbreak of viral meningitis in 1996 in the province of Tucuman, Argentina, and to study the outbreak's epidemiological characteristics.
  
  
  METHODS
  We analyzed information from the National Epidemiological Surveillance System of the Ministry of Health (MOH) of Argentina for 1994-1998 that had been provided by the MOH's Bureau of Epidemiology. We calculated incidence rates using population estimates for the years 1994-1998 developed by the National Statistics and Census Institute, based on the 1991 census. We studied frequencies with contingency tables, using the chi-square method with Yates' correction. Results were considered significant when P < 0.05.
  
  
  RESULTS
  We confirmed the occurrence of an outbreak of 189 cases of viral meningitis between 11 February and 18 May 1996. The incidence of cases in Tucuman province increased between 1995 and 1996, from 0.5 to 19.3 cases per 100 000 person-years. That 1996 rate in Tucuman was significantly higher than what was seen in the rest of the country (2.8 cases per 100 000 person-years). Of the 189 cases, 142 of them (75.1%) occurred in children less than 9 years old. Out of 111 samples studied, 65 of them (58.6%) were enterovirus-positive. Through reverse transcription-nested polymerase chain reaction, enteroviruses were found in 66.3% (53/80) of the cases studied by this method, versus in only 29.6% (24/81) of the cases studied through viral isolation. In the 22 samples that were serotyped, echovirus type 4 was identified in 15 of them (68%): 5 by isolation, 3 by sequencing, and 7 by both methods. During the Tucuman outbreak, at least 56% of the cases were hospitalized. This viral meningitis outbreak shows the capacity of enteroviruses to spread and cause disease.
  
  
  CONCLUSIONS
  The use of molecular methods makes it possible to rapidly diagnose the etiological virus and to better control an outbreak. Recognizing this outbreak in Tucuman sooner could have averted the majority of the hospitalizations and the indiscriminate use of antibiotics.
authors.affiliation: Servicio de Neurovirosis, Instituto Nacional de Enfermedades Infecciosas, Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) "Dr. Carlos G. Malbrán", Ministerio de Salud, Argentina. mcfreire@anlis.gov.ar
authors.forename: María Cecilia
authors.initials: MC
authors.lastname: Freire
authors.forename: Daniel Marcelo
authors.initials: DM
authors.lastname: Cisterna
authors.forename: Karina
authors.initials: K
authors.lastname: Rivero
authors.forename: Gustavo Fabián
authors.initials: GF
authors.lastname: Palacios
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Casas
authors.forename: Antonio
authors.initials: A
authors.lastname: Tenorio
authors.forename: José Alberto
authors.initials: JA
authors.lastname: Gómez
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001118:Argentina / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004770:Enterovirus / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D007223:Infant; D008587:Meningitis, Viral / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D020133:Reverse Transcriptase Polymerase Chain Reaction