title: An echovirus type 33 winter outbreak in New Zealand.
abstract: Echovirus type 33 (E33) is a relatively uncommon enterovirus. An E33 outbreak during the winter of 2000 in New Zealand led to 75 virologically-confirmed cases of E33 infection (2.6 cases per 100,000 individuals). Sixty-six (88%) of the 75 patients were aged <30 years, with the highest rates of infection recorded in Maori and Pacific ethnic groups. Overall, 47 (84%) of 56 patients whose cases were analyzed had either aseptic meningitis or encephalitis. Central nervous system involvement was more common after infancy (43 of 45 non-infant patients vs. 4 of 11 infants [relative risk, 2.6; 95% CI, 1.5-4.3]). Two infants died, including a neonate with fulminant hepatitis. Independent of symptom duration, neutrophil-predominant pleocytosis was detected in 17 (41%) of 41 cerebrospinal fluid specimens. Virus isolates could not be definitively typed by antibody neutralization testing but were identified as E33 by partial sequencing of the VP-1 capsid gene. The isolates were closely related to strains from Australia and Oman. Molecular typing, together with a serotype-specific E33 PCR, improved the speed and effectiveness of the outbreak investigation.
authors.affiliation: Institute of Environmental Science and Research, Porirua, Wellington, New Zealand. Sue.Huang@esr.cri.nz
authors.forename: Q Sue
authors.initials: QS
authors.lastname: Huang
authors.forename: Julia M
authors.initials: JM
authors.lastname: Carr
authors.forename: W Allan
authors.initials: WA
authors.lastname: Nix
authors.forename: M Steven
authors.initials: MS
authors.lastname: Oberste
authors.forename: David R
authors.initials: DR
authors.lastname: Kilpatrick
authors.forename: Mark A
authors.initials: MA
authors.lastname: Pallansch
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Croxson
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Lindeman
authors.forename: Michael G
authors.initials: MG
authors.lastname: Baker
authors.forename: Keith
authors.initials: K
authors.lastname: Grimwood
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D004196:Disease Outbreaks; D029822:Enterovirus B, Human / Q000187:drug effects / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D012703:Serotyping / Q000379:methods