title: An outbreak of viral meningitis associated with a public swimming pond.
abstract: From July to October 2001, 215 cases of aseptic meningitis occurred among the inhabitants of the German city of Kassel and neighbouring counties. A matched case-control study identified bathing in a public, nature-like pond during the beginning of the outbreak as a risk factor for disease [matched odds ratio (mOR) 44.8, 95% confidence interval (CI) 3.9-515.6]. Among bathers, patients with meningitis spent more time in the water (mOR 18.8, 95% CI 2.0-174.1) and swallowed water more frequently (mOR = 7.3, 95% CI 0.7-81.8). Of 30 cerebrospinal fluid samples tested, echovirus 30 was cultured from 16, and echovirus 13 from seven. An echovirus 30 sequence obtained from one pond water sample showed a 99% nucleotide and 100% amino-acid homology with patient isolates. This outbreak demonstrates the potential of nature-like swimming ponds to cause widespread community infection with substantial public health impact.
authors.affiliation: Government Health Service Institute, Dillenburg, Germany. a.hauri@suah-ldk.hessen.de
authors.forename: A M
authors.initials: AM
authors.lastname: Hauri
authors.forename: M
authors.initials: M
authors.lastname: Schimmelpfennig
authors.forename: M
authors.initials: M
authors.lastname: Walter-Domes
authors.forename: A
authors.initials: A
authors.lastname: Letz
authors.forename: S
authors.initials: S
authors.lastname: Diedrich
authors.forename: J
authors.initials: J
authors.lastname: Lopez-Pila
authors.forename: E
authors.initials: E
authors.lastname: Schreier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002555:Cerebrospinal Fluid / Q000821:virology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004457:Echovirus Infections / Q000453:epidemiology* / Q000635:transmission*; D029822:Enterovirus B, Human / Q000302:isolation & purification; D004777:Environment; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008587:Meningitis, Viral / Q000453:epidemiology* / Q000635:transmission*; D008875:Middle Aged; D016017:Odds Ratio; D016133:Polymerase Chain Reaction; D011634:Public Health; D012307:Risk Factors; D013551:Swimming Pools; D014881:Water Supply