title: An outbreak of aseptic meningitis due to echovirus 30 associated with attending school and swimming in pools.
abstract: OBJECTIVE
  To identify the risk factors of an outbreak of meningitis associated with echovirus 30-infection that occurred in Rome, Italy, in late 1997 among children from two different schools.
  
  
  METHODS
  A case-control study was carried out. A case was defined as a child from either of the two schools, A or B, who presented meningitis-like (fever, headache and vomiting), diarrhea, or respiratory tract symptoms. All asymptomatic students were included in the analysis as controls.
  
  
  RESULTS
  Among 446 pupils (80%) who answered the questionnaire, 68 met the case definition. Twenty pupils developed a meningitis-like illness. Echovirus 30 was isolated from cerebrospinal fluid (CSF) in four and from stools in six. Forty-eight pupils reported other symptoms. The attack rate was 10.8% in school A and 0.8% in school B for meningitis-like illness; it was 12% and 10%, respectively, for other enterovirus-like illnesses. The risk of meningitis-like illness was higher among children attending school A (crude OR = 14.9; 95% CI = 4.3-52.1), among children using any public pool (OR = 3.8; 95% CI = 1.5-9.9) and those using an outside swimming pool X (OR=13.4; 95% CI=2.7-65.8 versus no swimming pool and OR = 8.3; 95% CI = 1.1-62.6 versus other pools). The epidemic curve appears to suggest a person-to-person transmission.
  
  
  CONCLUSIONS
  The epidemic occurred by person-to-person transmission in a number of classrooms and at swimming pool X.
authors.affiliation: Department of Epidemiology, Local Health Agency RME, v. S. Costanza No. 53, 00198 Rome, Italy. faustini@asplazio.it
authors.forename: Annunziata
authors.initials: A
authors.lastname: Faustini
authors.forename: Valeria
authors.initials: V
authors.lastname: Fano
authors.forename: Michele
authors.initials: M
authors.lastname: Muscillo
authors.forename: Stefania
authors.initials: S
authors.lastname: Zaniratti
authors.forename: Giuseppina
authors.initials: G
authors.lastname: La Rosa
authors.forename: Laura
authors.initials: L
authors.lastname: Tribuzi
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Perucci
mesh_terms: D016022:Case-Control Studies; D002648:Child; D004196:Disease Outbreaks; D004457:Echovirus Infections / Q000453:epidemiology* / Q000821:virology; D029822:Enterovirus B, Human / Q000145:classification / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008582:Meningitis, Aseptic / Q000453:epidemiology* / Q000821:virology; D012307:Risk Factors; D012384:Rome; D012574:Schools; D013551:Swimming Pools