title: Molecular epidemiology of human enterovirus associated with aseptic meningitis in Shandong Province, China, 2006-2012.
abstract: BACKGROUND
  Human enteroviruses (HEVs) are common causes of acute meningitis. However, there is limited information about HEV associated with aseptic meningitis in mainland China because it has not been classified as a notifiable disease.
  
  
  OBJECTIVE
  To characterize the HEVs associated with sporadic aseptic meningitis in China and to analyze their genetic features.
  
  
  METHODS
  Cerebrospinal fluid, throat swab and feces specimens were collected from patients with aseptic meningitis in 5 sentinel hospitals in Shandong Province, China between 2006 and 2012. Virological investigation (viral isolation and molecular identification) and phylogenetic analysis were performed.
  
  
  RESULTS
  A total of 437 hospitalized patients were reported, and enteroviruses were detected in the specimens from 84 patients (19.2%) and were identified into 17 serotypes. The nine main serotypes were echovirus (E) 30 (27.4%), EV71 (13.1%), coxsackievirus (CV) B1 (9.5%), CVB3 (7.1%), CVB5 (7.1%), E6 (7.1%), E9 (7.1%), CVA9 (6.0%), and CVA10 (3.6%). Monthly distribution of isolated enteroviruses revealed a major peak in summer-fall season and a small second peak in winter constituted totally by EV71. Sequence analysis on VP1 coding region suggested Shandong strains had great genetic divergence with isolates from other countries.
  
  
  CONCLUSIONS
  Multiple serotypes were responsible for enterovirus meningitis in mainland China. Aseptic meningitis caused by EV71 and coxsackie A viruses-the predominant pathogens for the hand, foot, and mouth disease-is currently an important concern in mainland China.
authors.affiliation: Academy of Preventive Medicine, Shandong University, Jinan, People's Republic of China ; Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China.
authors.forename: Zexin
authors.initials: Z
authors.lastname: Tao
authors.affiliation: Academy of Preventive Medicine, Shandong University, Jinan, People's Republic of China ; Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Wang
authors.affiliation: Academy of Preventive Medicine, Shandong University, Jinan, People's Republic of China ; Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Academy of Preventive Medicine, Shandong University, Jinan, People's Republic of China ; Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China.
authors.forename: Guifang
authors.initials: G
authors.lastname: Liu
authors.affiliation: Academy of Preventive Medicine, Shandong University, Jinan, People's Republic of China ; Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China ; School of Public Health, Shandong University, Jinan, People's Republic of China.
authors.forename: Aiqiang
authors.initials: A
authors.lastname: Xu
authors.affiliation: Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China.
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Lin
authors.affiliation: Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China.
authors.forename: Lizhi
authors.initials: L
authors.lastname: Song
authors.affiliation: Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China.
authors.forename: Feng
authors.initials: F
authors.lastname: Ji
authors.affiliation: Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China.
authors.forename: Suting
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Preventive Medicine, College of Basic Medical Sciences, Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China.
authors.forename: Ning
authors.initials: N
authors.lastname: Cui
authors.affiliation: School of Public Health, Shandong University, Jinan, People's Republic of China.
authors.forename: Yanyan
authors.initials: Y
authors.lastname: Song
mesh_terms: D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D029821:Enterovirus A, Human / Q000235:genetics* / Q000302:isolation & purification; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008582:Meningitis, Aseptic / Q000453:epidemiology* / Q000821:virology; D017720:Molecular Epidemiology; D010802:Phylogeny; D012621:Seasons