title: Predominance of enterovirus B and echovirus 30 as cause of viral meningitis in a UK population.
abstract: Enteroviruses are the most common cause of aseptic or lymphocytic meningitis, particularly in children. With reports of unusually severe neurological disease in some patients infected with enterovirus D68 in North America, and a recent increase in the number of paediatric enterovirus meningitis cases presenting in this UK Midlands population, a retrospective regional surveillance study was performed.
  
  
  
  Cerebrospinal fluid (CSF) samples received were tested using the polymerase chain reaction (PCR) for HSV-1/2, VZV, enteroviruses and parechoviruses. Enterovirus PCR positive CSF samples were sent for further serotyping. A phylogenetic tree was constructed of the echovirus 30 VP1 sequences, where sufficient sample remained for sequencing.
  
  
  
  The number of enterovirus positive CSFs from each year were: 21 (2008), 7 (2011), 53 (2012), 58 (2013) and 31 (2014). Overall, 163 of the 170 serotyped enteroviruses belonged to the species B (echovirus 5, 6, 7, 9, 11, 13, 16, 17, 18, 21, 25, 30; coxsackie B1, B2, B3, B4, B5, A9), with only 7 belonging to species A (coxsackie A2, A6, A16 and enterovirus 71). Echovirus 30 was the predominant serotype overall, identified in 43 (25.3%) of samples, with a significantly higher proportion in the adult age group (37.3%) compared to the infant age group (12.3%). Phylogenetic analysis showed that these UK Midlands echovirus 30 VP1 sequences clustered most closely with those from Europe and China.
  
  
  
  This study showed a continued predominance of echovirus 30 as a cause of viral meningitis, particularly in adults, though more surveillance is needed.
authors.affiliation: Clinical Microbiology, University Hospitals Leicester, Leicester, UK.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Holmes
authors.affiliation: Clinical Microbiology, University Hospitals Leicester, Leicester, UK.
authors.forename: Sharon S F
authors.initials: SS
authors.lastname: Koo
authors.affiliation: Public Health Laboratory Birmingham, Birmingham, UK.
authors.forename: Husam
authors.initials: H
authors.lastname: Osman
authors.affiliation: Public Health Laboratory Birmingham, Birmingham, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Wilson
authors.affiliation: Virus Reference Department, Public Health England, Colindale, London, UK.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Xerry
authors.affiliation: Virus Reference Department, Public Health England, Colindale, London, UK.
authors.forename: Chris I
authors.initials: CI
authors.lastname: Gallimore
authors.affiliation: Virus Reference Department, Public Health England, Colindale, London, UK; National Institute for Health Protection Research Unit in Gastrointestinal Infections, Colindale, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Allen
authors.affiliation: Clinical Microbiology, University Hospitals Leicester, Leicester, UK. Electronic address: julian.tang@uhl-tr.nhs.uk.
authors.forename: Julian W
authors.initials: JW
authors.lastname: Tang
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004457:Echovirus Infections / Q000453:epidemiology / Q000821:virology; D029822:Enterovirus B, Human / Q000145:classification / Q000235:genetics; D004769:Enterovirus Infections / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008587:Meningitis, Viral / Q000453:epidemiology / Q000821:virology; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000134:cerebrospinal fluid; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D012367:RNA, Viral
keywords: Aseptic meningitis; Echovirus 30; Enterovirus; Midlands; Surveillance; Viral meningitis