Viral water contamination as the cause of aseptic meningitis outbreak in Belarus

Abstract

In the recent years Echovirus-30 associated outbreaks have taken place in different European countries. Aseptic meningitis caused by Echovirus-30 was the main diagnosis of a large outbreak in Belarus in Summer-Autumn, 1997, involving 460 patients. Echovirus-30 was detected in cerebrospinal fluid of the patients with aseptic meningitis. This serotype played the dominant role in the outbreak. Minor serotypes and mixtures of enteroviruses were detected in faeces and nasopharyngeal lavages. Investigation of environmental samples gave evidence of expressed viral contamination of drinking water and water sources (river and ground sources). River water sources were considerably contaminated with viruses. The incidence of virus isolation was 50%. After cleaning procedures, the incidence became two times lower, proving imperfect water purification and disinfection procedures. Sequence analysis of isolates from Belarus (isolates from water and patient's cerebrospinal fluid) showed the difference of 0.2%. The outbreak peculiarities such as high attack rate and wide-spread of the disease incidences, clinical form variability, isolation of outbreak strain from water and a good agreement between minor serotypes isolated from faeces and water samples as well as correlation in the dynamics of acute intestine infections, aseptic meningitis morbidity and bacterial water contamination can be considered as evidence of its water-borne. Echovirus-30 isolates from Belarus were very closely related to each other and to several European isolates. Sequence difference between isolates of 1994-1998 from European countries was found to be 4.3%. The data can point to the common primary source of enterovirus infection, connected to water and to the possibility of epidemic strain transmission from neighbouring states to the Republic of Belarus.