An outbreak of viral meningitis associated with a public swimming pond

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 o...

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Bibliographic Details
Published in:Epidemiology and infection 2005-04, Vol.133 (2), p.291-298
Main Authors: HAURI, A. M., SCHIMMELPFENNIG, M., WALTER-DOMES, M., LETZ, A., DIEDRICH, S., LOPEZ-PILA, J., SCHREIER, E.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aseptic meningitis
Bathing
Biological and medical sciences
Case-Control Studies
Cerebrospinal Fluid - virology
Child
Child, Preschool
Disease Outbreaks
Echovirus Infections - epidemiology
Echovirus Infections - transmission
Enterovirus B, Human - isolation & purification
Environment
Epidemics
Female
Fundamental and applied biological sciences. Psychology
Gastrointestinal diseases
Germany
Health services
Human enterovirus B
Humans
Infections
Male
Meningitis
Meningitis, Viral - epidemiology
Meningitis, Viral - transmission
Microbiology
Middle Aged
Odds Ratio
Polymerase Chain Reaction
Ponds
Predisposing factors
Public Health
Questionnaires
Risk Factors
Scandals
Statistical analysis
Swimming
Swimming Pools
Viral meningitis
Water pollution
Water samples
Water Supply
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Description
Summary: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.
ISSN:0950-2688
1469-4409
DOI:10.1017/S0950268804003437