An outbreak of aseptic meningitis due to echovirus 30 associated with attending school and swimming in pools

Summary Objectives 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