In the fall of 1982, the Bureau of Epidemiology, Texas
Department
of Health (TDH), began coordinating a virus isolation surveillance
system. Eighteen participating viral laboratories, located in
Austin
(1 laboratory), Dallas (4), Galveston (2), Houston (5), Lubbock
(1),
San Antonio (4), and Temple (1), report the type of isolate, along
with clinical and demographic data monthly.
In 1983, Coxsackievirus B5 (CB5) was the most common
enterovirus
isolate reported and represented 31.8% of all types isolated. Data
from the two participating laboratories that submitted reports for
all
of 1982 indicate that CB5 isolations increased over 20-fold from
1982
to 1983. CB5 isolations peaked in May and June, when 66.7% of all
1983 CB5 isolations were made. Ninety-two (65.2%) of the 141 CB5
isolates were associated with cases of aseptic meningitis, and CB5
isolates made up 40.7% of all 1983 viral isolates associated with
aseptic meningitis. CB5 isolates also comprised 66.4% of aseptic
meningitis isolates in May and June.
From 1982 to 1983, all reported aseptic meningitis cases in
Texas
increased 49.3% from 785 to 1,173. For June and July 1983,
reported
cases of aseptic meningitis increased 66% (79 to 131) and 193% (91
to
263), respectively, compared with June and July 1982. Physicians
take
a median of 6 weeks to send reports of aseptic meningitis to the
TDH;
therefore, the June-July 1983 increase in aseptic meningitis
correlates with the peak in CB5 isolations.
Reported by JP Taylor, MPH, C Reed, MPH, CE Alexander, MD, State
Epidemiologist, Texas Dept of Health; Respiratory and Enterovirus
Br,
Div of Viral Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: As a group, enteroviruses are the most commonly
identified cause of aseptic meningitis, and account for over 80% of
the identified agents (agents are identified for only about 20% of
patients) (1). Preliminary results from CDC's Enterovirus
Surveillance System show that CB5 was the most commonly reported
type--492 (20.2%) of 2,432 isolates--in 1983, with CB5 isolations
peaking in August 1983 in all regions except the West South Central
(which includes Texas), where CB5 peaked in June. This Texas
outbreak
occurred earlier than most enterovirus outbreaks and forecast
increased CB5 isolations in the United States in 1983. Review of
enterovirus surveillance data from 1970 to 1982 suggests that
nonpolio
enterovirus isolates from the West South Central, South Atlantic,
Mountain, and Pacific regions are often harbingers of the types of
enteroviruses that will be commonly isolated in the rest of the
United
States. Isolation data from these regions in March, April, and May
may be useful in predicting the common enterovirus types likely to
be
isolated in the remaining regions for that year (2).
References
Chonmaitree T, Menegus MA, Powell KR. The clinical relevance
of
'CSF viral culture.' A two-year experience with aseptic
meningitis in Rochester, NY. JAMA 1982;247:1843-7.
CDC. Unpublished data.
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