Meningitis - Serbia (Kosovo) (02)

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Source: Eurosurveillance weekly releases 2006, Volume 11 , Issue 9 [edited]
<http://www.eurosurveillance.org/ew/2006/060914.asp#4>

Kosovo: Enteroviral Meningitis Outbreak: July-September 2006
-----------------------------------------------
(From the National Institute of Public Health, Pristina, Kosovo - UN
Administered Territory, Infectious Disease Clinic, Pristina, Kosovo -
UN Administered Territory, Istituto Superiore di Sanita, Rome, Italy,
WHO Reference Laboratory for Polio in the European Region, WHO
Office, Pristina, Kosovo - UN Administered Territory, and the WHO
Regional Office for Europe, Copenhagen, Denmark <mailto:euroalert@euro.who.int>.

From 1 Jul to 13 Sep 2006, 878 cases of acute neurological syndrome
were notified to the National Institute of Public Health, Pristina
from 24 out of 30 municipalities of the UN administered territory of
Kosovo. The most affected municipalities are Malisheve (155 cases),
Mitrovice (112 cases), Gllogovc/Glogovac (109 cases),
Vushtrri/Vucitrn (100 cases), Skenderaj/Srbica (74 cases), Peje/Pec
(71 cases), Prishtine/Pritina (68 cases), accounting for 78 percent
of the reported cases. A total of 87 patients are currently in
hospital at the Infectious Disease Clinic in Pristina. According to
the preliminary epidemiological analysis of 245 cases, 80 percent of
the cases were in people under 15 years of age, and 66 percent were in males.
[Can anyone explain why a presumably waterborne infection would
preferentially attack males & children? - Mod.JW]

This outbreak of acute neurological syndrome of possible viral origin
was reported to the World Health Organization Regional Office for
Europe on 2 Aug 2006. On 15 Aug 2006, 28 samples (25 stool samples
and 3 cerebrospinal fluid samples) from 27 patients were shipped for
laboratory testing to the WHO Reference Laboratory for Polio in the
European Region at the Istituto Superiore di Sanita (ISS), Rome,
Italy. Enterovirus infection was detected by cell culture and
confirmed by serological and polymerase chain reaction (PCR) tests on
at least 16 of the 28 samples currently being tested. Echovirus 2
serotype was identified in 3 of the 16 samples. Further
characterization tests on isolates are ongoing.

Control measures
----------------
Control measures implemented by health authorities include: enhanced
surveillance, hospital screening and case management and awareness
campaigns to improve basic hygiene practices. The Ministry of Health
and the Ministry of Education have developed a dedicated information
package for school children. The Institute of Public Health, Pristina
is issuing daily information updates concerning the situation to the public.

References
----------
WHO. 11 Aug 2006 - Acute neurological syndrome in Kosovo (UN
Administered Territory),
< http://www.euro.who.int/surveillance/outbreaks/20060812_1>

WHO. 18 Aug 2006 - Acute neurological syndrome in Kosovo (UN
Administered Territory) - Update 1,
< http://www.euro.who.int/surveillance/outbreaks/20060818_1>

WHO. 1 Sep 2006 - Enteroviral Meningitis in Kosovo (UN Administered
Territory) - Update 2,
< http://www.euro.who.int/surveillance/outbreaks/20060901>_1>

WHO. 8 Sep 2006 - Enteroviral Meningitis in Kosovo (UN Administered
Territory) - Update 3,
< http://www.euro.who.int/surveillance/outbreaks/20060908_1>

The status of the Serbian province of Kosovo remains unresolved, and
the 1st report in this thread from a news agency source identified
Kosovo as a province of Serbia. This designation has been retained
for clarity, although Kosovo is designated now a UN administered Territory.

This outbreak is presumed to be an outbreak of aseptic (viral)
meningitis, since about 60 percent of Kosovo's population do not have
access to a mains water supply. A variety of enteroviruses have been
associated with outbreaks of aseptic meningitis, usually in
association with fecal contamination of sources of drinking water.
This report positively identifies human echovirus 2 as the likely
culprit in this outbreak, although so far only a minority of
patients' samples have tested positive for this enterovirus.

No vaccines are available for prevention of aseptic meningitis, and
the best protection remains boiling of drinking water and water used
in the preparation of food. In the longer term, improvements in the
supply of drinking water will be required to provide adequate
protection of the population of Kosovo.

A map of the Serbian province/UN administered territory of Kosovo can
be accessed via
<http://www.un.org/Depts/Cartographic/english/htmain.htm>.