Journal of Hospital Infection (2002) 51: 275±280 doi:10.1053/jhin.2002.1253, available online at http://www.idealibrary.com on Clinical and epidemiological aspects of an enterovirus outbreak in a neonatal unit V. Ph. Syriopoulou*, Ch. Hadjichristodoulouy, G. L. Daikosz, M. Pirounakiy V. Chatzicou*, I. Pavlopoulou*, M. Anagnostakoux, M. Theodoridou* and H. Dellagrammaticas{ *First Department of Pediatrics, Athens University, Aghia Sophia Children's Hospital; yNational Center for Surveillance and Intervention; zSismanoglio General Hospital; xSecond Neonatal Intensive Care Unit, Aghia Sophia Children's Hospital; {Neonatal Intensive Care Unit, Second Department of Pediatrics, Athens University, Aglaia Kyriakou Hospital, Athens, Greece Summary: An outbreak of enterovirus infection occurred among neonates in a maternity hospital between July 7 and 22, 1999. Twenty neonates became ill (18 confirmed and two probable), an attack rate of 33%. The incubation period ranged from three to six days (mean, 4.2). The male : female ratio was 11 : 9 and the mean age at the onset of illness was 5.5 days. All the babies had fever, eight, a maculopapular rash, and six had symptoms of gastroenteritis, 11 developed meningitis. Nineteen neonates required hospitalization for three to seven days, but all were discharged home without sequelae. Enteroviral RNA was detected in all of 18 urines, and 14 cerebrospinal fluid specimens tested. A case±control study was conducted to determine risk factors asso- ciated with the outbreak. Rooming in the nursery ward was a significant risk factor (odds ratio  33.35; 95% confidence interval, 3.79±800; P  0.00002). No association was found between illness and other possible risk factors. Appropriate control measures resulted in resolution of the outbreak. Our findings demonstrate the potential for enteroviruses to cause widespread illness among newborns, and emphasize the usefulness of polymerase chain reaction in the early diagnosis of infection, and underline the role of effective control measures in interrupting viral transmission. & 2002 The Hospital Infection Society Keywords: Enterovirus; outbreak; neonates; PCR. Introduction Non-polio enteroviruses, e.g., coxsackie, echo, etc are a frequent cause of viral infections in humans. They cause a broad range of clinical syndromes, from nonspecific febrile illness to aseptic meningitis, encephalitis and rarely even paralytic disease. Transmission is usually through direct or indirect contact by the faecal±oral route and respiratory secretions. 1,2 Community outbreaks are common during the summer, and children and infants are most commonly affected. Nosocomial outbreaks in neonatal units have been reported from many coun- tries leading to extensive discussion of the use of control measures and interventions. 3±15 Here we describe the investigation and the management of an enterovirus infection outbreak in a neonatal unit. Materials and methods Setting A 200-bed maternity hospital located in Athens, Greece, with three newborn units. One intensive care Received 12 February 2002; revised manuscript accepted 16 May 2002. Author for correspondence: Vassiliki Syriopoulou, Associate Professor of Pediatrics, First Department of Pediatrics, Athens University, `Aghia Sophia' Children's Hospital Thivon & Levadias Street. Athens, 11527. Tel.: 301 7467478; Fax: 301 7467669; E-mail: vsyriop@cc.uoa.gr 0195±6701/02/080275  06 $35.00 & 2002 The Hospital Infection Society