Oxford epidemic of bornholm disease, 1951

Abstract

A description is given of an epidemic of Bornholm disease which occurred among the general population of Oxford in the late summer and autumn of 1951. Detailed histories were obtained from 262 of the 277 cases traced. The weekly rate of incidence rose rapidly to a peak in about four weeks and was followed by an equally rapid fall. Although cases occurred throughout the city, the epidemic was characterized by local areas of very heavy infection. The incidence was highest in young children. Spread within the family often occurred, but one-third of the cases were found to be single infections in a household. No connexion was found between cleanliness or overcrowding of the home and density of infection. Spread within schools was not a feature of the epidemic, but the experience of one infant school attacked is described. The incubation period varied from 1 to 18 days, with the majority between two and five days. Symptoms were very diverse. The most useful single feature in diagnosis was the characteristic spasmodic nature of the pain. Pyrexia was usually present and severe headache was a common complaint. Other less frequent symptoms included vomiting, photophobia, shivering, sore throat, pain in the limbs or neck, dizziness, delirium, hyperaesthesiae, and paraesthesiae. In seven cases proved benign meningitis occurred as a complication, but the more probable figure was 16 (6%).Orchitis was a complication in 3 out of 30 adult males infected. Relapses, both early and late, were a characteristic feature of the outbreak. Viruses pathogenic for infant mice were isolated from the faeces of 6 out of 17 cases examined. Attempts to isolate virus from C.S.F., blood, and throat washings failed. The strain of Coxsackie virus isolated was identified as belonging to Dalldorf's Group B on account of the pathological lesions in mice. These included muscle, fat-pad, and cerebral lesions in infant mice, and extensive lesions of the acinar tissue of the pancreas in adult mice. Paired acute and convalescent sera were obtained from 13 patients and tested for the presence of neutralizing antibody against the Oxford virus. A marked rise in neutralizing power in the convalescent serum was demonstrated in eight patients, whilst the other five cases had a high titre of antibody in both sera. Preliminary cross-neutralization tests, using the Oxford virus, indicate that it may be a previously unrecognized antigenic type. © 1953, British Medical Journal Publishing Group. All rights reserved.