AN OUTBREAK OF DISEASE BELIEVED TO HAVE BEEN CAUSED BY ECHO 9 VIRUS

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Abstract
An epidemic of unfamiliar type was observed in the summer of 1956 among the people of Newton-le-Willows (population 21,000), England. At least 3.5% of the population was involved in the outbreak, people of every age being susceptible. Schoolchildren and their immediate relatives were affected predominantly. There were no deaths. The illness was usually over within 2 weeks but, particularly in adults, sometimes lasted many months. Children were less severely affected than adults, but some had a lymphocytic meningitis. Adults often suffered intense headache and pain in the limbs. Five % of adults developed signs of neuritis, with sensory loss or paresis, and 8% signs of encephalitis. Recovery was sometimes slow, and marked by easy fatiguing and depression. Fever was of moderate degree, commonly with an intermission for a day or 2 in the 1st week of illness. The peripheral blood showed slight neutropenia, with up to 5% of abnormal monuclears. Bradycardia often occurred. Rubelli-form rashes affected 42% of children, 9% of adults. The incubation period was 4-8 days, usually 5. The epidemic seemed to spread by host-to-host transfer. ECHO 9 virus strains were isolated on monkey kidney in 4 cases. Raised titers of ECHO 9 antibody were found in 6 ''convalescent'' sera. All other serological, virological and bacteriological tests were negative.

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