• Enteroviral meningitis outbreak under close watch across the island

Sri Lankan health authorities have issued an urgent public health alert following an outbreak of enteroviral meningitis reported from several districts across the country. The outbreak, first identified in the Deniyaya Medical Officer of Health (MOH) area in the Matara District in April, has now spread to multiple regions including the Kandy, Nuwara Eliya, and Badulla Districts.

Health authorities warn that children and individuals with weakened immunity are particularly vulnerable. Health officials are urging the public, schools, hospitals, and community organisations to strengthen preventive measures immediately in order to prevent a larger nationwide spread.

What is enteroviral meningitis?

Enteroviral meningitis is an infection caused by a group of viruses known as enteroviruses. These viruses can infect the protective membranes surrounding the brain and spinal cord, leading to inflammation known as meningitis.

Meningitis can be caused by bacteria, viruses, fungi, or other organisms. Viral meningitis, including enteroviral meningitis, is generally less severe than bacterial meningitis, but it can still cause considerable illness and anxiety among affected families.

Enteroviruses are very common worldwide and often circulate more actively during warm and rainy seasons. Many people infected with enteroviruses may only develop mild fever, cough, sore throat, or diarrhoea, while some may develop meningitis. Young children are especially vulnerable because their immune systems are still developing.

Globally, enteroviral meningitis outbreaks have been reported repeatedly over the years. According to the data, large outbreaks affecting more than 1,500 children were reported in countries such as the US and China in previous decades.

Current situation in SL

The first cluster of cases in Sri Lanka was reported on 15 April from Deniyaya. Since then, additional suspected and laboratory-confirmed cases have been identified from:

• Base Hospital, Rikillagaskada
• National Hospital, Kandy
• Base Hospital, Welimada
• Base Hospital, Diyatalawa

Investigations carried out by health authorities have shown that several infections are linked to schools and community settings, suggesting that close contact and poor hygiene may be contributing to the spread. Both clustered outbreaks and isolated sporadic cases have been identified.

Public health teams are currently carrying out surveillance and monitoring activities throughout affected areas. Hospitals and preventive health institutions have been instructed to immediately notify unusual increases in meningitis cases to the Ministry of Health’s Epidemiology Unit.

Although the current number of confirmed cases remains limited, health authorities are taking the outbreak seriously because viral infections can spread rapidly among schoolchildren and crowded communities if preventive measures are neglected.

How does the disease spread?

The virus spreads mainly through two major routes.

1. Faeco-oral transmission: This occurs when contaminated food or water enters the body due to poor hand hygiene or inadequate sanitation. Children are particularly at risk because they may not wash their hands properly after using toilets or before meals.

Unsafe water, contaminated surfaces, and poor waste disposal practices can increase transmission.

1. Respiratory droplets: The virus can also spread through coughing, sneezing, and close contact with infected individuals. Crowded classrooms, tuition classes, hostels, public transport, and poorly ventilated indoor spaces may increase the risk of transmission.

Because the virus spreads easily from person to person, outbreaks can occur quickly in schools and childcare centres.

Symptoms you should watch for

The incubation period (the time between exposure to the virus and appearance of symptoms) is usually 3–7 days. Common symptoms include:

• Sudden fever
• Severe headache
• Neck stiffness
• Irritability
• Vomiting
• Sensitivity to light
• Seizures
• Altered consciousness
• Poor feeding in infants
• Bulging soft spot (fontanelle) in babies

Some children may initially appear to have a simple viral fever before more serious symptoms develop. Parents should therefore pay close attention if fever is accompanied by unusual drowsiness, persistent crying, confusion, repeated vomiting, or neck pain.

Doctors warn that symptoms in infants may be less obvious. Babies may simply become irritable, refuse feeding, or appear excessively sleepy.

Who is most at risk?

Children are the most commonly affected group during enteroviral meningitis outbreaks. Infants, preschool children, schoolchildren, and immunocompromised individuals may experience more severe illness.

Schools and childcare environments can facilitate rapid spread because children frequently share utensils, food items, toys, and classroom materials while often neglecting adequate hand hygiene.

People living in crowded environments or areas with poor sanitation facilities may also face a higher risk of infection.

Diagnosis and treatment

Doctors may suspect meningitis based on symptoms and clinical examination. Laboratory confirmation can be performed using:

• Cerebrospinal fluid (CSF) analysis
• PCR testing for enteroviruses
• Throat swabs
• Stool samples

The Ministry of Health notes that lumbar puncture may not always be necessary and will be performed according to clinical judgement.

Fortunately, most patients recover without complications within about seven days. Treatment is mainly supportive and may include:

• Rest
• Adequate fluids
• Fever control
• Pain relief
• Monitoring for complications

Severe cases, especially among infants, may require hospital admission and close observation.

Importantly, antibiotics are ineffective against viral infections such as enteroviral meningitis unless a bacterial infection is also suspected.

How can the public protect themselves?

Health authorities emphasise that prevention depends heavily on hygiene and responsible public behaviour. Essential preventive measures include:

• Wash hands frequently
• Use soap and water, especially:
• Before eating
• After using the toilet
• After coughing or sneezing
• After caring for sick individuals
• Practice respiratory etiquette
• Cover coughs and sneezes using a tissue, a face mask, or the bent elbow method
• Dispose of used tissues safely in covered bins
• Avoid close contact with sick individuals: Children with fever or respiratory symptoms should stay home from school and avoid tuition classes, crowded functions, and public gatherings
• Ensure safe drinking water: Drink clean, boiled, and properly treated water, and maintain hygienic food preparation practices
• Improve ventilation: Open windows and doors whenever possible to improve airflow in classrooms, homes, and workplaces
• Clean shared surfaces regularly: Schools and institutions should disinfect toilets, door handles, taps, desks, stair railings, and frequently touched surfaces at least three times daily

Special warning for schools and public gatherings

The outbreak has shown links to school environments and community events. Authorities have therefore instructed schools to:

• Prevent overcrowding
• Promote hand washing
• Ensure proper sanitation
• Encourage sick students to remain at home
• Improve classroom ventilation
• Clean toilets and classrooms regularly

The public has also been advised to avoid attending large gatherings if feeling unwell.

During religious and community events such as Vesak dansal, organisers are urged to maintain strict hygiene standards, provide safe food and water, and discourage symptomatic individuals from participating.

When should you seek urgent medical care?

Immediate medical attention is necessary if a child or adult develops:

• Persistent high fever
• Neck stiffness
• Severe headache
• Convulsions
• Confusion
• Difficulty waking up
• Breathing difficulty
• Poor feeding in infants

Early medical evaluation helps doctors rule out dangerous causes such as bacterial meningitis, which can become life-threatening if treatment is delayed.

Public cooperation is essential

The Ministry of Health emphasises that the current outbreak can be controlled if communities cooperate with preventive measures and public health advice.

Simple actions such as proper hand washing, avoiding public gatherings when ill, maintaining clean environments, and ensuring safe food and water can significantly reduce transmission.

Public health officials continue to monitor the situation closely through the national surveillance system and urge healthcare institutions to report suspected cases promptly.

As Sri Lanka faces this emerging health challenge, awareness, vigilance, early medical attention, and community responsibility remain the strongest defences against further spread of enteroviral meningitis.

(The writer is the Assistant Editor of the Government Medical Officers’ Association)

(The views and opinions expressed in this article are those of the writer and do not necessarily reflect the official position of this publication)