The transmission of enteroviruses is abetted by poor sanitary conditions and may occur via numerous routes including contaminated water, food, and fomites. In this cluster of cases, all patients were probably

infected from the same source, because they became ill at the same Alectinib time and no secondary cases (family or health personnel) were reported. Under these circumstances the cause seems to have been the contaminated tap water they drank in the hostel the day before returning to Italy; but in spite of this suspicion, the cause of the outbreak was not completely confirmed and remains speculative, although the clustering of the dates of onset (all from 48 to 72 h after return) clearly suggest a common source of exposure. This is the first report about imported echovirus cluster in Italy: it may be assumed that usually the aseptic

meningitis appears, due to its short incubation period, in the same country of acquired infection. The high attack rate is surprising (almost 50%, all with meningeal symptoms): this may be related to a particular virulence of this echovirus strain or, more probably, to the absence of immunity in all but one subject against echovirus-4. This serotype is one of the most often isolated in India, generally in children, whereas in Italy it is not particularly common. It has been suggested that accumulation of a “critical mass” of susceptible young children find more may be necessary to sustain epidemic transmission.13 An outbreak with the same serotype was reported in Modena (Italy) in 2001: it was not imported and 23 of 25

patients were adults, confirming the low circulation and low immunity rate of this serotype in our country.14 Of all travelers, 80% Immune system did not follow the traditionally recommended dietary restrictions:1 the risk for most travel-related diseases can be significantly reduced by applying preventive measures such as avoiding dangerous food items such as tap water, dairy products, ice-cream, salad, and seafood. This is particularly important for travelers to India where the risk of becoming ill compared to other typical destinations is higher and not following traditionally recommended dietary restrictions in that country results in a twofold increased risk of illness.1 This advice is especially important for young travelers who often travel under basic conditions and for elderly people, as the clinical consequences of diseases like enteroviral meningitis can be more severe for them. Thanks to Dr. Giorgio Pistono of virology laboratory department, Ospedale Amedeo di Savoia, Turin, Italy. The authors state they have no conflicts of interest to declare. “
“Assistance Publique-Hôpitaux de Paris launched a specific strategy to survey and control the spread of emerging multidrug-resistant bacteria such as carbapenemase-producing Enterobacteria (CPE).