This is a case-control study of viral meningitis outbreak in Perry County, Missouri. All case-patients had viral meningitis per routine CSF analysis or PCR testing. Enterovirus VP1-specific RT-PCR and sequencing was performed on CSF. Univariate and multivariable logistic regression analysis was done to evaluate risk factors. The meningitis attack rate was 1/1,000 population. The main risk factor for meningitis was association with childcare. In patients with signs of meningitis, but normal routine CSF analysis, molecular testing of the CSF is helpful for conclusive diagnosis.