Increased detection of human parechovirus infection in infants in England during 2016: epidemiology and clinical characteristics

Ferreras-Antolín, Laura; Kadambari, Seilesh; Braccio, Serena; Tang, Julian W.; Xerry, Jacqueline; Allen, David J.; Ladhani, Shamez

doi:10.1136/archdischild-2017-314281

Cited by 21 publications

(44 citation statements)

References 23 publications

(13 reference statements)

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“…Most of these studies were conducted >20 years ago, used crude developmental assessment tools at inconsistent times after the acute illness and evaluated small numbers of infants. Notably, in our cohort, although only 189 infants underwent audiological testing after hospital discharge, none had hearing loss, which is in keeping with another recent UK national surveillance of 106 infants with HPeV and supports current consensus that audiological follow-up after hospital discharge in infants with EV and HPeV meningitis is not routinely required in infants who are otherwise well at hospital discharge 25…”

Section: Discussionsupporting

confidence: 91%

Enterovirus and parechovirus meningitis in infants younger than 90 days old in the UK and Republic of Ireland: a British Paediatric Surveillance Unit study

et al. 2018

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ObjectivesThis study aimed to prospectively collect detailed clinical information for all enterovirus (EV) and human parechovirus (HPeV) meningitis cases in infants aged <90 days in the UK and Ireland.Participants, design and settingProspective, active national surveillance during July 2014 to July 2015 through the British Paediatric Surveillance Unit. Reporting paediatricians completed questionnaires requesting information on clinical presentation, investigations, management and outcomes at hospital discharge and after 12 months.Main outcome measuresTo describe the clinical burden of EV and HPeV meningitis in infants aged <90 days.ResultsDuring the 13-month surveillance period, 703 cases (668 EV, incidence0.79/1,000 live- births; 35 HPeV, 0.04/1,000 live-births) were identified. The most common clinical presentations were fever (EV: 570/668(85%); HPeV: 28/35(80%)), irritability (EV: 441/668(66%); HPeV: 23/35(66%)) and reduced feeding (EV: 363/668(54%); HPeV 23/35(66%)). Features of circulatory shock were present in 27% (182/668) of EV and 43% (15/35) of HPeV cases. Overall, 11% (76/668) of EV and 23% (8/35) of HPeV cases required intensive care support. Nearly all cases (678/703, 96%) were confirmed by cerebrospinal fluid (CSF) PCR, with 52% (309/600) having normal CSF white cell count for age. Two infants with EV meningitis died (2/668, 0.3%) and four survivors (4/666, 0.6%) had long-term complications at 12 months’ follow-up. Infants with HPeV meningitis survived without sequelae. Overall 189 infants had a formal hearing test and none had sensorineural hearing loss.ConclusionThe incidence of laboratory-confirmed EV/HPeV meningitis in young infants is more than twice that for bacterial meningitis. Less than 1% will develop severe neurological complications or die of their infection. Further studies are required to formally assess long-term neurodevelopmental sequelae.

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Section: Discussionsupporting

confidence: 91%

Enterovirus and parechovirus meningitis in infants younger than 90 days old in the UK and Republic of Ireland: a British Paediatric Surveillance Unit study

et al. 2018

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“…PeV infection risk increased during summer, in agreement with some [2,3,7,11,15], but not all studies as late autumn peaks are also reported [6,11,13,15]. Presence of older household siblings was not associated with PeV or PeV-A3 infections within ORChID, a finding contrasting with hospital-based studies focusing mainly on PeV-A3 cases [33,34].…”

Section: Discussionsupporting

confidence: 56%

“…PeV-A1 detections occurred earlier than PeV-A3, agreeing with seroprevalence findings [10,11], but conflicting with RT-PCR-based studies [11,31]. However, the RT-PCR studies relied upon clinical samples, which may bias the PeV detection ages as PeV-A3 is associated primarily with disease before age 3 months [2,3,5,7,11]. Unlike stools, PeV was detected rarely in nasal swabs (0.2%) and was always associated with a PeV-positive stool of the same genotype, supporting fecal-oral as one transmission route.…”

Section: Discussionmentioning

confidence: 83%

Parechovirus A Infections in Healthy Australian Children During the First 2 Years of Life: A Community-based Longitudinal Birth Cohort Study

Wang

Ware

Lambert

et al. 2019

Clinical Infectious Diseases

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Background.Hospital-based studies identify parechovirus (PeV), primarily PeV-A3, as an important cause of severe infections in young children. However, few community-based studies have been published and the true PeV infection burden is unknown. We investigated PeV epidemiology in healthy children participating in a community-based, longitudinal birth cohort study.Methods. Australian children (n = 158) enrolled in the Observational Research in Childhood Infectious Diseases (ORChID) study were followed from birth until their second birthday. Weekly stool and nasal swabs and daily symptom diaries were collected. Swabs were tested for PeV by reverse-transcription polymerase chain reaction and genotypes determined by subgenomic sequencing. Incidence rate, infection characteristics, clinical associations, and virus codetections were investigated.Results. PeV was detected in 1423 of 11 124 (12.8%) and 17 of 8100 (0.2%) stool and nasal swabs, respectively. Major genotypes among the 306 infection episodes identified were PeV-A1 (47.9%), PeV-A6 (20.1%), and PeV-A3 (18.3%). The incidence rate was 144 episodes (95% confidence interval, 128-160) per 100 child-years. First infections appeared at a median age of 8 (interquartile range, 6.0-11.7) months. Annual seasonal peaks changing from PeV-A1 to PeV-A3 were observed. Infection was positively associated with age ≥6 months, summer season, nonexclusive breastfeeding at age <3 months, and formal childcare attendance before age 12 months. Sole PeV infections were either asymptomatic (38.4%) or mild (32.7%), while codetection with other viruses in stool swabs was common (64.4%).Conclusions. In contrast with hospital-based studies, this study showed that diverse and dynamically changing PeV genotypes circulate in the community causing mild or subclinical infections in children.

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“…The age distribution, specifically the younger age preference of these viruses, as shown in this study, are possibly due to an actual age preference of the HPeVs [14,22] or selection bias due to the relatively mild symptoms in older children. Patients with low immunity are susceptible to viral infection, especially with rotaviruses; however, the presence of an intact immune system might deter the process of viral infection.…”

Section: Discussionmentioning

confidence: 60%

“…This retrospective chart review study was performed on children who underwent cerebrospinal fluid (CSF) examination in the CHA Bundang Hospital for ME diagnosis due to fever or neck stiffness symptoms from 1st June 2018 to 31st August [10,[14][15][16][17]. We enrolled 228 patients all below 15 years of age who underwent lumbar puncture.…”

Section: Patient Enrollment Study Population and Study Designmentioning

confidence: 99%

Clinical Differences between Enterovirus and Human Parechovirus in Children and Infants

Rhie

2020

Ann Child Neurol

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Purpose: Enteroviruses (EVs) and human parechoviruses (HPeVs) are important pathogens that cause fever in young infants and meningitis in children and have similar clinical symptoms and characteristics. The aim of this study was to compare the clinical symptoms and characteristics of EV and HPeV infections in young children and infants. Methods: From June to August 2018, we obtained 50 cerebrospinal fluid (CSF) samples, of which 36 and 14 were EV-and HPeV-positive, respectively, as determined by film array methods. We then compared the clinical characteristics and laboratory values of patients with EV and HPeV infections. Results: HPeV patients had a lower age than EV patients, but had similar sex predominance and fever duration. Moreover, EV patients had a higher prevalence of headache and mannitol use than HPeV patients. The blood and CSF white blood cell counts were lower among HPeV patients even after adjusting for sex and age. Furthermore, both viruses were found to cause occasional transient white matter injuries in the brain. Conclusion: The clinical characteristics of HPeV and EV infections were found to be generally similar, but with a few noteworthy differences.

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Increased detection of human parechovirus infection in infants in England during 2016: epidemiology and clinical characteristics

Cited by 21 publications

References 23 publications

Enterovirus and parechovirus meningitis in infants younger than 90 days old in the UK and Republic of Ireland: a British Paediatric Surveillance Unit study

Enterovirus and parechovirus meningitis in infants younger than 90 days old in the UK and Republic of Ireland: a British Paediatric Surveillance Unit study

Parechovirus A Infections in Healthy Australian Children During the First 2 Years of Life: A Community-based Longitudinal Birth Cohort Study

Clinical Differences between Enterovirus and Human Parechovirus in Children and Infants

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