Rates of human parechoviruses have reached ‘epidemic’ levels, health authorities warn

[Nergal]

 

THE number of babies suffering severe complications from an emerging infection is on the rise in Australia, infectious disease experts are warning.

Rates of the human parechoviruses (HPeV) have reached “epidemic” levels and infants and children who contract the infection need closer medical attention by doctors and ongoing follow-up, they write in the The Medical Journal of Australia.

Most parechovirus infections cause no or mild symptoms, including gastroenteritis or influenza-like illness.

However some HPeV strains such as HPeV3 are associated with more severe infections, including encephalitis and sepsis — blood poisoning. Children under three-to-six months are particularly vulnerable to HPeV, which has been re-emerging every two years since 2013, according to the MJA paper published today.

Last year more than 200 infants were admitted to hospital as a result of HPeV infection.

“It is now recognised as a leading cause of sepsis-like illness and central nervous system infection, particularly in young infants,” wrote the authors, led by Professor Allen Cheng, director of the Infection Prevention and Healthcare Epidemiology Unit at Monash University in Melbourne.

The experts say that infants with the serious infection often appear red, hot and “angry”.

“HPeV3 disease can be severe with up to 20-50 per cent of admitted patients with sepsis-like illness requiring intensive care admission,” the authors wrote.

“Severe manifestations of the acute illness include severe sepsis and meningoencephalitis, which occur in around 10 per cent of hospitalised babies.”

There are no effective antiviral therapies for HPeV, and treatment is primarily the management of complications.

Because of this, closer observation by hospital doctors is required to exclude acute complications, the authors advise.

“Hand hygiene, cough etiquette and staying away from child care and school while unwell should be emphasised,” the authors wrote.

Follow-up by a paediatrician once the child has recovered is also recommended.

“Because of the evidence of adverse neurodevelopmental outcomes following severe HPeV infection, we recommend that all children hospitalised with HPeV infection should be followed up by a paediatrician at least until school entry, and preferably afterwards, to monitor development and learning, and manage complications including seizures,” the authors concluded.

The illness can also hit adults with the authors of the report writing: “In adults, HPeV is associated with upper respiratory tract infection and mild diarrhoeal illness, and less commonly with epidemic myalgia and myocarditis.

However pregnant women are not at risk

“There is currently no evidence to suggest particular concern regarding infection in pregnant women or foetuses,” the report reads.

WHAT IS PARECHOVIRUS?

* Epidemics of human parechovirus have occurred every two years in Australia since 2013

* Most HPeV infections cause no or mild symptoms including gastroenteritis or influenza-like illness. Characteristically, young infants present with fever, irritability and on occasions a diffuse rash (“red, hot and angry” babies).

* Severe disease can manifest as meningoencephalitis, seizures or sepsis-like presentations (including septic shock), or less common presentations including signs of surgical abdomen.

* Testing for HPeV by specific molecular tests is indicated in children younger than six months of age with characteristic presentations without another confirmed diagnosis including febrile illnesses with other suggestive features (eg, rash, seizures), sepsis syndromes (including shock), and suspected meningoencephalitis (which may be detected by magnetic resonance imaging only).

* No effective antiviral therapies exist and treatment is primarily supportive, including management of complications.

* Some infants with severe HPeV infection may have adverse neurodevelopment. Follow-up by a paediatrician is recommended.