Hospitals report more parechovirus cases in infants: ‘It’s not normal’

Several health systems are now reporting a potential increase in severe cases of parechovirus infections in infants, after cases largely disappeared from children’s hospitals over the past Covid-19 pandemic.

A new report released by the Centers for Disease Control and Prevention documents the rise in cases at a medical center in Tennessee, which has already hospitalized 29 cases so far this year, including 23 infants over a six-week period.

This marks an increase from previous years: only 19 cases were detected over five months in 2018.

While parechoviruses commonly infect children, causing only mild symptoms in many children, the virus can cause serious illness when it infects babies under three months old. Some develop sepsis-like symptoms or central nervous system infections. It can also increase the risk of longer-term developmental problems.

So far, at least 21 of the babies have recovered. A child is expected to face ‘severe developmental delay’ after ‘persistent seizures’.

The findings of doctors from Vanderbilt University Medical Center and the Tennessee Department of Health have been published Thursday in the CDC’s Morbidity and Mortality Weekly Report.

Fever, irritability and poor appetite were the most common symptoms in babies admitted to the study.

It follows a health alert released by the CDC earlier this month, which warned of several states reporting parechovirus infections in newborns and young infants. It comes as the country’s pediatric infectious disease doctors have been probing a potential rise in cases.

CBS Affiliate WFSB-TV reported earlier this month about a family mourning the death of a baby in Connecticut, after the baby suffered convulsions from his infection.

Is there really an increase in cases? “It is not normal”

“In the community, some doctors have started discussing in our infectious disease forums, ‘hey, we’re seeing more of these cases, are you seeing more of this?’ And yes, we, several institutions across the country, we see a lot of things and it is not our habit, “said Dr. Tomatis Souverbielle of Nationwide Children’s Hospital in Ohio.

Souverielle co-wrote a study published last year who routinely tested infants in multiple parts of the body, including cerebrospinal fluid and blood, for parechovirus. They’ve seen about 20 cases, mostly starting around June, so far this year.

Many other health systems have only recently ramped up testing for parechovirus infections, which can be expensive and are done by a handful of labs. There is also no routine national surveillance in the United States for parechovirus, according to the CDC.

“Some doctors were saying, well, maybe it’s because we’re testing more and we didn’t know. But I think we knew from before, we were testing before, and that’s not normal,” said Sovereign.

It is believed that parechoviruses generally circulate in summer and autumn. Souverbielle Hospital has seen a similar trend, but has also reported cases every month of the year.

Most children have likely survived parechovirus infections with little or no problems in kindergarten, according to the CDC, which can be spread through respiratory symptoms for weeks and through stool for months.

“They outnumber enteroviruses, which are well known to pediatricians as a cause of summertime meningitis in small infants. Parechoviruses are the most common viral pathogen that affects the central nervous system in babies, without exception,” said Dr. Mary Anne Jackson, dean of the University of Missouri-Kansas City School of Medicine.

Are we seeing more parechoviruses because of COVID-19?

Jackson’s hospital – Children’s Mercy-Kansas City – is also among those that have been regularly test for and research the virus for years in hospitalized young infants with potential symptoms.

Jackson shared surveillance data tracing the characteristic pattern of virus circulation every two years since 2006, peaking at 62 cases admitted to hospital for all of 2018.

But that pattern broke when the COVID-19 pandemic swept the country in 2020, with virtually no cases for months when they would have expected to see a wave of infections.

Now parechoviruses appear to be circulating again, infecting young children at a potentially faster rate than seen in previous years. Jackson Hospital has seen 25 so far this year.

“Obviously over the next two to four weeks I expect to see more cases, especially if our numbers keep going down for COVID and keep going up for parechovirus, because August is a big season for this. virus,” Jackson said.

Souverbielle said scientists are exploring various theories as to why transmission may be higher this year, following the COVID-19 pandemic. The easing of pandemic restrictions may simply have led to greater spread of the parechovirus, as families began to mix again.

“There is also a theory that because children haven’t been exposed to it for the past few years, they are now more exposed and more susceptible to it,” Souverbielle said.

How are cases of parechovirus treated in babies?

The CDC says that to date, all cases of parechovirus investigated by the agency have been a specific type of virus known as PeV-A3. This type of virus, which constituted the majority of “typed” parechoviruses in some previous studiesis also the one most often linked to severe cases.

Diagnosing an infant with parechovirus can help doctors manage infections, including avoiding unnecessary testing and ending the use of antibiotics that may have been started before a bacterial infection can be ruled out.

However, there are no specific antiviral drugs approved to treat these infections.

“The fact is, there is no treatment. Babies can get better on their own. All treatment is supportive. So it’s IV fluids, fever control, seizures for babies with seizures.” said Jackson.

Jackson said telling parents about their baby’s diagnosis can also help them over the next few years as they monitor their child’s development.

A growing number of searches suggests that a minority of children who survive the disease as babies may end up with neurodevelopmental delay as they age, which may warrant early intervention from their school and parents.

These developmental issues cannot always be predicted with the severity of the initial disease, Jackson said.

“We know babies affected, sometimes they’re altered, but sometimes they’re completely normal. And babies who weren’t significantly affected by their early infection, some of those babies didn’t seem to be developing quite normally,” Jackson said.

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