by Health Editor
Echovirus 11 would be responsible for serious infections. However, based on the available data, the public health risk for the general population remains low
Infection with enterovirus, Echovirus 11 (E-11), is on the rise. After the alert last May which concerned only France, the WHO regional office (World Health Organization) in Europe reports the spread of new cases in other member states.
As of June 26, Croatia, Italy, Spain, Sweden and the United Kingdom of Great Britain and Northern Ireland have reported confirmed cases of E-11 infection in newborns. Further public health investigations and responses are ongoing in each of these Member States. Based on the limited information available, WHO assesses the public health risk to the general population as low, while we continue to encourage countries to monitor and report on cases, the WHO statement reads.
No specific antiviral therapy is available for echovirus infection and treatment focuses on preventing complications.
Reports: Italy
On 5 May 2023, France had reported an increase in cases of severe neonatal sepsis associated with Enterovirus (Echovirus-11). A total of nine cases of neonatal sepsis with liver impairment and multiple organ failure with seven deaths were reported between July 2022 and April 2023 from four hospitals in three regions of France. As of 26 June, Croatia reported one confirmed case of E-11 infection from a group of enterovirus diseases in newborns detected in June 2023; Spain reported two cases of E-11 infection in 2023, Sweden reported five E-11 cases with four cases of meningoencephalitis among newborns due to E-11 infection between 2022 and 15 June 2023, and the UK reported two cases in March 2023.
As of June 26, Italy reported seven cases of neonatal E-11 infection were confirmed in Italy between April and last June. Three of the seven cases were admitted to the Neonatal Intensive Care Unit (NICU). At the time of reporting, one case remains in the NICU, one is showing clinical improvement and one discharged status. Two other cases, who tested positive at screening, had no significant symptoms.
What are enteroviruses
Enteroviruses are a group of rather common viruses that cause infections mainly of the respiratory tract and are responsible for annual epidemics. Although most people who come into close contact with these viruses do not get sick or show mild symptoms (such as a cold), some subjects – especially children and people with immune deficiencies – can run into even serious complications. There are multiple routes of transmission, particularly in the neonatal period, including the intrapartum period for exposure to maternal blood, secretions and/or feces, or postnatal for close contact with infected healthcare workers. Echovirus 11 (E-11) is a positive-strand RNA virus belonging to the genus Enterovirus of the family Picornaviridae.
The diseases caused: from gastroenteritis to acute flaccid paralysis
Like other enteroviruses, E-11 infections are associated with a broad spectrum of disease, ranging from mild nonspecific symptoms to systemic disorders such as skin rash, gastroenteritis, febrile illness to severe neurological disorders, including meningitis, encephalitis, and acute flaccid paralysis (AFP), myocarditis, pericarditis. Echovirus 11 (E-11) has been reported to cause severe disease in newborns and infants, with high morbidity and mortality. Additionally, E-11 can be passed from mother to child, making infection control more difficult. Infections can cause severe inflammatory disease in newborns, including severe acute hepatitis with coagulopathy. E-11 and other enteroviruses are circulating continuously in the European region.
The public health response
Based on the limited information available, WHO assesses the public health risk to be low for the general population. However, asymptomatic carriage and shedding of infectious viruses is a feature of enterovirus infection. Although some countries have enterovirus surveillance, there is no systematic surveillance of enteroviruses at the European level in the WHO region. therefore, it is difficult to estimate the extent of current severe neonatal E-11 infections or the baseline rates for circulation of E-11 viruses in the population. Without enterovirus surveillance, only the most severe cases are likely to be detected through active efforts to test and type samples from such cases. As non-polio enterovirus infection is often not a notifiable disease in Member States, further cases of severe neonatal enterovirus infection may have gone undiagnosed and/or unreported.
WHO advice
Non-polio enteroviruses are common and distributed worldwide. Although infections are often asymptomatic, some may present with respiratory tract infections. Some of the reported cases had fever and apnea and progressed to hepatocellular and renal failure within the presentation of neonatal sepsis. These viruses are also associated with occasional outbreaks in which an unusually high proportion of patients develop clinical disease, sometimes with serious and fatal consequences.
The Regional Office concludes: Physicians who manage newborns and infants presenting with circulatory shock should consider an underlying diagnosis of sepsis and perform appropriate diagnostic workups, including testing for enteroviruses. Healthcare personnel working with suspected non-polio enterovirus samples should be trained to collect, store, and transport various samples. If specimens are being shipped domestically and/or internationally for confirmation, typing, or sequencing purposes, appropriate national and international regulations on the transportation of infectious substances must be strictly followed. Laboratories that perform sequencing should consider sharing genetic sequence data through publicly accessible databases.
July 8, 2023 (change July 8, 2023 | 16:02)
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