Parechovirus Genotype 3 Outbreak among Infants, New South Wales, Australia, 2013–2014 - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC

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Parechovirus Genotype 3 Outbreak among Infants, New South Wales, Australia, 2013–2014 - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 7—July 2015

CME ACTIVITY - Research

Parechovirus Genotype 3 Outbreak among Infants, New South Wales, Australia, 2013–2014

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• Medscape CME Activity
• Methods
• Results
• Discussion
• Conclusion
• Suggested Citation

Figures

• Figure 1
• Figure 2
• Figure 3
• Figure 4
• Figure 5
• Figure 6

Tables

• Table 1
• Table 2
• Table 3

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Germaine Cumming1 , Ameneh Khatami, Brendan J. McMullan, Jennie Musto, Kit Leung, Oanh Nguyen, Mark J. Ferson, Georgina Papadakis, and Vicky Sheppeard

Author affiliations: Health Protection New South Wales, Sydney, New South Wales, Australia (G. Cumming, J. Musto, V. Sheppeard); New South Wales Ministry of Health, Sydney (G. Cumming, K. Leung); The Children’s Hospital at Westmead, Sydney (A. Khatami); Sydney Children’s Hospital, Sydney (B.J. McMullan); University of New South Wales, Sydney (B.J. McMullan, M.J. Ferson); Western Sydney Local Health District, Sydney (O. Nguyen); South Eastern Sydney Local Health District, Sydney (M.J. Ferson); Victorian Infectious Disease Reference Laboratory, Melbourne, Victoria, Australia (G. Papadakis)

Suggested citation for this article

Abstract

From October 2013 through February 2014, human parechovirus genotype 3 infection was identified in 183 infants in New South Wales, Australia. Of those infants, 57% were male and 95% required hospitalization. Common signs and symptoms were fever >38°C (86%), irritability (80%), tachycardia (68%), and rash (62%). Compared with affected infants in the Northern Hemisphere, infants in New South Wales were slightly older, both sexes were affected more equally, and rash occurred with considerably higher frequency. The New South Wales syndromic surveillance system, which uses near real-time emergency department and ambulance data, was useful for monitoring the outbreak. An alert distributed to clinicians reduced unnecessary hospitalization for patients with suspected sepsis.

The clinical manifestations of infection with human parechoviruses (HPeVs), members of the familyPicornaviridiae, are often indistinguishable from those caused by human enterovirus infections. Over the past decade, outbreaks of human parechovirus genotype 3 (HPeV3) have been reported from the Northern Hemisphere and are particularly well documented in Japan (where the virus was discovered), Canada, the United Kingdom, Denmark, and the Netherlands (1–4). Of the 16 HPeV genotypes, HPeV3 is the most aggressive and causes a sepsis-like syndrome in neonates (5). HPeV infection seems to follow a seasonal pattern; incidence is higher in summer and autumn (2,3). It can be spread by the fecal–oral and respiratory routes (4).

On November 22, 2013, Health Protection New South Wales (NSW), Australia, was notified of a possible cluster of HPeV cases at The Children’s Hospital at Westmead in Sydney. At that time, 7 neonates had experienced rapid onset of acute sepsis-like illness with fever >38°C and a combination of irritability/pain, diarrhea, confluent erythematous rash, tachycardia, tachypnea, encephalitis, myoclonic jerks, and hepatitis. Inquiries revealed that neonates described as “red, hot, angry” had also been admitted to other tertiary children’s hospitals in NSW (6). An expert advisory group comprising staff from the NSW Ministry of Health, Health Protection NSW, public health units, and the Sydney Children’s Hospital Network was convened to coordinate the investigation.

On November 25, 2013, PCR detection of HPeV RNA confirmed HPeV infection in 2 of the children. The NSW public health network and clinicians agreed that a surveillance program should be initiated to gather information on the epidemiologic and clinical characteristics and outcomes of children with HPeV infection.

In addition to the public health response, Health Protection NSW issued a media release to alert members of the public to the outbreak. On November 29, 2013, HPeV3 information including a case definition, instructions for accessing diagnostic testing, and recommended clinical management was distributed to all emergency departments, pediatricians, and early childhood health services in NSW. During the outbreak, the expert advisory group met regularly via teleconference to discuss and address any emerging issues. HPeV3 active surveillance activities were concluded on January 31, 2014, while other forms of surveillance continued into February 2014. We describe the epidemiology of the outbreak as observed through several surveillance mechanisms.

Ms. Cumming is a public health specialist working with the NSW health system. Her research areas of interest include population health surveillance and evaluations and public health response preparedness.

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Acknowledgments

We express our gratitude to clinicians at the sentinel sites and laboratory staff at South Eastern Areas Laboratory Services, Children’s Hospital Westmead Pathology, and Hunter Area Pathology Service. Particular thanks go to Stephanie Francis and Emma Goeman, Murray Webber, and Karin Timmers for their assistance with data collection and reporting to Public Health. We also thank the staff at the public health units for managing case information and laboratory results in the NSW Notifiable Conditions Information Management System, particularly Margaret Osbourn, Julie K. Kohlhagen, and Gareth Hockey. We thank the Ministry of Health staff, particularly Tracie Reinten, for statistical analysis contributions, and David Muscatello and Tina Navin-Cristina for continued weekly syndromic surveillance of HPeV infection in infants in NSW. We are very grateful for the knowledge, expertise, and advice received from our Expert Panel members, particularly Sheena Adamson, Stephen Corbett, David Durrheim, Alison Kesson, Tony Merritt, and Murray Webber. We appreciate the vital support received from VIDRL, particularly Julian Druce, for an excellent speedy turnaround of HPeV testing and genotyping, which was not available in NSW at the time.

This work was completed while G.C. was employed as a trainee in the NSW Public Health Officer Training Program funded by the NSW Ministry of Health.

References

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Figures

• Figure 1. Venn diagram showing capture and overlaps in human parechovirus (HPeV) case identification/reporting resulting from the 3 surveillance mechanisms used during the HPeV outbreak in New South Wales (NSW), Australia,...
• Figure 2. Patient human parechovirus (HPeV) and enterovirus (EV) results for all 198 patients in New South Wales, Australia, tested by the Victorian Infectious Diseases Reference Laboratory during November 1, 2013–February...
• Figure 3. Number of laboratory-confirmed human parechovirus (HPeV) cases identified by active and passive surveillance, by week of symptom onset, in New South Wales (NSW), Australia, during the October 2013–early February...
• Figure 4. Age distribution of 183 patients with confirmed human parechovirus (HPeV) infection at time of symptom onset, detected by active and passive surveillance, New South Wales (NSW), Australia, October 1,...
• Figure 5. Distribution of hospital length of stay for infants <3 months of age at sentinel sites during active surveillance of the human parechovirus outbreak in New South Wales (NSW), Australia,...
• Figure 6. Total weekly counts of visits to the emergency department for fever or unspecified infection for which patients were (A) admitted to ward and (B) admitted to critical care for...

Tables

• Table 1. Results of PCR testing of specimens from patients from New South Wales received at the VIDRL, Melbourne, Victoria, Australia, November 1, 2013–February 28, 2014
• Table 2. HPeV testing of specimens from patients from New South Wales, received at the VIDRL, Melbourne, Victoria, Australia, November 1, 2013–February 28, 2014, by specimen type
• Table 3. Characteristics of patients with laboratory-confirmed HPeV detected by active surveillance, New South Wales, Australia, October 1, 2013–February 2, 2014

Suggested citation for this article: Cumming G, Khatami A, McMullan BJ, Musto J, Leung K, Nguyen O, et al. Parechovirus genotype 3 outbreak among infants, New South Wales, Australia, 2013–2014. Emerg Infect Dis. 2015 Jul [date cited]. http://dx.doi.org/10.3201/eid2107.141149

DOI: 10.3201/eid2107.141149

1Current affiliation: Independent consultant, Freshwater, New South Wales, Australia