“A total of nine cases of neonatal sepsis with hepatic impairment and multi-organ failure with seven deaths were reported between July 2022 and April 2023 from four hospitals in three regions of France,” the World Health Organization (WHO) reported.1
As of June 26, 2023, Croatia, Italy, Spain, Sweden, and the United Kingdom have reported cases of E-11 infection in newborns. In general, the lack of a uniform enterovirus surveillance and reporting system in Europe means only more severe infections are likely to be detected. Investigations continue in European nations reporting E-11 cases, but none appear to have the high level of patient deaths reported in France.
The WHO is encouraging countries to try to detect and report E-11 infections in the highly vulnerable neonate population.
“Health facilities caring for obstetric and neonate populations should familiarize themselves with the signs and symptoms of echovirus infection and maintain vigilance for potential healthcare-associated infection cases and outbreaks in hospital units providing neonatal care,” the WHO recommended. “Health facilities and healthcare workers should implement infection prevention and control measures with a focus on adherence to hand hygiene, visitor restriction, reinforcing the importance of cleaning and disinfecting the environment and use of contact precautions when caring for neonates suspected or confirmed to have E-11.”
Some of the cases were transmitted vertically from mother to child, increasing the difficulty of controlling infections. In addition, asymptomatic carriage and shedding is common with enteroviruses. While E-11 can cause a broad range of infections, from mild to serious disease, the severe cases in neonates prompted a collaborative call between the WHO and the European Centre for Disease Prevention and Control. “Although some countries have enterovirus surveillance, there is no systematic European-wide enterovirus surveillance in place,” WHO noted. “It is therefore difficult to estimate the extent of the current severe neonatal E-11 infections or background rates for circulation of E-11 viruses in the population.”
REFERENCE
- World Health Organization. Enterovirus-echovirus 11 infection – the European Region. Published July 7, 2023. https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON474
Infection preventionists should be aware echovirus 11 continues to cause infections in newborns in Europe after high-mortality cases first were reported in France.
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