What’s the Buzz

In mid-July 2022, the Centers for Disease Control and Prevention (CDC) issued a health advisory informing healthcare providers about a virus called parechovirus that has been circulating in the US since May. The CDC urged healthcare professionals to consider parechovirus as a possible diagnosis in babies with fever and other symptoms. The illness caused by parechovirus causes mild symptoms in most children. Rarely, however, this virus can cause a serious illness that can be fatal, especially in infants younger than 3 months of age. Please continue reading to find out more.

What is parechovirus?

Parechovirus belongs to a larger group of viruses called enteroviruses that usually cause a mild illness with symptoms such as fevers, upper respiratory symptoms, eye symptoms (conjunctivitis), and hand, foot, and mouth disease. However, these viruses can also cause more serious illnesses like sepsis and brain infections in severe cases.

What is the parechovirus health alert from the Centers for Disease Control and Prevention?

The CDC has issued a health alert to raise awareness that more cases of a type of parechovirus called PeV-A3 have been reported in recent weeks. They encourage healthcare providers and pediatric experts to consider parechovirus infection and illness in young infants with severe symptoms. 

The health alert has been issued to make sure that healthcare professionals know about parechovirus infection and are on the lookout for more severe symptoms in infants.

It is worth noting, however, that most babies hospitalized with parechovirus recover fully. The illness can be fatal, but this is rare.

COVID, RSV, reverse flu, parechovirus… What is going on? 

In the last couple of years, COVID-19 has tampered with the typical seasonal patterns of many common viral illnesses. Parechovirus is a common virus that usually circulates in the summer and early fall, so the timing is not unexpected. However, influenza and RSV, usually winter viruses, have also been circulating in the summer months. 

The CDC does not specifically track parechovirus cases as it does with influenza. However, they have received reports of increasing parechovirus cases since May 2022, particularly the subtype A3, which is linked to severe illness in young infants.

Experts say there could be two reasons for this: 

• COVID lockdowns led to people having less exposure to common viruses. This may have led to poorer immunity. Now, with people moving about more normally, the infections are coming back. 
• It’s also possible that with more awareness, more babies with meningitis symptoms and sepsis symptoms are being tested for parechovirus.

The CDC health alert is not meant to alarm parents. It is to ensure that primary care providers, pediatricians, and other healthcare professionals are aware that parechovirus is circulating and that they should consider it as a diagnosis in sick infants.

Who is at risk of parechovirus? 

Parechovirus is a seasonal illness that occurs every year in the summer and early fall. Most young children have been infected by parechovirus by the time they start kindergarten. The infections tend to be mild and nonspecific. You cannot usually tell parechovirus infections apart from the mild flu-like symptoms caused by other common viruses. 

Recently, however, the CDC has identified a type of parechovirus called PeV-A3, which is reportedly causing severe infection and illness in babies, especially infants under 3 months of age. Newborns under 1 month of age are at particularly high risk because they do not have immunity to the virus.

Why is parechovirus dangerous for newborns and young infants?

The parechovirus can cross the blood-brain barrier and cause inflammation of the membranes around the brain (meninges) and the brain tissue itself. This is known as meningitis and encephalitis, respectively. It can lead to brain swelling, seizures, and irreversible brain damage in severe cases. More severe disease caused by parechovirus can also cause a sepsis-like infection in infants, which can be life-threatening. 

How does parechovirus spread?

Parechovirus spreads through the air via respiratory droplets and saliva. It can also spread through the hands and contaminated objects.

What are the symptoms of parechovirus? 

As mentioned above, parechovirus and other enteroviruses usually cause a mild flu-like illness in older children. Symptoms of parechovirus in most children include a scratchy throat, sore throat, coughing, runny nose, sneezing, and fever. Other symptoms may include nausea, vomiting, diarrhea, and a skin rash. Most young children recover fully from the illness. 

However, experts in pediatric infectious diseases say that parechovirus can cause more severe diseases in children ages 3 months and younger. Since babies cannot tell you about their symptoms, parents and caregivers must be vigilant. You should seek medical care for an infant with signs and symptoms such as:

• High fever (the fever may be persistent or may not be present at all)
• Feeding poorly or vomiting
• Red skin rash that is spreading
• Floppiness or abnormal movements (these could be signs of seizures)

Extremely irritable or inconsolable baby

• Respiratory distress (trouble breathing)

Is there an antibody test for parechovirus?

There is no home test or widely available laboratory test for parechovirus. However, if a young infant has a severe illness and is hospitalized, doctors can order specialized tests to identify the virus.

Is there a vaccine or antiviral drug for parechovirus?

There is no vaccine for parechovirus. Also, there is no specific treatment for this viral infection at the moment. 

The treatment for parechovirus consists of supportive care, monitoring, and medications to treat fever, upper respiratory symptoms, and gastrointestinal symptoms, as needed. 

Will antibiotics work for small babies with parechovirus?

No, antibiotics only work against bacterial infections. They are not effective against viral infections like parechovirus. It’s important to use antibiotics only when prescribed for bacterial infections by your infant’s pediatrician. Overuse of antibiotics can lead to antibiotic-resistant bugs and more severe infections. 

How can I protect my infant from parechovirus?

The ways to prevent infection with parechovirus are the same as for other viral illnesses. 

Everyone in the household should practice good hygiene with frequent hand washing, mask-wearing in public, social distancing, and other protective measures against viral illnesses. 

Families who are bringing a newborn home should talk to their pediatrician about extra precautions to prevent parechovirus. This is especially true if there are older children in the family who go to daycare or school. Babies should be kept away from sick children. Visits with sick people who have any type of infection should be avoided.

Parechovirus is not something that parents of young infants should be panicking about. However, it is good to be aware that this virus is circulating and know some of the symptoms it can cause. The American Academy of Pediatrics recommends that young babies with fevers or rash should always be evaluated by a pediatrician.
 

References:

https://emergency.cdc.gov/han/2022/han00469.asp