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Increased detection of human parechovirus infection in infants in England during 2016: epidemiology and clinical characteristics
  1. Laura Ferreras Antolín1,
  2. Seilesh Kadambari1,
  3. Serena Braccio1,2,
  4. Julian Wei-Tze Tang3,4,
  5. Jacqueline Xerry2,
  6. David James Allen2,5,
  7. Shamez N Ladhani1,2
  8. the Parechovirus Surveillance Network
    1. 1 Paediatric Infectious Diseases Research Group, St George’s University, London, UK
    2. 2 Immunisation Department, Public Health England, London, UK
    3. 3 Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
    4. 4 Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
    5. 5 Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
    1. Correspondence to Dr Shamez N Ladhani, Immunisation, Hepatitis and Blood Safety Department, Public Health England, London NW9 5EQ, UK; shamez.ladhani{at}


    Background Human parechovirus (HPeV), like enteroviruses, usually causes mild self-limiting respiratory and gastrointestinal symptoms. In infants, HPeV can occasionally cause serious illnesses, including sepsis-like syndrome and encephalitis. In summer 2016, Public Health England (PHE) received increasing reports of severe HPeV infections nationally. We, therefore, reviewed all infants with confirmed HPeV across England during 2016.

    Methods HPeV cases in infants aged <12 months reported to PHE during 2016 were followed up using a clinical questionnaire. Additional cases identified by clinicians completing the questionnaire were also included.

    Results We identified 106 infants with confirmed HPeV infection during 2016. The disease peaked during early summer. Most infants (98/106, 92%) were aged <90 days, and 43% (46/106) were neonates. Fever was the most commonly reported symptom (92%) and signs of circulatory shock were present in 53%. Eighteen infants (18%) required paediatric intensive care admission. Most infants had normal or low C reactive protein concentrations (<10 mg/dL in 75%, <50 mg/dL in 98%). A lumbar puncture was performed in 98% of cases; 92% (33/36) of neonates and 93% (53/57) of older infants had normal white cell count in the cerebrospinal fluid (CSF). Nearly all reported cases (98%) were confirmed by CSF PCR. All infants survived, but five had ongoing seizures after hospital discharge.

    Conclusions HPeV is an important cause of febrile illness in infants and can have severe clinical presentations. Early diagnosis may help reduce antimicrobial use, unnecessary investigations and prolonged hospitalisation. While prognosis remains favourable, some infants will develop long-term complications—paediatricians should ensure appropriate follow-up after discharge.

    • human parechovirus
    • infants
    • viral infections
    • sepsis-like infections
    • encephalitis

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    • Contributors SNL and SK contributed to study design and developed the questionnaire. LFA and SNL coordinated the study, contributed to data collection and data analysis, and drafted the manuscript. JX, DJA, SB and SNL contributed to data management and analysis from PHE. JW-TT had a substantial contribution to data collection, data interpretation and manuscript review. All authors listed and the ones included in the Parechovirus Surveillance Network helped with the recruitment and data collection, and contributed to manuscript review and approval of the final version.

    • Funding None declared.

    • Competing interests None declared.

    • Ethics approval PHE has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002, to process patient information for national surveillance of communicable diseases (

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators Parechovirus Surveillance Network: Addenbrooke’s Hospital, Cambridge, UK (Shruti Agrawal, Eleanor Keene); Alder Hey Children’s Hospital, Liverpool, UK (Andrew Riordan); Bristol Royal Hospital for Children, Bristol, UK (Stefania Vergnano, Rachel McLeod); Evelina Children’s Hospital, London, UK (Nuria Martinez-Alier, Jeremy Carr); King’s College Hospital, London, UK (Malur Sudhanva, Simon Broughton, Gabriella Watson); Leicester Children’s Hospital, Leicester, UK (Srini Bandi, Fadwa El Sausi); Oxford Children’s Hospital, Oxford, UK​ (Dominic Kelly, Robindra Basu Roy); Royal Cornwall Hospital, Truro, Cornwall, UK (Yadlapalli Kumar, Chrisopher Warren, Laura Vincent, Prithwiraj Chakrabarti); Sheffield Children’s Hospital, Sheffield, UK (Sarah Thompson, Mairi Gillespie, Lucy Hinds); Southampton Children’s Hospital, Southampton, UK (Christine E Jones); St George’s University Hospital, London, UK (Peter Riley); The Great North Children’s Hospital in Newcastle, Newcastle, UK (Stephen Owens, Sahar Habibollah).