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Published on: April 14, 2011
Infant deaths associated with human parechovirus infection in Wisconsin
Gerald Sedmak1, W Allan Nix, Jeffrey Jentzen
1Virology and Molecular Science Laboratory, City of Milwaukee Health Department, Madison, Wisconsin, USA.
Background:
From December 1987 through August 2004, lung tissue, nasopharyngeal swabs, and colon swab specimens obtained during 1263 autopsies of infants and young children were examined to assess the role of viruses in deaths of children aged <2 years.
Methods:
Multiple cell cultures were used to isolate viruses. With 4 exceptions, virus isolates were identified by neutralization, immunofluorescence assay, or enzyme immunoassay. RNA extracted from these 4 isolates and associated autopsy specimens was tested using parechovirus-specific real-time polymerase chain reaction (RT-PCR) and sequencing assays.
Results:
Specimens from 426 (34%) autopsies were positive for at least 1 virus; enteroviruses and adenoviruses were the most commonly identified. Human parechoviruses (HPeVs) were identified antigenically in isolates from 18 decedents (all HPeV type 1) and by RT-PCR in isolates and multiple autopsy specimens from 4 decedents with untypeable virus isolates. Sequencing of the VP1 region identified these 4 HPeVs as HPeV type 3 (n = 3) and HPeV type 6 (n = 1). Despite the detection of HPeV, the deaths of decedents 3 and 4 were determined to have been from noninfectious causes.
Conclusions:
These are the first confirmed HPeV type 3 and HPeV type 6 detections in the United States. This is also the initial report of fatal cases with associated HPeV type 3 infection. These results support prior findings associating HPeVs with serious disease in young children. Clinical testing for HPeVs and routine HPeV surveillance by public health laboratories will help determine the burden of disease caused by HPeVs.
Insights
Human parechoviruses (HPeVs) were detected in infant deaths, including the first fatal cases of HPeV type 3 and 6 in the US. These findings highlight HPeVs as a cause of serious illness in young children.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Public Health Surveillance
Background:
- Investigated the role of viruses in deaths of children under 2 years old using autopsy specimens.
- Examined lung tissue, nasopharyngeal, and colon swabs from 1263 autopsies conducted between 1987 and 2004.
Purpose of the Study:
- To assess the role of viral infections in the mortality of infants and young children.
- To identify and characterize human parechoviruses (HPeVs) in pediatric deaths.
Main Methods:
- Virus isolation using multiple cell cultures.
- Identification via neutralization, immunofluorescence assay, or enzyme immunoassay.
- Real-time PCR and sequencing for HPeV detection and typing.
Main Results:
- 426 (34%) autopsies yielded at least one virus; enteroviruses and adenoviruses were most common.
- Human parechoviruses (HPeVs) identified in 18 cases (HPeV type 1) and 4 additional cases via RT-PCR.
- Sequencing identified HPeV type 3 (n=3) and HPeV type 6 (n=1); two deaths were non-infectious.
Conclusions:
- First confirmed detections of HPeV type 3 and 6 in the United States.
- First report of fatal cases associated with HPeV type 3 infection.
- Results support HPeVs association with severe pediatric disease; recommend clinical testing and surveillance.
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