Examining Clinical Features and Severe Neurologic Disease of Parechovirus Infection in Young Infants: A Multistate...

Area of Science:

• Pediatric Infectious Diseases
• Virology
• Epidemiology

Background:

• Human parechovirus (HPeV) infections can lead to severe infant illness, including sepsis, seizures, brain injury, and death.
• A notable resurgence of HPeV infections in young infants occurred in 2022.
• The full spectrum of HPeV illness and associated outcomes in infants requires further description.

Purpose of the Study:

• To evaluate hospitalizations and outcomes of infants diagnosed with laboratory-confirmed HPeV infection in 2022.
• To describe the clinical characteristics and identify risk factors associated with severe HPeV disease in infants.
• To compare infants with severe HPeV disease to those with non-severe disease.

Main Methods:

• A multistate retrospective cohort study design was employed.
• Infants aged 6 months or younger admitted in 2022 with confirmed HPeV infection were included.
• Severe disease was defined by clinical seizures or neuroimaging/EEG abnormalities; descriptive statistics were used for comparison.

Main Results:

• 124 U.S. infants across 11 states were identified with HPeV infection, peaking in May.
• Severe neurologic disease occurred in 27% of infants, who were more likely to be younger, preterm, and present with respiratory symptoms or apnea.
• Subcortical white matter cytotoxic cerebral edema was common in severe cases; two infants with severe HPeV disease died.

Conclusions:

• This study represents the largest and most geographically diverse analysis of the 2022 U.S. HPeV infant outbreak.
• Infants with severe HPeV disease were characterized by earlier presentation, preterm birth, and respiratory symptoms.
• Further longitudinal studies are necessary to identify predictors and long-term outcomes of severe HPeV disease in infants.