ECDC investigates Echovirus 11 infections in neonates

ECDC would like to share with you a new event that ECDC is investigating (Communicable disease threats report, 11-17 June 2023, week 24).

On 28 April 2023, the French Paediatric Society reported that since July 2022, nine neonates presented with severe sepsis, complicated by hepatic failure, and neurological or myocardial involvement due to infection with Echovirus 11 (E11) in France, seven neonates died. Reported cases were predominantly male, including four pairs of premature twins and a full-term singleton. Five out of nine neonates were born with low birth weight. All cases presented clinical signs between three and six days of age. Maternal clinical symptoms, such as fever and gastrointestinal signs, were reported in four out of five mothers during the three days before or at delivery. Seven cases are reported to have occurred in the context of confirmed vertical transmission. According to the French Enterovirus (EV) surveillance, E11 was the predominant circulating EV in 2022 in neonates (30.2% of identified viruses). It is also reported that circulation of a new variant of E11 has been occurring since June 2022 in metropolitan France and in certain Overseas Countries and Territories (New Caledonia and Réunion).

On 15 June 2023, a scientific article was published in the Eurosurveillance journal reporting two cases of fulminant hepatitis in Italy linked with E11 infection. The cases are non-identical, male, late-preterm twins who were transferred in April to the neonatal intensive care unit due to episodes of apnoea requiring respiratory support. EV typing was performed in urine and plasma specimens by whole genome sequencing and showed the presence of E11. The phylogenetic and molecular analysis concluded that the Italian E11 strains clustered with French strains collected in 2023, which together composed a divergent lineage. The mother presented with a single episode of fever at 35 weeks and 2 days of gestational age. The infants were born the following day. No specimens were collected from the mother for virological investigations.

ECDC would like to raise awareness among the clinicians and specifically the neonatologists and paediatric infectious diseases doctors on this event. We would therefore appreciate if you could share the currently available information with the ESPID network with the aim to disseminate the current limited knowledge on the situation and encourage the testing and reporting of any suspected cases to national public health agencies. 

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Venue: Reykjavik, Iceland

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