Fatal neonatal echo 7 virus infection

Proactive approach to containment of enterovirus infection in the nursery

Administration of prophylactic intravenous immunoglobulins to contacts of infants actively shedding enterovirus during a hospital nursery outbreak may attenuate severity of disease in those contacts and aid in containment of the outbreak. Four cases of neonatal enteroviral disease were treated in our hospital nursery in July and August 2011; 3 were presumed or proven vertical transmission cases and 1 was a presumed horizontal transmission. We aimed to prevent development of severe illness in contacts of affected neonates following a ministry of health advisory during the summer of 2011 warning of increased neonatal enteroviral morbidity and mortality in Israel. Strict infection control measures were implemented, including meticulous decontamination of the nursery environment and administration of intravenous immunoglobulin prophylaxis to contacts. No further horizontal transmission occurred after infection control interventions. Immunoglobulin prophylaxis to control enteroviral infection in the nursery should be considered as an auxiliary infection control intervention during a nursery outbreak.

A new-born baby outbreak of echovirus type 33 infection

OBJECTIVES

In 1994, an outbreak of echovirus type 33 (EV33) infection occurred in a maternity hospital in Japan. Nine new-born babies were infected, some presenting symptoms of encephalitis or disseminated intravascular coagulopathy. EV33 was isolated from the faeces or cerebrospinal fluid of all seven of the patients sampled, and serum antibody titres against EV33 were significantly elevated in the convalescence phase sera in all cases.

SUBJECTS AND METHODS

To study what public health situations EV33 may become a serious pathogen for new born babies, serum EV33 antibody positivity in the general population was examined. Sera were obtained 649 samples before the outbreak, and 344 samples after the outbreak from aged 7 days to 65 years old.

RESULTS

The average positive rate was 12.0% and the rate increased depending on age. Comparison of positive rates before and after this outbreak showed no increase in any age group. However, the positive rate was found to average only 5.6% in persons aged 16-30 years old, including pregnant women. This low positive rate in young adults would result in a lack or only a low level of antibodies in newborn babies.

CONCLUSIONS

In conclusion, our findings suggest that EV33 infection in the new-born baby with no or low level of maternal neutralizing antibody may cause serious symptoms.

Coxsackie B virus epidemiology and neonatal infection in Belgium

Outbreaks of Coxsackie B virus infection occur mainly in the warm spring and summer when enteroviruses are most prevalent. A study of five Coxsackie B virus serotypes was made over the last decade by collecting and typing nearly all enteroviruses isolated in Belgium. The study showed that Coxsackie B virus infection appeared in waves. We describe two outbreaks of Coxsackie B virus infection in our maternity unit. The first took place in 1988, when Coxsackie B 2 virus was the most prevalent serotype in the general population. One baby fell ill 6 days after birth and developed signs of meningitis. In a second baby the infection showed a diphasic pattern. The first phase was relatively mild but, after a period of recovery the child developed signs of myocarditis. After a period of low prevalence or complete absence from 1982 to 1988, Coxsackie B I virus reappeared in the summer of 1989. That summer, a small outbreak was seen in our maternity unit where one baby was infected from his mother and the infection spread from that baby to another one. Both babies developed meningitis but their convalescence was uncomplicated. A higher risk of outbreaks in nurseries was observed in summer when viruses are most prevalent. Measures to prevent such infections are discussed.

Fatal echovirus 7 infection during an outbreak in a special care baby unit

A case of fatal echovirus 7 infection in a neonate which was probably acquired from the symptomatic mother and an outbreak of infection in a neonatal unit are described. The baby who died had extensive haemorrhagic necrosis of the brain, liver, adrenal glands and kidneys as well as disseminated intravascular coagulation. Three other babies and one member of staff were found to be infected. No other babies died. Human normal immunoglobulin was administered to all babies on the unit.

Conservative management of an echovirus 11 outbreak in a neonatal unit

Two babies in a neonatal unit presented on the same day with meningitis due to echovirus 11, which was thought to have been introduced by staff. At this time echovirus 11 was also isolated from the stools of eight other babies; five of them did not have signs of infection. No intervention was made except to emphasise the importance of handwashing. There was evidence of secondary spread to two babies who were both clinically well. The attack rate was twelve (29%) of forty-one babies exposed. Seven of the twelve infected babies were born before 30 weeks' gestation and would have had little or no maternal antibody, yet only two of the seven babies had signs of infection. Despite lack of special measures, all babies recovered. Most cases of horizontally acquired neonatal echovirus infection are mild: extreme measures in the management of outbreaks are unnecessary.

Therapeutic uses of intravenous gammaglobulin for pediatric infections

Immunoglobulin plays a critical role in the immune response to many pediatric illnesses. We have just begun to explore the potential uses of IVIG in the prevention and treatment of pediatric diseases. The ability to give large amounts of antibody quickly and with repeated doses will allow physicians to achieve and maintain very high levels of serum antibody. IVIG may be valuable in restoring humoral immune deficiency, treating a number of viral and bacterial infections, and modulating immune responses. It will be important to analyze carefully the effectiveness of IVIG therapy using well-designed, controlled trials and to have specific IVIG preparations with defined activity and high levels of pathogen-specific antibody.