There has been a global rise in enterovirus-echovirus 11 (E-11) neonatal sepsis cases, with another five countries reporting infections similar to those first reported in France that claimed the lives of seven babies of the nine affected, according to the WHO.
In its initial report, the agency said the French cases involved a recombinant enterovirus (echovirus 11 [E-11]) that hadn’t been detected in France before and were unusual due to extremely rapid health deterioration and a high case-fatality rate. Also, the proportion of infections seen in twins was much higher than expected.
Since then and as of 26 June, CIDRAP reports that 17 more cases have been noted, including in Croatia (1), Italy (7), Spain (2), Sweden (5) and the United Kingdom (2). Most were from 2023, but some of Sweden’s were reported from 2022, as were some of France’s cases.
Twins and multi-organ failure
Croatia’s confirmed E-11 case is part of a cluster of enterovirus cases reported from two maternity hospitals. In Italy, further investigation is under way into some of the cases, but the WHO said three were admitted to the neonatal intensive care unit (NICU) and two others who tested positive on screening didn’t have significant symptoms.
Spain’s cases involved twins who were admitted to the NICU, one of whom died from the infection. The country’s health officials said E-11 has been circulating in 2022 and 2023, but so far, data don’t suggest an increase in incidence or severity. They added that the virus probably passed from the mother to her babies.
Sweden’s cases all involved infants with meningoencephalitis, and so far the epidemiological investigation doesn't show findings beyond what doctors would expect.
The United Kingdom’s two cases were in twins, both of whom had several clinical conditions, including hepatitis and multi-organ failure, similar to the newborns in France who had the virus.
Also, like some of the French babies, the UK infants’ conditions deteriorated rapidly, and both died from their infections.
The WHO said investigation and virus typing is still under way in the five affected countries, and that while the risk to the general population appeared low, asymptomatic virus carriage and shedding are an enterovirus infection feature.
Extent unclear
With no system-wide enterovirus surveillance in place in Europe, it’s hard to gauge the extent of the severe cases and the background rates for E-11 circulation in the general population, the WHO said. And given that non-polio enterovirus infection isn’t a notifiable disease in most countries, other severe cases may have gone undiagnosed or unreported.
“Clinicians managing neonates and infants presenting with circulatory shock should consider an underlying diagnosis of sepsis and perform appropriate diagnostic investigations, including testing for enteroviruses,” it said.
It also urged countries to share sequences and for hospitals to familiarise themselves with the signs and symptoms of E-11 and implement infection prevention and control measures.
The WHO report – Enterovirus-Echovirus 11 Infection – the European Region (Open access)
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