PARECHOVIRUS, INFANT DEATHS - UNITED STATES OF AMERICA: (WISCONSIN) BACKGROUND

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Date: Mon 1 Feb 2010
Source: Clin. Infect. Dis., 50 357-61 [edited]



Infant deaths associated with human parechovirus infection in Wisconsin
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Abstract:
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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 less than 2 years.

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.

Specimens from 426 (34 percent) 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 type1) 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 and HPeV type 6. Despite the detection of
HPeV the deaths of decedents 3 and 4 were determined to have been from
noninfectious causes.

These are the 1st 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.

[Byline: Gerald Sedmak,1; W. Allan Nix,4; Jeffrey Jentzen,2; Thomas E.
Haupt,3; Jeffrey P. Davis,3; Sanjib Bhattacharyya,1; Mark A.
Pallansch,4; M. Steven Oberste,4
At: 1Virology and Molecular Science Laboratory, City of Milwaukee
Health Department, 2Milwaukee County Medical ExaminerÂ’s Office,
Milwaukee, 3Bureau of Communicable Diseases, Wisconsin Division of
Public Health, Madison, Wisconsin; 4Division of Viral Diseases,
Centers for Disease Control and Prevention, Atlanta, Georgia]

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[These retrospective data relating to infant deaths in Wisconsin are
posted to increase awareness of the potential importance of
parechoviruses in human pediatric disease.

Human parechoviruses (HPeVs) are members of the large and growing
family of _Picornaviridae_. Although originally described as echovirus
22 and 23 within the human enteroviruses group because of their
clinical and morphological properties, they have since been shown to
be distinct from this and other picornavirus groups in several
features of their genome organisation, structure and replication.
Human parechoviruses show genetic and antigenic heterogeneity and a
number of distinct HPeV types are known to circulate widely in human
populations throughout the world.

Although the majority of HPeV infections occur early in life without
specific symptoms, disease manifestations associated with many of the
currently described types have been described, ranging from
gastroenteritis and respiratory infections to neurological disease,
particularly in neonates. Although HPeV diagnosis has historically
been made by virus isolation, a new generation of sensitive and
specific molecular tests for HPeV RNA promises to greatly improve the
effectiveness of HPeV detection and type identification, as well as
providing a greater understanding its molecular epidemiology. (For a
detailed account see the review 'Human parechoviruses: biology,
epidemiology and clinical significance,' by H. Harvala and P. Simonds,
Journal of Clinical Virology, 45(1):1-9, 2009

subscription required.

The state of Wisconsin can be located using the HealthMap/ProMED-mail
interactive map of the United States at
. - Mod.CP]
................lm/cp/ejp/JW
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