French doctors and researchers have detected a new variant of echovirus, a common pathogen that in the forms known so far usually causes mild infections, associated with seven deaths of newborns in recent months in France. The severe cases registered in total are nine, eight of which correspond to four pairs of twins who were born prematurely and with low kissing. All diagnoses have occurred between July 2022 and last April in four hospitals in three cities. The French public health alerted the European Union a month ago of these episodes, although for now no other country has diagnosed similar cases.
"Doctors should be aware of the possible involvement of echovirus in serious clinical conditions diagnosed in newborns, since they are in the first line of patient care," warn these specialists, whose finding has now been published in the latest issue of the medical journal Eurosurveillance.
According to a communication from the French Society of Pediatrics, four of the five mothers had suffered in the 48 hours prior to delivery a clinical picture with fever and gastrointestinal disorders, which put the investigators on the trail of an infectious agent. The World Health Organization (WHO) has also been informed.
In Spain, a country that shares more than 650 kilometers of border with France, neither the autonomous communities consulted nor the National Center for Microbiology (CNM) are aware of an increase in the incidence or severity of echoviruses circulating in the country, says the Ministry of Health. "Information is being collected from the communities," says a spokesman, who recalls that for now "no other European country besides France has detected an increase in cases," so the health alert for now is limited to that country.
Belén Fernández Colomer, member of the advisory committee of the Spanish Society of Neonatology (SENeo), considers it very unlikely that the cases detected in France "will spread, increase a lot or be the beginning of something similar to an epidemic."
"In these types of episodes, several factors usually coincide. One is the emergence of a new, more virulent variant. The other is that the virus reaches a particularly susceptible population, in this case premature babies born to mothers with gastrointestinal problems. This makes it easier for infection to occur during childbirth. If the new virus circulates more, the chances of specific cases increase. It is something that should be monitored, but it has already happened some other time and does not have to go further, "adds Fernández Colomer.
The authors of the article published by Eurosurveillance explain that the disease "initially presents as neonatal sepsis clinically indistinguishable from bacterial or herpes simplex virus infections." Therefore, the doctors recommend that those newborns who, in addition to signs of sepsis, "present signs of myocarditis or liver failure" be evaluated quickly to "detect an echovirus infection, especially if the mother has had acute symptoms of gastroenteritis in the days before birth."
Of the nine cases, eight were from four twin pregnancies and were born prematurely between 31 weeks and 5 days gestation and 36 weeks and 3 days. A pregnancy is considered to be carried to term when the 38th week has been completed. In all patients, the first symptoms appeared between the third and fifth day of life. These were "initially fever and apnea" (interruptions in breathing), which were followed "quickly" by signs of septic shock and liver failure, among other problems related to vital organs.
Genetic investigations carried out by the hospitals that treated the babies showed that the cases were caused by a new variant of an echovirus 11 (E-11), an RNA virus of the species Enterovirus B that normally inhabits the gastrointestinal tract. This pathogen "usually causes several types of infections in childhood, almost always mild and often characterized by febrile, gastrointestinal or exanthematic symptoms [with skin rashes], although sometimes they can evolve into more severe forms," explains Manuel Rodríguez Iglesias, head of the microbiology service at the Puerta del Mar Hospital (Cádiz). These complications, according to the specialist, are more common in newborn children who can cause meningoencephalitis and hepatitis.
The severity and high mortality of neonatal cases detected in France led the country's authorities to alert the European Union Early Warning System (EWS) on May 4, 2023. The European Centre for Disease Prevention and Control (ECDC) included the warning on May 6 in the weekly alert bulletin published every Friday.
In the document, the EU public health body "encourages countries to report any unusual increases in E-11 infections," as well as "clusters of cases and outbreaks" related to the pathogen. The ECDC will continue to monitor the situation through its epidemiological intelligence tools," the agency said at the time.
With the available information, the ECDC considers for now "low" the risk to "the health of the neonatal population of the EU" and "moderate" that of babies born "premature or with low weight if the mother has suffered an acute infection by E-11 in the days before delivery".
