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Parechovirus Genotype 3 Outbreak among Infants, New South Wales, Australia, 2013–2014 - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC

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Parechovirus Genotype 3 Outbreak among Infants, New South Wales, Australia, 2013–2014 - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 7—July 2015


Parechovirus Genotype 3 Outbreak among Infants, New South Wales, Australia, 2013–2014

Germaine Cumming1Comments to Author , Ameneh Khatami, Brendan J. McMullan, Jennie Musto, Kit Leung, Oanh Nguyen, Mark J. Ferson, Georgina Papadakis, and Vicky Sheppeard
Author affiliations: Health Protection New South Wales, Sydney, New South Wales, Australia (G. Cumming, J. Musto, V. Sheppeard)New South Wales Ministry of Health, Sydney (G. Cumming, K. Leung)The Children’s Hospital at Westmead, Sydney (A. Khatami)Sydney Children’s Hospital, Sydney (B.J. McMullan)University of New South Wales, Sydney (B.J. McMullan, M.J. Ferson)Western Sydney Local Health District, Sydney (O. Nguyen)South Eastern Sydney Local Health District, Sydney (M.J. Ferson)Victorian Infectious Disease Reference Laboratory, Melbourne, Victoria, Australia (G. Papadakis)


From October 2013 through February 2014, human parechovirus genotype 3 infection was identified in 183 infants in New South Wales, Australia. Of those infants, 57% were male and 95% required hospitalization. Common signs and symptoms were fever >38°C (86%), irritability (80%), tachycardia (68%), and rash (62%). Compared with affected infants in the Northern Hemisphere, infants in New South Wales were slightly older, both sexes were affected more equally, and rash occurred with considerably higher frequency. The New South Wales syndromic surveillance system, which uses near real-time emergency department and ambulance data, was useful for monitoring the outbreak. An alert distributed to clinicians reduced unnecessary hospitalization for patients with suspected sepsis.
The clinical manifestations of infection with human parechoviruses (HPeVs), members of the familyPicornaviridiae, are often indistinguishable from those caused by human enterovirus infections. Over the past decade, outbreaks of human parechovirus genotype 3 (HPeV3) have been reported from the Northern Hemisphere and are particularly well documented in Japan (where the virus was discovered), Canada, the United Kingdom, Denmark, and the Netherlands (14). Of the 16 HPeV genotypes, HPeV3 is the most aggressive and causes a sepsis-like syndrome in neonates (5). HPeV infection seems to follow a seasonal pattern; incidence is higher in summer and autumn (2,3). It can be spread by the fecal–oral and respiratory routes (4).
On November 22, 2013, Health Protection New South Wales (NSW), Australia, was notified of a possible cluster of HPeV cases at The Children’s Hospital at Westmead in Sydney. At that time, 7 neonates had experienced rapid onset of acute sepsis-like illness with fever >38°C and a combination of irritability/pain, diarrhea, confluent erythematous rash, tachycardia, tachypnea, encephalitis, myoclonic jerks, and hepatitis. Inquiries revealed that neonates described as “red, hot, angry” had also been admitted to other tertiary children’s hospitals in NSW (6). An expert advisory group comprising staff from the NSW Ministry of Health, Health Protection NSW, public health units, and the Sydney Children’s Hospital Network was convened to coordinate the investigation.
On November 25, 2013, PCR detection of HPeV RNA confirmed HPeV infection in 2 of the children. The NSW public health network and clinicians agreed that a surveillance program should be initiated to gather information on the epidemiologic and clinical characteristics and outcomes of children with HPeV infection.
In addition to the public health response, Health Protection NSW issued a media release to alert members of the public to the outbreak. On November 29, 2013, HPeV3 information including a case definition, instructions for accessing diagnostic testing, and recommended clinical management was distributed to all emergency departments, pediatricians, and early childhood health services in NSW. During the outbreak, the expert advisory group met regularly via teleconference to discuss and address any emerging issues. HPeV3 active surveillance activities were concluded on January 31, 2014, while other forms of surveillance continued into February 2014. We describe the epidemiology of the outbreak as observed through several surveillance mechanisms.
Ms. Cumming is a public health specialist working with the NSW health system. Her research areas of interest include population health surveillance and evaluations and public health response preparedness.


We express our gratitude to clinicians at the sentinel sites and laboratory staff at South Eastern Areas Laboratory Services, Children’s Hospital Westmead Pathology, and Hunter Area Pathology Service. Particular thanks go to Stephanie Francis and Emma Goeman, Murray Webber, and Karin Timmers for their assistance with data collection and reporting to Public Health. We also thank the staff at the public health units for managing case information and laboratory results in the NSW Notifiable Conditions Information Management System, particularly Margaret Osbourn, Julie K. Kohlhagen, and Gareth Hockey. We thank the Ministry of Health staff, particularly Tracie Reinten, for statistical analysis contributions, and David Muscatello and Tina Navin-Cristina for continued weekly syndromic surveillance of HPeV infection in infants in NSW. We are very grateful for the knowledge, expertise, and advice received from our Expert Panel members, particularly Sheena Adamson, Stephen Corbett, David Durrheim, Alison Kesson, Tony Merritt, and Murray Webber. We appreciate the vital support received from VIDRL, particularly Julian Druce, for an excellent speedy turnaround of HPeV testing and genotyping, which was not available in NSW at the time.
This work was completed while G.C. was employed as a trainee in the NSW Public Health Officer Training Program funded by the NSW Ministry of Health.


  1. Selvarangan RNzabi MSelvaraju SBKetter PCarpenter CHarrison CJHuman parechovirus 3 causing sepsis-like illness in children from Midwestern United States. Pediatr Infect Dis J2011;30:23842DOIPubMed
  2. Sharp JHarrison CJPuckett KSelvaraju SBPenaranda SNix WACharacteristics of young infants in whom human parechovirus, enterovirus or neither were detected in cerebrospinal fluid during sepsis evaluations. Pediatr Infect Dis J2013;32:2136 .PubMed
  3. Fischer TKMidgley SDalgaard CNielsen AYHuman parechovirus infection, Denmark. Emerg Infect Dis2014;20:837DOIPubMed
  4. Harvala HWolthers KCSimmonds PParechovirus in children: understanding a new infection. Curr Opin Infect Dis2010;23:22430.DOIPubMed
  5. Guo YDuan ZQian YChanges in human parechovirus profiles in hospitalised children with acute gastroenteritis after a three-year interval in Lanzhou, China. PLoS ONE2013;8:e68321DOIPubMed
  6. Khatami AMcMullan BWebber MStewart PFrancis STimmers KSepsis-like disease in infants due to human parechovirus type 3 during an outbreak in Australia. Clin Infect Dis2015;60:22836DOIPubMed
  7. Muscatello DJChurches TKaldor JZheng WChiu CCorrell PAn automated, broad-based, near real-time public health surveillance system using presentations to hospital emergency departments in New South Wales, Australia. BMC Public Health2005;5:141DOIPubMed
  8. Wolthers KCBenschop KSSchinkel JMolenkamp RBergevoet RMSpijkerman IJHuman parechovirus as an important viral cause of sepsis-like illness and meningitis in young children. Clin Infect Dis2008;47:35863DOIPubMed
  9. Shoji KKomuro HMiyata IMiyairi ISaitoh ADermatologic manifestations of human parechovirus type 3 infection in neonates and infants. Pediatr Infect Dis J2013;32:2336 .PubMed
  10. Druce JTran TKelly HKaye MChibo DKostecki RLaboratory diagnosis and surveillance of human respiratory viruses by PCR in Victoria, Australia, 2002–2003. J Med Virol2005;75:1229DOIPubMed
  11. Nix WAMaher KPallansch MAOberste MSParechovirus typing in clinical specimens by nested or semi-nested PCR coupled with sequencing. J Clin Virol2010;48:2027DOIPubMed
  12. Papadakis GChibo DDruce JCatton MBirch CDetection and genotyping of enteroviruses in cerebrospinal fluid in patients in Victoria, Australia, 2007–2013. J Med Virol2014;86:160913 . DOIPubMed
  13. Australian Bureau of Statistics. Estimated resident population (ERP) by region, age, and sex, 2001 to 2013 [cited 2014 Feb 24].http://www.abs.gov.au/.
  14. Benschop KSSchinkel JMinnaar RPPajkrt DSpanjerberg LKraakman HCHuman parechovirus infections in Dutch children and the association between serotype and disease severity. Clin Infect Dis2006;42:20410DOIPubMed
  15. Lenski REMay RMThe evolution of virulence in parasites and pathogens: reconciliation between two competing hypotheses. J Theor Biol.1994;169:25365DOIPubMed



Suggested citation for this article: Cumming G, Khatami A, McMullan BJ, Musto J, Leung K, Nguyen O, et al. Parechovirus genotype 3 outbreak among infants, New South Wales, Australia, 2013–2014. Emerg Infect Dis. 2015 Jul [date cited]. http://dx.doi.org/10.3201/eid2107.141149
DOI: 10.3201/eid2107.141149
1Current affiliation: Independent consultant, Freshwater, New South Wales, Australia

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