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

Abstract

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.

Keywords: Australia; New South Wales; human parechovirus 3; infantile fever; neonatal infection; piconarvirus; public health surveillance; sepsis-like syndrome; skin rash; viruses.

Figure 1

Venn diagram showing capture and overlaps in human parechovirus (HPeV) case identification/reporting resulting from the 3 surveillance mechanisms used during the HPeV outbreak in New South Wales (NSW), Australia, during October 2013–February 2014.

Figure 2

Patient human parechovirus (HPeV) and enterovirus (EV) results for all 198 patients in New South Wales, Australia, tested by the Victorian Infectious Diseases Reference Laboratory during November 1, 2013–February 28, 2014.

Figure 3

Number of laboratory-confirmed human parechovirus (HPeV) cases identified by active and passive surveillance, by week of symptom onset, in New South Wales (NSW), Australia, during the October 2013–early February 2014 outbreak (total = 183 cases). Source: NSW Notifiable Conditions Information Management System data (http://www.health.nsw.au/epidemiology/Pages/Notifiable-diseases.aspx), February 18, 2014. Source: NSW Notifiable Conditions Information Management System data (http://www.health.nsw.au/epidemiology/Pages/Notifiable-diseases.aspx), February 18, 2014.

Figure 4

Age distribution of 183 patients with confirmed human parechovirus (HPeV) infection at time of symptom onset, detected by active and passive surveillance, New South Wales (NSW), Australia, October 1, 2013–February 2, 2014. Source: NSW Notifiable Conditions Information Management System data (http://www.health.nsw.au/epidemiology/Pages/Notifiable-diseases.aspx), February 18, 2014.

Figure 5

Distribution of hospital length of stay for infants <3 months of age at sentinel sites during active surveillance of the human parechovirus outbreak in New South Wales (NSW), Australia, October 1, 2013–February 2, 2014. Source: NSW Notifiable Conditions Information Management System data (http://www.health.nsw.au/epidemiology/Pages/Notifiable-diseases.aspx), February 18, 2014.

Figure 6

Total weekly counts of visits to the emergency department for fever or unspecified infection for which patients were (A) admitted to ward and (B) admitted to critical care for 2013, compared with each of the 5 previous years, children <1 year of age, for 59 hospitals in New South Wales, Australia. Source: Emergency department syndromic surveillance report produced on June 3, 2014.