Severe and fatal neonatal infections linked to a new variant of echovirus 11, France, July 2022 to April 2023

doi:10.2807/1560-7917.ES.2023.28.22.2300253

Comment

. 2023 Jun;28(22):2300253.

doi: 10.2807/1560-7917.ES.2023.28.22.2300253.

Severe and fatal neonatal infections linked to a new variant of echovirus 11, France, July 2022 to April 2023

Mathilde Grapin^{1

2}, Audrey Mirand^{2

3

4}, Didier Pinquier⁵, Aurélie Basset⁶, Matthieu Bendavid¹, Maxime Bisseux^{3

4}, Marion Jeannoël⁷, Bérengère Kireche⁸, Manoelle Kossorotoff⁹, Anne-Sophie L'Honneur¹⁰, Lila Robin⁸, Yves Ville¹¹, Sylvain Renolleau¹, Véronique Lemee¹², Pierre-Henri Jarreau⁶, Isabelle Desguerre⁹, Florence Lacaille¹³, Marianne Leruez-Ville¹⁴, Clémence Guillaume¹⁵, Cécile Henquell^{3

4}, Alexandre Lapillonne¹⁶, Isabelle Schuffenecker^{17

7}, Mélodie Aubart^{18

17

9}

Affiliations

¹ Paediatric Intensive Care Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
² These authors contributed equally to the work and share the first authorship.
³ Clermont-Ferrand University Hospital, 3IHP - Infection Inflammation et Interaction Hôtes Pathogènes Virology Department, French Reference Centre for enteroviruses and parechovirus, coordination laboratory, Clermont-Ferrand, France.
⁴ Auvergne University, LMGE UMR CNRS 6023, Team Epidemiology and pathophysiology of enterovirus Infection, Clermont-Ferrand, France.
⁵ Neonatal and Paediatric Intensive Care Units, Rouen University Hospital, Rouen, France.
⁶ Neonatal Intensive Care Unit, Cochin-Port Royal University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
⁷ Hospices Civils de Lyon, Virology Department, French Reference Centre for enteroviruses and parechoviruses, associated laboratory, Lyon, France.
⁸ Neonatal and Paediatric Intensive Care Units, Orléans Regional Hospital, Orléans, France.
⁹ Paediatric Neurology Department, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
¹⁰ Virology laboratory, Cochin University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
¹¹ Obstetrics and Fetal Medicine Department, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
¹² Virology Department, Rouen University Hospital, Rouen, France.
¹³ Pediatric Gastroenterology-Hepatology-Nutrition Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France.
¹⁴ Clinical Microbiology laboratory and Virology unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
¹⁵ Orléans Hospital, Microbiology laboratory, Orléans, France.
¹⁶ Neonatal Intensive Care Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
¹⁷ These authors contributed equally to the work and share the last authorship.
¹⁸ Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Imagine Institute, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France.

PMID: 37261730
PMCID: PMC10236930
DOI: 10.2807/1560-7917.ES.2023.28.22.2300253

Comment

Severe and fatal neonatal infections linked to a new variant of echovirus 11, France, July 2022 to April 2023

Mathilde Grapin et al. Euro Surveill. 2023 Jun.

. 2023 Jun;28(22):2300253.

doi: 10.2807/1560-7917.ES.2023.28.22.2300253.

Authors

Affiliations

¹ Paediatric Intensive Care Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
² These authors contributed equally to the work and share the first authorship.
³ Clermont-Ferrand University Hospital, 3IHP - Infection Inflammation et Interaction Hôtes Pathogènes Virology Department, French Reference Centre for enteroviruses and parechovirus, coordination laboratory, Clermont-Ferrand, France.
⁴ Auvergne University, LMGE UMR CNRS 6023, Team Epidemiology and pathophysiology of enterovirus Infection, Clermont-Ferrand, France.
⁵ Neonatal and Paediatric Intensive Care Units, Rouen University Hospital, Rouen, France.
⁶ Neonatal Intensive Care Unit, Cochin-Port Royal University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
⁷ Hospices Civils de Lyon, Virology Department, French Reference Centre for enteroviruses and parechoviruses, associated laboratory, Lyon, France.
⁸ Neonatal and Paediatric Intensive Care Units, Orléans Regional Hospital, Orléans, France.
⁹ Paediatric Neurology Department, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
¹⁰ Virology laboratory, Cochin University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
¹¹ Obstetrics and Fetal Medicine Department, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
¹² Virology Department, Rouen University Hospital, Rouen, France.
¹³ Pediatric Gastroenterology-Hepatology-Nutrition Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France.
¹⁴ Clinical Microbiology laboratory and Virology unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
¹⁵ Orléans Hospital, Microbiology laboratory, Orléans, France.
¹⁶ Neonatal Intensive Care Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France.
¹⁷ These authors contributed equally to the work and share the last authorship.
¹⁸ Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Imagine Institute, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France.

PMID: 37261730
PMCID: PMC10236930
DOI: 10.2807/1560-7917.ES.2023.28.22.2300253

Abstract

We report nine severe neonatal infections caused by a new variant of echovirus 11. All were male, eight were twins. At illness onset, they were 3-5 days-old and had severe sepsis and liver failure. This new variant, detected in France since April 2022, is still circulating and has caused more fatal neonatal enterovirus infections in 2022 and 2023 (8/496; 1.6%, seven associated with echovirus 11) compared with 2016 to 2021 (7/1,774; 0.4%). National and international alerts are warranted.

Keywords: Echovirus-11; Enterovirus; liver failure; neonatal sepsis.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

**Figure 1**
Phylogenetic tree of echovirus 11 complete 1D^VP1 sequences from neonatal and non-neonatal infections in France and other countries, 2010–2023 (n = 142)

**Figure 2**
Analysis of nt similarity of echovirus 11 complete genome sequences from neonatal and non-neonatal infections, France and other countries, 2010–2023 (n = 38)

**Figure 3**
Distribution of neonatal cases by week, France, January 2022–April 2023 (n = 496)

See this image and copyright information in PMC

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References

1. Abzug MJ. Presentation, diagnosis, and management of enterovirus infections in neonates. Paediatr Drugs. 2004;6(1):1-10. 10.2165/00148581-200406010-00001 - DOI - PubMed
1. Sandoni M, Ciardo L, Tamburini C, Boncompagni A, Rossi C, Guidotti I, et al. Enteroviral Infections in the first three months of life. Pathogens. 2022;11(1):60. 10.3390/pathogens11010060 - DOI - PMC - PubMed
1. Chuang YY, Huang YC. Enteroviral infection in neonates. J Microbiol Immunol Infect. 2019;52(6):851-7. 10.1016/j.jmii.2019.08.018 - DOI - PubMed
1. Duval M, Mirand A, Lesens O, Bay JO, Caillaud D, Gallot D, et al. Retrospective study of the upsurge of enterovirus D68 clade D1 among adults (2014-2018). Viruses. 2021;13(8):1607. 10.3390/v13081607 - DOI - PMC - PubMed
1. Mirand A, le Sage FV, Pereira B, Cohen R, Levy C, Archimbaud C, et al. Ambulatory pediatric surveillance of hand, foot and mouth disease as signal of an outbreak of coxsackievirus A6 infections, France, 2014-2015. Emerg Infect Dis. 2016;22(11):1884-93. 10.3201/eid2211.160590 - DOI - PMC - PubMed

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[1] Abzug MJ. Presentation, diagnosis, and management of enterovirus infections in neonates. Paediatr Drugs. 2004;6(1):1-10. 10.2165/00148581-200406010-00001 - DOI - PubMed

[2] Abzug MJ. Presentation, diagnosis, and management of enterovirus infections in neonates. Paediatr Drugs. 2004;6(1):1-10. 10.2165/00148581-200406010-00001 - DOI - PubMed

[3] Sandoni M, Ciardo L, Tamburini C, Boncompagni A, Rossi C, Guidotti I, et al. Enteroviral Infections in the first three months of life. Pathogens. 2022;11(1):60. 10.3390/pathogens11010060 - DOI - PMC - PubMed

[4] Sandoni M, Ciardo L, Tamburini C, Boncompagni A, Rossi C, Guidotti I, et al. Enteroviral Infections in the first three months of life. Pathogens. 2022;11(1):60. 10.3390/pathogens11010060 - DOI - PMC - PubMed

[5] Chuang YY, Huang YC. Enteroviral infection in neonates. J Microbiol Immunol Infect. 2019;52(6):851-7. 10.1016/j.jmii.2019.08.018 - DOI - PubMed

[6] Chuang YY, Huang YC. Enteroviral infection in neonates. J Microbiol Immunol Infect. 2019;52(6):851-7. 10.1016/j.jmii.2019.08.018 - DOI - PubMed

[7] Duval M, Mirand A, Lesens O, Bay JO, Caillaud D, Gallot D, et al. Retrospective study of the upsurge of enterovirus D68 clade D1 among adults (2014-2018). Viruses. 2021;13(8):1607. 10.3390/v13081607 - DOI - PMC - PubMed

[8] Duval M, Mirand A, Lesens O, Bay JO, Caillaud D, Gallot D, et al. Retrospective study of the upsurge of enterovirus D68 clade D1 among adults (2014-2018). Viruses. 2021;13(8):1607. 10.3390/v13081607 - DOI - PMC - PubMed

[9] Mirand A, le Sage FV, Pereira B, Cohen R, Levy C, Archimbaud C, et al. Ambulatory pediatric surveillance of hand, foot and mouth disease as signal of an outbreak of coxsackievirus A6 infections, France, 2014-2015. Emerg Infect Dis. 2016;22(11):1884-93. 10.3201/eid2211.160590 - DOI - PMC - PubMed

[10] Mirand A, le Sage FV, Pereira B, Cohen R, Levy C, Archimbaud C, et al. Ambulatory pediatric surveillance of hand, foot and mouth disease as signal of an outbreak of coxsackievirus A6 infections, France, 2014-2015. Emerg Infect Dis. 2016;22(11):1884-93. 10.3201/eid2211.160590 - DOI - PMC - PubMed

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Severe and fatal neonatal infections linked to a new variant of echovirus 11, France, July 2022 to April 2023

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Severe and fatal neonatal infections linked to a new variant of echovirus 11, France, July 2022 to April 2023

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