Increased reports of severe myocarditis associated with enterovirus infection in neonates, United Kingdom, 27 June 2022 to 26 April 2023

Abstract

Enteroviruses are a common cause of seasonal childhood infections. The vast majority of enterovirus infections are mild and self-limiting, although neonates can sometimes develop severe disease. Myocarditis is a rare complication of enterovirus infection. Between June 2022 and April 2023, twenty cases of severe neonatal enteroviral myocarditis caused by coxsackie B viruses were reported in the United Kingdom. Sixteen required critical care support and two died. Enterovirus PCR on whole blood was the most sensitive diagnostic test. We describe the initial public health investigation into this cluster and aim to raise awareness among paediatricians, laboratories and public health specialists.

Keywords: coxsackie; enterovirus; myocarditis; neonatal infection.

Figure 1

Epidemiological curve of neonatal (< 28 days) enteroviral myocarditis cases, United Kingdom, 27 June 2022–26 April 2023 (n = 20)

Figure 2

Enterovirus PCR quantification cycle (Cq) values on whole blood specimens from six neonatal (< 28 days) enteroviral myocarditis cases, where sequential sampling was available, United Kingdom

Figure 3

Detection and identification of enterovirus in infants aged < 90 days, England and Wales, 2003–2023

Figure 4

Hospitalisations of myocarditis cases in infants (aged < 90 days) in England and Wales, 2002–2023