Enteroviruses are a group of viruses that can cause various diseases in humans, ranging from mild respiratory infections to severe neurological and cardiac complications. They are named after their ability to infect the gastrointestinal tract and cause enteric symptoms, such as diarrhea, vomiting and abdominal pain.
Echoviruses are a subgroup of enteroviruses that are named after their ability to cause enteric cytopathic human orphan (ECHO) effects in cell cultures. They are numbered from 1 to 34, based on their antigenic properties.
Echovirus 11 (E-11) is one of the most common and virulent echoviruses that can cause severe neonatal sepsis, hepatic impairment and multi-organ failure. It can also cause meningitis, encephalitis, myocarditis, pancreatitis and rash in infants and children.
Echovirus 11 infection has been reported in several regions of the world, such as Asia, Africa and the Americas. However, in recent years, there has been an increase in cases of echovirus 11 infection among newborns in several European countries, raising public health concerns and challenges.
In this article, we will inform you about the recent situation of echovirus 11 infection in Europe and its implications for your health and well-being. We will also provide you with some tips and recommendations on how to prevent and control this emerging disease.
Echovirus 11 Infection in Europe: What We Know So Far
According to the Disease Outbreak News published by the World Health Organization (WHO) on 7 July 2023, six European countries have reported cases of echovirus 11 infection confirmed in newborns since 2022. These countries are France, Croatia, Italy, Spain, Sweden and the United Kingdom of Great Britain and Northern Ireland (the UK).
The table below shows the number of cases, deaths and case fatality ratio (CFR) by country as of 26 June 2023:
| Country | Cases | Deaths | CFR |
|---|---|---|---|
| France | 9 | 7 | 78% |
| Croatia | 1 | 0 | 0% |
| Italy | 7 | 0 | 0% |
| Spain | 2 | 0 | 0% |
| Sweden | 5 | 0 | 0% |
| UK | 2 | 0 | 0% |
The clinical features and outcomes of the cases vary by country, but some common patterns can be observed:
- Most cases were preterm babies born before 37 weeks gestation
- Most cases presented with one or more clinical signs less than seven days after birth, suggesting a mother-to-child transmission route
- Most cases developed severe neonatal sepsis with hepatic impairment and multi-organ failure
- Most cases required intensive care and mechanical ventilation
- Most cases died within a few days of symptom onset
- Some cases recovered and were discharged from the hospital
The epidemiological characteristics and risk factors of the cases also vary by country, but some common factors can be identified:
- Most cases occurred in clusters or pairs of twins born at the same hospital or region
- Some cases had a history of maternal fever or respiratory infection during pregnancy or delivery
- Some cases had a history of contact with other enterovirus-infected patients or healthcare workers
- Some cases had no known exposure or risk factors
The genetic analysis of the echovirus 11 strains isolated from the cases revealed that they belong to a recombinant lineage that has not been previously detected in Europe. This lineage is derived from recombination events between different echovirus types and coxsackievirus types. The origin and evolution of this lineage are not fully understood yet.
The potential for echovirus 11 infection to spread to other age groups or regions is not known yet. However, there is a possibility that echovirus 11 infection could cause outbreaks or sporadic cases among older children or adults who have not been exposed to this virus before or who have low immunity.
Echovirus 11 Infection in Europe: What We Don’t Know Yet
Despite the efforts of health authorities and professionals to investigate and respond to the echovirus 11 infection situation in Europe, there are still many limitations and gaps in the current knowledge and data on this emerging disease.
Some of the unanswered questions are:
- What is the exact source and mode of transmission of echovirus 11 infection among newborns?
- How did the recombinant lineage of echovirus 11 emerge and evolve in Europe?
- How virulent and transmissible is this lineage compared to other echovirus types?
- How effective and safe are the existing diagnostic, preventive and therapeutic interventions for echovirus 11 infection?
- What are the long-term consequences and sequelae of echovirus 11 infection for the survivors and their families?
To answer these questions, more research and studies are needed to improve the understanding and management of echovirus 11 infection. Some of the areas that need further exploration are:
- The molecular epidemiology and phylogenetics of echovirus 11 strains circulating in Europe and other regions
- The clinical spectrum and natural history of echovirus 11 infection in different age groups and populations
- The immunological and genetic factors that influence the susceptibility and severity of echovirus 11 infection
- The development and evaluation of new or improved diagnostic tools, vaccines and antiviral drugs for echovirus 11 infection
- The socio-economic and psychological impacts of echovirus 11 infection on the affected individuals, families and communities
Echovirus 11 Infection in Europe: What We Can Do Now
While we wait for more evidence and information to emerge on echovirus 11 infection, there are some actions that we can take now to prevent and control this disease.
The WHO recommends the following public health measures and best practices for health authorities, professionals and communities:
- Enhance the surveillance and reporting of echovirus 11 infection cases and outbreaks in Europe, as well as the laboratory capacity to confirm and characterize the virus
- Implement standard precautions and infection prevention and control measures in healthcare settings, especially neonatal units, to prevent healthcare-associated infections and outbreaks
- Educate pregnant women and their families about the signs and symptoms of enterovirus infection and advise them to seek medical attention promptly if they develop any
- Promote breastfeeding and immunization as protective factors against enterovirus infection
- Provide supportive care and treatment for echovirus 11 infected newborns according to clinical guidelines and protocols
- Conduct further research and studies to improve the understanding and management of echovirus 11 infection
As individuals, we can also do our part to protect ourselves and our loved ones from enterovirus infection by following some simple tips:
- Wash your hands frequently with soap and water or use alcohol-based hand rubs
- Cover your mouth and nose with a tissue or your elbow when coughing or sneezing
- Dispose of used tissues properly and wash your hands afterwards
- Avoid touching your eyes, nose or mouth with unwashed hands
- Avoid close contact with people who are sick or have symptoms of enterovirus infection
- Stay home if you are sick or have symptoms of enterovirus infection
- Seek medical advice if you have severe or persistent symptoms of enterovirus infection, such as fever, headache, stiff neck, chest pain, difficulty breathing or rash
Symptoms of Echovirus 11 Infection
The symptoms of echovirus 11 infection can vary depending on the age, immune status and organ system involved. However, some common symptoms that may occur in both babies and adults are :
- Fever
- Diarrhea
- Rash
- Jaundice (yellowing of the skin or eyes)
- Congested nose
- Cough
- Headache
In some cases, echovirus 11 infection can cause more serious symptoms that affect the brain, heart, liver or other organs. These may include :
- Sepsis (a body-wide infection response that can be fatal if untreated)
- Meningoencephalitis (a swelling of the membranes around the brain and spinal cord)
- Myocarditis (inflammation of the heart muscle)
- Hepatitis (inflammation of the liver)
- Encephalitis (swelling of the brain)
The symptoms of echovirus 11 infection can appear gradually or very quickly in different people. They tend to appear more rapidly in babies. If you or your child have any of these symptoms, especially if they are severe or persistent, you should seek medical attention as soon as possible.
Treatment of Echovirus 11 Infection
There is no specific treatment for echovirus 11 infection. The treatment is mainly supportive, meaning that it aims to relieve the symptoms and prevent complications. The specific treatment will depend on the symptoms, but may include :
- Breathing support — using treatments like supplemental oxygen and mechanical ventilation, your doctor can make sure your lungs get enough air if you have difficulty breathing
- Medication to reduce inflammation or fluid buildup — specialized medicine can reduce the strain put on your heart or other organs by inflammation or excess fluid in your body
- Medication to control seizures — anticonvulsant drugs can help prevent or stop seizures if you have encephalitis or meningitis
- Medication to treat infections — antibiotics or antifungal drugs can help treat any secondary bacterial or fungal infections that may occur due to a weakened immune system
- Immune system treatment — intravenous immunoglobulin (IVIG) is a treatment that contains antibodies from donated blood that can help boost your immune system and fight the virus
- Antiviral treatment — pocapavir is an experimental drug that has shown some activity against enteroviruses in laboratory studies, but its effectiveness and safety for echovirus 11 infection are not well established
Most cases of echovirus 11 infection will resolve on their own within a few days or weeks. However, some cases may require hospitalization and intensive care, especially if they involve severe or life-threatening symptoms. The recovery and prognosis will depend on the severity of the infection and the presence of any complications or underlying conditions.
Conclusion
Echovirus 11 infection is a new emerging disease in Europe that can cause severe neonatal sepsis, hepatic impairment and multi-organ failure. It has been reported in six European countries since 2022, with a high case fatality rate among newborns.
Echovirus 11 infection poses a public health challenge and requires urgent attention and action from health authorities, professionals and communities. We need to enhance our surveillance, prevention and control measures, as well as our research and studies, to better understand and manage this disease.
