title: Severe Parechovirus 3 Infections in Young Infants-Kansas and Missouri, 2014.
abstract: BACKGROUND
  Infection with parechovirus type 3 (PeV3) can cause severe neurologic and sepsis-like illness in young infants; clinical and epidemiologic descriptions have been limited. We aimed to characterize PeV3 illness and explore risk factors for acquisition in a cluster of neonatal cases at Children's Mercy Hospital in Kansas City, Missouri.
  
  
  METHODS
  Cerebrospinal fluid specimens were obtained from infants aged <180 days who were hospitalized with sepsis-like illness or meningitis between June 1 and November 1, 2014. PeV-positive specimens were sequenced at the Centers for Disease Control and Prevention. We reviewed the medical and birth charts of the infants and performed face-to-face parent interviews. We analyzed characteristics according to infant age and intensive care admission status.
  
  
  RESULTS
  We identified 35 cases of PeV infection in infants aged 5 to 56 days. Seven infants required intensive care (median age, 11 days vs 27 days among those who did not require intensive care; P = .0044). Six of these 7 infants had neurologic manifestations consistent with seizures, and all 6 of them were treated with acyclovir but subsequently tested negative for herpes simplex virus. Virus sequences formed 2 lineages, both of which were associated with severe illness. Half of the infants were reported to have household contacts who were ill during the week before onset. Infants aged ≤7 days at onset were more likely to have been delivered at the same hospital.
  
  
  CONCLUSIONS
  PeV3 can cause severe neurologic illness in neonates, and younger infants are more likely to require intensive care. PeV3 should be considered along with herpes simplex virus and other pathogens when evaluating young infants with sepsis-like illness or meningitis. More widespread testing for PeV3 would enable us to gain a better understanding of the clinical scope and circulation of this virus.
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.|Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Midgley
authors.affiliation: Children's Mercy Hospital, Kansas City, Missouri.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Jackson
authors.affiliation: Children's Mercy Hospital, Kansas City, Missouri.
authors.forename: Rangaraj
authors.initials: R
authors.lastname: Selvarangan
authors.affiliation: Missouri Department of Health and Senior Services, Jefferson City.
authors.forename: Patrick
authors.initials: P
authors.lastname: Franklin
authors.affiliation: Kansas Department of Health and Environment, Topeka.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Holzschuh
authors.affiliation: Missouri Department of Health and Senior Services, Jefferson City.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lloyd
authors.affiliation: Kansas Department of Health and Environment, Topeka.
authors.forename: Joseph
authors.initials: J
authors.lastname: Scaletta
authors.affiliation: Kansas Department of Health and Environment, Topeka.
authors.forename: Anne
authors.initials: A
authors.lastname: Straily
authors.affiliation: Kansas Department of Health and Environment, Topeka.
authors.forename: Sheri
authors.initials: S
authors.lastname: Tubach
authors.affiliation: Children's Mercy Hospital, Kansas City, Missouri.
authors.forename: Ashley
authors.initials: A
authors.lastname: Willingham
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
authors.forename: W Allan
authors.initials: WA
authors.lastname: Nix
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
authors.forename: M Steven
authors.initials: MS
authors.lastname: Oberste
authors.affiliation: Children's Mercy Hospital, Kansas City, Missouri.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Harrison
authors.affiliation: Kansas Department of Health and Environment, Topeka.
authors.forename: Charles
authors.initials: C
authors.lastname: Hunt
authors.affiliation: Missouri Department of Health and Senior Services, Jefferson City.
authors.forename: George
authors.initials: G
authors.lastname: Turabelidze
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
authors.forename: Susan I
authors.initials: SI
authors.lastname: Gerber
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
authors.forename: John T
authors.initials: JT
authors.lastname: Watson
mesh_terms: D003422:Critical Care; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008587:Meningitis, Viral / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy / Q000821:virology; D008923:Missouri / Q000453:epidemiology; D030061:Parechovirus / Q000145:classification / Q000235:genetics; D010802:Phylogeny; D010850:Picornaviridae Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy / Q000821:virology; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology