Oral Presentation 8th Australasian Virology Society Meeting and 11th Annual Meeting of the Australian Centre for Hepatitis & HIV Virology Meeting 2015

Human parechovirus type 3 (HPeV 3) neurological infection is an important cause of neurodevelopmental concerns at 12 months post infection in young infants (#21)

Philip N Britton 1 2 3 , Gulam Khandaker 1 2 3 4 , Ameneh Khatami 1 3 , Suzy Teutsch 1 2 3 , Stephanie Francis 5 , Brendan McMullan 5 , Cheryl A Jones 1 2 3
  1. Sydney Medical School, The University of Sydney, Sydney
  2. Marie Bashir Institute of Infectious Diseases and Biosecurity, Sydney
  3. The Children's Hospital at Westmead, Westmead
  4. National Centre for Immunisation Research and Surveillance, Westmead
  5. Sydney Children's Hospital, Randwick

Objective:

Human parechovirus Type 3 (HPeV 3) is an emerging cause of neurological disease in young children, however there are limited data on long-term consequences of infection. We aimed to describe neurodevelopmental outcomes and quality of life, at 12 months post HPeV infection in infants hospitalised at Sydney Children’s Hospitals (Westmead or Randwick) during the 2013-2014 NSW outbreak; one of the largest HPeV outbreaks to date.

Methods:

We sought consent for follow-up from parents of infant survivors of the 2013/14 NSW HPeV 3 outbreak, with ethics approval. Demographic, clinical and investigation data were collected. Outcome at 12 months post-discharge was measured using screening tests including the telephone Ages and Stages questionnaire version 3 (ASQ3), Pediatric Quality of Life Inventory (PEDS-QL), and Liverpool Outcomes Score (LOS) for Assessing Children at Follow-up surveys. Associations between demographic, clinical variables and ASQ3 outcome scores were measured using univariate statistical methods.

Results:

Most of those hospitalised with HPeV3 infection were young infants (median 37 days; range 4 days to 7.8 months). More than two thirds had neurological manifestations, particularly seizures, irritability and myoclonic jerks, and many had a characteristic erythematous rash. One third were admitted to intensive care units. 70% had laboratory confirmed neurological infection (HPeV detected in the CSF by PCR). 46/79 infants in the HPeV3 cohort were available for 12 months follow up. Almost half (45%) had developmental concerns on screening at 12 months (ASQ3); 17% were rated as ‘Significant’, 28% rated as ‘Some’ concern; most deficits were in gross-motor and problem-solving functions. Infants with developmental concerns also had lower PEDS-QL and LOS overall scores.

Conclusion:

HePV 3 neurological infection in infancy may be a cause of neurodevelopmental disability. Long term (3-5 year) neurodevelopmental follow-up of this cohort is needed to further define the consequences of HPeV infection and inform risk factors for adverse outcomes.