Prevalence, Genotypes, Clinical Manifestations and Outcomes Associated with Human Parechovirus (HPeV) Infections in Infants up to 2 Months old in Central Ohio

BACKGROUND: HPeV have been associated with severe disease in young infants. Of the 17 genotypes described, HPeV 1 and 3 have been the most frequently reported. The epidemiology and clinical features associated with different genotypes have not been well defined. We analyzed the prevalence, genotypes, and clinical manifestations and outcomes of HPeV in infants ≤ 60 days evaluated at Nationwide Children’s Hospital, Columbus, Ohio. METHODS: We retrospectively reviewed EMRs of all infants ≤ 60 days undergoing sepsis evaluation with a positive HPeV PCR from any site between July 2013 and September 2016. All available HPeV CSF, blood, and superficial site specimens were typed by PCR or Sanger sequencing (types assigned per GenBank®). RESULTS: Of 1,265 patients tested, 131 (10%) were positive for HPeV in at least one site, of which 100 had available isolates for genotyping. Median age was 30 days (IQR 19–39), 55% were male. HPeV3 was identified in 87 (87%), HPeV4 in 6, HPeV1 in 5, and HPeV5 and 6 were identified in one infant each. For comparisons we grouped types 1, 4, 5 and 6 into HPeV0 (n = 13). The circulation of HPeV peaked in the months of July to October independent of the type. However, while HPeV0 were identified only in second half of the year, HPeV3 was detected year round. HPeV3 patients had higher temperatures (P < 0.05). There were no significant differences between HPeV3 vs. HPeV0 in age, gender, presenting symptoms, length of stay, PICU admission and CBC. ALT values were higher in HPeV0 patients (P < 0.01). CSF indices were also similar in both groups. Of the positive CSF isolates for HPeV, 43% had no pleocytosis; all CSF isolates typed were HPeV3. HPeV4 was found in blood and superficial sites. HPeV1, 5 and 6 were only found in superficial sites and more commonly with coinfections (enterovirus [EV], rhinovirus, group B streptococcus). There were 4 PICU admissions, 3 of them had HPeV3 and 1 had HPeV1 (patient also had Rhinovirus/EV bronchiolitis). All patients recovered at the time of discharge. CONCLUSION: HPeV was commonly identified in infants ≤ 60 days undergoing sepsis evaluation. HPeV3 was the most common type in this age group. HPeV4 also caused viremia, while other infrequent types were identified with coinfections. DISCLOSURES: O. Ramilo, Abbvie: Board Member, Consulting fee; Regeneron: Board Member, Consulting fee; Janssen: Board Member and Investigator, Consulting fee and Research grant; NIH: Grant Investigator, Research grant; A. Leber, BioFIre Diagnostics: Research Contractor and Scientific Advisor, Research support, Speaker honorarium and Travel expenses