Baby dies after unusual 'cluster' of heart infections in south Wales (linked to enterovirus)

[Shiloh]

Source: https://www.itv.com/news/wales/2023-...art-infections

Baby dies after unusual 'cluster' of heart infections in south Wales
Thursday 4 May 2023 at 8:58am


A baby has died and nine others have been treated in hospital after a "cluster" of heart infections in south Wales, according to Public Health Wales.

It is investigating the enterovirus cases in the babies, all of whom were under a month old when they fell ill.

The babies developed myocarditis, a rare complication of enteroviruses.

Ten babies have received treatment in the area since June 2022, with the cluster described as "unusual" because of the number of cases reported over a relatively short period.

Enteroviruses are a group of viruses that cause a number of infectious illnesses which are usually mild.

However, in rare cases it can cause myocarditis, where the heart becomes inflamed.

Public Health Wales described the heart infection as "extremely rare" and is working with the pediatric team at the Noah's Ark Children's Hospital for Wales to understand the reasons behind the cluster.

Dr Christopher Williams, consultant epidemiologist for Public Health Wales, said the cluster is "unusual" due to the number of cases reported in a short space of time....

[Pathfinder]

Baby dies and nine more admitted to hospital in ‘unusual’ cluster of heart infections

WHO warns of a surge in severe myocarditis – a potentially deadly inflammation of the heart – in south Wales and southwest England

By
Sarah Newey,
GLOBAL HEALTH SECURITY CORRESPONDENT
17 May 2023 • 10:03am

One baby died and a further nine were admitted to hospital in an “unusual” cluster of heart infections in south Wales and southwest England, according to health officials.

Late on Tuesday night, the World Health Organisation said there had been a rise in severe myocarditis – a potentially deadly inflammation of the heart – in newborns and infants between June 2022 and March 2023.

A total of 15 babies – 10 in Wales, five in England – presented with the condition during this period, the WHO said. Of these, nine tested positive for an enterovirus – a common pathogen which can cause respiratory illness, hand, foot and mouth disease, and viral meningitis. In very rare instances, young babies can develop myocarditis.
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https://www.telegraph.co.uk/global-health/science-and-disease/myocarditis-baby-deaths-heart-infections-viruses-wales/

[Pathfinder]

Myocarditis - United Kingdom of Great Britain and Northern Ireland

17 May 2023


This Disease Outbreak News was first published on 16 May 2023 and later updated on 17 May 2023 to correct the number of cases, deaths, and the number of cases with PCR testing.

Situation at a glance

On 5 April 2023, the National IHR Focal Point for the United Kingdom informed WHO of an increase in severe myocarditis in neonates associated with enterovirus infection in Wales. Between June 2022 and April 2023, ten hospitalised neonates with a positive enterovirus Polymerase Chain Reaction (PCR) test were found to have myocarditis. Seven of the ten cases had further subtyping, with either coxsackie B3 or coxsackie B4 identified. As of 5 May 2023, one patient was still hospitalised, and one had died.

Although enterovirus infections are common in neonates and young infants, the reported increase in myocarditis with severe outcomes in neonates and infants associated with enterovirus infection is unusual.

Description of the situation

On 5 April 2023, the National IHR Focal Point for the United Kingdom informed WHO of an increase in severe myocarditis in neonates and infants associated with enterovirus infection in Wales.

Between June 2022 and April 2023, ten neonates, under 28 days of age, presented with a picture consistent with myocarditis and a positive enterovirus PCR. Seven cases were treated in intensive care, and one case died before transfer to tertiary care. Cases presented with features of sepsis, myocarditis, or in cardiorespiratory arrest. The peak incidence of cases was in November 2022, with sporadic cases in other months.

Enterovirus PCR testing of all ten cases (with either blood, throat swab, nose swab, nasopharyngeal aspirate or cerebrospinal fluid samples) confirmed the presence of an enterovirus, subtyping (where available) to either coxsackie B3 or coxsackie B4.

Critical care support including intubation, ventilation and circulatory support was given to the patients who went to intensive care.

As of 5 May 2023, one patient was still hospitalised and one had died.

The reported increase in severe myocarditis in neonates and infants associated with enterovirus infection is unusual. In the tertiary hospital covering the South Wales region, two other similar cases have been identified in the 6 years prior to June 2022.

A further five cases have been identified over the same period in the Southwest of England. No additional information is currently available about these cases. Details of five of the cases from South Wales and three of the additional cases from Southwest England have recently been published (Ng et al., 2023).

Epidemiology of Myocarditis (acute infective)

Myocarditis is an inflammation of the heart muscle (myocardium). The most common cause of myocarditis is viral infection (e.g., Enteroviruses), but it can also be caused by a bacterial infection, a reaction to a drug or an autoimmune disease. Myocarditis symptoms include new and persistent chest pain, shortness of breath and heart palpitations (racing or pounding heartbeat).

Enteroviruses can cause a number of infectious illnesses and are responsible for annual epidemics. These are usually mild but have been found to affect neonates differently, and often more severely, than older children. There are multiple transmission routes, particularly in the neonatal period. The reported incident represents an increase in both the number and severity of enterovirus (coxsackieviruses) infections in infants under the age of one month. There is increased morbidity and mortality associated with the current incident.

Public health response

On 28 February 2023, pediatricians in the South Wales region were alerted about the recent cases, with advice to consider myocarditis in infants and neonates presenting in shock. A briefing note to clinicians, microbiologists, health boards and public health teams was sent from Public Health Wales on 3 May 2023, following an incident meeting in Wales on 26 April 2023.

An Incident Management Team set up by the United Kingdom authorities are reviewing the evidence from all English Regions and United Kingdom countries and agree on the next steps for response. Epidemiological investigations are ongoing.

WHO risk assessment


According to the authorities of the United Kingdom, a review of past data from the previous six years from the same tertiary care centre in Wales, United Kingdom, has identified only two similar cases prior to June 2022 (which may or may not be linked to the current incident).

Based on the limited information available at this point, WHO assesses the public health risk for the general population to be low. However, asymptomatic carriage and shedding of infectious virus is a feature of enterovirus infection and there was little evidence in this case series of maternal infection prior to or during delivery. As enterovirus infection is often not among the notifiable diseases in Member States, additional cases of severe, neonatal enterovirus infections might have gone undiagnosed and/or unreported elsewhere.

WHO advice


Non-polio enteroviruses are common and distributed worldwide. Although infections often are asymptomatic, others present with mild to moderate respiratory tract infections. Symptoms include fever, runny nose and body weakness. These viruses are also associated with occasional outbreaks in which an unusually high proportion of patients develop clinical disease, sometimes with serious and fatal consequences – in this instance myocarditis. Clinicians seeing infants and neonates presenting in shock may consider a diagnosis of myocarditis and consider testing for enteroviruses.

No specific antiviral therapy is available, and treatment focuses on prevention of complications. As there is no vaccine for this virus, control measures during outbreaks are focused on classical hygiene measures including frequent handwashing and disinfection of soiled clothing and surfaces. In certain situations, it may be advisable to close child-care facilities and schools to reduce the intensity of transmission.

WHO does not recommend any travel and/or trade restrictions to United Kingdom based on the information available for this event.


Further information

• World Health Organization, Health topics, Enterovirus 71, available at https://www.who.int/teams/health-pro...enterovirus-71

• UK Health Security Agency, Enterovirus: summary of strain characterisation available at: https://www.gov.uk/government/public...aracterisation [accessed 20 April 2023]

• Ng KF, Gibb J, Struik S Neonatal Enteroviral Myocarditis Consortium, et al. Remember the heart: neonatal myocarditis Archives of Disease in Childhood 2023;108:417-419. Available at: http://dx.doi.org/10.1136/archdischild-2023-325316

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https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON465