What to watch for with human parechovirus (HPeV) infections...

With HPeV infections generally around during summer (see specific earlier story arising from cases in babies from New South Wales), it's well worth mirroring the advice form NSW health on what to look for. 

The full sources of this information can be visited at the pages listed below.

A brief agglomeration of the information...

HPeV (closely related to enteroviruses) has been detected in a number of neonates and young infants admitted to NSW hospitals during October and November 2019. Infants present very unwell with a rapid onset of acute sepsis-like (whole-body or systemic inflammation to a widespread infection) symptoms and can infect teh central nervous system. This is often followed by an erythematous, often confluent rash. Children under 3 months of age are the group most likely to develop severe disease, but most recover with supportive treatment.

Suspect HPeV infections in neonates (newborn) or young infants can present with a fever (>38.0°C) and:

• Irritability and appearing to be in pain 
• Tachypnoea
• Maculopapular or erythematous rash 
• Encephalitis
• Diarrhoea or loose stools 
• Myoclonic jerks
• Tachycardia 
• Hepatitis

How is it diagnosed?

Stool samples, nose and throat swabs, cerebrospinal fluid (CSF), or blood can be tested for HPeV at a specialist laboratory.

Initial Management and Treatment

Children presenting with a fever, sepsis-like signs &/or neurological signs, including irritability, should be assessed and treated for suspected sepsis using local protocols and discussed with an Emergency Consultant or Paediatrician.
There is no specific treatment for HPeV, treatment is supportive only.

How is HPeV disease prevented?

There is no vaccine to protect you from HPeV infection.

Good hygiene is the best protection: wash hands with soap and water after going to the toilet, before eating, after wiping noses, and after changing nappies or soiled clothing
Ensure the mouth and nose are covered when coughing and sneezing. Wipe the nose and mouth with tissues, dispose of used tissues and then wash your hands.

People who are unwell with colds, flu-like illness or gastro illness should stay away from small babies. 

If you are caring for a small baby and are unwell, wash your hands or use an alcohol-based hand rub before touching or feeding the baby.

Further reading...

• News from Medicare local south eastern Sydney.
  http://www.sesml.org.au/news.php?newsid=261
• A NSW Health factsheet on HPeV.
  http://www.health.nsw.gov.au/Infectious/factsheets/Pages/parechovirus.aspx

Infection prevention and control and CORONA

Harriman, Brosseau and Triverdi have written to the Editor of the New England Journal of Medicine (NEJM) to express their concerns over the lack of apparent preventative measures undertaken during the Al-Ahsa Middle East respiratory syndrome (CORONA) coronavirus outbreak communicated by Assiri et al (previously reviewed here).

The new letter indicates that with so little known about CORONA-CoV transmission route(s), a safer bet would have been to protect healthcare workers as much as possible. They suggest use of  respirators rather than surgical masks (see Mike Coston's reviews of the differences here, here, here, here and here...likes his masks does Mike). 

Possibly eye protection as well given the transmission unknowns. 

I've previously listed these and other precautions for managing patients with endemic or with less well-defined respiratory pathogens. Worth a reminder read.

The authors highlight it would be prudent, in a well-resourced country like the Kingdom of Saudi Arabia, to roll out as many extra personal protective safeguards for the front-line healthcare workers as possible; at least while the slow hunt to understand how the virus is acquired and transmitted seeks some answers.

The reply to this letter by Memish, Al-Tawfiq and Assiri did not specifically agree with its specifics or address enhanced care for HCWs, instead restating what was done to respond. The key comment summing up the use of respirators indicates a reactive rather than proactive approach to HCW care in trying to prevent a case from spreading their laboratory confirmed infection. 

...putting surgical masks on all patients undergoing hemodialysis and particulate respirators (N95 masks) on any patient with confirmed CORONA-CoV who was undergoing an aerosol-generating procedure...

As we've seen over and over again during this outbreak and others, by the time a laboratory confirmation is available, it is far too late to halt early transmission events. 

When those events occur in a hospital environment it's not just the relatively (to the CORONA-CoV case averages) younger and more healthy HCWs that are at risk of infection and disease. CORONA-CoV and other respiratory viruses are at their most lethal among the elderly with comorbidities. Delays in lab testing, in waiting for something to happen or in following other's guidelines to the letter rather than modifying or creating new ones based on front-line experiences, can have severe consequences.

I take the message from this letter as: Be proactive not reactive.

Middle East coronavirus infection control and personal protective equipment...

...are not at all part of the thinking judging by the imagery in this story on alRiyadh.

For a virus that kills 2 in 5 symptomatic people and for which animal hosts or intermediate hosts remain to be excluded or confirmed, there is an alarming and completely irresponsible level of safety being employed by those workers.

Thanks to FluTrackers for bringing it to my attention.