What Is Parechovirus in Babies?

Parechovirus (PeV) can cause a wide range of symptoms ranging from mild to severe. In many ways, these symptoms are similar to those of a common cold.

Mild to moderate symptoms of PeV infection include:

• Sore or scratchy throat
• Runny nose
• Coughing
• Sneezing 
• Fever 
• Nausea and or vomiting
• Diarrhea
• Viral or red skin rash
• Irritability
• Lethargy
• No appetite
• Congestion
• Insomnia

Serious symptoms of PeV infection include:

• Severely distended abdomen
• Respiratory tract infections
• Sepsis-like syndrome (blood infections)
• Unable to tolerate bright lights
• Appearing to be in pain and irritation
• Abnormal or jerking movements
• Severe rashes throughout the body
• Increase in heartbeat rate and rapid breathing
• Excessive tiredness
• Feeling of drowsiness
• Excessive irritability
• Neurologic illness, including seizures, paralysis, meningitis (swelling of the protective membranes covering the brain and spinal cord) or meningoencephalitis (swelling of both the meninges and brain)

Signs of meningitis include headaches, fever, and a stiff neck.

Most human parechovirus infections generate no or minor symptoms, such as gastroenteritis or influenza-like sickness. However, serious illness can occur in rare circumstances. Upper respiratory tract infection, fever, and rash are frequent in children aged six months to five years, with the majority of children affected by the time they attend kindergarten.

If a newborn younger than three months exhibits any of the following symptoms, parents should contact a doctor immediately:

• A temperature of 100.4°F (38°C) or higher or temperature below 97°F (36.1°C)
• Unable to eat and appears dehydrated (drowsiness, a dry or sticky mouth, sunken eyes or soft spot on the head, no wet diaper in six to eight hours, crying with little or no tears)
• Severe vomiting or diarrhea
• Sudden rash
• Fussy, irritable, or crying and can't be calmed down
• Troubled breathing
• Looks severely pale
• Extremely sleepy and hard to wake

The important instruction according to the Centers for Disease Control and Prevention is that if you suspect something is wrong with your child, consult your doctor. They will be able to perform the appropriate tests to establish whether it is PeV.

Parechoviruses (PeVs) are classified into two types:

• PeV-A
• PeV-B

PeV-A is a human disease, but PeV-B affects animals.

Researchers have found 19 distinct forms of human PeVs, ranging from human parechovirus (HPeV) 1 to HPeV 19. HPeV 1 and 3 are the most prevalent and frequent human infections among these kinds.

Possible causes of and risk factors for PeV include:

• HPeV can infect people of all ages although young children in their initial few days of life appear to be the most vulnerable.
• According to the Centers for Disease Control and Prevention (CDC), newborns younger than three months, particularly those younger than one month, are at a higher risk of serious diseases. This is due to their lack of antibodies to the virus, and the disease can easily spread through infected surfaces or air.
• These viruses can spread from person to person by direct or indirect contact with an infected person's respiratory droplets, saliva, or feces. 
• Although the virus has not been proven to be teratogenic, there is evidence of uterine transfer from the mother to the kid.
• A person may be contagious for one to three weeks through the respiratory system and for up to six months through the digestive system. However, even if a person is infectious for a long period, symptoms may only last a few days.

Most children get the PeV infection at some point, and many may not realize it.

Although the virus is not new, the sudden alarm comes in response to a surge of unexpected cases. According to experts, the PeV-A3 strain is the one most often connected with a serious sickness. The CDC has not yet released any data on current hospitalization or fatality rates. The CDC warns that as we transition from summer to fall, the virus will become more prevalent owing to its seasonality (similar to how we have a "flu season").

Depending on the severity of signs and symptoms, if parechovirus (PeV) is suspected, testing will be performed.

• Fecal (stool) sample
• A cerebrospinal fluid sample is taken by a procedure called a lumbar puncture (spinal fluid in infants with PeV often has few to no white blood cells)
• Nose and throat swabs or blood can be tested for human parechovirus (HPeV) at a specialized laboratory

HPeV testing using particular molecular assays is recommended in children younger than six months who exhibit distinctive symptoms. Most children, even those suspected of having PeV-A3, will not be tested because the majority of instances are not serious, and the treatment of the sickness (which normally resolves without intervention) is the same regardless of the test result.

There are no effective antiviral treatments available. Treatment is generally supportive and aimed at managing the complications.

• Depending on the symptoms, doctors may advise adequate hydration, rest, and drugs such as Advil or Tylenol. Children younger than 12 years should not be given aspirin unless prescribed by a doctor.
• Oral antiviral medications may be prescribed by doctors in some instances.
• If an infant has severe symptoms, they may require hospitalization. Such individuals may require intravenous drugs and ongoing monitoring.
• According to sepsis guidelines, most newborns are prescribed empiric antibiotics. Some people will need breathing and/or circulatory care.
• Newborns infected with parechovirus (PeV) may be treated with immune-boosting medications (immunoglobulins) or an antiviral drug called Picovir (pleconaril). 
• Depending on the severity of your baby's symptoms, they may require hospitalization until their symptoms resolve and their doctor certifies that they are well enough to go home.
• Some newborns with severe human parechovirus infection may experience neurodevelopment problems, which may require them to pediatrician regularly.

The acute sickness lasts four to seven days, after which there may be a fast recovery. Even people who are severely unwell and require special care and the majority of newborns recover completely.

There is no vaccination available to guard against parechovirus (PeV) infection. The best precaution and prevention are good hygiene.

• The Centers for Disease Control and Prevention advises parents that the best method to protect themselves and others is to wash their hands thoroughly to prevent fecal-oral transmission.
• If you have older children, especially small toddlers, among whom the disease frequently spreads, be sure to educate them on the necessity of consistently washing their hands for 20 seconds or longer.
• Minimize your baby's contact with others throughout the first three months.
• If guests insist on holding the infant during the first few months, advise them to wear a mask and gloves.
• After using the restroom, wiping noses, and changing diapers or soiled clothing, wash your hands with soap and water before eating.
• When coughing or sneezing, cover your mouth and nose. Wipe your nose and mouth with tissues, then discard them and wash your hands.
• People who are sick with colds, flu-like illnesses, or gastroenteritis should avoid interaction with newborns.
• If you are sick and care for an infant, wash your hands or use an alcohol-based sanitizer before handling or feeding the baby.
• Disinfect commonly touched surfaces or objects.
• Avoid being around ill people.
• If you have a cold, flu, or stomach symptoms, remain at home and away from infants and young children.
• Avoid sharing cups, dining utensils, and personal hygiene goods (such as towels, washers, and toothbrushes), as well as clothes (especially shoes and socks).
• Teach youngsters proper coughing and sneezing techniques.

Anyone concerned about a possible PeV infection should consult their healthcare physician.

According to the Centers for Disease Control and Prevention, parechovirus (PeV)-A is known to be infectious in people. However, there are several strains of PeV-A, and some age groups are more likely than others to be affected by these strains.

The PeV-A3 strain has been the most frequent in recent occurrences of the virus. It is the most hazardous strain for infants younger than three months. 

Complications may include:

• Meningoencephalitis with seizures (rare)
• Abdominal complications (volvulus, intussusception, and bowel ischemia)
• Irreversible brain-tissue damage
• Developmental disability
• Death

More viral awareness and testing will assist doctors and researchers to gain a clearer idea of the magnitude of the diseases. This might lead to future antiviral therapies, fast testing, and possible vaccination, especially for pregnant women.