Parents: What is Parechovirus?

Viruses seem to be having a moment, with reports about COVID-19, monkeypox, pediatric hepatitis, and respiratory syncytial virus (RSV) filling the airwaves. Now, another virus is making the rounds, and though it’s not new to the U.S., many parents may not have heard of it.

Parechovirus (PeV) cases have been reported in several states, which is not uncommon because clinicians know that it infects most children by age 5. However, the newly reported cases are caused by subtype PeV-A3 strain, which is associated with a more serious disease.

The situation is concerning enough that the U.S. Centers for Disease Control and Prevention issued a health alert in August. It urges physicians and other public health officials to be on the lookout.

These new cases are different, says Brandon Chatani, M.D., a pediatric infectious disease expert at the University of Miami Health System. In the past, most patients with PeV infections displayed mild illness or non-existent symptoms. Hence, parents usually didn’t bring their children for testing and treatment, and the infection resolved itself at home without incident.

“But this strain causes more severe disease,” Chatani adds, “and we now have several reports of infants being tested for parechovirus.”

The medical community knew that most of us had been infected by some parechovirus in our early years only because of antibody studies.

The CDC doesn’t have systematic surveillance set up to track this virus, so it’s unclear how many cases there are.

Nor do we know how this year’s reported numbers compare to previous seasons. What’s more, infectious disease specialists like Dr. Chatani say the uptick may be due to increased testing or other factors.

“COVID lockdown limited our exposure to viruses,” he says, “but that was only temporary. Now respiratory viruses are circulating again, and they’ve returned in different ways than we’re used to seeing them. That’s true, not just for parechovirus.”

For instance, PeV is most common during late summer and fall. By winter, infections have usually disappeared. 2022 has been the exception.

The uptick in cases began in May — entirely out of season.

Parechovirus is a group of viruses (known as Picornaviridae) that can vary in severity and manifestation.

Symptoms — fever, upper respiratory infection, rash, diarrhea, nausea, and vomiting — resemble other diseases. 

“It’s often dismissed as a common cold,” Dr. Chatani says.

That said, the most telling clue is often the rash, which clinicians have dubbed the “mittens and booties rash” since it appears on the hands and feet. The appearance of the rash can vary, from a flat redness to small bumps.

While most kids recuperate in a few days in the comfort of home, parechovirus infection can prove very dangerous for newborns, particularly during the first month. Babies six months and younger face the most risk for complications because of their underdeveloped immune systems. 

Life-threatening complications include seizures, meningitis, sepsis, and encephalitis (brain inflammation).

 “Outcome [for the youngest patients] really comes down to how soon you seek medical care,” says Dr. Chatani, who recommends all babies be seen by a doctor at the presentation of the symptoms. Telltale signs that there’s something wrong include poor feeding, irritability, lethargy, and unusual fussiness. He also advises keeping an eye on the baby’s energy level.

No cures exist for parechovirus, though a physician may treat a sick infant with antiviral medication to stop the spread of the disease and/or antibodies to boost the immune system.

That said, there is plenty that adults can do to keep PeV from spreading.

Here are Dr. Chatani’s recommendations:

• Cover your mouth and nose when you cough and sneeze. PeV spreads through respiratory droplets. Children can also contract it by sharing a toy or touching a contaminated surface covered with the virus.
• Wash your hands with soap and water often, especially after changing a poopy diaper. PeV can also spread through fecal matter. (Sanitizers that are at least 60% alcohol can be used, but soap and water are preferable.)
• Wipe down the diaper-changing area, washing it thoroughly with soap and water. Make sure your daycare provider follows the hand-washing and wipe-down rules as well. The poop may have been cleaned off, but the germs can remain for days.
• Avoid others who are sick.
• Consult your pediatrician at the first sign of symptoms. As with other diseases, treatment tends to work best with an early diagnosis.

Ana Veciana-Suarez, Guest Columnist

Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author, who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.

Tags: common childhood infections, Dr. Brandon Chatani, human parechovirus pev, infectious disease, kids health, pediatric care in Miami, pev in the united states, rashes