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Coxsackievirus B1 most commonly reported enterovirus serotype from 2007 to 2008
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From 2007 to 2008, coxsackievirus B1 accounted for 23% of reported enterovirus infections in infants and was the most common serotype reported to the National Enterovirus Surveillance System for the first time, according to study findings.
In 2007, three clusters of coxsackievirus B1 (CVB1) were detected in Los Angeles (n=30 patients), Chicago (n=50 patients) and Kotzebue, Alaska (n=three patients) and reported to the National Enterovirus Surveillance System (NESS), a voluntary, passive system used to monitor enterovirus infections nationwide. The most common clinical presentations included myocarditis, respiratory distress, meningitis and hepatitis. Among these cases, ICU care was needed for 34%; five neonates (median age, 15 to 33 days) died. Also, 20 states reported cases of CVB1 infection to the CDC that were not associated with the aforementioned clusters. Six neonates died, and all cases involved multisystem disease within the first four days of life.
In this study, the researchers conducted a review of U.S. enterovirus surveillance data from the NESS. From 2007 to 2008, the NESS received 1,079 reports of enterovirus infection; CVB1 accounted for 23% of cases with a known serotype vs. 2% from the period of 1970 to 2005. “In both years, CVB1 accounted for a greater proportion of serotypes reported to the NESS than in any prior year since 1970,” wrote Mary E. Wikswo, MD, and colleagues from the CDC and other U.S sites. However, the majority of cases of CVB1 infection were among children aged younger than 1 year (71%) — which was similar to data from 1970 to 2005.
Although there are no approved vaccines for nonpolio enterovirus infections in the United States, IV immunoglobulin has been used for treatment of patients; however, its efficacy remains unknown. In addition, pleconaril (Schering-Plough) has been effective in treating certain strains of enterovirus, and a phase-2 trial to assess pleconaril’s efficacy among neonates is currently underway, according to the researchers. In the meantime, good hygienic practices, such as hand-washing and disinfecting contaminated surfaces, can help reduce transmission of infection.
The reason behind the recent spike in reported cases remains unclear, and the researchers wrote that more studies are needed to “better evaluate the role of CVB1 in severe neonatal illness and the reasons for the unusually high activity of CVB1 in the United States in 2007 and 2008 that was associated with severe neonatal morbidity and multiple deaths.”
Wikswo ME. Clin Infect Dis. 2009;49:e44-e51.