Parechovirus

Parechovirus is an important emerging illness in young infants. Even though anyone can become infected with human parechoviruses (HPeV), children under 3 months of age are most likely to develop severe disease such as blood infection (sepsis) and meningitis. For most people, the symptoms appear to be a mild and manifest as a minor respiratory infection or diarrhoeal illness.

There is no specific medical treatment for parechovirus, treatment is aimed at simply managing the symptoms. If the symptoms are mild, self-care strategies such as rest and nutraceuticals that build up immunity can help resolve the infection faster.

What is human parechovirus?

Human parechoviruses are closely related to echoviruses. In fact, when they were first discovered in 1956 where they were known as echoviruses 22 and 23. In 1999 they were reclassified as HPeV1 and 2.

Although HPeVs were considered to be one of the common viruses which cause mild gastroenteritis and respiratory infections, the concept of HPeVs has changed significantly after the discovery of HPeV3 in 2004.

HPeV3 infection is an emerging infectious disease which attracts the attention of health professionals, because it can cause blood infection, seizures and meningoencephalitis in infants younger than 3 months. In Australia, the epidemics of HPeV3 infection have occurred every 2 years since 2013. HPeV genotype 3 caused the epidemic from late 2017 to early 2018.

Symptoms of parechovirus

Usually the symptoms resemble a mild cold or digestive bug and include:

• Fever
• Rash
• Fast breathing
• Fatigue
• Loss of appetite
• Loose stools or diarrhoea

Parechovirus in infants

Additional signs that a newborn or young infant might have a more serious form of human parechovirus infection include abnormal/jerking movements, excessive irritability and a distended abdomen.

If any of these signs (including ones mentioned previously) are present, the child should be reviewed by a doctor urgently, even if they have been checked earlier in the illness. In rare cases, infection with some strains (type 3 & 4) can lead to more severe sepsis, meningitis (infection of the lining of the brain) and encephalitis (infection of the brain).

How is it spread?

Parechovirus is spread from person to person by direct contact with nose and throat discharge such as saliva, sputum or nasal mucus. Tiny droplets released into the air when you sneeze or cough or faeces (stools) of infected people are other ways you can become infected.

If you are unwell with any respiratory or digestive symptoms avoid contact with babies if possible. If you are caring for an infant and are unwell yourself, below is a list of ways you prevent infecting others with the virus.

Prevent the spread of parechovirus

Following good personal hygiene is paramount to preventing the spread of parechovirus. This includes:

• Washing your hands with soap and water after going to the bathroom, changing nappies, before eating and blowing your nose
• Avoid sharing utensils, cups, personal hygiene items such as a toothbrush and clothing
• Thoroughly wash any soiled clothing and any surfaces that may have been contaminated
• Cover your face when you sneeze and wash your hands afterwards

Treatment

Medical treatment is required, especially in young children who have severe symptoms. If the symptoms are milder, self-care strategies at home combined with natural therapies can help you to recover faster.

Antivirals

Antiviral herbs and vitamins contain properties which specifically target viruses. Here are some suggestions of what you can take to prevent or treat mild infection with parechovirus in adults and children over the age of 2.

Elderberry—the fruit or leaves from the shrub sambucus nigra are traditionally used for upper respiratory tract infection due to the plants antiviral properties. Although no studies to date have tested the use of elderberry specifically for human parachoviruses, it has been found to be very effective against strains of viruses that lead to the common cold and influenza. Elderberry is a fruity flavoured herbal medicine which can be helpful in treating fever, nasal catarrh and coughs.

Echinacea—this amazing immune herb has a long history of use in colds and flus and may also be helpful in parechovirus infection. Evidence indicates that echinacea potently lowers the risk of recurrent respiratory infections and complications such as otitis media, tonsillitis and pneumonia.

Not only is echinacea an antiviral herb, it also possesses anti-inflammatory and immune modulating properties which allows the body to fight infection more effectively.

Zinc and vitamin C—essential nutrients for any kind of infection, zinc and vitamin C have antioxidant, antiviral and immune boosting properties. They can be found in powder form and given in small divided doses to children and adults to support healthy immunity.

Probiotics

If the stools are loose, probiotics can be added to restore healthy levels of beneficial bacteria. Saccharomyces boulardii is a yeast with probiotic qualities and is indicated in children and adults with diarrhoea from a variety of different causes including infection. Lactobacillus spp. and Bifidobacterium strains are other probiotics to help support healthy immunity and digestion. In infants, it is important to supplement with a specific probiotic that is suitable for use in that age group.

Self-care strategies

• Stay at home and rest
• Eat warm soups, broths or pureed food in young children
• Add ginger and garlic to the diet
• Stay hydrated by ensuring adequate fluid intake

References

1. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/parechovirus
2. http://www.health.nsw.gov.au/infectious/factsheets/pages/parechovirus.aspx
3. Kolehmainen P, et al. Human parechovirus type 3 and 4 associated with severe infections in young children. Pediatr Infect Dis J. 2014 Nov;33(11):1109-13 https://www.ncbi.nlm.nih.gov/pubmed/25361406
4. Parechovirus: an important emerging infection in young infants Britton P, et al. Parechovirus: an important emerging infection in young infants. Med J Aust 2018; 208 (8): 365-369 https://www.mja.com.au/journal/2018/208/8/parechovirus-important-emerging-infection-young-infants
5. Aizawa Y, et al. Human Parechoviruses. Uirusu. 2015;65(1):17-26 https://www.ncbi.nlm.nih.gov/pubmed/26923954
6. Krawitz C, et al. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC Complement Altern Med. 2011 Feb 25;11:16 https://www.ncbi.nlm.nih.gov/pubmed/21352539
7. Schapoal A, et al. Echinacea reduces the risk of recurrent respiratory tract infections and complications: a meta-analysis of randomized controlled trials. Adv Ther. 2015 Mar;32(3):187-200 https://www.ncbi.nlm.nih.gov/pubmed/25784510
8. Guarino A, et al. Probiotics for Prevention and Treatment of Diarrhea. J Clin Gastroenterol. 2015 Nov-Dec;49 https://www.ncbi.nlm.nih.gov/pubmed/26447963