Enterovirus outbreak sends 29 kids to hospital with encephalitis

An outbreak of an enterovirus that can cause severe illness has already affected 60 children in Catalonia, according to the most recent figures released by the regional health department.

Of these, 29 were hospitalized after suffering a form of encephalitis, which causes inflammation of the brain stem and cerebellum. Health authorities said most of the children are recovering well, although two remain in a serious condition.

Similar outbreaks have been reported in Bulgaria, the United States and several Asian countries, but this is the first time Spain has experienced so many cases at the same time.

It’s behaving differently from what we usually see, and it is hard to know what to expect

Carles Rodrigo, Vall d'Hebron Hospital chief of pediatrics

Enteroviruses are common at this time of the year and normally produce mild symptoms similar to the common cold or flu. But preliminary lab results for this particular outbreak suggest the presence of a more aggressive subtype affecting the central nervous system.

Two days after issuing an alert, Catalan health authorities admitted that 21 children had been treated at regional hospitals for related symptoms. There is no known vaccine or prescription drug against the microorganism.

The first severe case of enterovirus was reported in February, when a three-year-old child suffered a myelitis – an inflammation of the spinal cord – that has left her quadraplegic. But doctors said that she was infected by a different, even more virulent enterovirus called EV-D68, which can cause paralysis similar to poliomyelitis.

Experts have ruled out the presence of EV-D68 in all 48 cases reported since April 13, when the first case arrived at the emergency room of Vall d’Hebron Hospital in Barcelona. That child, who went into cardiac arrest, remains in hospital with “serious effects,” according to Carles Rodrigo, head of pediatrics at the hospital. Most of the other cases were reported in May.

Another child in the Catalan province of Tarragona has died with similar symptoms to those produced by enteroviruses, but health authorities have not included him in the present outbreak.

“Although clinically he would be part of the group, we have been unable to detect the enterovirus in his samples. It is a probable case, but we are not certain,” said Josep María Argimon, deputy director of the Catalan health services, CatSalut.

Faced with an avalanche of concerned parents, doctors are underscoring that most cases of enterovirus infection are benign.

“The vast majority recover well,” said Rodrigo, noting that if the child has trouble breathing, swallowing or talking, along with a fever, parents should go see the doctor.

Experts say it is difficult to foresee what will happen next. “It’s behaving differently from what we usually see, and it is hard to know what to expect. We cannot predict how many more cases will emerge in future,” said Rodrigo.

English version by Susana Urra.