WHO issues alert about 'unusual' cluster of deadly infant myocarditis cases in the UK

The United Kingdom has been rocked by a cluster of deadly cases of myocarditis in babies.

The World Health Organization issued an alert Wednesday, indicating that there was an "increase in severe myocarditis in neonates associated with enterovirus infection in Wales" between June 2022 and March 2023.

The UK Health Security Agency (UKHSA) confirmed the report, noting that a "higher than average number of cases" of enterovirus had been seen in "very young babies" in the fall and winter months, reported the Telegraph.

The biggest spike in myocarditis cases occurred in November.

The International Committee on Taxonomy of Viruses noted that enteroviruses, a genus of single-stranded RNA viruses, "multiply primarily in the gastrointestinal tract or the upper respiratory tract or sometimes both, but they can also multiply in other tissues, e.g., nerve, muscle, etc. Infection may frequently be asymptomatic. Clinical manifestations include common cold, mild meningitis, encephalitis, myelitis, myocarditis and conjunctivitis."

While enterovirus infection in babies is reportedly common, the WHO acknowledged that the "increase in myocarditis with severe outcomes in neonates and infants associated with enterovirus infection is unusual."

Fifteen babies have been afflicted under these "unusual" circumstances. Nine babies are known to have been admitted to the hospital. One child has died. All were less than 28 days old. As of May 5, one patient remains hospitalized.

Several of the babies rushed to intensive care presented features of sepsis and cardiorespiratory arrest extra to having inflamed hearts.

Since there are no specific antiviral therapies available for enteroviruses, treatment focuses on prevention of complications, said the WHO.

Dr. Christopher Williams, consultant epidemiologist for Public Health Wales, said in a statement, "This cluster is unusual due to the number of cases reported in a relatively short time frame, and so investigations are now ongoing in collaboration with the paediatric team in the children’s hospital of Wales to understand the reasons why and to investigate any further cases that may be reported in the coming weeks and months."

Williams added, "Parents should be reassured that although there has been an increase in cases, this is still an extremely rare occurrence."

The Daily Mail detailed the case of one newborn, just a few weeks old, who died on March 9 in southwest England. While the boy, Elijah Edwards, tested positive for enterovirus, his case was not included in the official tally, suggestive that the problem may have affected more than the officially reported 15 babies.

Elijah's mother, Joann Edwards, said her family has been ignored and that she was "gobsmacked" to learn that other children were affected, especially after her family was "led to believe that we were a one-off."

"To be left in the dark made us feel then like as if there's something to hide," Joann Edwards told the BBC.

Dr. Shamez Ladhani, a consultant pediatrician at UKHSA, indicated that officials were looking into whether England had suffered similar cases and "whether there are any factors driving the increase in cases."

While some scientists reckon the cluster was an anomaly — perhaps the result of testing or diagnostic quirks — not all are convinced.

The Telegraph reported that some reckon "it could have been brought about due to changes in epidemiology as a result of Covid pandemic lockdowns."

Dr. Liz Whitakker, a consultant in pediatric infectious diseases at Imperial College Healthcare NHS Trust, said, "What I think is slightly unusual about this one, like with everything else, is there weren’t many in 2021. ... It may be that the epidemiology of everything has shifted a bit so they have occurred in a slightly different time period," noting various other contagions, such as group A strep, have undergone changes in infection patterns following the lockdowns.

A 2021 study in the infectious disease journal Eurosurveillance indicated there was a "rapid increase" in enterovirus infections following the COVID-19 lockdowns. Babies under 3 months accounted for 5% of enterovirus D68 infection cases; 4- to 12-month-olds represented 11% of the total number of cases detailed in the study.

An April 2022 study published in the journal Infection revealed "an extraordinary increase in the number of viral respiratory infections, predominantly caused by human Rhino-/Enterovirus and respiratory syncytial virus (RSV), was observed after relaxation of preventive measures," adding that enterovirus infections increased 16-fold after reopening.

Despite the uncertainty surrounding the unusual cluster, health officials continue to reassure parents that there is no need to be worried, reported the Telegraph.

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