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We report nine severe neonatal infections caused by a new variant of echovirus 11. All were male, eight were twins. At illness onset, they were 3–5 days-old and had severe sepsis and liver failure. This new variant, detected in France since April 2022, is still circulating and has caused more fatal neonatal enterovirus infections in 2022 and 2023 (8/496; 1.6%, seven associated with echovirus 11) compared with 2016 to 2021 (7/1,774; 0.4%). National and international alerts are warranted.


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  1. Abzug MJ. Presentation, diagnosis, and management of enterovirus infections in neonates. Paediatr Drugs. 2004;6(1):1-10.  https://doi.org/10.2165/00148581-200406010-00001  PMID: 14969566 
  2. Sandoni M, Ciardo L, Tamburini C, Boncompagni A, Rossi C, Guidotti I, et al. Enteroviral Infections in the first three months of life. Pathogens. 2022;11(1):60.  https://doi.org/10.3390/pathogens11010060  PMID: 35056008 
  3. Chuang YY, Huang YC. Enteroviral infection in neonates. J Microbiol Immunol Infect. 2019;52(6):851-7.  https://doi.org/10.1016/j.jmii.2019.08.018  PMID: 31607572 
  4. Duval M, Mirand A, Lesens O, Bay JO, Caillaud D, Gallot D, et al. Retrospective study of the upsurge of enterovirus D68 clade D1 among adults (2014-2018). Viruses. 2021;13(8):1607.  https://doi.org/10.3390/v13081607  PMID: 34452471 
  5. Mirand A, le Sage FV, Pereira B, Cohen R, Levy C, Archimbaud C, et al. Ambulatory pediatric surveillance of hand, foot and mouth disease as signal of an outbreak of coxsackievirus A6 infections, France, 2014-2015. Emerg Infect Dis. 2016;22(11):1884-93.  https://doi.org/10.3201/eid2211.160590  PMID: 27767012 
  6. Nix WA, Oberste MS, Pallansch MA. Sensitive, seminested PCR amplification of VP1 sequences for direct identification of all enterovirus serotypes from original clinical specimens. J Clin Microbiol. 2006;44(8):2698-704.  https://doi.org/10.1128/JCM.00542-06  PMID: 16891480 
  7. Schuffenecker I, Mirand A, Josset L, Henquell C, Hecquet D, Pilorgé L, et al. Epidemiological and clinical characteristics of patients infected with enterovirus D68, France, July to December 2014. Euro Surveill. 2016;21(19):30226.  https://doi.org/10.2807/1560-7917.ES.2016.21.19.30226  PMID: 27195770 
  8. French Reference Centre for enteroviruses and parechovirus. CNR enterovirus. Clermont-Ferrand-Lyon: France. [Accessed: 6 May 2023]. Available from: http://cnr.chu-clermontferrand.fr/CNR
  9. European Centre for Disease Prevention and Control (ECDC). Weekly bulletin. Communicable Disease Threats Report. Week 18, 30 April–6 May 2023. Stockholm: ECDC; 2023. Available from: https://www.ecdc.europa.eu/en/publications-data/communicable-disease-threats-report-30-april-6-may-2023-week-18
  10. Khetsuriani N, Lamonte A, Oberste MS, Pallansch M. Neonatal enterovirus infections reported to the national enterovirus surveillance system in the United States, 1983-2003. Pediatr Infect Dis J. 2006;25(10):889-93.  https://doi.org/10.1097/01.inf.0000237798.07462.32  PMID: 17006282 
  11. Zhang M, Wang H, Tang J, He Y, Xiong T, Li W, et al. Clinical characteristics of severe neonatal enterovirus infection: a systematic review. BMC Pediatr. 2021;21(1):127.  https://doi.org/10.1186/s12887-021-02599-y  PMID: 33722228 
  12. Chen J, Jing H, Martin-Nalda A, Bastard P, Rivière JG, Liu Z, et al. Inborn errors of TLR3- or MDA5-dependent type I IFN immunity in children with enterovirus rhombencephalitis. J Exp Med. 2021;218(12):e20211349.  https://doi.org/10.1084/jem.20211349  PMID: 34726731 
  13. Yen MH, Huang YC, Chen MC, Liu CC, Chiu NC, Lien R, et al. Effect of intravenous immunoglobulin for neonates with severe enteroviral infections with emphasis on the timing of administration. J Clin Virol. 2015;64:92-6.  https://doi.org/10.1016/j.jcv.2015.01.013  PMID: 25728086 
  14. Abzug MJ, Michaels MG, Wald E, Jacobs RF, Romero JR, Sánchez PJ, et al. . A Randomized, double-blind, placebo-controlled trial of pleconaril for the treatment of neonates with enterovirus sepsis. J Pediatric Infect Dis Soc. 2016;5(1):53-62.  https://doi.org/10.1093/jpids/piv015  PMID: 26407253 
  15. Torres-Torres S, Myers AL, Klatte JM, Rhoden EE, Oberste MS, Collett MS, et al. First use of investigational antiviral drug pocapavir (v-073) for treating neonatal enteroviral sepsis. Pediatr Infect Dis J. 2015;34(1):52-4.  https://doi.org/10.1097/INF.0000000000000497  PMID: 25229269 

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