BPSU study - Severe complications of enterovirus or human parechovirus infection

This BPSU study investigates severe complications of enterovirus (EV) or human parechovirus (HPeV). It is intended to improve our knowledge of the age-specific incidence, clinical presentation and management, as well describe the survival and rates of long-term complications of severe EV/HPeV infections at 12 months.

Lead investigator

Dr Shamez Ladhani
Public Health England
61 Colindale Avenue
London NW9 5EQ
Email: shamez.ladhani@phe.gov.uk

About the study

Enterovirus and human parechovirus are two related viruses that commonly cause mild, self-limiting illnesses in children, mainly flu-like syndromes or diarrhoea and vomiting. Rarely, however, these viruses can cause very severe infections including meningitis, encephalitis, myocarditis, hepatitis and septic shock. These severe conditions can lead to permanent damage to the brain and spinal cord, liver or the heart, and even death. Our knowledge of these rare but very severe complications is very limited.

Through this BPSU study, we hope to collect more robust data on the epidemiology, clinical course and outcomes of children who develop these rare manifestations.

You can download the protocol card, including references, below.

Case definition

Any child aged <16 years with laboratory-confirmed enterovirus or human parechovirus infection (from any site) who develops any severe complication, including (but not restricted to):

  • Cardiovascular collapse requiring inotropes (sepsis-like syndrome), or leading to myopericarditis, arrhythmias or cardiomyopathy; OR
  • Neurological complications lasting >48 hours including cranial/peripheral nerve palsy/paralysis (including acute flaccid paralysis) +/- seizure +/- coma +/- intracranial damage on imaging; OR
  • Fulminant or acute liver failure requiring specialist hepatology advice/referral: including deranged liver function tests, coagulopathy and encephalopathy
  • Intensive care admission for management of enterovirus/parechovirus infection.

Reporting instructions

Please report any cases seen within the last month that meet the case definition.


February 2019 to February 2020 (13 months of surveillance). Follow-up until February 2021 (1 year follow-up).


This study is funded by Public Health England and St George's University of London.


The study has been approved by London - London Bridge Research Ethics Committee (reference: 17/LO/1518) and Public Benefit & Privacy Panel, Scotland (reference: 1718-0330) . Public Health England has approval under Section 251 of the NHS Act 2006 to process confidential patient information for public health purposes. See The Health Service (Control of Patient Information) Regulations 2002.

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