Outbreak investigation of Echovirus 11 among neonates in two confinement centres, Petaling District, Malaysia, 2023

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Objectives In November–December 2023, an outbreak of Echovirus 11 (E11) infection involving neonates was identified in two confinement centres of Malaysia. This public health investigation aimed to describe its control measures. Methods An epidemiological, environmental and laboratory investigation was conducted among neonates and staff of the two confinement centres. Environmental assessments focused on hand hygiene, cleaning, cot spacing, feeding, bathing, and diaper handling. Clinical specimens were tested using molecular tests. Results Two concurrent E11 outbreaks occurred without an established epidemiological link. Six cases occurred in Centre A and four in Centre B, with neonatal attack rates of 66.7% and 50.0% respectively. Five neonates were managed as presumed sepsis, including two asymptomatic neonates. Three had meningoencephalitis features, one presented with hand, foot and mouth disease, and one succumbed to septicaemic shock with severe pneumonia. Environmental assessment identified transmission risks, including close cot spacing, consecutive handling of neonates, shared bathing equipment, and inadequate hand hygiene or environmental cleaning. Conclusion Similar infection prevention and control gaps in both confinement centres might have facilitated viral transmission, highlighting the need for strengthened hygiene practices and staff training. Asymptomatic and severe E11 infections emphasise the importance of early detection and appropriate laboratory investigation.