Key result
Adults under 50 face ~8.2-fold higher incidence of invasive enterovirus or parechovirus infection.
Why the study?
The study aimed to characterize adult invasive enterovirus and parechovirus infections and to identify groups at high risk for those infections.
Cohort (n=39)
No
Invasive enterovirus and parechovirus infections in adults are rare and generally benign in immunocompetent hosts, but patients receiving B-cell depleting therapy with ocrelizumab face a markedly elevated risk of fatal disseminated coxsackievirus B3 myocarditis and heart failure.
Supports heightened clinical vigilance for fulminant enteroviral myocarditis during B-cell depletion; leaves open whether targeted screening or prophylaxis is warranted in ocrelizumab-treated adults.
We conducted a retrospective, population-based laboratory surveillance study during May 2023-December 2025 in Alberta, Canada, to characterize adult invasive enterovirus and parechovirus infections and to identify groups at high risk for those infections. Of 15,621 samples tested, 162 (1.0%) were virus positive, of which 51 (31.5%) samples from 39 patients indicated invasive infections. Cerebrospinal fluid, blood, and cardiac tissue were the most frequent virus-positive specimens. The invasive enterovirus and parechovirus incidence rate was 0.37 cases/100,000 person-years; rates were higher in patients <50 versus >50 years of age (incidence rate ratio 8.2; p<0.001). The annual incidence rates were 0.20-0.56 cases/100,000 person-years; rates appeared higher in 2025 than in 2024 (incidence rate ratio 2.1; p = 0.11). Severe disseminated enterovirus infection occurred in 2 patients who received ocrelizumab. Continuous surveillance and ongoing optimization of enterovirus and parechovirus detection assays is essential for comprehensive public health tracking.
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Kanji et al. (2026) conducted a cohort in Invasive enterovirus and parechovirus infections in adults (n=39). Age <50 years (and subgroup exposure to ocrelizumab B-cell depleting therapy) vs. Age ≥50 years (and immunocompetent/general adult population) was evaluated on Population-estimated incidence rate of invasive enterovirus and parechovirus infection (IRR 8.21, 95% CI 2.59-41.65, p=<0.001). Adults <50 years had an 8.2-fold higher incidence of invasive enterovirus/parechovirus infection than older adults (IRR 8.21, p<0.001), while fatal myocarditis occurred only with ocrelizumab.
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