Top 5 Takeaways

  1. Outbreak Identification: Between April 12 and May 24, 2022, 23 previously healthy infants aged 5 days to 3 months were admitted with human parechovirus (PeV) meningoencephalitis to a Tennessee children’s hospital.
  2. Diagnostic Practices: The hospital employed lumbar puncture for sepsis evaluation in infants <1 month old or when clinically indicated in older infants, using a multiplex molecular panel for cerebrospinal fluid (CSF) testing in infants ≤3 months or in older patients with specific CSF findings.
  3. Clinical Presentation and Outcomes: Patients showed signs such as fever, fussiness, and poor feeding, with a median age of 24 days. Most patients recovered without complications, but severe cases required NICU care and had significant risks of developmental delays or other health issues.
  4. Transmission Insights: The cluster’s emergence in 2022, following a drop in cases in 2020 attributed to COVID-19 isolation, suggests PeV transmission is closely linked to social activity, with a notable increase as social distancing measures were relaxed.
  5. Recommendations for Clinicians and Parents: During PeV circulation periods, clinicians should consider testing for PeV in young infants, even those with normal CSF parameters, to limit unnecessary antibiotic use and improve patient management. Parents of infants, especially those <3 months old, should be vigilant for symptoms and seek pediatric care if they persist.

Original Article Author and Citation

Corresponding Author

Romney M. Humphries,, 615-875-3210.

Suggested Citation

Tao L, Fill MA, Banerjee R, Humphries RM. Notes from the Field: Cluster of Parechovirus Central Nervous System Infections in Young Infants — Tennessee, 2022. MMWR Morb Mortal Wkly Rep 2022;71:977–978. DOI:


This MMWR note reports a significant cluster of human parechovirus (PeV) meningoencephalitis cases among young infants in Tennessee. The article provides detailed insights into the outbreak’s identification, clinical presentation, diagnostics, outcomes, and implications for public health practice.


The study involved a comprehensive review of electronic health records to assess demographics, social history, signs and symptoms at admission, laboratory test results, and treatment course of patients diagnosed with PeV during the cluster period.


The discussion highlights the implications of the findings, including the importance of rapid detection of PeV in CSF to limit unnecessary antibiotic use and the need for awareness among clinicians and parents about PeV symptoms in young infants.


The outbreak underscores the need for vigilant pediatric care and consideration of PeV testing in young infants presenting with symptoms consistent with viral infections, particularly in the context of increased social activity and reduced COVID-19 precautions.

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