Outbreak of severe myocarditis in England: Havoc by a harmless virus

Anis H., Basha Shaik A., Tiwari A., Alemayehu A., Nazir A., Atulinda L., ...More

Health Science Reports, vol.6, no.9, 2023 (ESCI) identifier identifier identifier

  • Publication Type: Article / Letter
  • Volume: 6 Issue: 9
  • Publication Date: 2023
  • Doi Number: 10.1002/hsr2.1541
  • Journal Name: Health Science Reports
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, EMBASE, Directory of Open Access Journals
  • Keywords: critical care, enterovirus, myocarditis, public health
  • Karadeniz Technical University Affiliated: No


Background: The World Health Organization (WHO) has been alerted to a concerning upsurge of severe myocarditis, an inflammatory heart condition, in neonates within Wales and South West England. The myocarditis cases are being intricately associated with enterovirus infection, belonging to the Picornaviridae family. The concerned pathogen poses a significant global disease burden, with an estimated 10 to 15 million symptomatic cases occurring annually in the United States alone. Neonates are particularly vulnerable with children under the age of one accounting for approximately 40% of enterovirus infections. Material and Methods: A comprehensive literature search was conducted using various databases including ClinicalTrials, Google Scholar, PubMed, ScienceDirect, MEDLINE, and Ovid Resources. The search strategy included utilizing keywords such as “myocarditis,” “Randomized controlled trials (RCTs). Only articles written in English were considered, and selection criteria included relevance to the research objectives, reasonable sample sizes, and robust methodology. In addition to the identified articles, meta-analyses, animal models and studies, and references from the selected articles were also examined to ensure a comprehensive review of the literature. Results: Ten hospitalized neonates, reported in the United Kingdom (UK), with positive PCR tests were reported to have myocarditis, predominantly caused by coxsackieviruses. The current situation in the region has brought global attention. With this study, we hope to draw attention to the critical aspects of the illness and, more crucially, the present strategies required to control the disease outbreak in England. Discussion: Current European Society of Cardiology (ESC) recommendations for the treatment of acute heart failure apply. Emerging research supports the use of immunosuppressive medication in some circumstances. Patients are advised to avoid aerobic activities for several months after healing. Neonatal enterovirus infections can vary in how they respond to IVIG therapy. The majority of enterovirus infections are self-limited, require no special therapy, and only little supportive care is required. Conclusion: The recent elevation in numbers for reported severe myocarditis in neonates within Wales and South West England, linked to enterovirus infection, poses a significant public health concern. Myocarditis caused by enteroviruses, particularly Group B coxsackieviruses, is associated with significant mortality rates. Diagnosis is supported by non-invasive techniques and cardiac enzyme blood tests. Treatment modalities primarily involve a palliative approach.