A comparison of hospitalized children with enterovirus D68 to those with rhinovirus

Foster, Charles B.; Coelho, Ritika; Brown, Paul; Wadhwa, Aman; Dossul, Amena; Gonzalez, Blanca E.; Cardenas, Silvia; Sabella, Camille; Kohn, Debbie; Vogel, Sherilynn; Yen‐Lieberman, Belinda; Piedimonte, Giovanni

doi:10.1002/ppul.23661

Cited by 16 publications

(19 citation statements)

References 8 publications

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“…An increased rate of hospitalization was also reported in another smaller study; however, both patients presenting to the ED and hospitalized patients were included, and thus, the absolute hospitalization rate is unclear . Our study did not find increased rates of ICU admission in unadjusted or adjusted models, possibly due to small numbers of ICU admissions in both the EV‐D68 and non‐EV‐D68 HRV/EV groups; this is consistent with several prior studies …”

Section: Discussionsupporting

confidence: 90%

“…Higher proportions of LRTI were seen in patients with documented EV‐D68 infection compared to non‐EV‐D68 HRV/EV; this finding remained significant after adjusting for age and underlying asthma. Other reports specifically evaluating LRTI associated with EVD‐68 have shown conflicting results, possibly due to the fact that only small numbers of patients were included and adjusted models could not be performed . Similarly, the need for oxygen supplementation has varied among studies, which may be related in part to a lack of standardized protocols for supplemental oxygen administration, especially in circumstances of mild hypoxia, or the patient population selected for analysis .…”

Section: Discussionmentioning

confidence: 99%

“…Factors associated with inpatient admission in these patients are not well described, and the role of viral load in disease severity has not been investigated systematically. Pediatric patients with asthma are of particular interest as asthma affects nearly 10% of children, and data regarding EV‐D68 disease severity within this group have been conflicting . Our study aims to define the burden of EV‐D68 in a large cohort of pediatric patients presenting for urgent or emergent care in the ED or urgent care clinic at a regional children's hospital and to compare the clinical presentation, role of comorbidities, and outcomes between patients with EV‐D68 and those with other strains of human rhinovirus/enterovirus (HRV/EV) during an outbreak.…”

Section: Introductionmentioning

confidence: 99%

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Enterovirus D‐68 in children presenting for acute care in the hospital setting

Savage

Kuypers

Chu

et al. 2018

Influenza Resp Viruses

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BackgroundSevere respiratory disease associated with enterovirus D68 (EV‐D68) has been reported in hospitalized pediatric patients. Virologic and clinical characteristics of EV‐D68 infections exclusively in patients presenting to a hospital Emergency Department (ED) or urgent care have not been well defined.MethodsMid‐nasal swabs from pediatric patients with respiratory symptoms presenting to the ED or urgent care were evaluated using a commercial multiplex PCR platform. Specimens positive for rhinovirus/enterovirus (HRV/EV) were subsequently tested using real‐time reverse‐transcriptase PCR for EV‐D68. The PCR cycle threshold (CT) was used as a viral load proxy. Clinical outcomes were compared between patients with EV‐D68 and patients without EV‐D68 who tested positive for HRV/EV.ResultsFrom August to December 2014, 511 swabs from patients with HRV/EV were available. EV‐D68 was detected in 170 (33%) HRV/EV‐positive samples. In multivariable models adjusted for age and underlying asthma, patients with EV‐D68 were more likely to require hospitalization for respiratory reasons (odds ratio (OR): 3.11, CI: 1.85‐5.25), require respiratory support (OR: 1.69, CI: 1.09‐2.62), have confirmed/probable lower respiratory tract infection (LRTI; OR: 3.78, CI: 2.03‐7.04), and require continuous albuterol or steroids (OR: 3.91, CI: 2.22‐6.88 and OR: 4.73, CI: 2.65‐8.46, respectively). Higher EV‐D68 viral load was associated with need for respiratory support and LRTI in multivariate models.ConclusionsAmong pediatric patients presenting to the ED or urgent care, EV‐D68 causes more severe disease than non‐EV‐D68 HRV/EV independent of underlying asthma. High viral load was associated with worse clinical outcomes. Rapid and quantitative viral testing may help identify and risk stratify patients.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Enterovirus D‐68 in children presenting for acute care in the hospital setting

Savage

Kuypers

Chu

et al. 2018

Influenza Resp Viruses

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“…compared the clinical features of severe respiratory illnesses caused by rhinovirus and EV‐D68 and found that children aged 5–11 years were more commonly infected with EV‐D68, perhaps explaining the correlation between AFM and respiratory illness in children aged 7–12 years in the present study – if indeed EV‐D68 was the major cause of respiratory illness. Several studies have also shown that EV‐D68 triggers severe respiratory illness in adolescents and young adults . Respiratory illness requiring ICU admission is uncommon in adolescents.…”

Section: Discussionmentioning

confidence: 99%

“…Enterovirus D68 (EV‐D68) seems to be the principal cause of acute flaccid myelitis (AFM) since the 2014 outbreak in the USA; however, a causal relationship has yet to be firmly established. EV‐D68 causes a severe respiratory illness that sometimes requires admission to the intensive care unit (ICU) and artificial ventilation in both children and adults . Previous studies have shown that the peak incidences of AFM and severe respiratory illness coincide .…”

mentioning

confidence: 99%

Respiratory illness and acute flaccid myelitis in the Tokai district in 2018

Okumura

Numoto

Iwayama

et al. 2020

Pediatrics International

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Background An outbreak of acute flaccid myelitis was chronologically correlated with an outbreak of severe respiratory illness in Japan in 2015. We hypothesized that increases in children hospitalized with severe respiratory illnesses might also be associated with increase in acute flaccid myelitis in autumn 2018. Methods We explored the temporal correlations between respiratory illness outbreaks and acute flaccid myelitis during autumn season between 2016 and 2018 using questionnaire surveys. One questionnaire explored the monthly numbers of children with acute flaccid myelitis, Guillain–Barré syndrome, and other acute flaccid paralyses. The other questionnaire explored the monthly numbers of children hospitalized with respiratory illnesses associated with wheezing. A correlation between the monthly numbers of children with acute flaccid myelitis and those with respiratory illness was analyzed using the Pearson correlation test. Results Although the number of patients hospitalized with respiratory illness did not correlate with the number of those admitted with myelitis, increases in children aged 7–12 and 13–19 years requiring intensive care unit admission correlated temporally with an outbreak of acute flaccid myelitis. Conclusions An increase in intensive care unit admissions to treat respiratory disease occurred in association with a cluster of acute flaccid myelitis. An increase in the number of intensive care unit admissions due to respiratory illness may be a clue to expect the occurrence of acute flaccid myelitis.

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Dynamics and predisposition of respiratory viral co-infections in children and adults

Mandelia

Procop

Richter

et al. 2021

Clinical Microbiology and Infection

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Objectives: The epidemiology of respiratory co-infection pairings is poorly understood. Here we assess the dynamics of respiratory viral co-infections in children and adults and determine predisposition for or against specific viral pairings. Methods: Over five respiratory seasons from 30 November 2013 through 6 June 2018, the mono-infection and co-infection prevalence of 13 viral pathogens was tabulated at The Cleveland Clinic. Employing a model to proportionally distribute viral pairs using individual virus co-infection rate with prevalence patterns of concurrent co-circulating viruses, we compared predicted occurrence with observed occurrence of 132 viral pairing permutations using binomial analysis. Results: Of 30 535 respiratory samples, 9843 (32.2%) were positive for at least one virus and 1018 (10.8%) of these were co-infected. Co-infected samples predominantly originated from children. Co-infection rate in paediatric population was 35.0% (2068/5906), compared with only 5.8% (270/4591) in adults. Adenovirus C (ADVC) had the highest co-infection rate (426/623, 68.3%) while influenza virus B had the lowest (55/546, 10.0%). ADVCerhinovirus (HRV), respiratory syncytial virus A (RSVA)eHRV and RSVB eHRV pairings occurred at significantly higher frequencies than predicted by the proportional distribution model (p < 0.05). Additionally, several viral pairings had fewer co-infections than predicted by our model: notably metapneumovirus (hMPV)eparainfluenza virus 3, hMPVeRSVA and RSVAeRSVB. Conclusions: This is one of the largest studies on respiratory viral co-infections in children and adults. Coinfections are substantially more common in children, especially under 5 years of age, and the most frequent pairings occurred at a higher frequency than would be expected by random. Specific pairings occur at altered rates compared with those predicted by proportional distribution, suggesting either direct or indirect interactions result between specific viral pathogens.

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A comparison of hospitalized children with enterovirus D68 to those with rhinovirus

Cited by 16 publications

References 8 publications

Enterovirus D‐68 in children presenting for acute care in the hospital setting

Enterovirus D‐68 in children presenting for acute care in the hospital setting

Respiratory illness and acute flaccid myelitis in the Tokai district in 2018

Dynamics and predisposition of respiratory viral co-infections in children and adults

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