Enterovirus D68 Infection Among Children With Medically Attended Acute Respiratory Illness, Cincinnati, Ohio, July–October 2014

Abstract

Background Enterovirus D68 (EV-D68) caused a widespread outbreak of respiratory illness in the United States in 2014, predominantly affecting children. We describe EV-D68 rates, spectrum of illness, and risk factors from prospective, population-based acute respiratory illness (ARI) surveillance at a large US pediatric hospital. Methods Children <13 years of age with ARI and residence in Hamilton County, Ohio were enrolled from the inpatient and emergency department (ED) settings at a children’s hospital in Cincinnati, Ohio, from 1 July to 31 October 2014. For each participant, we interviewed parents, reviewed medical records, and tested nasal and throat swabs for EV-D68 using real-time reverse-transcription polymerase chain reaction assay. Results EV-D68 infection was detected in 51 of 207 (25%) inpatients and 58 of 505 (11%) ED patients. Rates of EV-D68 hospitalization and ED visit were 1.3 (95% confidence interval [CI], 1.0–1.6) and 8.4 per 1000 children <13 years of age, respectively. Preexisting asthma was associated with EV-D68 infection (adjusted odds ratio, 3.2; 95% CI, 2.0–5.1). Compared with other ARI, children with EV-D68 were more likely to be admitted from the ED (P ≤ .001), receive supplemental oxygen (P = .001), and require intensive care unit admission (P = .04); however, mechanical ventilation was uncommon (2/51 inpatients; P = .64), and no deaths occurred. Conclusions During the 2014 EV-D68 epidemic, high rates of pediatric hospitalizations and ED visits were observed. Children with asthma were at increased risk for medically attended EV-D68 illness. Preparedness planning for a high-activity EV-D68 season in the United States should take into account increased healthcare utilization, particularly among children with asthma, during the late summer and early fall.

Enterovirus-D68 (EV-D68) in pediatric patients with respiratory infection: The circulation of a new B3 clade in Italy

“…In this study, EV-D68 infections were diagnosed mainly in June and July and in pre-school children. These findings agree with those reported by other authors, who found a higher incidence of EV-D68 diseases in warm months and in younger subjects [36][37][38][39]. However, in this study, differently from other viral infections, particularly those due to RSV, the EV-D68-related respiratory infections were all of mild or moderate severity, and no patients showed signs and symptoms of Fig.…”

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

“…It also enabled us to perform multivariable analyses to evaluate the effect of EV‐D68 semi‐quantitative viral load on clinical outcomes, specifically adjusting for strongly associated covariates of age and underlying asthma. Interestingly, in our study population, patients with EV‐D68 had asthma at a much higher rate than in other studies . In spite of this, when we controlled for asthma, we still found patients with EV‐D68 had higher rates of LRTI, need for continuous albuterol, and need for steroids.…”

“…In this report, we describe a cohort of 511 patients with EV‐D68 and non‐EV‐D68 HRV/EV who presented to the ED and urgent care at Seattle Children's Hospital during the late summer and fall of 2014. This study provides a unique focus on patients who presented to the ED or urgent care and is the largest study to date of patients with EV‐D68 in this setting . Our large sample size enabled us to robustly demonstrate that pediatric patients in the ED or urgent care with EV‐D68 were hospitalized, had LRTI, and required respiratory support, albuterol, and steroids more often than their counterparts with non‐EV‐D68 HRV/EV.…”

“…This study provides a unique focus on patients who presented to the ED or urgent care and is the largest study to date of patients with EV-D68 in this setting. 13,21,22 Our large sample size enabled us to robustly demonstrate that pediatric patients in the ED or urgent care with EV-D68 were hospitalized, had LRTI, and required respiratory support, albuterol, and steroids more often than their counterparts with non-EV-D68 HRV/EV. It also enabled us to perform multivariable analyses to evaluate the effect of EV-D68 semi-quantitative viral load on clinical outcomes, specifically adjusting for strongly associated covariates of age and underlying asthma.…”

Prevention and treatment of respiratory viral infections: Presentations on antivirals, traditional therapies and host-directed interventions at the 5th ISIRV Antiviral Group conference

“…However, it has spread worldwide in the 21st century (Oberste et al, 2004;Tokarz et al, 2012). Most recently, the reported number of EV-D68 cases in acute respiratory infections (ARI) significantly increased (Biggs et al, 2017). To explore possible reasons for the recent increase, the epidemiological and clinical characteristics of EV-D68 in children (< 5-year-old) were analyzed.…”