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. 2017 Jul 15;65(2):315-323.
doi: 10.1093/cid/cix314.

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

Holly M Biggs  1 , Monica McNeal  2 , W Allan Nix  1 , Carolyn Kercsmar  3 , Aaron T Curns  1 , Beverly Connelly  2 , Marilyn Rice  2 , Shur-Wern Wang Chern  1 , Mila M Prill  1 , Nancy Back  2 , M Steven Oberste  1 , Susan I Gerber  1 , Mary A Staat  2
Affiliations

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

Holly M Biggs et al. Clin Infect Dis. .

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.

Keywords: acute respiratory illness; enterovirus D68; respiratory virus.

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Conflict of interest statement

Potential conflicts of interest. M. S. O. and W. A. N. report a potential patent application on enterovirus D68 diagnostic assay. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1
Figure 1
A, Inpatient enrollment flow diagram. B, Emergency department enrollment flow diagram.
Figure 2
Figure 2
Enterovirus D68 (EV-D68)–positive tests among hospitalized and emergency department patients <13 years of age with acute respiratory illness, weekly number and percentage positive, Cincinnati, Ohio, 1 June–30 November 2014. Test results for June and November represent hospitalized children only.
Figure 3
Figure 3
Respiratory viruses detected among hospitalized and emergency department (ED) patients <13 years of age with acute respiratory illness using a commercial multiplex assay, 1 July–31 October 2014. Labels display No. (%). Among hospitalized patients, co-detection of >1 respiratory virus occurred in 3 of 207 (1%) children. Among ED patients, co-detection of >1 respiratory virus occurred in 17 of 505 (3%) children. Abbreviations: ADV, adenovirus; EV-D68, enterovirus D68; EV/RV, enterovirus/rhinovirus (excluding EV-D68 in this figure); HMPV, human metapneumovirus; PIV, parainfluenza virus; RSV, respiratory syncytial virus.
See this image and copyright information in PMC

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