1974. Enterovirus D68 Illness in Hospitalized Children
Session: Oral Abstract Session: The Spectrum of Viral Infection
Saturday, October 10, 2015: 2:30 PM
Room: 32--ABC
Background: We identified a surge of patients presenting to Children’s Mercy Hospital, Kansas City, Missouri with severe respiratory tract infection caused by Enterovirus 68 (EV-D68) in August 2014. Cases were subsequently documented internationally. While small clusters of EV-D68 disease were previously reported, the clinical scope of disease is not well defined.

Methods: Specimens collected from hospitalized patients, aged 0-17 years, with positive enterovirus/rhinovirus (EV/RV) testing by multiplex PCR assay, admitted from August 1-September 15, 2014, were retrospectively tested for EV-D68 by sequencing or PCR. Specific viral typing was not available to practitioners during admission. Clinical data was obtained from the medical chart.

Results: 570 patients were positive for EV/RV. 20 patients were excluded because the condition necessitating admission was unrelated to the positive test or an alternate primary diagnosis was identified, and 8 had no specimen for further testing. Of the remaining 542 patients, 339 (63%) were EV-D68 positive and 203 (37%) were EV-D68 negative. EV-D68 positive patients were older (4.6 vs 2.2 years, P<0.001) and more likely to have a history of asthma (39% vs 30%, P=0.04) or recurrent wheezing (22% vs 15%, P=0.04). EV-D68 positive patients were more likely to be hypoxic (56% vs 46%, P=0.04) and have retractions (74% vs 53%, P<0.001) or wheezing (72% vs 47%, P<0.001) on initial examination. For patients with a history of bronchospasm, children with EV-D68 were more likely to require supplemental oxygen (93% vs 82%, P=0.007), albuterol (99% vs 92%, P=0.004), more hours of continuous albuterol (3 vs 2, P=0.03), magnesium (43% vs 30%, P=0.03), and aminophylline (7% vs 0%, P=0.007) compared to children with other EV/RV. Sixty (18%) EV-D68 positive patients required intensive care unit (ICU) management, and age ≥5 years was a risk factor. There were no differences in length of stay or ICU admission between patients with EV-D68 and other EV/RV. No EV-D68 positive subjects died or had acute flaccid myelitis.

Conclusion: EV-D68 is more likely to cause respiratory disease in school-aged children. EV-D68 patients with a history of asthma or recurrent wheeze require more aggressive management of bronchospasm than those with other EV/RV. Rapid laboratory testing would assist in patient management.

Jennifer Schuster, MD, MSCI1, Rangaraj Selvarangan, PhD2, Kayla Briggs, Medical Student3, Ferdaus Hassan, PhD1, Lindsay Hays, Medical Laboratory Scientist2, Barbara Pahud, MD MPH4, Gina Weddle, DNP, RN, CPNP4, Jenna Miller, MD5, Marita Thompson, MD5, Henry Puls, MD6, Mary Ann Queen, MD6 and Mary Anne Jackson, MD, FIDSA, FPIDS4, (1)Children's Mercy Hospital, Kansas City, MO, (2)Pathology, Children's Mercy Hospital, Kansas City, MO, (3)University of Missouri-Kansas City School of Medicine, Kansas City, MO, (4)Pediatric Infectious Diseases, Children's Mercy Hospital, Kansas City, MO, (5)Pediatric Critical Care, Children's Mercy Hospital, Kansas City, MO, (6)Pediatric Hospital Medicine, Children's Mercy Hospital, Kansas City, MO


J. Schuster, None

R. Selvarangan, None

K. Briggs, None

F. Hassan, None

L. Hays, None

B. Pahud, GSK: Research Contractor , Research support
ROCHE: Research Contractor , Research support
CDC: Grant Investigator , Grant recipient
NIH: Grant Investigator , Research support
Pfizer: Scientific Advisor , Consulting fee

G. Weddle, None

J. Miller, None

M. Thompson, None

H. Puls, None

M. A. Queen, None

M. A. Jackson, None

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