Enterovirus D68 (EV-D68) emerged in 2014, causing substantial respiratory disease throughout the United States. The extent and burden of this outbreak has been difficult to estimate, due to limited EV-D68 testing available. We propose that resource utilization at a tertiary care children's hospital better indicates the true burden of the EV-D68 outbreak.
The outbreak period was defined as Aug 1 – Sep 30, 2014 based on epidemiologic data from respiratory virus testing (Figure 1). Observed values of patient volume, medication and equipment utilization, and staffing demands at Children's Hospital Colorado (CHCO) during the outbreak period were compared with expected values using a one-sample student t-test. Expected values, adjusted for seasonal variation and annual hospital growth, were calculated by applying the expected seasonal change in August-September from 2011-13 to the 2014 annual mean (excluding the outbreak period).
From Aug 1 – Sep 30, 2014, 567 children at CHCO tested positive for rhino/enterovirus and 62% of positive surveillance samples from PICU patients were subtyped as EV-D68 (Figure 1). During this outbreak period, ED visits increased by 1006 (+8%)*, hospitalizations increased by 249 (+9%)*, and PICU admissions increased by 38 (+10%)* compared to expected volumes (Figure 2). Albuterol use increased by 2632 days of therapy (DOT; +97%)* above expected, depleting supplies to a critical shortage (Figure 3). Increased use of steroids* (+896 DOT, +83%)*, second-line asthma medications (including terbutaline, magnesium, aminophylline; +143 DOT, +153%)*, ventilators (+175 DOT, +29%)* and non-invasive ventilation (+122 DOT, +17%) were also noted. Respiratory therapist units of service reached an institutional maximum, 69% above expected*.
The 2014 EV-D68
respiratory disease outbreak caused severe resource burden on a tertiary care
children's hospital with increased patient volumes, utilization of medications and
respiratory equipment, disease severity, and staffing demands. This study illustrates
the true burden of EV-D68 and highlights the importance of syndromic
surveillance in surge preparedness for future unexpected outbreaks of emerging
S. Rao, None
J. Baker, None
K. Pearce, None
R. D. Mistry, None
G. Demasellis, None
J. Milton, None
S. R. Dominguez, None
S. Parker, None