511. Enterovirus D-68 in Critically-ill Children: a Comparison to Pandemic H1N1 Influenza
Session: Poster Abstract Session: Respiratory Infections: Pediatric
Thursday, October 8, 2015
Room: Poster Hall
  • ID week 2015 EV68_H1N1 poster.png (551.5 kB)
  • Background: In 2014, the US experienced a nationwide outbreak of enterovirus D 68 (EV-D68) severe respiratory illness, with a perceived impact similar to H1N1 influenza in 2009.  The objectives of this study were to characterize clinical features and outcomes of critically ill children with EV-D68 and compare them to critically ill children with H1N1 influenza during the pandemic period. 

    Methods: We characterized the clinical features of EV-D68 among children admitted to our pediatric ICU (PICU) between August 1 and October 31 2014 and compared them with children with H1N1 influenza admitted to the PICU between May 1, 2009 and January 31, 2010. Univariate and multivariate analyses were conducted using SPSS and SAS. 


    Among 224 children admitted to the PICU with respiratory specimens positive for enterovirus/rhinovirus during our study period, 101 (45%) were positive for EV-D68.  Compared to 69 PICU patients with H1N1 influenza in 2009-10, children with EV-D68 were more likely to have a history of asthma (64% vs 22%, P <0.001) and present earlier in their illness course (day 1 of illness vs day 3 of illness, P = 0.01).  Clinically, they were more likely to present with reactive airway disease exacerbations, as evidenced by increased work of breathing/shortness of breath, wheezing, and cough (P<0.01 for all), and greater receipt of albuterol (93% vs 49%) and steroids (88% vs 41%, P< 0.0001 for both).  In contrast, patients with H1N1 were more likely to present with fever (80% vs 38%), pneumonia (68% vs 40%) and ARDS (25% vs 3%, P<0.0015 for all).  While there were more patients with EV-D68 admitted to the PICU compared with H1N1influenza, patients with EV-D68 had a shorter length of stay in the hospital (4 vs 7 days) and PICU (2 vs 3 days, P< 0.0001 for both), with lower rates of intubation (7% vs 43%), vasopressor use (3% vs 32%), ECMO (0% vs 6%), ARDS (3% vs 25%), shock (0% vs 16%) and death (0% vs 12%) (P< 0.05 for all).  


    Children with EV-D68 were more likely to present with reactive airway disease exacerbations, whereas children with H1N1 were more likely to present with pneumonia. Compared to the pandemic H1N1 outbreak, the EV-D68 outbreak resulted in more children requiring admission to the PICU, but was associated with less severe outcomes.  These findings highlight the need for distinctive therapeutic approaches and preparedness strategies for EV-D68.

    Suchitra Rao, MB, BS1, Jeffrey Holzberg, MD2, Anne-Marie Rick, MD2, Aaron Montano, BS3, Kevin Messacar, MD1, Michelle Torok, PhD3,4, Dayanand Bagdure, MD5, Donna Curtis, MD, MPH1, Steve Oberste, PhD6, William A. Nix, BS7 and Samuel R. Dominguez, MD, PhD1, (1)Pediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, (2)Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, (3)University of Colorado School of Medicine, Aurora, CO, (4)Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, CO, (5)Pediatric Critical Care, University of Maryland, Baltimore, MD, (6)Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA, (7)Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, Atlanta, GA


    S. Rao, None

    J. Holzberg, None

    A. M. Rick, None

    A. Montano, None

    K. Messacar, None

    M. Torok, None

    D. Bagdure, None

    D. Curtis, MedImmune: Investigator , Research support
    Sanofi-Pasteur: Investigator-initiated research, company provides vaccine and will run one assay , Research support

    S. Oberste, None

    W. A. Nix, None

    S. R. Dominguez, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.