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.
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