509. Impact of Enterovirus D68 in Children with Asthma and Other Complex Medical Conditions
Session: Poster Abstract Session: Respiratory Infections: Pediatric
Thursday, October 8, 2015
Room: Poster Hall
Background: In 2014, an outbreak of enterovirus D68 (EV-D68) caused severe respiratory illness in the United States. To date most of the data have been derived from small case series that included previously healthy children or those with asthma. The burden of EV-D68 in children with other chronic complex medical conditions (CCMC) is not well characterized.

Methods: From 5/2014 to 11/2014 nasopharyngeal (NP) samples from pediatric patients that detected rhinovirus/enterovirus (RV/EV) by the FilmArray Respiratory Panel (BioFire Diagnostics) were tested for EV-D68 by real time PCR. Demographic, clinical, and outcome data were reviewed.

Results: 431 NP samples detected RV/EV in hospitalized children with acute respiratory infections. EV-D68 was detected in 177 (41%) patients (median age 4.7 years; 58% males) including: (1) 65 (37%) with CCMC [genetic syndromes (20, 31%), congenital heart disease (16, 25%), prematurity (15, 23%), immunocompromised (8, 12%), neurologic disorders (6, 9%)]; (2) 72 (41%) with asthma; and (3) 40 (23%) previously healthy. EV-D68 semiquantitative viral loads (ct) were similar between groups (Table 1). Co-pathogens were detected in 3/177 (1.7%) patients (influenza A, coronavirus and parainfluenza). Asthmatic children, but not those with CCMC or previously healthy were more likely to require PICU admission (p<.001), non-invasive ventilation (p=.01), and supplemental O2 (p=.006). Duration of hospitalization was similar between healthy and asthmatic children but longer in CCMC children (p <.0001). No cases of acute flaccid myelitis were identified.

Conclusion: To our knowledge, this is the largest reported case series of children with EV-D68. The majority of infected children had asthma or CCMC. The clinical course of EV-D68 infection was not more severe in CCMC children, including immunucompromised patients. However, EV-D68 patients with asthma required more aggressive management, suggesting that asthma is a significant risk factor for severe EV-D68 disease.

 

Healthy

n=40

Asthma

n = 72

CCMC

n=65

P value

Age (y)

4.3 (1.3-7.05)

5.6 (3.2-8.5)

4.7(1.4-7.8)

.057

PICU, n (%)

21 (52.5)

62 (86.1)

42 (64.6)

.0004

LOS (d)

2.2 (1.8-2.9)

2.9(1.9-4.2)

3.7 (2.4-7.5)

<.0001

Supplemental O2, n (%)

18 (45)

54 (75)

40 (61.5)

.006

Non-invasive ventilation, n (%)

7 (17.5)

33 (45.8)

26 (40.0)

.010

EV-D68 Ct values

24.9 (20.9-28.5)

26.9 (23.4-29.8)

24.8 (20.7-30.1)

.131

Continuous variables are displayed as median IQR

Katherine Moyer, DO1, Huanyu Wang, PhD2, Douglas Salamon, MB(ASCP)SV2, Jesse Haines, CCRP3, Pablo J. Sanchez, MD, FIDSA, FPIDS4, Monica I. Ardura, DO, MSCS5, Asuncion Mejias, MD, PhD6 and Amy Leber, PhD2, (1)Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, (2)Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, (3)Research Data and Computing, Nationwide Children's Hospital, Columbus, OH, (4)Pediatrics, Nationwide Children's Hospital - The Ohio State University, Columbus, OH, (5)Pediatrics, Infectious Diseases and Immunology, The Ohio State University and Nationwide Children’s Hospital, Columbus, OH, (6)Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH

Disclosures:

K. Moyer, None

H. Wang, None

D. Salamon, None

J. Haines, None

P. J. Sanchez, AbbVie Inc: Consultant and Scientific Advisor , Consulting fee and Speaker honorarium
MedImmune: Grant Investigator , Research support

M. I. Ardura, None

A. Mejias, None

A. Leber, Biofire: Scientific Advisor , Research support

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