510. Enterovirus-D68 Causes More Severe Respiratory Disease than Human Rhinoviruses in Children
Session: Poster Abstract Session: Respiratory Infections: Pediatric
Thursday, October 8, 2015
Room: Poster Hall
Background:

Enterovirus D68 (EV-D68) caused an outbreak of severe respiratory illness in children across the United States in 2014.  Prior to this outbreak, little was known about the epidemiology of EV-D68 and whether the disease produced was more severe than that associated with human rhinoviruses (HRV) and other respiratory viral pathogens.

Methods:

We performed a retrospective cohort study of patients presenting to Maria Fareri Children’s Hospital (MFCH) with respiratory illness from September 1, 2014 through October 31, 2014.  Subjects were identified based on ICD-9 codes for respiratory illness.  Data were collected via chart review.  Univariable analysis and multiple logistic regression were used to compared characteristics of patients testing positive for EV-D68 with patients positive for HRV. Respiratory specimens were tested using a commercial multiplex PCR assay; specimens positive for rhino/enterovirus were then tested specifically for EV-D68.

Results:

Of 578 patients presenting with respiratory complaints, 80 tested positive for EV-D68 and 183 were positive for HRV.  Mean age was 5.8 years in the EV-D68 group and 4.8 years in the HRV group.  24% of patients in the HRV group were discharged from the ED compared with 16% of EV-D68 patients (p=0.08). History of asthma/wheezing was similar in both groups, 47% EV-D68 group vs. 42% HRV group.  The primary outcome, length of stay, was not significantly different between groups (4.4 days for EV-D68 and 4.9 days for HRV, p=0.1). However, the rate of admission to PICU was 13.8% for the EV-D68 group versus 6.6% in the HRV group (p= 0.03).  Of note, 89% of EV-D68 patients received steroids vs. 53% of HRV patients (p<0.005).   

Conclusion:

During the EV-D68 outbreak in 2014, we confirmed EV-D68 in 80 patients presenting to MFCH with respiratory complaints.  Age, history of asthma/wheezing, and length of stay were similar among patients with EV-D68 and HRV.  EV-D68 patients were twice as likely to be admitted to the PICU suggesting that EV-D68 may produce more severe disease.  Steroid use was also significantly greater among patients with EV-D68 indicating that patients with EV-D68 potentially had more severe airway inflammation than patients with HRV.  Further analyses are needed to characterize other clinical features of EV-D68 disease and compare the severity of disease with other respiratory pathogens.

Sheila Nolan, MD, MSCE1, John Welter, MD2, Esra Caylan, MD2, Ezra Weinblatt, MD3, Rita Sussner, BSN, RN, CIC4, Allen Dozor, MD5 and Guiqing Wang, MD, PhD6, (1)Pediatric Infectious Diseases, New York Medical College, Valhalla, NY, (2)Division of Pediatric Pulmonology, Allergy and Sleep Medicine, New York Medical College, Valhalla, NY, (3)Pediatrics, New York Medical College, Valhalla, NY, (4)Infection Prevention and Control, Westchester Medical Center, Valhalla, NY, (5)Pediatric Pulmonology, Allergy & Sleep Medicine, New York Medical College, Valhalla, NY, (6)Pathology and Clinical Laboratories, New York Medical College/ Westchester Medical Center, Valhalla, NY

Disclosures:

S. Nolan, None

J. Welter, None

E. Caylan, None

E. Weinblatt, None

R. Sussner, None

A. Dozor, None

G. Wang, None

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