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.
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.
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).
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.
E. Caylan, None
E. Weinblatt, None
R. Sussner, None
A. Dozor, None
G. Wang, None