157. Clinical and Virologic Characterization of Children Presenting with Enterovirus-D68 Infection in Seattle, WA
Session: Poster Abstract Session: Big Viruses in Little People (Pediatric Viral Diseases)
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • EV-D68 Poster ID Week AW Final.pdf (234.8 kB)
  • Background: In mid-2014, severe respiratory disease associated with enterovirus D68 (EV-D68) was reported in pediatric patients. We studied virologic characteristics and clinical disease due to EV-D68 in patients at Seattle Children's Hospital (SCH).

    Methods: Mid-nasal swabs from children with respiratory symptoms were evaluated. A single specimen from each patient with rhinovirus/enterovirus (HRV/EV) detected via commercial multiplex polymerase chain reaction (PCR) platform underwent real-time reverse-transcriptase PCR for EV-D68 using an assay developed in our laboratory. Cycle threshold (CT) was used as a proxy for semi-quantitative viral load. Patient characteristics were compared between EV-D68 pos and EV-D68 neg patients.

    Results: From Aug-Dec 2014, 878 patients tested positive for HRV/EV, and 625 had samples available for further testing.  187 (30%) of HRV/EV+ samples tested had EV-D68 detected, an unusually high fraction for a single strain of HRV/EV+ when compared to previous years (11% in 2012, P<0.01).  EV-D68 was only detected from Aug. 22-Dec. 18, 2014 (Figure 1). Among our analyzed cohort, 139 (75%) of EV-D68 pos patients were hospitalized prior to or at time of testing vs 232 (57%) of patients positive for HRV/non-D68 EV (p < 0.001). Of those hospitalized, 2 (2%) of patients with EV-D68 required mechanical ventilation (MV) compared to 10 (4%) of patients with HRV/non-D68 EV (P=0.29).  Median CT was lower in EV-D68 pos patients requiring MV than those who did not (17.4 v. 25.3, P = 0.04) and between those requiring any supplemental oxygen and those remaining on room air (24.2 v. 26.1, P = 0.05).  Median CT did not significantly differ between those with EV-D68 who were and were not admitted to the hospital (25.3 v. 24.9, P=0.2).

    Conclusion: Over 30% of pediatric patients positive for HRV/ENT with samples available were infected with EV-D68. Compared to patients with confirmed HRV/non-D68 EV, patients with EV-D68 had a higher rate of hospitalization but no difference in rate of MV. Patients with EV-D68 who required oxygen had lower CT than those that did not, suggesting that viral load may be a marker of clinical severity.  Rapid and quantitative testing may help stratify risk; further research is required to understand the pathogenesis of EV-D68.

     

    Figure 1: Frequency of HRV/EV and EV-D68 infections at Seattle Children's Hospital in 2014

    Timothy Savage, MD, MSc1,2, Jane Kuypers, PhD3, Helen Chu, MD MPH4, Anne Marie Buccat, BA1, Xuan Qin, PhD1,3, Janet Englund, MD, FIDSA2,5 and Alpana Waghmare, MD2,5,6, (1)Seattle Children's Hospital, Seattle, WA, (2)Pediatrics, University of Washington, Seattle, WA, (3)Laboratory Medicine, University of Washington, Seattle, WA, (4)Medicine, University of Washington, Seattle, WA, (5)Pediatric Infectious Diseases, Seattle Children's Hospital, Seattle, WA, (6)Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA

    Disclosures:

    T. Savage, None

    J. Kuypers, None

    H. Chu, None

    A. M. Buccat, None

    X. Qin, None

    J. Englund, Pfizer: Consultant and Investigator , Research grant and Speaker honorarium
    Gilead: Consultant and Investigator , Consulting fee and Research support
    GlaxoSmithKline: Investigator and Member Data Safety Monitoring Board , Hourly payment for DSMB work and Research support
    Alios: Investigator , Research support
    Roche: Investigator , Research support

    A. Waghmare, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.