Key result
The 2018 EV-D68 outbreak was associated with a lower rate of pediatric intensive care unit admissions compared to the 2014 outbreak (49.1% vs 68.2%, p<0.0001), though severe neurologic manifestations were only observed in 2018.
Why the study?
Enterovirus D68 causes respiratory tract infections and neurologic manifestations, prompting comparison of clinical manifestations and phylogenetic characteristics across outbreak and low-activity periods.
Observational (n=469)
No
Absolute Event Rate: 49.1% vs 68.2%
p-value: p=<0.0001
The 2018 EV-D68 outbreak in Ohio was associated with milder respiratory illness but more severe neurologic manifestations compared to the 2014 outbreak, corresponding to a phylogenetic shift.
May indicate shifting EV-D68 phenotypes warranting neurologic vigilance; hypothesis-generating for clade-phenotype associations in emerging outbreaks.
Enterovirus D68 (EV-D68) causes respiratory tract infections and neurologic manifestations. We compared the clinical manifestations from 2 EV-D68 outbreaks in 2014 and 2018 and a low-activity period in 2016 among hospitalized children in central Ohio, USA, and used PCR and sequencing to enable phylogenetic comparisons. During both outbreak periods, infected children had respiratory manifestations that led to an increase in hospital admissions for asthma. The 2018 EV-D68 outbreak appeared to be milder in terms of respiratory illness, as shown by lower rates of pediatric intensive care unit admission. However, the frequency of severe neurologic manifestations was higher in 2018 than in 2014. During the same period in 2016, we noted neither an increase in EV-D68 nor a significant increase in asthma-related admissions. Phylogenetic analyses showed that EV-D68 isolates from 2018 clustered differently within clade B than did isolates from 2014 and are perhaps associated with a different EV-D68 subclade.
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Wang et al. (2019) conducted an observational in Enterovirus D68 infection (n=469). 2018 EV-D68 outbreak vs. 2014 EV-D68 outbreak was evaluated on Pediatric intensive care unit (PICU) admission (p=<0.0001). The 2018 EV-D68 outbreak was associated with a lower rate of pediatric intensive care unit admissions compared to the 2014 outbreak (49.1% vs 68.2%, p<0.0001), though severe neurologic manifestations were only observed in 2018.
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