Key result
Enterovirus D68 infection in hospitalized children was associated with higher rates of pediatric intensive care unit admission compared to non-EV-D68 rhinovirus/enterovirus infections.
Why the study?
Does EV-D68 infection increase disease severity and healthcare utilization compared to non-EV-D68 RV/EV infections in hospitalized children?
Observational (n=438)
No
Does EV-D68 infection increase disease severity and healthcare utilization compared to non-EV-D68 RV/EV infections in hospitalized children?
During the 2014 outbreak, EV-D68 infection was associated with significantly higher morbidity, including increased PICU admissions and need for respiratory support, particularly in children with asthma and comorbidities.
Answers are grounded in this paper and cite their sources.
EV-D68 may warrant closer monitoring in hospitalized children; leaves open causal inference and generalizability beyond this cohort.
BACKGROUND: An outbreak of enterovirus D68 (EV-D68) caused severe respiratory illness in 2014. The disease spectrum of EV-D68 infections in children with underlying medical conditions other than asthma, the role of EV-D68 loads on clinical illness, and the variation of EV-D68 strains within the same institution over time have not been described. We sought to define the association between EV-D68 loads and sequence variation, and the clinical characteristic in hospitalized children at our institution from 2011 to 2014. METHODS: May through November 2014, and August to September 2011 to 2013, a convenience sample of nasopharyngeal specimens from children with rhinovirus (RV)/EV respiratory infections were tested for EV-D68 by RT-PCR. Clinical data were compared between children with RV/EV-non-EV-D68 and EV-D68 infections, and among children with EV-D68 infections categorized as healthy, asthmatics, and chronic medical conditions. EV-D68 loads were analyzed in relation to disease severity parameters and sequence variability characterized over time. RESULTS: In 2014, 44% (192/438) of samples tested positive for EV-D68 vs. 10% (13/130) in 2011-13 (p<0.0001). PICU admissions (p<0.0001) and non-invasive ventilation (p<0.0001) were more common in children with EV-D68 vs. RV/EV-non-EV-D68 infections. Asthmatic EV-D68+ children, required supplemental oxygen administration (p = 0.03) and PICU admissions (p <0.001) more frequently than healthy children or those with chronic medical conditions; however oxygen duration (p<0.0001), and both PICU and total hospital stay (p<0.01) were greater in children with underlying medical conditions, irrespective of viral burden. By phylogenetic analysis, the 2014 EV-D68 strains clustered into a new sublineage within clade B. CONCLUSIONS: This is one of the largest pediatric cohorts described from the EV-D68 outbreak. Irrespective of viral loads, EV-D68 was associated with high morbidity in children with asthma and co-morbidities. While EV-D68 circulated before 2014, the outbreak isolates clustered differently than those from prior years.
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Moyer et al. (2016) conducted an observational in Acute respiratory illness (n=438). Enterovirus D68 infection vs. Rhinovirus/Enterovirus non-EV-D68 infection was evaluated on PICU admission (p=<0.0001). Enterovirus D68 infection in hospitalized children was associated with higher rates of pediatric intensive care unit admission compared to non-EV-D68 rhinovirus/enterovirus infections.
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