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Enterovirus D68 Infection Among Children With Medically Attended Acute Respiratory Illness, Cincinnati, Ohio, July-October 2014.
Clin Infect Dis. 2017 Jul 15; 65(2):315-323.CI

Abstract

Background

Enterovirus D68 (EV-D68) caused a widespread outbreak of respiratory illness in the United States in 2014, predominantly affecting children. We describe EV-D68 rates, spectrum of illness, and risk factors from prospective, population-based acute respiratory illness (ARI) surveillance at a large US pediatric hospital.

Methods

Children <13 years of age with ARI and residence in Hamilton County, Ohio were enrolled from the inpatient and emergency department (ED) settings at a children's hospital in Cincinnati, Ohio, from 1 July to 31 October 2014. For each participant, we interviewed parents, reviewed medical records, and tested nasal and throat swabs for EV-D68 using real-time reverse- transcription polymerase chain reaction assay.

Results

EV-D68 infection was detected in 51 of 207 (25%) inpatients and 58 of 505 (11%) ED patients. Rates of EV-D68 hospitalization and ED visit were 1.3 (95% confidence interval [CI], 1.0-1.6) and 8.4 per 1000 children <13 years of age, respectively. Preexisting asthma was associated with EV-D68 infection (adjusted odds ratio, 3.2; 95% CI, 2.0-5.1). Compared with other ARI, children with EV-D68 were more likely to be admitted from the ED (P ≤ .001), receive supplemental oxygen (P = .001), and require intensive care unit admission (P = .04); however, mechanical ventilation was uncommon (2/51 inpatients; P = .64), and no deaths occurred.

Conclusions

During the 2014 EV-D68 epidemic, high rates of pediatric hospitalizations and ED visits were observed. Children with asthma were at increased risk for medically attended EV-D68 illness. Preparedness planning for a high-activity EV-D68 season in the United States should take into account increased healthcare utilization, particularly among children with asthma, during the late summer and early fall.

Authors+Show Affiliations

National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.Infectious Diseases.National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.Pulmonology, Cincinnati Children's Hospital Medical Center, Ohio.National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.Infectious Diseases.Infectious Diseases.National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.Infectious Diseases.National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.Infectious Diseases.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28379349

Citation

Biggs, Holly M., et al. "Enterovirus D68 Infection Among Children With Medically Attended Acute Respiratory Illness, Cincinnati, Ohio, July-October 2014." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 65, no. 2, 2017, pp. 315-323.
Biggs HM, McNeal M, Nix WA, et al. Enterovirus D68 Infection Among Children With Medically Attended Acute Respiratory Illness, Cincinnati, Ohio, July-October 2014. Clin Infect Dis. 2017;65(2):315-323.
Biggs, H. M., McNeal, M., Nix, W. A., Kercsmar, C., Curns, A. T., Connelly, B., Rice, M., Chern, S. W., Prill, M. M., Back, N., Oberste, M. S., Gerber, S. I., & Staat, M. A. (2017). Enterovirus D68 Infection Among Children With Medically Attended Acute Respiratory Illness, Cincinnati, Ohio, July-October 2014. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 65(2), 315-323. https://doi.org/10.1093/cid/cix314
Biggs HM, et al. Enterovirus D68 Infection Among Children With Medically Attended Acute Respiratory Illness, Cincinnati, Ohio, July-October 2014. Clin Infect Dis. 2017 Jul 15;65(2):315-323. PubMed PMID: 28379349.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Enterovirus D68 Infection Among Children With Medically Attended Acute Respiratory Illness, Cincinnati, Ohio, July-October 2014. AU - Biggs,Holly M, AU - McNeal,Monica, AU - Nix,W Allan, AU - Kercsmar,Carolyn, AU - Curns,Aaron T, AU - Connelly,Beverly, AU - Rice,Marilyn, AU - Chern,Shur-Wern Wang, AU - Prill,Mila M, AU - Back,Nancy, AU - Oberste,M Steven, AU - Gerber,Susan I, AU - Staat,Mary A, PY - 2016/12/20/received PY - 2017/03/31/accepted PY - 2017/4/6/pubmed PY - 2018/5/16/medline PY - 2017/4/6/entrez KW - acute respiratory illness KW - enterovirus D68 KW - respiratory virus SP - 315 EP - 323 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 65 IS - 2 N2 - Background: Enterovirus D68 (EV-D68) caused a widespread outbreak of respiratory illness in the United States in 2014, predominantly affecting children. We describe EV-D68 rates, spectrum of illness, and risk factors from prospective, population-based acute respiratory illness (ARI) surveillance at a large US pediatric hospital. Methods: Children <13 years of age with ARI and residence in Hamilton County, Ohio were enrolled from the inpatient and emergency department (ED) settings at a children's hospital in Cincinnati, Ohio, from 1 July to 31 October 2014. For each participant, we interviewed parents, reviewed medical records, and tested nasal and throat swabs for EV-D68 using real-time reverse- transcription polymerase chain reaction assay. Results: EV-D68 infection was detected in 51 of 207 (25%) inpatients and 58 of 505 (11%) ED patients. Rates of EV-D68 hospitalization and ED visit were 1.3 (95% confidence interval [CI], 1.0-1.6) and 8.4 per 1000 children <13 years of age, respectively. Preexisting asthma was associated with EV-D68 infection (adjusted odds ratio, 3.2; 95% CI, 2.0-5.1). Compared with other ARI, children with EV-D68 were more likely to be admitted from the ED (P ≤ .001), receive supplemental oxygen (P = .001), and require intensive care unit admission (P = .04); however, mechanical ventilation was uncommon (2/51 inpatients; P = .64), and no deaths occurred. Conclusions: During the 2014 EV-D68 epidemic, high rates of pediatric hospitalizations and ED visits were observed. Children with asthma were at increased risk for medically attended EV-D68 illness. Preparedness planning for a high-activity EV-D68 season in the United States should take into account increased healthcare utilization, particularly among children with asthma, during the late summer and early fall. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/28379349/Enterovirus_D68_Infection_Among_Children_With_Medically_Attended_Acute_Respiratory_Illness_Cincinnati_Ohio_July_October_2014_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cix314 DB - PRIME DP - Unbound Medicine ER -