Severe enterovirus 68 respiratory illness in children requiring intensive care management
Section snippets
Background
Enterovirus 68 (EV-D68) was identified from oropharyngeal swabs of 4 children hospitalized with acute lower respiratory tract illness (LRTI) in 1962 [1]. EV-D68 has features of both enteroviruses and rhinoviruses and is associated with respiratory symptoms [2], [3]. Many multiplex PCR assays used in clinical practice do not distinguish between the two species, so the manifestations and severity of EV-D68 have not been well characterized. Previous epidemiologic studies have been primarily
Objective
We aim to describe severe EV-D68 disease, including at-risk populations, presenting symptoms, and extent of intensive therapies used compared with children with severe disease from other enteroviruses/rhinoviruses. We report the largest cohort of pediatric EV-D68 disease to date, and the first to focus on children requiring pediatric ICU (PICU) stay.
Study subjects
An increase in emergency department visits and hospital admissions associated with severe respiratory disease was noted on August 15, 2014 at Children’s Mercy Hospital (CMH). A case definition was established on August 21, and respiratory pathogen panel (RPP) (Biofire Inc, Salt Lake City, Utah) testing was recommended for all inpatient children with increased work of breathing requiring supplemental oxygen or continuous albuterol. This assay does not distinguish between human enteroviruses and
Results
From August 1 to September 15, 2014, 562 children were admitted to CMH, had positive enterovirus/rhinovirus testing, and had specimens available for EV-D68 testing. 61/341 (17.9%) EV-D68 positive (EV-D68+) children required PICU management compared with 34/221 (15.4%) children with non-EV-D68 enteroviruses/rhinoviruses (EV-D68-). Of the 95 PICU children, 10 EV-D68- children and 2 EV-D68+ children were excluded because they required PICU management for non-respiratory reasons. Thus, 83 children
Discussion
In August 2014, we identified an outbreak of severe respiratory infection in children, which was confirmed to be caused by EV-D68 [18]. The need for ICU management of children was uncommonly reported in previous EV-D68 outbreaks, and descriptive literature provided little data to highlight specific clinical features, potential high-risk populations, or effective therapies. To our knowledge, this study is the largest pediatric cohort of EV-D68 disease and is the first to characterize severe
Competing interests
None declared.
Ethical approval
Children’s Mercy Hospital Institutional Review Board approved this study.
Funding
This work was funded in part by federal appropriations from the Emerging Infections line item to the Department of Health and Human Services.
References (43)
- et al.
Emergence and epidemic occurrence of enterovirus 68 respiratory infections in The Netherlands in 2010
Virology
(2012) - et al.
The emergence of enterovirus D68 in a Dutch University Medical Center and the necessity for routinely screening for respiratory viruses
J. Clin. Virol.
(2015) - et al.
Upsurge of human enterovirus infections in patients with severe respiratory tract infections
J. Clin. Virol.
(2011) - et al.
Enterovirus D68- associated community-acquired pneumonia in children living in Milan, Italy
J. Clin. Virol.
(2015) - et al.
Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support
J. Biomed. Inform.
(2009) - et al.
Clinical disease due to enterovirus D68 in adult hematologic malignancy patients and hematopoietic cell transplant recipients
Blood
(2015) - et al.
Regional variation in ICU care for pediatric patients with asthma
J. Pediatr.
(2005) - et al.
Flaccid paralysis of the limbs after an asthmatic attack
Pediatr. Neurol.
(2010) - et al.
A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USA
Lancet
(2015) - et al.
Risk of childhood asthma following infant bronchiolitis during the respiratory syncytial virus season
J. Allergy Clin. Immunol.
(2013)
A probable new human picornavirus associated with respiratory diseases
Am. J. Epidemiol.
Human rhinovirus 87 and enterovirus 68 represent a unique serotype with rhinovirus and enterovirus features
J. Clin. Microbiol.
Enterovirus 68 is associated with respiratory illness and shares biological features with both the enteroviruses and the rhinoviruses
J. Gen. Virol.
Enterovirus 68 among children with severe acute respiratory infection, the Philippines
Emerg. Infect. Dis.
Outbreak of lower respiratory tract illness associated with human enterovirus 68 among American Indian children
Pediatr. Infect. Dis. J.
Lineages, sub-lineages and variants of enterovirus 68 in recent outbreaks
PLoS One
Phylogenetic characterization of enterovirus 68 strains in patients with respiratory syndromes in Italy
J. Med. Virol.
Continued seasonal circulation of enterovirus D68 in the Netherlands, 2011–2014
Euro Surveillance
Enterovirus 68 in children with acute respiratory tract infections, Osaka, Japan
Emerg. Infect. Dis.
Enterovirus 68 in pediatric patients hospitalized for acute airway diseases
J. Clin. Microbiol.
Molecular epidemiology and evolution of human enterovirus serotype 68 in Thailand, 2006–2011
PLoS One
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2022, Infectious MedicineCitation Excerpt :However, there is conflicting evidence on the outcome of the emergent EV-D68 strain both in terms of acute complications of infections and longer-term prognosis. One study found that EV-D68 positive children admitted to intensive care were more likely to receive asthma or steroid medications and ventilatory support as part of their acute clinical management, as compared to enterovirus/rhinovirus positive, EV-D68 negative children [16]. Many studies have found EV-D68 to be associated with severe clinical respiratory disease in children [16–19,22,32].
Respiratory presentation of patients infected with enterovirus D68 in Taiwan
2020, Pediatrics and NeonatologyEnterovirus D68 outbreak detection through a syndromic disease epidemiology network
2020, Journal of Clinical VirologyCitation Excerpt :EV-D68 respiratory illness in children typically presents with mild-to-severe clinical symptoms, such as runny nose, fever, cough, wheezing, and dyspnea, which may lead to hospitalization requiring intensive care [2,3]. Children with an underlying medical condition, such as asthma or recurrent wheezing, are at particular risk of severe EV-D68 infection [4]. In recent years, there is accumulating evidence to support that EV-D68 is associated with acute flaccid myelitis (AFM) in children [5–9].
Current status of enterovirus D68 worldwide and in Taiwan
2020, Pediatrics and Neonatology
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These authors contributed equally to this work.