Abstract
In the fall of 2014, an outbreak of enterovirus D68 (EV-D68)-associated acute respiratory illness (ARI) occurred in the United States (1,2); before 2014, EV-D68 was rarely reported to CDC (2,3). In the United States, reported EV-D68 detections typically peak during late summer and early fall (3). EV-D68 epidemiology is not fully understood because testing in clinical settings seldom has been available and detections are not notifiable to CDC. To better understand EV-D68 epidemiology, CDC recently established active, prospective EV-D68 surveillance among pediatric patients at seven U.S. medical centers through the New Vaccine Surveillance Network (NVSN) (4). This report details a preliminary characterization of EV-D68 testing and detections among emergency department (ED) and hospitalized patients with ARI at all NVSN sites during July 1-October 31, 2017, and the same period in 2018. Among patients with ARI who were tested, EV-D68 was detected in two patients (0.8%) in 2017 and 358 (13.9%) in 2018. Continued active, prospective surveillance of EV-D68-associated ARI is needed to better understand EV-D68 epidemiology in the United States.
Highlights
Associated with acute flaccid myelitis (AFM), a rare neurologic condition characterized by acute flaccid limb weakness [7,8]
Contemporaneous with the 2014 outbreak of enterovirus D68 (EV-D68) associated with respiratory illness, Centers for Disease Control and Prevention (CDC) received increased reports of AFM, supporting a temporal association between EV-D68 and AFM [7]
AFM is rare in the United States, these AFM surveillance data, along with the EV-D68 activity documented
Summary
Test results were positive for EV-D68 for two (0.08%) of 2,433 patients with ARI who were tested during 2017 and 358 (13.9%) of 2,579 tested during 2018. In 2017, one patient whose test result was positive for EV-D68 was hospitalized in Houston, and one was evaluated in the ED in Rochester. In 2018, patients with EV-D68-positive test results were identified at all seven sites, and 242 of 358 patients (67.6%) were hospitalized (range by site = 53.3%–76.8%) (Table). EV-D68 was detected in 9.2% of patients with ED visits for ARI and 18.3% of hospitalized patients with ARI. The peak of detections varied by site, with Cincinnati and Kansas City peaking in late August through September; Houston, Pittsburgh, and Rochester in mid-September; and Nashville and Seattle in October. Among 42 EV-D68–positive specimens from 2018 sequenced at CDC, all were lineage B3
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