Abstract
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.
Highlights
Enterovirus D68 (EV-D68) causes respiratory tract infections and neurologic manifestations
Symptoms were similar in the 2 outbreaks, with the notable exceptions of greater gastrointestinal manifestations in 2018, as well as 3 children with severe neurologic manifestations (2 with AFM and 1 with OMS), which we did not observe during 2014 or 2016
Since 2014, concurrent with the surge of EV-D68 respiratory-associated illness, children with severe neurologic manifestations have been reported in the United States and elsewhere; episodic increases were identified in 2016 and 2018 [5,12,14,15,16,17,18,19,20,21]
Summary
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 objective of this study was to compare differences in clinical characteristics and disease severity among children hospitalized with EV-D68 infection at NCH in 2018 with those identified during the 2014 outbreak and during a low-activity period (2016). We sought to define the overlap between EV-D68 circulation and hospitalizations for asthma and compare the sequence variation of EV-D68 strains identified during the 2018 outbreak with strains identified in previous years
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