Respiratory Presentation of Pediatric Patients in the 2014 Enterovirus D68 Outbreak.

Georgina Martin,Rachel Li,Patrick Tang,Laura Sauve,Akshat Kapur,Matthew Carwana,Connie L Yang,Peter Tilley,Victoria E Cook

doi:10.1155/2016/8302179

Abstract

Background. In the fall of 2014, a North American outbreak of enterovirus D68 resulted in a significant number of pediatric hospital admissions for respiratory illness throughout North America. This study characterized the clinical presentation and risk factors for a severe clinical course in children admitted to British Columbia Children's Hospital during the 2014 outbreak. Methods. Retrospective chart review of patients with confirmed EV-D68 infection admitted to BCCH with respiratory symptoms in the fall of 2014. Past medical history, clinical presentation, management, and course in hospital was collected and analyzed using descriptive statistics. Comparison was made between those that did and did not require ICU admission to identify risk factors. Results. Thirty-four patients were included (median age 7.5 years). Fifty-three percent of children had a prior history of wheeze, 32% had other preexisting medical comorbidities, and 15% were previously healthy. Ten children (29%) were admitted to the pediatric intensive care unit. The presence of complex medical conditions (excluding wheezing) (P = 0.03) and copathogens was associated with PICU admission (P = 0.02). Conclusions. EV-D68 infection resulted in severe, prolonged presentations of asthma-like illness in the hospitalized pediatric population. Patients with a prior history of wheeze and preexisting medical comorbidities appear to be most severely affected, but the virus can also cause wheezing in previously well children.

Highlights

Enterovirus D68 (EV-D68) is a nonpolio human enterovirus that shares some biologic features with human rhinoviruses [1, 2]
During an outbreak in the United States in 2009, over half of EVD68 cases detected in children affected those less than four years of age, and 54% resulted in pediatric intensive care unit (PICU) admission [5]
The start date represents the first confirmed case of EV-D68 at British Columbia Children’s Hospital (BCCH) and the end date correlates with the end of the British Columbia Centre for Disease Control’s (BCCDC’s) enhanced surveillance period for EV-D68

Summary

Introduction

Enterovirus D68 (EV-D68) is a nonpolio human enterovirus that shares some biologic features with human rhinoviruses [1, 2]. The pediatric population appears to be disproportionately affected and the virus can be associated with severe respiratory disease in children [5, 7, 11]. During an outbreak in the United States in 2009, over half of EVD68 cases detected in children affected those less than four years of age, and 54% resulted in pediatric intensive care unit (PICU) admission [5]. EV-D68 infection resulted in severe, prolonged presentations of asthma-like illness in the hospitalized pediatric population. Patients with a prior history of wheeze and preexisting medical comorbidities appear to be most severely affected, but the virus can cause wheezing in previously well children

Methods

Results

Conclusion