Clinical Course of Enterovirus D68 in Hospitalized Children.

Schuster, Jennifer E; Selvarangan, Rangaraj; Hassan, Ferdaus; Briggs, Kayla B; Hays, Lindsay; Miller, Jenna O; Pahud, Barbara; Puls, Henry T; Queen, Mary Ann; Thompson, Marita T; Weddle, Gina; Jackson, Mary Anne

BACKGROUND Enterovirus D68 (EV-D68) has been sporadically reported as a cause of respiratory tract infections. In 2014, an international outbreak of EV-D68 occurred and caused severe respiratory disease in the pediatric population. METHODS A retrospective chart review was performed of children admitted to Children's Mercy Hospital from August 1-September 15, 2014 with positive multiplex PCR testing for enterovirus/rhinovirus (EV/RV). Specimens were subsequently tested for EV-D68, and clinical data were obtained from the medical records. Patients with EV-D68 were compared with children presenting simultaneously with other EV/RV. RESULTS Of 542 eligible specimens, children with EV-D68 were significantly older than children with other EV/RV (4.6 vs. 2.2 years, P<0.001). Children with EV-D68 were more likely to have a history of asthma (38.6% vs. 30.0%, P=0.04) or recurrent wheezing (22.1% vs. 14.8%, P=0.04). EV-D68 positive children more commonly received supplemental oxygen (86.7% vs. 65.0%, P<0.001), albuterol (91.2% vs. 65.5%, P<0.001), and corticosteroids (82.9% vs. 58.6%, P<0.001). Age ≥5 years was an independent risk factor for intensive care unit (ICU) management in EV-D68 infected children. Children with a history of asthma or recurrent wheezing and EV-D68 received supplemental oxygen (92.7% vs. 82.4%, P=0.007) and magnesium (42.7% vs. 29.7%, P=0.03) at higher rates and more continuous albuterol (3 vs. 2 hours, P=0.03) than those with other EV/RV. CONCLUSIONS EV-D68 causes severe disease in the pediatric population, particularly in children with a history of asthma or recurrent wheezing. EV-D68 positive children are more likely to require therapy for refractory bronchospasm and may need ICU level care.