Enterovirus D68 Infection Among Children With Medically Attended Acute Respiratory Illness, Cincinnati, Ohio, July-October 2014

Clin Infect Dis. 2017 Jul 15;65(2):315-323. doi: 10.1093/cid/cix314.


Background: Enterovirus D68 (EV-D68) caused a widespread outbreak of respiratory illness in the United States in 2014, predominantly affecting children. We describe EV-D68 rates, spectrum of illness, and risk factors from prospective, population-based acute respiratory illness (ARI) surveillance at a large US pediatric hospital.

Methods: Children <13 years of age with ARI and residence in Hamilton County, Ohio were enrolled from the inpatient and emergency department (ED) settings at a children's hospital in Cincinnati, Ohio, from 1 July to 31 October 2014. For each participant, we interviewed parents, reviewed medical records, and tested nasal and throat swabs for EV-D68 using real-time reverse- transcription polymerase chain reaction assay.

Results: EV-D68 infection was detected in 51 of 207 (25%) inpatients and 58 of 505 (11%) ED patients. Rates of EV-D68 hospitalization and ED visit were 1.3 (95% confidence interval [CI], 1.0-1.6) and 8.4 per 1000 children <13 years of age, respectively. Preexisting asthma was associated with EV-D68 infection (adjusted odds ratio, 3.2; 95% CI, 2.0-5.1). Compared with other ARI, children with EV-D68 were more likely to be admitted from the ED (P ≤ .001), receive supplemental oxygen (P = .001), and require intensive care unit admission (P = .04); however, mechanical ventilation was uncommon (2/51 inpatients; P = .64), and no deaths occurred.

Conclusions: During the 2014 EV-D68 epidemic, high rates of pediatric hospitalizations and ED visits were observed. Children with asthma were at increased risk for medically attended EV-D68 illness. Preparedness planning for a high-activity EV-D68 season in the United States should take into account increased healthcare utilization, particularly among children with asthma, during the late summer and early fall.

Keywords: acute respiratory illness; enterovirus D68; respiratory virus.

MeSH terms

  • Acute Disease
  • Adolescent
  • Asthma / complications
  • Child
  • Child, Preschool
  • Disease Outbreaks
  • Enterovirus D, Human / genetics
  • Enterovirus D, Human / isolation & purification*
  • Enterovirus Infections / epidemiology*
  • Enterovirus Infections / virology
  • Female
  • Hospitalization
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Male
  • Medical Records
  • Nose / virology
  • Ohio / epidemiology
  • Pharynx / virology
  • Prospective Studies
  • Real-Time Polymerase Chain Reaction
  • Respiratory Tract Infections / epidemiology*
  • Respiratory Tract Infections / virology
  • Seasons