title: Clinical severity of pediatric respiratory illness with enterovirus D68 compared with rhinovirus or other enterovirus genotypes.
abstract: BACKGROUND
  Enterovirus D68 (EV-D68) resulted in a reported increase in the number of children needing hospital or critical care admission because of respiratory insufficiency during 2014. It remains unclear, however, whether EV-D68 infections were more severe than rhinovirus or non-EV-D68 enterovirus infections.
  
  
  METHODS
  We evaluated consecutive children presenting to a pediatric hospital between Aug. 1 and Oct. 31, 2014, with positive nasopharyngeal swabs for rhinovirus or enterovirus that were sent automatically for EV-D68 testing. We compared characteristics and outcomes of patients with EV-D68 with those with rhinovirus or non-EV-D68 enterovirus in a matched cohort study.
  
  
  RESULTS
  A total of 93/297 (31.3%) of rhinovirus or enterovirus samples tested positive for EV-D68, and it was possible to compare 87 matched pairs. Children with EV-D68 infection were more likely to have difficulty breathing (odds ratio [OR] 3.00, 95% confidence interval [CI] 1.47-6.14). There was no significant difference in admission to the critical care unit or death among children with EV-D68 infection compared with those with other rhinovirus or enterovirus infections (adjusted OR 1.47, 95% CI 0.61-3.52). Children with EV-D68 infection were more often admitted to hospital, but not significantly so (adjusted OR 2.29, 95% CI 0.96-5.46).
  
  
  CONCLUSIONS
  Enterovirus D68 seems to be a more virulent pulmonary pathogen than rhinovirus or non-EV-D68 enterovirus, but we did not find a significant difference in death or need for critical care.
authors.affiliation: Departments of Medicine (Mertz, Alawfi, Smieja), Clinical Epidemiology and Biostatistics (Mertz, Smieja), Pathology and Molecular Medicine (Mertz, Smieja); Michael G. DeGroote Institute for Infectious Diseases Research (Mertz, Smieja); Department of Pediatrics (Pernica, Smieja), McMaster University; Hamilton Regional Laboratory Medicine Program (Rutherford, Smieja); Department of Laboratory Medicine (Luinstra, Smieja), St. Joseph's Healthcare, Hamilton, Ont. mertzd@mcmaster.ca.
authors.forename: Dominik
authors.initials: D
authors.lastname: Mertz
authors.affiliation: Departments of Medicine (Mertz, Alawfi, Smieja), Clinical Epidemiology and Biostatistics (Mertz, Smieja), Pathology and Molecular Medicine (Mertz, Smieja); Michael G. DeGroote Institute for Infectious Diseases Research (Mertz, Smieja); Department of Pediatrics (Pernica, Smieja), McMaster University; Hamilton Regional Laboratory Medicine Program (Rutherford, Smieja); Department of Laboratory Medicine (Luinstra, Smieja), St. Joseph's Healthcare, Hamilton, Ont.
authors.forename: Abdulsalam
authors.initials: A
authors.lastname: Alawfi
authors.affiliation: Departments of Medicine (Mertz, Alawfi, Smieja), Clinical Epidemiology and Biostatistics (Mertz, Smieja), Pathology and Molecular Medicine (Mertz, Smieja); Michael G. DeGroote Institute for Infectious Diseases Research (Mertz, Smieja); Department of Pediatrics (Pernica, Smieja), McMaster University; Hamilton Regional Laboratory Medicine Program (Rutherford, Smieja); Department of Laboratory Medicine (Luinstra, Smieja), St. Joseph's Healthcare, Hamilton, Ont.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pernica
authors.affiliation: Departments of Medicine (Mertz, Alawfi, Smieja), Clinical Epidemiology and Biostatistics (Mertz, Smieja), Pathology and Molecular Medicine (Mertz, Smieja); Michael G. DeGroote Institute for Infectious Diseases Research (Mertz, Smieja); Department of Pediatrics (Pernica, Smieja), McMaster University; Hamilton Regional Laboratory Medicine Program (Rutherford, Smieja); Department of Laboratory Medicine (Luinstra, Smieja), St. Joseph's Healthcare, Hamilton, Ont.
authors.forename: Candy
authors.initials: C
authors.lastname: Rutherford
authors.affiliation: Departments of Medicine (Mertz, Alawfi, Smieja), Clinical Epidemiology and Biostatistics (Mertz, Smieja), Pathology and Molecular Medicine (Mertz, Smieja); Michael G. DeGroote Institute for Infectious Diseases Research (Mertz, Smieja); Department of Pediatrics (Pernica, Smieja), McMaster University; Hamilton Regional Laboratory Medicine Program (Rutherford, Smieja); Department of Laboratory Medicine (Luinstra, Smieja), St. Joseph's Healthcare, Hamilton, Ont.
authors.forename: Kathy
authors.initials: K
authors.lastname: Luinstra
authors.affiliation: Departments of Medicine (Mertz, Alawfi, Smieja), Clinical Epidemiology and Biostatistics (Mertz, Smieja), Pathology and Molecular Medicine (Mertz, Smieja); Michael G. DeGroote Institute for Infectious Diseases Research (Mertz, Smieja); Department of Pediatrics (Pernica, Smieja), McMaster University; Hamilton Regional Laboratory Medicine Program (Rutherford, Smieja); Department of Laboratory Medicine (Luinstra, Smieja), St. Joseph's Healthcare, Hamilton, Ont.
authors.forename: Marek
authors.initials: M
authors.lastname: Smieja
mesh_terms: D002648:Child; D002675:Child, Preschool; D004770:Enterovirus; D030016:Enterovirus D, Human; D004769:Enterovirus Infections; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010850:Picornaviridae Infections / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000821:virology*; D012229:Rhinovirus; D012720:Severity of Illness Index