title: Management of the 2014 Enterovirus 68 Outbreak at a Pediatric Tertiary Care Center.
abstract: OBJECTIVE
  Enterovirus 68 (EV-D68) is an uncommonly recognized cause of acute respiratory tract infections. During the late summer of 2014, an international EV-D68 outbreak occurred. We review the steps of outbreak recognition and management in the context of 1 hospital's experience with the EV-D68 outbreak.
  
  
  METHODS
  We reviewed the role of Children's Mercy Hospital as one of the first hospitals to recognize the 2014 EV-D68 outbreak in the United States. The steps of outbreak management were applied to real-life examples as the outbreak unfolded at our hospital.
  
  
  RESULTS
  Management of the 2014 EV-D68 outbreak was a multifaceted effort requiring close coordination with hospitals, local and state health departments, and the Centers for Disease Control and Prevention. The importance of clear and frequent communication is highlighted both intra- and interinstitutionally. Increased respiratory disease-related pediatric admissions at hospitals nationally were attributed to EV-D68. Outcomes for these children, including the association of EV-D68 with acute flaccid myelitis, remain under investigation.
  
  
  CONCLUSIONS
  Following the steps of outbreak management is critical to providing optimal patient care and ensuring the health of the public. During the 2014 EV-D68 outbreak, close adherence to outbreak principles led to swift recognition of illness, rapid diagnostic measures, institution of appropriate therapies, and dissemination of information to health care providers and the public. Equally important was the subsequent identification of an increase in acute flaccid myelitis cases against the backdrop of an increase in EV-D68 detections nationally. Future prospective studies are needed to determine the true burden of EV-D68 disease, potential vaccines and therapeutics, and outcomes of children with EV-D68 infection.
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri. Electronic address: jeschuster@cmh.edu.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Schuster
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D002675:Child, Preschool; D004196:Disease Outbreaks; D030016:Enterovirus D, Human / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000453:epidemiology*; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology; D012621:Seasons; D062606:Tertiary Care Centers; D014481:United States
keywords: EV-D68; acute respiratory tract infection; enterovirus; outbreak; pediatric