title: Epidemiology of Enterovirus D68 in Ontario.
abstract: In August 2014, children's hospitals in Kansas City, Missouri and Chicago, Illinois notified the Centers for Disease Control and Prevention (CDC) about increased numbers of pediatric patients hospitalized with severe respiratory illness (SRI). In response to CDC reports, Public Health Ontario Laboratories (PHOL) launched an investigation of patients being tested for enterovirus D-68 (EV-D68) in Ontario, Canada. The purpose of this investigation was to enhance our understanding of EV-D68 epidemiology and clinical features. Data for this study included specimens submitted for EV-D68 testing at PHOL from September 1, 2014 to October 31, 2014. Comparisons were made between patients who tested positive for the virus (cases) and those testing negative (controls). EV-D68 was identified in 153/907 (16.8%) of patients tested. In the logistic regression model adjusting for age, sex, setting and time to specimen collection, individuals younger than 20 years of age were more likely to be diagnosed with EV-D68 compared to those 20 and over, with peak positivity at ages 5-9 years. Cases were not more likely to be hospitalized than controls. Cases were more likely to be identified in September than October (OR 8.07; 95% CI 5.15 to 12.64). Routine viral culture and multiplex PCR were inadequate methods to identify EV-D68 due to poor sensitivity and inability to differentiate EV-D68 from other enterovirus serotypes or rhinovirus. Testing for EV-D68 in Ontario from July to December, 2014 detected the presence of EV-D68 virus among young children during September-October, 2014, with most cases detected in September. There was no difference in hospitalization status between cases and controls. In order to better understand the epidemiology of this virus, surveillance for EV-D68 should include testing of symptomatic individuals from all treatment settings and patient age groups, with collection and analysis of comprehensive clinical and epidemiological data.
authors.affiliation: Public Health Ontario Laboratory, 661 University Ave, Toronto, Ontario, Canada.
authors.forename: Adriana
authors.initials: A
authors.lastname: Peci
authors.affiliation: Public Health Ontario, 480 University Ave, Toronto, Ontario,Canada.
authors.forename: Anne-Luise
authors.initials: AL
authors.lastname: Winter
authors.affiliation: Public Health Ontario, 480 University Ave, Toronto, Ontario,Canada.
authors.forename: Bryna
authors.initials: B
authors.lastname: Warshawsky
authors.affiliation: National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington St., Suite H5300, Winnipeg, Manitoba, Canada.
authors.forename: Tim F
authors.initials: TF
authors.lastname: Booth
authors.affiliation: Public Health Ontario Laboratory, 661 University Ave, Toronto, Ontario, Canada.
authors.forename: AliReza
authors.initials: A
authors.lastname: Eshaghi
authors.affiliation: Public Health Ontario Laboratory, 661 University Ave, Toronto, Ontario, Canada.
authors.forename: Aimin
authors.initials: A
authors.lastname: Li
authors.affiliation: Public Health Ontario Laboratory, 661 University Ave, Toronto, Ontario, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Perusini
authors.affiliation: Public Health Ontario Laboratory, 661 University Ave, Toronto, Ontario, Canada.
authors.forename: Romy
authors.initials: R
authors.lastname: Olsha
authors.affiliation: Public Health Ontario Laboratory, 661 University Ave, Toronto, Ontario, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Marchand-Austin
authors.affiliation: Public Health Ontario Laboratory, 661 University Ave, Toronto, Ontario, Canada.
authors.forename: Erik
authors.initials: E
authors.lastname: Kristjanson
authors.affiliation: Public Health Ontario Laboratory, 661 University Ave, Toronto, Ontario, Canada.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Gubbay
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D030016:Enterovirus D, Human / Q000235:genetics*; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000821:virology*; D005260:Female; D006801:Humans; D008297:Male; D060885:Multiplex Polymerase Chain Reaction; D015999:Multivariate Analysis; D016017:Odds Ratio; D009864:Ontario / Q000453:epidemiology; D012044:Regression Analysis; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology*; D014481:United States