title: Enterovirus D68 in Critically Ill Children: A Comparison With Pandemic H1N1 Influenza.
abstract: In 2014, the Unites States experienced an outbreak of enterovirus D68 associated with severe respiratory illness. The clinical characteristics associated with severe illness from enterovirus D68 during this outbreak compared with those associated with the 2009 H1N1 influenza virus outbreak are unknown.
  
  
  
  In this retrospective cohort study, we characterized the clinical features of children with enterovirus D68 admitted to the PICU between August 1, 2014, and November 1, 2014, and compared them with critically ill children infected with H1N1 influenza during the pandemic admitted between May 1, 2009, and January 31, 2010.
  
  
  
  PICU patients.
  
  
  
  None.
  
  
  
  Ninety-seven severely ill children with enterovirus D68 infections were compared with 68 children infected with H1N1 influenza during the 2009 pandemic. Children with enterovirus D68 were more likely to have asthma (62% vs 23%; p < 0.001) and present with reactive airway disease exacerbations, with greater receipt of albuterol (94% vs 49%) and steroids (89% vs 40%; p < 0.0001 for both). Although more children with enterovirus D68 were admitted to the ICU compared with those with H1N1 influenza, they had a shorter hospital length of stay (4 vs 7 d; p < 0.0001), with lower intubation rates (7% vs 44%), vasopressor use (3% vs 32%), acute respiratory distress syndrome (3% vs 24%), shock (0% vs 16%), and death (0% vs 12%; p < 0.05 for all). Compared with children with other enteroviruses and rhinoviruses, children with enterovirus D68 were more likely to have a history of asthma (64% vs 45%) or multiple prior wheezing episodes (54% vs 34%; p < 0.01 for both).
  
  
  
  Critically ill children with enterovirus D68 were more likely to present with reactive airway disease exacerbations, whereas children with H1N1 influenza were more likely to present with pneumonia. Compared with the pandemic H1N1 influenza outbreak, the enterovirus D68 outbreak resulted in more children requiring admission to the ICU, but was associated with less severe outcomes.
authors: 1Department of Pediatrics (Hospital Medicine and Infectious Diseases), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.2Department of Pediatrics (Hospital Medicine), University of Colorado School of Medicine; Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, CO.3Department of Pediatrics, University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora, CO.4University of Colorado School of Medicine, Aurora, CO.5Department of Pediatrics (Critical Care), University of Maryland School of Medicine, Baltimore, MD.6Department of Pediatrics (Infectious Diseases), University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora, CO.7Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA.8Department of Pediatrics (Critical Care), University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora, CO.9Department of Microbiology (Virology), Children's Hospital Colorado, Aurora, CO.
authors: Suchitra
authors: S
authors: Rao
authors: Kevin
authors: K
authors: Messacar
authors: Michelle R
authors: MR
authors: Torok
authors: Anne-Marie
authors: AM
authors: Rick
authors: Jeffrey
authors: J
authors: Holzberg
authors: Aaron
authors: A
authors: Montano
authors: Dayanand
authors: D
authors: Bagdure
authors: Donna J
authors: DJ
authors: Curtis
authors: M Steven
authors: MS
authors: Oberste
authors: W Allan
authors: WA
authors: Nix
authors: Gina
authors: G
authors: de Masellis
authors: Christine C
authors: CC
authors: Robinson
authors: Samuel R
authors: SR
authors: Dominguez
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D017281:Cost of Illness; D016638:Critical Illness; D004196:Disease Outbreaks; D030016:Enterovirus D, Human; D004769:Enterovirus Infections / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000175:diagnosis* / Q000453:epidemiology; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index