Respiratory Presentation of Pediatric Patients in the 2014 Enterovirus D68 Outbreak.
Background. In the fall of 2014, a North American outbreak of enterovirus D68 resulted in a significant number of pediatric hospital admissions for respiratory illness throughout North America. This study characterized the clinical presentation and risk factors for a severe clinical course in children admitted to British Columbia Children's Hospital during the 2014 outbreak. Methods. Retrospective chart review of patients with confirmed EV-D68 infection admitted to BCCH with respiratory symptoms in the fall of 2014. Past medical history, clinical presentation, management, and course in hospital was collected and analyzed using descriptive statistics. Comparison was made between those that did and did not require ICU admission to identify risk factors. Results. Thirty-four patients were included (median age 7.5 years). Fifty-three percent of children had a prior history of wheeze, 32% had other preexisting medical comorbidities, and 15% were previously healthy. Ten children (29%) were admitted to the pediatric intensive care unit. The presence of complex medical conditions (excluding wheezing) (P = 0.03) and copathogens was associated with PICU admission (P = 0.02). Conclusions. EV-D68 infection resulted in severe, prolonged presentations of asthma-like illness in the hospitalized pediatric population. Patients with a prior history of wheeze and preexisting medical comorbidities appear to be most severely affected, but the virus can also cause wheezing in previously well children.
Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada S7N 0W8.
Georgina
0000-0001-9227-9712
G
Martin
Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada V6H 3V4.
Rachel
0000-0002-2673-0242
R
Li
Division of Allergy and Clinical Immunology, British Columbia Children's Hospital, Vancouver, BC, Canada V6H 3V4.
Victoria E
0000-0002-9269-8498
VE
Cook
Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada V6H 3V4.
Matthew
0000-0001-8743-0342
M
Carwana
Pathology & Lab Medicine, British Columbia Children's Hospital, Vancouver, BC, Canada V6H 3V4.
Peter
P
Tilley
Division of Infectious Diseases, British Columbia Children's Hospital, Vancouver, BC, Canada V6H 3V4.
Laura
L
Sauve
British Columbia Centre for Disease Control, Vancouver, BC, Canada V5Z 4R4.
Patrick
P
Tang
Division of Respiratory Medicine, British Columbia Children's Hospital, Vancouver, BC, Canada V6H 3V4.
Akshat
A
Kapur
Division of Respiratory Medicine, British Columbia Children's Hospital, Vancouver, BC, Canada V6H 3V4.
Connie L
0000-0003-2060-3290
CL
Yang
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001955:British Columbia / Q000453:epidemiology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D045422:Continuous Positive Airway Pressure; D003371:Cough / Q000209:etiology* / Q000628:therapy; D004196:Disease Outbreaks; D004417:Dyspnea / Q000209:etiology* / Q000628:therapy; D030016:Enterovirus D, Human; D004769:Enterovirus Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology* / Q000628:therapy; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008168:Lung / Q000000981:diagnostic imaging; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008297:Male; D010102:Oxygen Inhalation Therapy; D013902:Radiography, Thoracic; D012135:Respiratory Sounds / Q000209:etiology*; D012141:Respiratory Tract Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D012621:Seasons; D013610:Tachycardia / Q000209:etiology* / Q000628:therapy; D059246:Tachypnea / Q000209:etiology* / Q000628:therapy
D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D002121:Calcium Channel Blockers; D008278:Magnesium Sulfate